States search for ways to keep children in CHIP programs

It’s been two years since the Children’s Health Insurance Program (CHIP) started its work in the states. That’s long enough for many children to have dropped off the enrollment list and for states to search for the best ways to re-enroll those who are eligible.

Forty-four percent of eligible families did not renew their CHIP memberships in Alabama in the first year of the program’s existence. Looking into the numbers, Alabama officials found that 21% of them, 4,677 children, simply did not return their re-enrollment forms.

"We discovered we needed to educate people about the ways to re-enroll," Cathy Caldwell, CHIP data manager for the Alabama Department of Health in Montgomery, told those attending the National Academy for State Health Policy convention in Bloomington, MN, in August.

Alabama officials investigated and found that most children and families learned about the program through the public schools, so an effort was made to distribute forms and follow through on re-enrollment there. Public service announcements on radio and in newspapers were also phenomenally successful, said Gayle Lees Sandlin, CHIP director for Alabama’s Department of Health.

Further research in Alabama yielded some in-depth background on why children did not have health insurance:

• Costs too much: 44%.

• No longer eligible for Medicaid: 25%.

• Lost/changed jobs: 18%.

• Employer dropped health coverage: 2%.

• Child had a pre-existing condition: 1%.

• Other: 10%.

Alabama state research also showed that the two main reasons for ineligibility for CHIP were that families were either over the required income limit or below it (qualifying the family for Medicaid). Other reasons included requested cancellations, nonpayment of premiums, other insurance, on Medicaid, over required age limit, and no response to correspondence.

In its first year, Wisconsin’s CHIP program, BadgerCare, enrolled more than 77% of the state’s eligible children. Enrolling and re-enrolling children and families presented their own unique challenges, said Susan Wood, director of Wisconsin’s Department of Health and Family Services. The first step was to focus the state’s approach.

"We found there was a welfare stigma, so marketing is important. We focus on health insurance for working families,’" Ms. Wood said. "And the public approval of the state’s governor helped dispel the stigma, too."

Other lessons that Wisconsin officials have learned to improve CHIP include:

• Seamless, family-based coverage results in high enrollment for both Medicaid and CHIP.

• Integrating programs and data collection presents opportunities to understand the target population and their health status and to improve participation in other entitlements.

• Select and package administrative and policy options to reach families who have never applied and to address barriers that cause eligible families to drop out.

Simplifying the program as much as possible is also a goal for BadgerCare. Automating support for new mail and phone options for applications and reviews has helped. The program now does its review annually instead of semi-annually, participants have an option to do program reviews and file applications by mail, and there are reduced verification requirements.

Overall enrollment for BadgerCare is 70,651. About 77% of the targeted group of uninsured children under 200% of poverty in the state have been enrolled in Medicaid or BadgerCare in the first 12 months of the program’s operation, according to state officials.