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There are many reasons why children who are eligible for the state Children’s Health Insurance Program (CHIP) fall off the rolls, but the reasons given by their parents and the reasons given by the state do not always match. That’s the finding of a National Academy for State Health Policy team study conducted in seven states.
"What states believed happened and what parents believed happened are often very different," said Susan Kannel, senior analyst with Lake Snell Perry and Associates in Washington, DC, which conducted the polling in the study.
For instance, states and parents often do not agree whether a child actually is enrolled in CHIP. About 20% of state-reported disenrollees, according to the study, believe their children are currently enrolled. Preliminary analysis suggests however that between one-fourth and one-third of the 20% have legitimately re-enrolled. Sometimes, those who are enrolled do not know they are no longer eligible; 8% of enrollees, the study says, are no longer enrolled.
The reasons for falling off the rolls also take different twists, depending on who’s providing the reasons — the state or the eligible recipient. Among state-reported disenrollees, 30% to 50% of the state-reported disenrollees said they left for "nonpreventable" reasons, such as a change in income, their child being put on Medicaid, their child aging out, or their child getting private insurance.
This means, according to the study’s preliminary findings, that 50% to 70% of this state-reported disenrollee sample actually say they disenrolled for "possible preventable reasons."
Whatever the reasons, says Chad Westover, CHIP administrator for the Utah Department of Health in Salt Lake City, "it’s incumbent upon states to figure out ways to get people to re-enroll."
Reasons range far and wide as to why parents often do not re-enroll their eligible children, he adds. "A lot of people didn’t want to be on the program because their kid is healthy and they say they are making room for others to be enrolled," he said. "Some of them loved their caseworker, and others said they felt like a number."
Tracking down those who are eligible but have fallen off the rolls is not easy.
"These are hard-to-find people," said Michael Perry, vice president of Lake Snell Perry and Associates.
"We found current and disenrolled families like the program; the health care part works for them. The disenrolled want back in. Families fall off the rolls because of communication problems. The renewal process is a hassle, and the premium payment is not high on their list of bills priorities," he says.
The only consistent complaint about CHIP, the study uncovered, referred to dental coverage.
Paying premiums was a costly but acceptable way to maintain coverage, the study found. Of those who pay a premium, 88% said they felt the premium amount "is about right" and 97% said paying the premium is "well worth it for the care you get in return." Disenrollees are more than twice as likely (39% vs. 16%) as current enrollees to say the premium is sometimes a problem.
More than half of self-reported nonpayment disenrollees said the reason they did not or could not pay was because of financial difficulties. Twenty-five percent said they either forgot or "did not get around to it," according to the study.
A majority of those surveyed (82%) said the renewal process was easy, but some found it problematic; 34% of current enrollees and 38% of disenrollees agree that "too much background paperwork is required" for renewal.
Other findings from the study:
The seven states in the study were Alabama, Arizona, California, Georgia, Iowa, New Jersey, and Utah.