Ringing in 2011 by Celebrating Progress in Children’s Coverage – Say Ahhh! A Children’s Health Policy Blog


By Vikki Wachino, Director of Family and Children’s Health Programs Group, CMS

The New Year began just a few days ago, and many of us
are just winding down from the festivities.  But, if you’re still hearing the sounds of revelry, it may
be the states that are continuing to celebrate the CHIPRA performance bonuses
they were awarded last week.  All
of us at CMS congratulate the 15 states that shared $206 million in bonuses –
Alabama, Alaska, Colorado, Illinois, Iowa, Kansas, Louisiana, Maryland,
Michigan, New Jersey, New Mexico, Ohio, Oregon, Washington, and Wisconsin.  The awards reflect their achievements
in two critical areas: increasing access to children’s health coverage by
simplifying the enrollment and renewal process, and meeting ambitious targets
for boosting the number of eligible children enrolled in coverage. The amount
of each state’s bonus is tied to the number of children the state actually
enrolled in Medicaid, and is designed to help offset the state’s share of the
cost of covering those most vulnerable children.

That states continue to move forward to provide coverage
for uninsured children, especially in these difficult economic times, is a
reason to cheer.  But it’s even
more toast-worthy to point out that the procedural improvements states have put
in place now will have lasting advantages for children who apply for coverage
in the future. When states implement policies like presumptive eligibility and
Express Lane eligibility – and when they allow families to mail-in applications
or apply on-line or by phone — they are committing to enrolling eligible
children quickly and efficiently so they can get the care they need.  When states adopt 12-month continuous
eligibility and administrative renewal procedures, they are telling families
that they want eligible children to retain their coverage for as long as they
qualify so they can have a reliable source of care. 

We are delighted to be working with states to send these
affirming messages loud and clear. 
The results speak volumes when you consider how the red-tape-cutting
measures have contributed to the progress states have made.  The states that have adopted these
measures are not only increasing enrollment of eligible children, but are also
achieving program efficiencies and lightening the paperwork burdens on both
families and eligibility workers. 

Here are some of the ways states that received 2010
performance bonuses have helped enroll eligible children:

  • Ohio added a presumptive eligibility option for all
    children applying for the State’s joint Medicaid and CHIP program. 
    Coverage for children who appear eligible can begin right away, even if their
    families need time to present verification of eligibility information. 
    Since April, Ohio has used presumptive eligibility to enroll about 2,000 to
    2,500 children each month. A large majority of children have been able to
    transition seamlessly to ongoing Medicaid eligibility.
  • Wisconsin families can apply for children’s health
    coverage using the State’s on-line application, ACCESS, and currently, about 45
    percent of applicants take advantage of this convenient choice.  In January 2010, the on-line renewal
    process was simplified. Families now can go into their personal ACCESS account
    and answer a few simple questions about changes in job or home address.  They can either make changes or confirm
    existing information, and then sign electronically.  The system will soon go a step further, using state
    databases to automatically update the family’s case summary so that at renewal
    families are responding to the most recent data the state has about their
  • In March
    2010, Iowa began implementing presumptive eligibility on a small scale,
    training 16 outreach workers and, later, school nurses to carry out eligibility
    determinations.  The process is
    expected to ramp up next year when certified workers will be allowed to use an
    on-line process. Iowa also has added 12-month continuous eligibility to its
    Medicaid program, an advantage children in the state’s CHIP program, HAWK-i,
    have had since 1999.  The new policy
    produced a 22 percent increase in Medicaid enrollment in the first year.
    Because this program feature was implemented before the recession took hold,
    the State Medicaid Agency is confident that continuous eligibility is the
    central factor behind this significant enrollment boost.
  • New Mexico Medicaid pre-populates renewal forms with
    the most recent income information that has been reported by the child’s
    family.  To confirm that the information is correct, families can respond
    by mail, fax, email or call a hotline.  If the family has an active SNAP
    or cash assistance case, Medicaid staff also use information from these
    programs to renew the child’s Medicaid coverage.  According to State officials, the renewal rate has jumped to
    80 percent — from a range of 40 percent to 60 percent — since the
    pre-populated renewal form was launched.

What about the states that did not qualify for a
performance bonus this year?  
Many of these are states that have consistently shown leadership and
commitment when it comes to providing health coverage for children –they are
already covering a very high proportion of eligible children, so they are less
likely to be able to boost enrollment significantly in order to qualify for a
bonus.  The Urban Institute study
on children’s enrollment released last September highlights ten states that
already have achieved Medicaid and CHIP participation rates of 90 percent or
higher.  These states, which
represent every region of the country, remind us that our goals for children’s
coverage are realistic and that we can be successful!

When I think about the states that still have progress to
make – and I realize that many of them are moving forward — it brings to mind
another New Year’s tradition: taking the time to stake out some milestones for
the year ahead.  To that end, I
encourage you to set a 2011 goal for your state of increasing enrollment of
eligible children and joining the growing list of states that are earning
performance bonuses at a time when both family and state budgets are
stretched.   Secretary
Sebelius has challenged the federal government, states, health care providers,
and community organizations across the country to cover the five million
children who are eligible for CHIP or Medicaid over the next five years, and
performance bonuses are one way we at CMS can help support this challenge (see
www.insurekidsnow.gov for more information).  CMS stands ready to help by providing any technical
assistance your state may need to implement the program features required to
qualify. That might mean taking just one or two more simplification steps —
and doing it by April 1st when state plan amendments must be filed in order to
qualify for a bonus for 2011. 

I learned a long time ago that the rule of thumb for a
successful New Year’s resolution is to pick something important, something I
really care about … and something that is within reach.  If you set your sights on a goal like
that – and enrolling eligible children in Medicaid and CHIP fits that bill —
there is bound to be a cause for celebration.   Until then, a happy and healthy New year to all!

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