Born and raised in Mississippi, I’ve always heard that
Mississippians are “first in the worst” and “last in the best.” Unfortunately,
Mississippi’s enrollment and renewal practices for children in Medicaid and
CHIP put us in the running for worst in the government efficiency competition
and reinforce those views about my home state. Mississippi is currently the only state in the country that
requires face-to-face interviews for applications and renewals of Medicaid and
This requirement was implemented in 2005 under Governor
Haley Barbour’s Division of Medicaid.
A report by the Center on Budget and Policy Priorities (CBPP) found that 62,000 fewer individuals were enrolled in Medicaid and CHIP
coverage in Mississippi from 2004 to 2006.
Governor Barbour has stated that the face-to-face requirement is used to
help prevent fraud and abuse in Medicaid.
However, research has shown that the likelihood of fraud and abuse on
the part of Medicaid beneficiaries is extremely low. Policies such as this really serve as a method of putting up roadblocks to coverage for eligible individuals and families.
Requiring the face-to-face interviews is not only
inefficient for the government, it adds an extra hurdle to coverage for
families. Mississippians seeking
to enroll or renew their Medicaid insurance coverage have to take time off work
and find a ride to the Medicaid offices as many do not own a car and have no
form of public transportation available to them. As a result, many children and families who are eligible for
Medicaid will gain and lose coverage, known as “churning,” or even worse,
remain uninsured. Consequently,
those who are uninsured are less likely to have a usual source of medical care
and are more likely to use the ER for non-urgent care and as their primary source
of care, which often leads to more severe health problems and increasing
Removing this barrier would not only help children and
families secure adequate health coverage and drive down medical costs, but it
would also reduce administrative costs in Mississippi from all of the paperwork
that is involved with enrolling and re-enrolling individuals that are already
eligible for the program. A number
of states have not only moved away from face-to-face requirements, but also
have implemented more measures to cut the red tape, such as presumptive
eligibility and express lane eligibility.
Presumptive eligibility allows providers and “qualified entities” to
temporarily enroll children in Medicaid who appear eligible, while the agency
determines eligibility. Express
lane eligibility is a relatively new option that was implemented with the
Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) that
would allow Mississippi to use data and eligibility findings from other public
benefit programs such as WIC, SNAP, school lunch programs, etc. to determine
children’s eligibility for Medicaid.
Governor Barbour doesn’t have to look far to see a good
example of how to improve government efficiency. Mississippi’s neighboring
state, Louisiana, has done such a good job at cutting red-tape that it has been
recognized by the Centers for Medicare and Medicaid Services (CMS) as a
national best practice on how to streamline the Medicaid application process.
(By the way, Louisiana also has one of the lowest error rates in the country
which debunks the argument that face-to-face interviews are needed to combat
fraud and abuse.) Replicating
Louisiana’s success in improving government efficiency for Medicaid and CHIP
beneficiaries would give all Mississippians something to be proud of and get us
out of our “first in the worst”
status in how we manage our Medicaid/CHIP application and renewal process.