GOVERNMENT & MEDICINE

States zero in on coverage for uninsured children

After declining for several years, Medicaid enrollment is increasing, says new research. State efforts to find eligible low-income children may be the reason.

By Susan J. Landers, AMNews staff. May 1, 2000.

Washington -- In his Montgomery, Ala., office, pediatrician Robert Beshear, MD, offers uninsured low-income families the enrollment form that might gain their children's participation in either Medicaid or its companion children's health insurance program.

Many other pediatricians in Alabama are doing the same, along with elementary schools. Soon hospitals will join the enrollment effort.

So far, 35,000 of the estimated 50,000 eligible children in the state now have coverage through Medicaid or ALL KIDS, Alabama's version of the State Children's Health Insurance Program. Dr. Beshear estimates that 1,500 more children are enrolled monthly.

The success can be attributed to a "spectacular" effort by the state public health department to seek eligible children, said Dr. Beshear, who served on the state board that developed ALL KIDS -- the first SCHIP program that has been approved by the federal government.

Alabama's efforts are being mirrored in many other states. That's a reversal from just last year, when Medicaid rolls were down and enrollment progress in the 3-year-old SCHIP program was criticized as too slow.

Now, according to new data from the Kaiser Family Foundation, Medicaid enrollment may be on the upswing -- thanks, in part, to the spillover effect of states' efforts to find SCHIP-eligible children.

The program, enacted in 1997, targets children whose families earn too much to qualify for Medicaid but too little to afford private coverage. It allows states to offer coverage by broadening Medicaid, creating a separate state insurance program or developing an approach combining both.

Medicaid makes a comeback

The Kaiser foundation data "provide promising signs that many states are engaging in efforts to reverse the decline in Medicaid enrollment," said Diane Rowland, the executive director of the organization's Commission on Medicaid and the Uninsured.

Data collected for Kaiser by Health Management Associates of Lansing, Mich., show that Medicaid enrollment increased by 1.4% from June 1998 to June 1999. The increase follows enrollment declines that began in 1995.

"These enrollment numbers provide an early measure of the relationship between Medicaid and SCHIP," said the study's co-author, Vernon Smith, PhD, former Michigan Medicaid director.

"The implementation of SCHIP programs, often accompanied by substantial outreach, appears to be contributing to the identification and enrollment of children and families eligible for Medicaid," he said.

Simpler applications

Simplifying the application and enrollment process is a key factor in boosting the enrollment for both programs, said Donna Cohen Ross, who serves as the director of outreach for the Center on Budget and Policy Priorities. Ross also had conducted a study of children's health insurance programs for the Kaiser Family Foundation.

Ross found that states have eased the enrollment process for low-income families by dropping asset tests, eliminating face-to-face interviews so working families don't need to take time away from work to apply, and lengthening the enrollment period to relieve the stress of frequent reapplications.

Ross estimates that two-thirds of the nation's 11 million uninsured children qualify for health insurance under Medicaid or SCHIP.

Concern over the falloff in Medicaid enrollment recently prompted the Clinton administration to order states to search their computer files for families who lost their coverage when they left state welfare programs. States were urged to take action to reinstate that health insurance coverage.

When welfare reform was enacted in 1996, many states inadvertently dropped recipients of their cash assistance programs from their Medicaid programs as well.

As a result of the new federal directive, hundreds of thousands of poor families are expected to regain their coverage.

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