Enrollment

States have employed innovative strategies to enroll eligible children in Medicaid and CHIP, yet many children remain unenrolled for a variety of reasons and therefore remain uninsured. Ten percent of children in the United States do not have health insurance, and of all uninsured children, as many as two-thirds are eligible for Medicaid or CHIP but not enrolled. Research has provided insight into why some children are not enrolled suggesting that the key factors include:

• Families’ lack of knowledge or perceptions of Medicaid and CHIP,
• Administrative barriers to families completing the application process,
• State challenges maintaining continuous enrollment for children,
• Language and cultural barriers,
• State responses to budget pressures, and
• Uncertain federal funding and restrictions.

Simplifying the enrollment process has been one strategy states have employed to overcome barriers to enrollment. Research indicates that keeping the enrollment process simple for families by minimizing barriers to obtaining and maintaining coverage can be central to facilitating enrollment of children in Medicaid and CHIP. Enrollment simplifications also have the potential to help states and the federal government achieve administrative savings. The three most common strategies states have adopted for both Medicaid and separate CHIP programs include:

• eliminating the asset test (92% of state Medicaid programs for children and 92% of CHIP programs);
• eliminating face-to-face interviews upon enrollment (94% of state Medicaid programs for children and 97% of CHIP programs); and
• using joint Medicaid-CHIP applications (90% of states with a separate CHIP program use a single application for both programs and 54% of states use a joint renewal form for the two programs).

Beyond these three strategies, states have adopted a wide range of simplified enrollment and renewal procedures and in recent years have implemented strategies which particularly are designed to reduce paperwork and jump-start enrollment. More recently states have begun exploring the use of technology to overcome administrative barriers to enrollment, but the research on the particular impact of these changes has been limited thus far. Research has described many innovative efforts put forth by states that facilitate data sharing, speed the application process, and reduce errors, all of which leads to faster, simpler enrollment that reaches more children and costs less for states to administer. Specific strategies include universal application forms, online applications, and information-sharing among programs with similar eligibility requirements.
 
Maximizing Enrollment for Kids will work with grantee states to test the effectiveness of known strategies and identify new strategies to enable states to enroll more eligible children. The program will provide grantee states with technical assistance to implement improvements and assist in data collection and analysis to enable states to measure their progress. Through this work, Maximizing Enrollment for Kids aims to reveal new information for all states and policymakers to learn more about what really works to make a difference in enrolling eligible kids.