Moving the Needle on Kids' Enrollment in Public Insurance Programs

Today’s post comes to us from Catherine Hess, Senior Program Director at the National Academy for State Health Policy (NASHP) and Program Director, Maximizing Enrollment for Kids.

Too often, when trying to address problems in our society, we look for a silver bullet – one solution. To the casual observer, last year’s passage of the Children’s Health Insurance Program Reauthorization Act (CHIPRA) might seem like a silver bullet for the problem of uninsured children. Unfortunately, while public insurance programs like the Children’s Health Insurance Program (CHIP) and Medicaid theoretically extend coverage to a wide swath of the uninsured, many who are eligible are not enrolled in these programs.

But we know from research and over a decade of experience with CHIP that there is no silver bullet. There are multiple key strategies, and to be effective, they need to be tailored to different state and local circumstances.

To that end, the National Academy for State Health Policy (NASHP) collaborated with the Robert Wood Johnson Foundation (RWJF) to launch Maximizing Enrollment for Kids, a four-year, $15 million national program that helps states tailor and adopt key strategies to improve enrollment. Our ultimate goal is to “move the needle” to cover many more uninsured children, and we are documenting and sharing what works as we go along. 

We received applications from over half the states for this program, a positive sign of their interest. Eight states demonstrating commitment and vision to maximizing enrollment of eligible, uninsured children were selected: Alabama, Illinois, Louisiana, Massachusetts, New York, Utah, Virginia and Wisconsin.

If this program is successful – and so far, so good – these states will increase the efficiency of their systems. But another simple but particularly remarkable point is that as they improve systems, these states will spend more on covering additional children. Think about that. Even in a nasty budget climate, states want these programs to function at their top potential. This is highly encouraging.

The first phase of our program was to get baseline assessments of strengths, challenges, and opportunities for these states’ enrollment and retention systems for children. These assessments are helping guide these states and NASHP, the national program office, as we work together to achieve the program’s goals. Each state is receiving about $1 million over 4 years, technical assistance and opportunities to work through challenges and solutions with peers through learning collaboratives.

What we found through the assessments is that these states have taken important steps to improve enrollment and retention, but all of them also have a lot of room for improvement. From further simplifying policies and procedures, to making better use of data and technology, to changing agency culture, to better engaging partners, these eight states – and we think, all states – have many ready opportunities to get more children covered and keep them covered.

As we look toward implementing national health care reform, it is important for the federal government, foundations like RWJF and national organizations like NASHP to know more about how we can best help states to develop efficient systems that can succeed in enrolling those eligible for coverage. These baseline assessments as well as the online self-assessment tool we are developing can help states – and those working to support states – to understand systemic challenges that will be relevant in future reform efforts.

But some of the best lessons learned from the first phase of this program were expressed in our summary conclusions with our partner in conducting the assessments, Health Management Associates. There may not be one silver bullet, but creativity, perseverance and challenging the status quo have resulted in more children covered in the states we are working with, and many more across the country. We are going to need to draw on these lessons as we tackle the historic challenges before us.