Eligible but Not Enrolled

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Abstract

More than 6 in 10 uninsured children qualify for Medicaid or the State Children's Health Insurance Program (SCHIP) but are not enrolled. Reaching these children may not be easy. Medicaid and SCHIP already cover 79 percent of their target population—more than any other traditional, means-tested program. Moving significantly beyond current participation may require non-traditional strategies. For example, Medicare now uses government data to identify eligible, low-income seniors and provide them with subsidies for prescription drugs and other benefits. SCHIP reauthorization could give Medicaid and SCHIP the flexibility to use similar methods for enrolling eligible, low-income children.

Introduction

More than six in 10 uninsured children qualify for Medicaid or the State Children's Health Insurance Program (SCHIP) but are not enrolled. Although controversy surrounds many aspects of SCHIP reauthorization, leaders across the political spectrum agree on the need to cover these children.

Achieving that goal may not be easy. Child health coverage programs now reach 79 percent of their target population—more than any other traditional, means-tested program. Since the enactment of SCHIP in 1997, states have intensively pursued a decade of outreach efforts and streamlining of application procedures, with positive results—but non-traditional methods may now be required to reach the remaining children who qualify for coverage but are not enrolled.

In recent years, Medicare has significantly exceeded traditional programs in covering a high percentage of individuals who qualify for need-based subsidies. Federal officials achieved this result through innovative strategies that provide low-income seniors with assistance based on data accessible to public agencies. Such strategies significantly reduce families' need to complete forms before obtaining help. For child health programs to move substantially beyond current enrollment levels, SCHIP reauthorization will need to offer states the flexibility to use similar data-driven methods like those Medicare now employs to help low-income seniors. Among additional required steps, SCHIP reauthorization will also need to provide enough federal resources to pay for coverage of eligible children.

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The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

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