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Automated enrollment strategies have achieved remarkable results with many public and private benefit programs, dramatically increasing program participation while lowering administrative costs and reducing erroneous eligibility determinations. The recently passed Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) should make such steps much easier for states to take in covering eligible but uninsured children. Following CHIPRA's enactment, states have both new tools and new incentives to use automated strategies in fulfilling four key functions: identifying uninsured children; determining their eligibility for health coverage; enrolling eligible children into coverage; and retaining eligible children.
For several years, the majority of uninsured children have been eligible for, but not enrolled in, Medicaid and the Children's Health Insurance Program, or CHIP (formerly called “the State Children's Health Insurance Program,” or SCHIP). This paper explores how states can identify and enroll eligible but uninsured children by borrowing automated strategies that have proven effective with other public and private benefits. By “automated strategies,” this paper refers to procedures that use data matches or other methods that substantially reduce or even eliminate the need for families to complete traditional application forms.
After briefly discussing the background of automated enrollment, the paper explores how the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) gives states new financial incentives to maximize the enrollment of eligible children as well as new tools to use data to help eligible children participate, including an option for so-called “Express Lane Eligibility.” Finally, it explains how Express Lane Eligibility and other automated enrollment approaches could help achieve four goals essential to covering the greatest possible number of eligible children: namely, identifying uninsured children; determining their eligibility; enrolling them into coverage; and keeping them covered.
Following the body of the paper are appendices that address the following topics:
- How a range of public and private benefit programs have used automated enrollment strategies in the past;
- Basic perspectives on automated enrollment;
- Samples of state income tax forms that ask parents about their children's health coverage;
- Operational details about implementing some strategies described in this report;
- The statistical methods used to obtain some of the findings of this report; and
- Using data matches with the Social Security Administration to establish children's satisfactory immigration status.
Although auto-enrollment methods have an impressive track-record with other benefit programs, they are just beginning to be applied to children's health coverage. Nevertheless, particularly after recent changes in federal law, automated enrollment strategies deserve serious consideration by policymakers willing to innovate in reaching bold coverage goals for children's health care.
Two final preliminary comments are important. First this paper catalogs examples of how states could move in this direction. No single state could or would want to implement all of the policy options explored here.
Second, interpreting a new and groundbreaking statute like CHIPRA is necessarily a tentative enterprise without guidance from the Centers for Medicare and Medicaid Services (CMS). Some states may hesitate to move forward until CMS has announced its view. On the other hand, as noted below, Congress forbade CMS from denying federal matching funds if a state implements a good-faith reading of CHIPRA with which CMS subsequently disagrees. For many states, this statutory protection may allow them to act quickly and decisively in using CHIPRA's new tools to reach and enroll as many eligible, uninsured children as possible.
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