CHIP AND MEDICAID: New Study Tracks California’s Progress

      Although states are "investing an unprecedented amount of time, energy, and resources" in identifying low-income uninsured children and enrolling them in Medicaid and CHIP programs, "much room for improvement exists," according to several new study by the Kaiser Family Foundation/Commonwealth Low-Income Coverage and Access Project. The report, "Making Child Health Coverage a Reality," assesses Medicaid and CHIP outreach and enrollment strategies since 1997 in four states -- California, Georgia, Ohio and New Mexico -- to determine whether they have succeeded in minimizing administrative burdens for enrollment and raising awareness of the programs among low-income "families, particularly those with no ... experience receiving public benefits," who may have eligible children. Researchers found that while states have met with some success in their efforts, they must work harder to "integrate Medicaid and CHIP eligibility determination systems and outreach strategies," conduct market research on how to "employ outreach strategies at all levels, including community-based and one-on-one strategies as well as mass media campaigns," streamline the enrollment process and monitor the "effectiveness of alternative outreach and enrollment strategies." In addition, states may never obtain their goal of fully enrolling eligible" children unless "the systems and structures that support [Medicaid and CHIP] are completely de-linked from those that support public welfare programs," as many families "may prefer to avoid" the welfare-related benefits.

The California Story
      Using CHIP funds in July 1998 to extend Medi-Cal eligibility to all children through age 18 with family incomes below poverty and to establish a separate program, Healthy Families, which covers children with family incomes below 200% of poverty but not eligible for Medi-Cal, enrolled 33,000 of about 1,216,000 eligible children in the first four months and 53,000 by Dec. 1998 in the CHIP programs. Officials expected that a total of 100,000 new children would join the program by the end of FY 1998. "To many this is an impressive start for a brand-new program," Kaiser reports, adding, "However, the case study revealed several issues that may have kept the state from even greater success." Among the key problems: The linking of Healthy Families to Medi-Cal, previously associated with the welfare system, continues to scare off eligible families who want to avoid the stigma of welfare; 60% of uninsured children eligible for the programs are Latino, but "families are hesitant to enroll due to concerns about the effect of the use of public services on their efforts to become citizens or legal residents;" eligibility workers continue facing difficulties in simplifying a "program operated by a long-established country welfare bureaucracy;" and locally-based outreach efforts must be tailored to individual communities (Kaiser report, 9/99).