MEDICAID: Enrollment Increases by 1.1M, Report States
After declining each year between 1996 and 1998, Medicaid enrollment between December 1998 and December 1999 increased by 1.1 million individuals, or 3.6%, according to a new report released at an Oct. 13 briefing by the Kaiser Family Foundation. While official HCFA figures are not expected until January, the report, "Medicaid Enrollment in 50 States: June 1997 to December 1999," prepared by Health Management Associates, indicates a "very significant change" in Medicaid, Vern Smith, a Health Management Associates principal, said. HCFA statistics indicate that Medicaid enrollment declined by 1% in 1996, 1.7% in 1997 and 0.5% in 1998, representing a net total decrease of 1.9 million individuals, Smith said. Using information reported by the states on individuals enrolled in regular Medicaid programs, as well as state CHIPs that are Medicaid expansions, the Kaiser report finds that only seven states experienced decreases in their Medicaid enrollment between December 1998 and December 1999, compared to 26 states that had decreases from December 1997 to December 1998. In the period from December 1998 to December 1999, no state experienced a decrease of more than 4%, while other states experienced increases of as much as 20% or higher. Accounting for CHIP's influence on increased Medicaid enrollment, the report notes that Medicaid-expansion CHIPs accounted for 27% of the increased enrollment. Although the figure is not counted in the overall Medicaid enrollment increase, CHIPs that are completely separate from Medicaid experienced an enrollment increase of 639,200 between December 1998 and December 1999. The report also addresses the link between welfare and Medicaid, noting that the number of Medicaid beneficiaries who also receive Temporary Assistance to Needy Families declined by about 39% in 21 states between June 1997 and December 1999.
A Word of Caution
Despite the improved numbers, Tim Westmoreland, director of HCFA's Center of Medicaid and State Operations, said that it is "too early to celebrate," adding that the "good and bad news is often blurred together." He also said that the program's "many moving parts," such as each state having its own program complete with varying regulations, make evaluating the data "difficult." The data actually represent a return to Medicaid enrollment levels prior to welfare reform, Westmoreland said, noting that Medicaid experienced a "inappropriate decline," as families who were eligible to retain Medicaid coverage did not. But he added that "flat is certainly better after some serious declines." Medicaid's "promise is really clear," Westmoreland said, suggesting that states simplify application processes and the federal government make the program more publicly accepted, like public education. He concluded, "We need to rebrand Medicaid and really make it work for working families."
Improving Outreach, Streamlining Programs
During the briefing, the Kaiser Family Foundation released two other reports, summarized below:
- "Marketing Medicaid and CHIP: A Study of State Advertising Campaigns" -- Michael Perry of Lake Snell Perry & Associates examined 37 print, 24 television and 15 radio ads from 38 states to identify approaches and messages used to promote state health programs. Perry found that most states promoted CHIP and Medicaid together, and most used a combination of media types, as well as paid and unpaid ads. "States are spending a lot of money to make these [ads] look good," he said. Most states also target specific geographic areas or populations, run ads in various languages and work with community-based organizations to get the word out. Overall, Perry said that states are "really optimistic" in their approaches and try to create a "positive buzz." In their ads, states attempt to convey that the programs are affordable and for working parents, that health care for children is a basic necessity and that parents will have peace of mind if their children have coverage. Most ads also focus on the programs' affordability -- but provide limited details -- and state that enrollment is "easy." The ads also varied in their approaches to conveying information. While ads in New Mexico and California showed healthy children and families, ads in New Jersey and Texas used "scare tactics," showing children in situations where they could get hurt and would need medical care. In conclusion, Perry suggested that states stick with "what works" -- such as showing a diverse number of children and adults, emphasizing contact information and the program's low costs -- but he added that states can make some changes, such as including more specific information. As some states already have begun to evaluate their next steps, Perry said, "I predict [states] will be a lot more strategic" in the future.
- "Making It Simple: Medicaid for Children and CHIP Income Eligibility Guidelines and Enrollment Procedures" -- Diana Cohen Ross, director of outreach for the Center on Budget and Policy Priorities, surveyed 50 states and the District of Columbia to determine which states are simplifying their programs and aligning CHIP and Medicaid. Ross specifically focused on income eligibility guidelines, asset tests, joint Medicaid/CHIP application and redetermination forms, mail-in applications (without face-to-face interview requirements), presumptive eligibility for children, 12-month continuous eligibility, selected verification requirements and enrollment and redetermination procedures. According to the report, most states have taken "significant" steps in streamlining their eligibility and enrollment processes. Ross said there is "no magic formula" for how states are reworking their CHIP/Medicaid programs, but the states that have made progress have various qualities in common. For example, 97% of states have dropped asset tests and face-to-face interviews for their CHIPs, while 69% allow children to remain eligible and in the program for 12 consecutive months. Still, Ross suggested that states can take further steps to simplify their programs, such as reducing the number of documents required to prove residency or income levels, making renewal processes easier and establishing presumptive eligibility, which allows individuals to begin receiving benefits while the government verifies their eligibility. Furthermore, she said that removing age-based eligibility guidelines, using CHIP innovations in Medicaid and enabling a smooth transfer between programs during the application and renewal processes would help to align Medicaid and CHIP. The report is available at http://www.kff.org/content/2000/2166/hjksmall.pdf