MEDICAID: Enrollment Problems Persist, Study Shows

Complex eligibility rules, improperly trained staffs and outdated computer systems are just of few of the barriers keeping eligible families from obtaining Medicaid benefits, according to a study released Monday by Mathematica Policy Research Inc. The study found that "operational problems ... may thwart outreach efforts to sign up more eligible children and their parents" (MPR release, 11/1). Welfare reform has had a significant negative impact on Medicaid enrollment, the AP/Austin American-Statesman reports. As people move from welfare to work, leaving public assistance rolls, many leave Medicaid as well -- unaware that they still qualify for Medicaid benefits. Until 1996, welfare recipients were automatically enrolled in Medicaid, a relationship severed in the "massive welfare overhaul." "Medicaid eligibility has become even more complicated that it used to be," study author Marilyn Ellwood remarked (Meckler, 11/2). The report, based on a five-state study for projects at the Urban Institute and the Kaiser Commission on Medicaid and the Uninsured, focused on California, Colorado, Florida, Minnesota and Wisconsin and highlighted common Medicaid enrollment difficulties. Key findings include:

Confused staff: Welfare staff workers continue to play a vital role in educating families about welfare and determining eligibility. But often these workers are not thoroughly trained in Medicaid policies or objectives and "struggle with the conflicting objective of reducing welfare dependency while expanding Medicaid enrollment."
Complex rules: Medicaid eligibility rules have been complicated by incremental changes at both the state and federal levels, making the application process difficult. Moreover, in many states, eligibility rules for the poorest families are often the most complex -- immigrants are especially confused and many believe that they no longer qualify.
Antiquated computer systems: Most states rely on computer systems that were designed for welfare programs, not Medicaid. As a result, these systems "generate correspondence that can be legalistic and difficult to understand" (MPR release, 11/01).

American Public Human Services Association spokesperson Amy Tucci noted that most states are aware of these problems and are working to solve them. She said, "States are bending over backwards to try to get these people who are entitled to Medicaid on the rolls. We have known for many months that the Medicaid rolls have been falling along with the welfare rolls, and there's been a great deal of concern on the part of policy people and states, too, to figure out why this is happening" (AP/American-Statesman, 11/02). The full report is available on the Kaiser Family Foundation web site at www.kff.org or by calling 800-656-4533 and requesting Document 2164. This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.