NEW YORK CITY: Report Details Access Problems For Poor

      A new Commonwealth Fund report sheds light on New York City's problems in enrolling uninsured children in public assistance programs. The report, Insuring the Children of New York City's Low Income Families: Focus Group Findings on Barriers to Enrollment in Medicaid and Child Health Plus, based on focus group research of enrollees, enrollment workers and participating health plans, attempts to explain in part why about 275,000 -- 75% -- of the city's eligible children under 18 remain uninsured. The report finds that parents face substantial obstacles in getting their children on Medicaid and keeping them there, and have minimal awareness of Child Health Plus (CHP), New York State's kiddiecare plan for children ineligible for Medicaid. With respect to Medicaid, parents cited as barriers lost days of work due to face-to-face interview requirements, confusing information about required documents and conflicting information about Medicaid eligibility rules. Enrollment workers reported they are sometimes unable to communicate with immigrant parents, and are sometimes required to complete paperwork for illiterate applicants.

Child Health Plus
      While Medicaid is relatively well-known among low-income parents, CHP was virtually unheard of in the parents' focus groups. Eligibility workers corroborated that families are rarely referred to CHP. Lack of awareness was especially notable in families not receiving public assistance, an avenue through which many Medicaid recipients receive their information. Donna Lawrence, executive director of the Children's Defense Fund in New York, said, "Thousands of low-income children are needlessly going without health coverage simply because parents are unaware of the existence of Child Health Plus, or don't think their children are eligible."

Potential Solutions
      New York State plans to use $256 million in annual Title XXI funds to expand eligibility and benefits for Medicaid and Child Health Plus to families with incomes up to 250% of the federal poverty line ($41,059 for a family of four). But David Sandman, program officer at the Commonwealth Fund, said, "[P]assing new legislation is only a partial solution. The problem of hundreds of thousands of uninsured children without health care in New York City will only be solved by developing new outreach strategies and revamping the enrollment process for the programs we already have." Parents listed schools, workplaces, local community centers, doctors' offices and public benefits agencies as the best places to receive information. The report also recommends removing barriers to enrollment by improving program staffing and accuracy of information, scaling back required documentation, extending business hours for working parents and possibly even presuming eligibility for some applicants. Commonwealth Fund President Karen Davis said, "[W]e should evaluate Medicaid's processes and make changes to ensure that it reaches the families it was designed to help. A streamlined application process and better outreach to low-income families would be important steps toward ensuring that all children in New York City have access to basic health care" (Commonwealth Fund release, 12/1).