NY CHIP: Reasons for Slow Enrollment Not Always Obvious
Deep-seated reasons for New York families' reluctance to enroll their children in public health insurance are both statewide and region-specific, according to a report by the New York Forum for Child Health. Conducted using community roundtable discussions, the study found that while many families are attracted to the streamlined application for the state children's health insurance program, Child Health Plus, about the enrollment process is still a major concern. Further, regional variations in families' reluctance to enroll their children suggest that a "one-size- fits-all" strategy for outreach might not be the best approach, according to the report. "Farm families, immigrants, working- class families, those on welfare and urban families all view public health insurance through different lenses," said forum Chair Dr. Robert Haggerty. For instance, while schools were identified as a good setting to distribute information for urban and suburban families, they were found to be too public a setting for rural families. Participants also said confusing eligibility requirements, the stigma of public assistance, concerns about privacy and immigrant fear were factors that hampered enrollment.
More Unusual Barriers
Other, less-known barriers to enrollment uncovered by the study include a need to better inform outreach officials about program specifics, a need for simpler re-enrollment procedures and a need to address fear about contact with absent fathers (release, 3/19). In addition, the report found that families are reluctant to sign up because of conflicting messages: the state discourages cash assistance enrollment but is supposed to encourage families to apply for child health insurance. And families that are dropped from the welfare rolls are often inadvertently dropped from the Medicaid program. Another barrier that participants mentioned was the practice of Medicaid eligibility workers "humiliat[ing] applicants" or even making them feel as if the benefits were "coming out of the workers' pockets." The report concluded that "the legislation, resources and political will exist to ensure near universal coverage for children in the state" and that the recommendations from the study participants "can significantly inform the process taking shape to translate this opportunity into reality" (Andrulis et al., "Voices for Children's Health in New York State," 2/99).