Academic journal article The Future of Children

Enrolling Eligible Children and Keeping Them Enrolled

Academic journal article The Future of Children

Enrolling Eligible Children and Keeping Them Enrolled

Article excerpt


Coverage under Medicaid and the State Children's Health Insurance Program (SCHIP) provides low-income children with a vital link to needed health care, yet a significant proportion of children eligible for these programs remain uninsured. States have found that expanding eligibility and marketing new programs are not enough to increase enrollment of eligible uninsured children in public health programs. States also need to simplify enrollment and renewal procedures to make them more family-friendly. According to survey data, a key reason for underenrollment is that families find enrollment and renewal procedures too complex.

This article details the efforts that states have made to increase enrollment in Medicaid and SCHIP, and it offers recommendations for strengthening these efforts. Although barriers to enrollment and renewal still exist, states are making progress in several ways, such as:

* Simplifying eligibility procedures.

* Using community-based application assistance.

* Eliminating procedural differences between Medicaid and separate SCHIP programs.

The authors recommend that states continue to simplify program requirements and procedures, making it easier for children to enroll in Medicaid and SCHIP, retain coverage for as long as they qualify, and transfer between programs when necessary. In addition, outreach and community-based application assistance will continue to be essential activities, along with developing efforts to enroll children through other public programs, such as the food stamp program.

Health insurance can make a striking difference in the lives of children and their families. It not only can influence whether a child obtains needed health care, but it also can affect a child's school attendance and ability to fully participate in school activities. (1) In addition, families that lack health insurance are more vulnerable to financial stress than families with health coverage, making it more challenging for them to meet the needs of their children. (2) For the vast majority (84%) of low-income, uninsured children, Medicaid and SCHIP can provide a vital link to health care, improved participation in school, and greater financial stability. (3) Yet, 6.7 million low-income children who qualify, for these programs remain uninsured. (4) States' experiences indicate that expanding eligibility and marketing new programs are not sufficient to reduce the number of uninsured children. To achieve success, a combination of these strategies, supported by ongoing, concerted efforts to facilitate the enrollment of eligible children in health coverage and keep them enrolled, is needed.

Surveys indicate that the complexity of enrollment and renewal procedures has deterred families with eligible children from applying for health coverage. Thus, many children appear to be going without insurance, not because they do not qualify for existing programs, but because their families have difficulty completing forms and assembling the documents that states require them to submit. (5) For example, a national survey found that 67% of low-income families with uninsured children eligible for Medicaid had tried to enroll their children, but only 43% had been successful, largely due to confusion about the process and difficulty producing required documents. (6) Similar procedural barriers impede families from completing the renewal process, causing their children to lose coverage even when they remain eligible. (7)

With the creation of SCHIP in 1997, much attention was focused on the considerable flexibility states had to design new children's health coverage programs that were free of enrollment obstacles. The surge of state activity, that followed led federal officials to emphasize that states could also use this flexibility to remove barriers in their existing Medicaid programs, making it easier to coordinate children's health coverage and to conduct outreach, as the law requires. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed


An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.