Getting the Most Bang from our Post-Health Reform Buck:

Enrolling and Retaining Everyone Who’s Eligible

December 1, 2009Alliance for Health Reform Briefing

Tricia Brooks

How are we doing in Medicaid & CHIP?How can we do better post-health reform?

5 million of the 8 million uninsured children are currently eligible for Medicaid or CHIP…

As many of 40% of uninsured children were enrolled in Medicaid or CHIP in the prior year…

In 2008, the number of uninsured children dropped to it’s lowest rate in more than 2 decades largely due to

the success of Medicaid and CHIP but…

Lessons Learned from Medicaid and CHIP

Barriers to Enrollment & Retention

• Unnecessarily excessive paperwork and red tape

• Lack of clarity in communication• Affordability; payment policies• Past experiences with “the

system”• Cultural orientation to coverage

and access to healthcare• Outdated, inflexible technology

Coordination Issues

• Lack of alignment between programs:• Policies• Procedures • Requirements

• Separate eligibility systems with limited ability to exchange data

• Incomplete, unsuccessful hand-offs between programs

It’s Not Rocket Science

• Harness technology to enhance productivity and accuracy

• Engineer the business policies and processes to be:• Efficient• Client-focused• Performance-based

• Seamless to families and individuals

But There Are Challenges

• Resistance to change• Political will and State

resources• Technology costs• Data collection and

analysis capacity• Effort required to map processes, test new

ideas, identify best practices, spread change• Subsidies through tax code would add new

element to coordinate

Effective Strategies Moving Forward

Maximize the Use of Technology

• Program information• Self-service options• Screen, apply, renew and manage

account• Centralized eligibility or highly

functional data exchanges• Administrative verifications• Express lane eligibility• Better data; quality control

Make the System Simple and Consistent

• Requirements, processes, and procedures• Income, in particular

• Materials, forms, letters, all communications

• Multiple points of entry• Via mail, phone, web, in-person• Attention to consistency across venues• Screen and enroll for all programs regardless

of access point

Support Community-Based Assistance

• Help overcome stigma, cultural and language barriers

• Offer breadth of services from outreach to screening eligibility to app assistance

• Clarify requirements for families• Reduce administrative load on eligibility offices• Provide excellent feedback mechanism

Offer Affordable Premiums with Flexible Payment Policies

• No rule of thumb on affordability but must take into account all cost-sharing• Premiums impact enrollment• Co-payments impact access

• Need multiple payment options

• Generous grace periods and premium rescues can help

Focus on Outcomes

• Establish clear program goals and outcomes measures

• Collect, analyze and act on enrollment and retention data

• Adopt a continuous improvement approach to program administration

• Report data publicly to enhance accountability and transparency

Put Out the Welcome Mat

• Reform offers opportunity to create renewed interest in and enthusiasm for all coverage programs

• Care should be taken to create and refine a system of coverage that is seamless and easy to maneuver for families and individuals

Contact Information

Tricia BrooksSenior FellowGeorgetown University Center for

Children and Familiespab62@georgetown.eduhttp://ccf.georgetown.edu/http://www.theccfblog.org/202-365-9148