Innovative strategies to enroll eligible people into Medicaid and CHIP

Innovative strategies to enroll eligible people into Medicaid and CHIP SCI National Meeting Albuquerque, NM Stan Dorn The Urban Institute [email_address] 202.261.5561 July 30, 2009

Topics to discuss ,[object Object],[object Object]

Part I. Express Lane Eligibility under CHIPRA ,[object Object],[object Object]

Key ELE principles ,[object Object],[object Object],[object Object]

Key limits and requirements ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

No CMS interpretation as yet ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

First example of ELE: state income tax forms CHIPRA specifically authorizes ELE based on gross income or adjusted gross income shown on state income tax returns and records

Uninsured children who qualify for Medicaid or CHIP, by legal requirement to file federal income taxes and eligibility for federal EITC: 2004 Source : Dorn, et al., Feb. 2009.

Among various groups of uninsured children, the estimated percentage whose families filed federal income tax returns: 2004 Sources : Dorn, et al., Feb. 2009.

What about state income taxes? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

How state income tax ELE could work ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],*In 2009, IA passed a law mandating the completion of Medicaid/CHIP application forms when parents identify their children as uninsured on their tax returns. No enforcement is planned as yet.

How it could work, continued ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Possible adjustments ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Second example of ELE: food stamps Note: Food stamps has been officially renamed the Supplemental Nutrition Assistance Program, or SNAP

Background information on food stamps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

How food stamp ELE could work ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Third example of ELE: the National School Lunch Program (NSLP)

Background information on NSLP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

How ELE could work with NSLP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

NSLP-recipient children, by type of NSLP benefit and income-eligibility under standard Medicaid and CHIP rules (based on audited family income) Source : Dorn, April 2009. Children receiving free school lunches Children receiving reduced-price school lunches Income-eligible for Medicaid 81% 49% Income-eligible for CHIP 14% 38% Income too high for both programs 4% 13% Total: 100% 100%

Part II. Eligibility determination and enrollment in Massachusetts Preliminary findings from a SHARE grant funded by the Robert Wood Johnson Foundation

Coverage expansion in Massachusetts ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Net increase in the number of Massachusetts residents with health insurance, by coverage type: 6/30/06 to 9/30/08 Source: Massachusetts Division of Health Care Finance and Policy, February 2009.

How did Medicaid and CommCare enroll so many people? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Eligibility determination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Eligibility determination (continued) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Data-driven eligibility - rules ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],*Some of these auto-assignees had self-initiated applications, were found eligible, but did not select a plan.

The effects of data-driven eligibility ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Massachusetts is not paradise ,[object Object],[object Object],[object Object],[object Object],[object Object]

Conclusion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Sources ,[object Object],[object Object],Stan Dorn, Express Lane Eligibility and Beyond: How Automated Enrollment Can Help Eligible Children Receive Medicaid and CHIP , prepared by the Urban Institute for the Robert Wood Johnson Foundation and the National Academy for State Healthy Policy, April 2009. Stan Dorn, Bowen Garrett, Cynthia Perry, Lisa Clemans-Cope, and Aaron Lucas, Nine in Ten: Using the Tax System to Enroll Eligible, Uninsured Children into Medicaid and SCHIP, prepared by the Urban Institute for First Focus, February 2009. Stan Dorn and Genevieve Kenney, Automatically Enrolling Eligible Children and Families Into Medicaid and CHIP: Opportunities, Obstacles, and Options For Federal Policymakers , prepared by the Economic and Social Research Institute and the Urban Institute for The Commonwealth Fund, June 2006. Massachusetts Division of Health Care Finance and Policy, Health Care in Massachusetts: Key Indicators , February 2009. Stephanie Anthony, Robert W. Seifert, Jean C. Sullivan, The MassHealth Waiver: 2009-2011…and Beyond , prepared by the Center for Health Law and Economics, University of Massachusetts Medical School, for the Massachusetts Medicaid Policy Institute and the Massachusetts Health Policy Forum, February 2009. The Massachusetts Health Insurance Connector Authority, Report to the Massachusetts Legislature: Implementation of the Health Care Reform Law, Chapter 58, 2006-2008 , October 2008. Note: much of the presentation’s discussion of Massachusetts reforms is based on a site visit to Massachusetts, which was part of Urban Institute research conducted through a grant under the State Health Access Reform Evaluation program (SHARE). SHARE is funded by the Robert Wood Johnson Foundation, with the State Health Access Data Assistance Center serving as the national program office. Together with state administrative data, findings from the site visit will be published shortly.

Innovative strategies to enroll eligible people into Medicaid and CHIP

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Innovative strategies to enroll eligible people into Medicaid and CHIP