This article examines changes in children’s eligibility for Medicaid and SCHIP and their effect on coverage.  Between 1996 and 2001, the number of children eligible for public insurance programs nearly doubled, and the number of children enrolled in public coverage grew during the post-expansionary period (2001-2005), even as eligibility levels remained steady. The authors also simulate the effects of a uniform expansion of eligibility to 300% of the federal poverty level (FPL), which would make an additional 9.1 million children eligible for SCHIP or Medicaid, and the effects of a uniform contraction of eligibility to 200% of the FPL, which would result in the loss of public insurance coverage for an estimated 500,000 children. 

This report reviews discussion during the 2007 SCHIP reauthorization debate on the number of children who are uninsured but eligible for Medicaid or SCHIP. It shows that the Congressional Budget Office concluded that there are between 5 and 6 million children who are uninsured and eligible for Medicaid and SCHIP, which is in sharp contrast to estimates recently by the Bush Administration indicating there were only 1.1 million eligible but uninsured children. This brief describes the methodologies underlying the two sets of estimates that have been at the center of the controversy.

This brief addresses coverage patterns among SCHIP-eligible children and their policy implications. Using data from the 2005 Current Population Survey, the findings estimate that close to 2 million children who are eligible for SCHIP remain uninsured. Most SCHIP enrollees do not have access to employer-sponsored health insurance, and about four in ten SCHIP enrollees live with a parent who is uninsured. The study concludes that if SCHIP is not adequately funded, millions of eligible children will remain uninsured and that other children who lose SCHIP coverage will likely become uninsured. 

In an analysis based on the 2005 Current Population Survey, the authors estimate that approximately 80 percent of the uninsured are currently eligible for public health insurance coverage or live in families with income below 300% of the federal poverty level. The report states that policy options to reduce the number of uninsured will vary depending on if the population is eligible for public coverage or if financial assistance is needed to obtain coverage.

In an analysis based on the 2005 Current Population Survey, the authors estimate the share of uninsured Americans eligible for coverage through Medicaid or SCHIP. Seventy-four percent of uninsured children were found to be eligible for public coverage. The report states that reducing the number of uninsured among those eligible for public programs will require extensive outreach efforts and simplified enrollment and redetermination procedures.

In early 2007, eleven focus groups were conducted with low-income parents in Chicago, Houston, Los Angeles and Miami. This report explores their perceptions, motivations, and experiences enrolling their children in Medicaid and SCHIP.

This study recruited uninsured Latino children and their parents from community sites in Boston to examine the effect community case managers have on the process of obtaining and keeping health insurance coverage among Latino children. Children assigned a case manager were about eight times more likely to obtain health insurance than children who received only traditional Medicaid and SCHIP outreach and enrollment assistance. Children with case managers also had higher rates of continuous coverage, they obtained health insurance in less time, and their parents were significantly more satisfied with the process of obtaining coverage. 

This report presents the findings of a survey of eligibility rules, enrollment and renewal procedures and cost-sharing policies in Medicaid and SCHIP for children and families in effect in the 50 states and the District of Columbia in July 2004. The report shows that the reintroduction by states of procedural barriers have made it harder for eligible children to enroll and stay enrolled in coverage. It documents the impact these procedural barriers have on enrollment in states.

This report contains the results of case studies and qualitative interviews with state and local officials as part of a congressionally mandated evaluation of SCHIP. Over the first three years of the program’s implementation, states experienced rapid growth in enrollment due, in part, to extensive outreach campaigns and a simplified enrollment process. Case study respondents regard SCHIP as a successful program, providing low-cost, comprehensive benefits and improved access to care for enrollees.

This paper examines outreach efforts to increase take-up of public programs among the Medicaid-eligible population in California.  Outreach efforts studied include bilingual application assistance and state-wide English- and Spanish-language television campaigns. The results indicate that outreach efforts targeted toward Asian and Hispanic children had the largest effects in increasing enrollment and that increasing Medicaid enrollment before a child gets sick leads to a decline in the number of hospitalizations for conditions that could have been avoided if treated with timely primary care. Another version of this paper, Got Health? Advertising, Medicaid and Child Health, is also available.

During 2007, states revitalized their efforts to expand health coverage for low-income, uninsured individuals, in particular uninsured children. This annual report presents the eligibility rules, enrollment and renewal procedures, and cost-sharing practices in Medicaid and SCHIP implemented or authorized between July 2006 and January 2008. The data from this report is also available at Facts and Statistics.

SCHIP reauthorization in 2007 provides an opportunity for Congress to adopt policies that help assure that children can gain the coverage they need and for which they already qualify. To make progress, the cost concerns of states must be addressed and new tools for identifying and enrolling eligible uninsured children must be implemented. This issue brief describes the barriers to covering additional uninsured but eligible children, as well as the options for addressing them.

Children fail to enroll and/or lose coverage primarily due to misinformation, difficult enrollment and renewal procedures, and inefficient administrative practices. This report explores how technological innovations can be applied to remove these impediments for Medicaid and SCHIP enrollment and retention, while at the same time making the programs more efficient.

This report illustrates the many creative and collaborative ways the Covering Kids & Families coalitions worked to break down barriers to public health coverage for low-income children and adults. From 1997-2002, these coalitions encouraged the adoption of outreach, simplification, and coordination strategies across the states. 

As Congress began to debate SCHIP reauthorization in 2007, policymakers examined what prevents eligible children from enrolling in either SCHIP or Medicaid. In February 2007, the Alliance for Health Reform held a briefing to discuss the success of state outreach, enrollment, and retention efforts, as well as the role of community and private sector partners. A transcript of the briefing is provided; for additional resources, see the Alliance for Health Reform.

By focusing efforts on those children that are eligible for public coverage, up to 95% of the uninsured children can be covered. This report details a 10-step plan for opening doorways to Medicaid and SCHIP coverage for all of these eligible children.

This article outlines the efforts states have undertaken to enroll and retain eligible children in Medicaid and SCHIP. Among the successful changes are simplified eligibility procedures, the use of community-based application assistance (help from schools, child-care providers, and faith-based organizations in understanding and applying for the programs), streamlining enrollment procedures between Medicaid and SCHIP, and reaching out to eligible families to encourage them to enroll. The authors urge states to continue making it easier for families to enroll and renew coverage for their children in public programs by eliminating waiting periods, enrolling children through other benefit programs such as food stamps, and continuing outreach programs.

Due to recent changes in federal law through the Deficit Reduction Act of 2005, individuals who declare that they are citizens for Medicaid eligibility purposes must present documentation that proves citizenship and documents personal identity. This report discusses issues related to Medicaid citizenship documentation, as well as proposed legislation that would affect the requirement.

Data from three states, Alabama, Kansas, and Virginia, show that white and African American children are much more likely than Hispanic children to have their Medicaid coverage delayed, denied, or terminated as a result of a citizenship documentation requirement that took effect in July 2006. These data provide further evidence that the requirement, purportedly aimed at preventing undocumented immigrants from improperly obtaining Medicaid, is instead overwhelmingly affecting U.S. citizens who are eligible for the program.

States reported that the citizenship documentation requirement resulted in barriers to access to Medicaid for some eligible citizens. Twenty-two of the 44 states reported declines in Medicaid enrollment due to the requirement, and a majority of these states attributed the declines to delays in or losses of Medicaid coverage for individuals who appeared to be eligible citizens. Of the remaining states, 12 reported that the requirement had no effect and 10 reported they did not know the requirement’s effect on enrollment.

This policy brief presents the initial results of the impact on health centers and their patients of federal Medicaid changes contained in the Deficit Reduction Act of 2005, that require applicants and recipients to document their citizenship. The results suggest that the requirements have caused a nationwide disruption in coverage for health center patients, with more than 90% reporting enrollment difficulties. The authors estimate that the documentation requirements will eliminate Medicaid coverage for between 2.2 and 6.7 percent of patients.

This study finds that the new Medicaid citizenship documentation requirements have had a much broader impact than expected, adversely affecting thousands of citizen children. The state has seen a significant decrease in the number of children enrolled in Medicaid in Virginia; 4-6 month delays in obtaining Medicaid coverage for Virginia children; an inability of citizen children to obtain medical care; and a dramatic increase in emergency room utilization by those caught up in lengthy eligibility determinations. The requirements have also increased costs and administrative burdens to state and local government agencies, requiring additional tax dollars.

This report shows that the Medicaid citizenship requirement is creating a barrier to health-care coverage for U.S. citizens—especially children—who are eligible for health insurance through Medicaid. In the eight months following implementation of the new requirement, an increasing number of states are reporting marked declines in Medicaid enrollment, particularly among low-income children, as well as significant increases in administrative costs as a consequence of the requirement.

This report provides an overview of the Medicaid citizenship requirement that took effect July 1, 2006. It details how it will effect an estimated 38 million current Medicaid beneficiaries, as well as an additional 10 million applicants, that are subject to the new requirement.

On July 6, 2006, the Centers for Medicare & Medicaid Services released interim final regulations implementing the new documentation requirement for Medicaid beneficiaries. This brief details the final regulations, as well as the risks to those affected.