Coordinating Medicaid and SCHIP
State ExperiencesProviding truly seamless coverage in Massachusetts. MassHealth is a single public health insurance program that provides coverage by combining federal Medicaid and SCHIP funds and state resources. Enrollment and renewal procedures are the same for all children, and all children have access to the same delivery systems. It is only behind-the-scenes, in a process invisible to families, that the state determines which funding streams are used to finance a child’s care. The range of covered benefits does vary based on family income and other factors. However, as long as a child remains eligible for MassHealth, movement among coverage categories (as a result of changes in family income or status) is accomplished through a consolidated eligibility system, without requiring the member to re-apply. Members receive written notice of any changes in their benefits. 1 (See MassHealth Web site.) Coordinating renewals in Washington State. In Washington, although different entities handle renewals for Medicaid and SCHIP, the requirements are the same and the programs use the same pre-populated renewal form (i.e., a form that is filled out with information that the state already has on hand about the family). If a child’s eligibility changes at renewal, a letter informs the family and a new identification card is automatically sent. If a child transfers from Medicaid to SCHIP, premiums begin the month after the change. Following annual adjustment of the federal poverty level (FPL), an automated review determines if SCHIP participants have become Medicaid-eligible. If so, an automatic transfer is made and the original eligibility review schedule remains. 2 (See Washington State Health and Recovery Services Administration Web site.) No “Wrong Door” in Virginia. In 2002, Virginia had low SCHIP enrollment and families struggled to navigate between the separate Medicaid and SCHIP programs. With the commitment of a new Governor, committed agency staff, and the support of the General Assembly, however, the state took some key steps, including: eliminating premiums, eliminating age-based differences in eligibility rules (i.e., expanding Medicaid for children ages six to 18 to 133 percent of the FPL); developing a joint application; and streamlining verification requirements across the programs. The state also adopted a “No Wrong Door” policy, meaning the family can go (or send their paperwork) to either their local Department of Social Services or to the SCHIP central processing unit, and the child will be enrolled in the program for which he or she is eligible. The approved cases are then automatically forwarded to the appropriate office for ongoing case management. The end result of the no wrong door policy is that families can get coverage even if they erroneously applied for the “wrong” program. The impact of these and other improvements has been substantial. Between September, 2002 and December, 2007, SCHIP enrollment in Virginia increased by more than 125 percent. 3 (See Virginia Department of Medicaid Assistance Services Web site.) Electronic referral connects Medicaid and SCHIP in Iowa. In Iowa, children who lost Medicaid eligibility due to increased income were not being consistently referred to SCHIP. Eligibility workers found the referral system cumbersome— forms had to be copied and faxed—and there were increasing complaints from families about loss of coverage. In response, a team of Medicaid and SCHIP administrators, staff and advocates developed an electronic referral process that was added to the Medicaid computer system. The Department of Human Services was also restructured so that the SCHIP Administrator could oversee eligibility for both programs. The system has cut down on eligibility workers’ paperwork and children missing out on referrals to SCHIP. As a result, referrals have increased substantially: from 293 in August 2003 to 943 in August 2006. The state reports that the vast majority of these referrals are approved. 4 (See Iowa's hawk-i Web site.) Go To Next Section: ResourcesFootnotes1. FY 2006 Massachusetts Annual SCHIP Report; Personal communication with Robin Callahan, Director of Member Policy and Program Development, Massachusetts Office of Medicaid, 2007. Back 2. FY 2006 Washington Annual SCHIP Report; Personal communication with Kevin Cornell, Regional Medicaid Eligibility Representative, Washington DSHS/HRSA, 2007. Back 3. Personal communication with Rebecca Mendoza, Virginia Department of Medical Assistance Services, 2007. Back 4. Southern Institute on Children and Families, "Covering Kids And Families: Promising Practices From The Nation's Single Largest Effort To Insure Eligible Children And Adults Through Public Health Coverage," (April 2007); and Personal communication with Mike Baldwin, Iowa Department of Human Services, 2007. Back |
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