As private coverage has eroded over the last decade and low-income residents have faced barriers to needed care, the state's publicly funded programs have become increasingly important sources of health coverage. Unfortunately, many individuals have not succeeded in enrolling in the programs, or retaining their coverage once enrolled. The Fund is studying the best approaches to connect eligible adults and children with public insurance programs and to ensure that they stay covered. Currently, a complex maze of rules means that people may not enroll in public programs for which they are eligible, or they may lose benefits for administrative reasons. Fund support has enabled the Children's Defense Fund to analyze the complexities families face and recommend policies that would simplify and coordinate coverage.

A project by Deborah Bachrach and colleagues sought to quantify how often administrative processes, rather than higher incomes or other eligibility changes, were causing children to lose coverage. They found that 93 percent of children who lost their Child Health Plus Part B coverage were actually still eligible but had failed to complete New York's recertification process. In a field report,⁽⁴⁴⁾ the authors propose strategies to make it easier for families to retain their children's coverage.

Another Fund-supported effort, the Model Office Project, has made great strides in streamlining enrollment in New York's Medicaid, Child Health Plus, and Family Health Plus programs. Over the past year, the New York City Mayor's Office of Health Insurance Access has piloted and implemented the redesign of Medicaid community offices, applications, and enrollment processes, resulting in dramatically shorter waiting times, an application process that can be completed in one visit rather than two, and greater satisfaction among clients and eligibility workers.

New York State's Medicaid managed care program was the subject of a comprehensive report prepared by Kathryn Haslanger of the United Hospital Fund (UHF).⁽⁴⁵⁾ For the past 12 years, the state has been attempting to transform Medicaid's fee-for-service delivery system to a managed care model, which policymakers believe has the potential to control costs and improve care. But the report, which was based on a seven-year UHF assessment supported in part by The Commonwealth Fund, concludes that Medicaid managed care has thus far not lived up to its promises. While Haslanger says the program has succeeded in some ways — for example, by improving patients' access to office-based specialists and reducing waiting times for care — frequent disruptions in enrollees' coverage "have rendered financial incentives for prevention and early detection fairly meaningless." Much of this turnover in enrollment, the report finds, results from administrative problems, not changes in individuals' eligibility status.

In March 2003, many New Yorkers came together as part of a national campaign to raise awareness about the problems of the uninsured. The Commonwealth Fund joined the Robert Wood Johnson Foundation, the United Hospital Fund, and others to cosponsor the events of New York City's Cover the Uninsured Week, which included town hall meetings, health fairs, and forums at hospitals, universities, and other locations throughout the city. Through its participation, the Fund sought to help consumers, payers, and providers find and enact real solutions to assist uninsured New Yorkers.