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Report Finds Children Gaining Public Health Coverage Even in Poor Economy

By Jane Norman, CQ HealthBeat Associate Editor

August 18, 2011 -- While there may be a growing number of children in families that lack health insurance as the economic crisis continues, the good news Thursday was that more kids are getting enrolled in public health insurance programs.

A report by the Robert Wood Johnson Foundation and the Urban Institute released on Thursday says that participation rates among children eligible for Medicaid and the Children’s Health Insurance Program (CHIP) rose from 82.1 percent to 84.8 percent nationally between 2008 and 2009.

In addition, the Department of Health and Human Services announced $40 million in grants Thursday to state agencies, community health groups, school-based groups and non-profits to help enroll more children and teens. Grants ranging from $200,000 to $2.5 million were awarded in 23 states, many intended to boost the use of technology.

The grants were authorized in the 2009 reauthorization of CHIP ( PL 111-3 ).

Cindy Mann, deputy administrator of the Center for Medicare and Medicaid Services, said that “great progress” is being made in signing up eligible children, and efforts to streamline both new enrollees and renewals have paid off.

According to the study, increases in participation in Medicaid and CHIP were seen across racial and income groups, with the exception of children who are not U.S. citizens.

Overall, the number of children who could be in those two public programs went up by 2.5 million between 2008 and 2009, due to the economic downturn and the expansion of Medicaid and CHIP programs in many states, the study says. Total enrollment rose to 42.7 million.

Participation rates in public programs rose in 30 states. In 15 states and the District of Columbia, 90 percent or more of eligible children are signed up. In Colorado, there was an increase of more than 11 percent in just one year. No states had statistically significant declines.

In all, 62 percent of children nationally who are uninsured but eligible for insurance live in one of 10 populous states—Arizona, California, Florida, Georgia, Illinois, Indiana, New York, Ohio, Pennsylvania, and Texas.

In some states, participation rates are below national averages — Florida, Montana, Nevada, North Dakota, Texas, and Utah.

Genevieve Kenney, a senior fellow and economist at the Urban Institute who co-authored the study, said that there’s no precise combination of strategies that researchers have been able to pinpoint that results in an increase in enrollment. However, “a large number of states seem to have figured it out,” she said.

What helps is for states to make enrollment and renewal less time consuming and complicated. For example, not demanding a long list of information such as copies of pay stubs or lists of assets each time an applicant re-applies. Some states still require face to face interviews for enrollment or re-enrollment. And states like Texas or California may be home to large numbers of parents who aren’t legal citizens, even if their children are citizens and are eligible.

Kenney noted that in 2009, states were still receiving an enhanced federal match for Medicaid as a result of the economic stimulus law ( Pl 110-185 ). That match ran out in July, which may affect enrollment numbers down the line.

The researchers based their results on estimates from the American Community Survey, a U.S. Census survey that includes a question about health insurance coverage for each member of a household. Adjustments were made to the survey material out of concerns that the survey under counts CHIP and Medicaid enrollment. In addition, modeling techniques were used.

The grants announced by HHS will be directed at many states with lower participation rates. Georgia, for example, will receive $2.5 million for better technology for Medicaid and PeachCare for Kids. That will include forms for renewal with information already filled in, as well as portable lap tops and scanners for enrollment outside government offices.

HHS officials said that besides technology, the $40 million in grants will target retainment of children in coverage, engaging schools in outreach activities, reaching out to children likely to have gaps in coverage and ensuring eligible teens are signed up.

Recent Trends in Children’s Participation in Medicaid and CHIP (pdf)

Jane Norman can be reached at [email protected].  

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