Starting the Year Off with a Victory Lap

By Guest Blogger

Last week, while most of us were enjoying time with family and friends and taking a much deserved break, the Department of Health and Human Services (HHS) announced a holiday bonus of sorts for 23 states: enrollment “performance bonuses” totaling nearly $300 million for their measurable progress in enrolling children in Medicaid and the Children’s Health Insurance Program (CHIP). What a great accomplishment to celebrate as we kick off the new year! 

These bonuses were created as part of the CHIP Reauthorization Act of 2009 (CHIPRA) to provide a financial incentive to states that make progress with children’s enrollment. Bonuses are awarded annually to states that (1) enact at least five of eight “enrollment best practices” and (2) increase children’s enrollment in Medicaid. Some of this year’s biggest winners were Maryland ($28.3 million), Virginia ($26.7 million), and Colorado ($26.1 million).

Enrollment Best Practices 

CHIPRA designates eight enrollment best practices for states: 12 month continuous eligibility, elimination or liberalization of asset limits, no in-person interview requirements, use of a single application for initial enrollment and renewal, automatic or administrative renewal, presumptive eligibility, Express Lane Eligibility, and premium assistance. (To learn more about these policies, see this Families USA issue brief.) These policies make it easier for families to complete the enrollment process and to keep their kids enrolled in coverage as long as they are eligible. These are some of the same best practices that will make it easier for anyone to enroll in the new coverage options that will be available starting in 2013. This year, every state that won a bonus has (for children) eliminated or liberalized its asset test, eliminated in-person interview requirements, and established a single application. These policies will be required for most children and adults applying for Medicaid in 2014, so these states are getting a head start.

Meeting Enrollment Targets

States also need to meet enrollment targets in order to qualify for a bonus. The size of a state’s bonus is based on the number of children above a certain “baseline” that enroll in Medicaid. States that received bonuses exceeded their enrollment baselines by between 4 and 27 percent, getting hundreds of thousands of children enrolled in coverage during the 2011 fiscal year.

The Take-Away

New data from the National Center for Health Statistics show that an estimated 1.2 million children (who likely would otherwise have been uninsured) have gained health coverage as a result of states’ efforts to simplify and streamline enrollment and renewal in Medicaid and CHIP over the last three years. Efforts like these have helped keep children insured, even while the rate of uninsured adults has been increasing.

States are free to use their performance bonus in any way they choose, but one excellent use of this windfall would be to begin broadening these enrollment best practices to include adult coverage as well.

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