It Pays to Follow Enrollment Best Practices

By Deepak Madala

Last month, the Department of Health and Human Services (HHS) awarded enrollment “performance bonuses” totaling nearly $306 million to 23 states for their progress in enrolling children in Medicaid and the Children’s Health Insurance Program (CHIP). Congratulations to Alabama, Alaska, Colorado, Connecticut, Georgia, Idaho, Illinois, Iowa, Kansas, Maryland, Michigan, Montana, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, South Carolina, Utah, Virginia, Washington, and Wisconsin.

These bonuses were created as part of the CHIP Reauthorization Act of 2009 (CHIPRA) to encourage states to 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 Colorado ($42.9 million), Maryland ($36.5 million), New Jersey ($22.2 million), Oregon ($25.8 million), and Wisconsin ($23.3 million).

Enrollment Best Practices 

CHIPRA designates eight enrollment best practices for states:


  1. 12 month continuous eligibility
  2. Elimination or liberalization of asset limits
  3. No in-person interview requirements
  4. Use of a single application for enrollment and renewal
  5. Automatic or administrative renewal
  6. Presumptive eligibility
  7. Express Lane Eligibility
  8. 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 later this year. Some of the most commonly adopted best practices among these states are eliminating in-person interview requirements for children and using a single application for children’s coverage. 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. Sixteen of the 23 states produced enrollment increases of more than 10 percent above their baselines, getting hundreds of thousands of children enrolled in coverage during the 2012 fiscal year.

Click here for more information on CHIPRA performance bonuses.


Enroll America Menu
Are you looking for affordable health insurance?