States Earn $307 Million in Performance Bonuses for Streamlining Children’s Enrollment

By William Tomasko

It pays for states to make it easier for kids to sign up for Medicaid and the Children’s Health Insurance Program (CHIP). Last week, the Department of Health and Human Services (HHS) awarded more than $307 million in its final round of performance bonuses to 23 states that made it easier for eligible children to get covered—and stay covered—in Medicaid and CHIP.

For the past five years, HHS has been granting the bonuses, which were created as part of the Children’s Health Insurance Program Reauthorization Act (CHIPRA). States were eligible to get the additional funding if (1) they implemented at least five of eight policy options for simplifying Medicaid and CHIP enrollment and renewal, and (2) children’s enrollment in Medicaid increased over a baseline level for the fiscal year. States got bigger bonuses in proportion to how many more kids they got covered.

Since the bonuses began in 2009, 27 states have received bonuses at least once, and 19 states have qualified for a “tier II” bonus at least once (because they exceeded their annual children’s Medicaid enrollment baseline by more than 10 percent). Fourteen states received tier II bonuses in three of more years. By incentivizing states to adopt simplifications like continuous eligibility, administrative renewal, and Express Lane Eligibility, performance bonuses have helped drive marked improvements in children’s coverage in recent years, including:

  • A steady decline in the uninsured rate among children, from 8.6 percent in 2009 to 7.2 percent in 2012
  • Increased participation rates (the percentage of eligible children who are actually enrolled) in Medicaid and CHIP from 81.7 percent in 2008 to 87.2 percent in 2011

Simply put, rewarding “good enrollment behavior” has resulted in real gains for children’s coverage. Now it’s time to put these same policies to work to connect the remaining uninsured children and adults with their new coverage options through Medicaid, CHIP, and the Marketplace.

Need a refresher on simplification options?

  • Our fact sheet provides a checklist of strategies that all states can use to streamline enrollment in Medicaid and CHIP. States can, for example, use data from the Supplemental Nutrition Assistance Program (SNAP, formerly known as food stamps) to determine eligibility. We’ve been tracking how Arkansas is using SNAP data to conduct outreach to uninsured individuals who were income-eligible for Medicaid, which helped cut the number of uninsured non-elderly adults by around 14 percent by the end of October!
  • Or, check out our interactive “SNAP Map”, that shows what percentage of the uninsured is already connected to SNAP in different regions of the country. States have the opportunity to quickly and simply connect these individuals to coverage in a way similar to Express Lane Eligibility for children.
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