Key lessons from Medicaid and CHIP for outreach and enrollment under the Affordable Care Act: getting into gear for 2014
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Issue brief (Henry J. Kaiser Family Foundation)
- Author(s):
- Stephens, Jessica, author Artiga, Samantha, author
- Contributor(s):
- Henry J. Kaiser Family Foundation, issuing body. Kaiser Commission on Medicaid and the Uninsured, issuing body.
- Publication:
- Menlo Park, CA : Kaiser Commission on Medicaid and the Uninsured, June 2013
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Child Health Services -- statistics & numerical data Community Health Workers Eligibility Determination Health Insurance Exchanges -- statistics & numerical data Insurance Coverage -- statistics & numerical data Medicaid -- statistics & numerical data United States
- Genre(s):
- Technical Report
- Abstract:
- The Affordable Care Act (ACA) will significantly increase coverage options through an expansion of Medicaid and the creation of new health insurance exchange marketplaces. However, effective outreach and enrollment efforts will be key to ensuring these new coverage opportunities translate into increased coverage. Based on a review of existing research, this brief identifies five key lessons learned through previous Medicaid and CHIP experience to help inform outreach and enrollment under the ACA. It finds that: (1) Individuals want to have health coverage and value the Medicaid program for the key benefits it provides to their health and lives more broadly. Most individuals believe that having health coverage is important and say they would enroll in Medicaid if eligible. Individuals value the Medicaid program for the services it provides as well as for providing peace of mind and protection from large medical bills. Experiences among previously uninsured Medicaid enrollees show that obtaining Medicaid coverage enables individuals to get treatment for health needs and preventive care that they went without while uninsured as well as to establish a relationship with a primary care provider and seek care from a physician early, rather than delaying care or relying on the emergency room. Moreover, by helping individuals get their health under control, Medicaid coverage facilitates individuals' ability to focus on other priorities and goals, including work and caring for their family. (2) A combination of broad and targeted outreach strategies is key for reaching eligible families. Families learn about Medicaid and CHIP through multiple avenues, including word of mouth, mass media, and healthcare providers, and have varied preferences about where and how to receive information. Broad-based messages through mass media are effective in educating families about coverage, but targeted messages and efforts are important for reaching and enrolling hard-to-reach groups. As such, combining broad messages with more targeted outreach approaches, often through trusted community-based partners, is important. In particular, health care providers can serve as an important and trusted link to health coverage. In addition, having outreach materials and application forms available in plain language and in multiple languages may reduce enrollment barriers for individuals with limited English proficiency and low literacy. (3) Providing accessible, welcoming, and family-friendly application and enrollment processes helps reduce enrollment barriers for families. Numerous studies find that simplifying enrollment procedures, offering multiple enrollment avenues, eliminating interviews, and reducing documentation requirements, contribute to increases in Medicaid enrollment. In particular, use of electronic data to verify information and automatically enroll individuals into coverage has been shown to reduce paperwork burdens for families and eligibility workers. Shifts in eligibility worker culture to promote a culture of coverage and reduce stigma also facilitate enrollment. (4) One-on-one enrollment assistance provided by trusted individuals within the community is a key component of successful enrollment efforts. Research shows that direct one-on-one enrollment assistance is associated with increased enrollment rates. Such assistance can be provided through varied avenues. For example, 35 states have out-stationed state eligibility workers who provide enrollment assistance and preliminary eligibility determinations at hospitals, clinics, schools, and other locations within the community. In addition, community-based organizations are able to provide culturally competent and trusted assistance at convenient times and locations. To support this assistance, nearly half of states (23) fund community-based application assisters. (5) Facilitating renewals of coverage is important for promoting stability of coverage over time. Research shows that gaps in Medicaid and CHIP coverage due to coverage losses at renewal increase costs and have a negative impact on quality of care. Extending the length of time between renewals and providing continuous eligibility help families maintain stable coverage. In addition, simplifying renewal procedures, often through the use of technology and electronic data matches, supports increases in retention. Coordinating transitions between Medicaid and CHIP through aligned rules and policies and electronic referrals also has been shown to help maintain children's coverage. Looking ahead, the ACA will significantly increase coverage options through an expansion in Medicaid and the creation of new health insurance exchange marketplaces in 2014. However, the Supreme Court ruling on the ACA effectively made the Medicaid expansion a state option, and, in states that do not expand Medicaid, poor adults will not gain a new coverage option and likely remain uninsured. Regardless of state decisions to expand Medicaid, however, the ACA will establish new streamlined eligibility, enrollment, and renewal policies for all Medicaid programs as of 2014.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (16 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101611317 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101611317