It's been nearly 15 years since SCHIP or Kidcare was established as a way of providing health insurance to children who "couldn't afford it." Back then, hard hearted people such as me argued that the problem was not cost but that kids who were eligible were never enrolled. Back then there were estimates that 5 million kids fell into that category. Such facts were ignored in favor of creating a new entitlement. So where are we today?
Sebelius Pledges Further Action To Enroll Children in Medicaid, CHIP - 7 September 2010 Health Care Daily Report (By Steve Teske)
Health and Human Services Secretary Kathleen Sebelius Sept. 3 said the federal government would continue efforts to enroll children in Medicaid and the Children's Health Insurance Program as a new report indicated that nearly 5 million children are eligible for the programs but not enrolled.
Sebelius and other federal officials appeared at a press briefing to discuss issues involved in enrolling more children in the two health care programs following Sebelius's announcement in February of an initiative aimed at enrolling 5 million additional children within five years.
A report by the Urban Institute published Sept. 3 in the online journal Health Affairs found there were about 7.3 million uninsured children on an average day in 2008, of whom 4.7 million were eligible for Medicaid or CHIP but not enrolled.
Of the 4.7 million children, 3 million had family incomes below 133 percent of the federal poverty level, 1.2 million had family incomes of 133 percent to 200 percent of poverty, and 500,000 had incomes above 200 percent of poverty, said the report, "Who And Where Are The Children Yet To Enroll In Medicaid And The Children's Health Insurance Program?"
Medicaid and CHIP enrollment rates varied across states from 55 percent to 95 percent, and 10 states had participation rates close to or above 90 percent, the report said.
Thirty-nine percent of eligible uninsured children (1.8 million) lived in just three states-California, Texas, and Florida-while 61 percent (2.9 million) lived in 10 states, the report said.
Overall, the report estimated that the national rate of Medicaid and CHIP participation for children was 81.8 percent in 2008.
"This new data will help us to focus our efforts and our grant funding where they are most needed," Sebelius said. "We now have a much better sense of where most uninsured children live, and which communities may need more help."
Currently, health coverage is available to children in families with incomes up to about $45,000 per year in nearly every state, Sebelius said.
"Nothing is more important to our future than the health of our children," she said. "No child should have to skip a doctor's appointment or go without the medicine they need because their family can't pay."
"I'm challenging everyone, from my state and federal counterparts, to local governments and community-based organizations, to health centers and school districts, to faith-based groups and Indian tribes, to take this conversation about children's coverage to the next level-to find and enroll those 5 million kids," she added.
Connecting Kids to Coverage Challenge
Sebelius in February announced a new initiative aimed at enrolling children eligible for Medicaid and CHIP. She challenged advocates and policymakers to enroll those eligible for the programs but not enrolled and set forth ways that could be achieved.
The initiative, dubbed Connecting Kids to Coverage Challenge, dovetails with the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009.
The act gave states additional tools to help increase children's enrollment in Medicaid and CHIP. The tools included outreach and enrollment grants and bonus payments to states that adopt five of eight enrollment and retention strategies and states that experience Medicaid enrollment increases that exceed target growth rates, according to the Urban Institute report.
States also were given "Express Lane" options, which allow them to use administrative data from other programs such as the Special Supplemental Nutrition Program for Women, Infants, and Children to facilitate enrollment, the report said.
The act also allowed states to use federal dollars to cover legal immigrant children who had been in the United States fewer than five years, and it provided states with additional federal funds to cover more children, the report said.
"By February 2010, one year after CHIPRA became law, a number of states had either expanded eligibility for coverage or introduced improvements to their enrollment and retention processes," the report said.
"By April 2010, the federal government had awarded $50 million in outreach grants, including $40 million to organizations in forty-two states and an additional $10 million for targeting Native American children," the report said.
"These policy changes are expected to change the composition of the population of children enrolled in public coverage and raise participation rates among children who are already eligible," it added.
CHIPRA and the Patient Protection and Affordable Care Act (Pub. L. No. 111-148) provide $120 million for grants designed to promote enrollment and retention strategies that will increase the prevalence of health coverage, according to HHS.
17 Groups Signed On
Sebelius said 17 national organizations and a number of states have agreed to sign on to the "Connecting Kids" challenge. The organizations, ranging from the United Way to the American Academy of Pediatrics, represent a broad base of organizations who are working to enroll children in health insurance, HHS said.
The Urban Institute report said the recession and state budget problems could hamper state efforts to promote greater enrollment and retention among eligible children.
The new health care law will help boost coverage, but "it is not clear how much higher participation can be in the states that already have rates greater than 90 percent, given the dynamic nature of family circumstances and eligibility for public coverage," the report said.
"Without strong economic growth, states may be reluctant to seek aggressively to increase enrollment among eligible children in the near term, or even to maintain recent coverage improvements," the report stated. "The recently enacted extension of enhanced federal Medicaid matching rates through the first half of 2011 may encourage states to implement new policies or maintain existing policies aimed at increasing Medicaid/CHIP participation among children," it added.
"Absent increases in Medicaid/CHIP participation in the ten states that account for 61 percent of all eligible uninsured children, there would still be close to three million uninsured children nationally who are eligible for Medicaid/CHIP even if the remaining forty states were able to achieve participation rates close to 100 percent," the report said.
"Moreover, because California, Florida, and Texas together account for 1.8 million of the total eligible uninsured children, increasing participation in those three states will be critical to reaching the national goal," it added.
Support From Federal Government
In a commentary accompanying the report, Sebelius said the federal government "will provide support and technical assistance to build on efforts already under way in several states to streamline the enrollment process. We are also working with partners across the country to explore ways to expand the use of telephones, text messaging, and other technologies in outreach and enrollment."
Sebelius said the federal government also is working with states and community organizations to identify the most effective ways to reach out to families, and then enroll their children "where they live, learn, play, work, worship, and receive health care."
"We are striving to make enrollment assistance an ongoing and routine activity," she stated.
The Urban Institute study is available at http://content.healthaffairs.org/cgi/content/full/hlthaff.2010.0747v2
The commentary on the issue by Sebelius can be found at http://content.healthaffairs.org/cgi/content/full/hlthaff.2010.0852v1.
More information on Sebelius's "Connecting Kids to Coverage Challenge" program can be found at http://insurekidsnow.gov
Sebelius and other federal officials appeared at a press briefing to discuss issues involved in enrolling more children in the two health care programs following Sebelius's announcement in February of an initiative aimed at enrolling 5 million additional children within five years.
A report by the Urban Institute published Sept. 3 in the online journal Health Affairs found there were about 7.3 million uninsured children on an average day in 2008, of whom 4.7 million were eligible for Medicaid or CHIP but not enrolled.
Of the 4.7 million children, 3 million had family incomes below 133 percent of the federal poverty level, 1.2 million had family incomes of 133 percent to 200 percent of poverty, and 500,000 had incomes above 200 percent of poverty, said the report, "Who And Where Are The Children Yet To Enroll In Medicaid And The Children's Health Insurance Program?"
Medicaid and CHIP enrollment rates varied across states from 55 percent to 95 percent, and 10 states had participation rates close to or above 90 percent, the report said.
Thirty-nine percent of eligible uninsured children (1.8 million) lived in just three states-California, Texas, and Florida-while 61 percent (2.9 million) lived in 10 states, the report said.
Overall, the report estimated that the national rate of Medicaid and CHIP participation for children was 81.8 percent in 2008.
"This new data will help us to focus our efforts and our grant funding where they are most needed," Sebelius said. "We now have a much better sense of where most uninsured children live, and which communities may need more help."
Currently, health coverage is available to children in families with incomes up to about $45,000 per year in nearly every state, Sebelius said.
"Nothing is more important to our future than the health of our children," she said. "No child should have to skip a doctor's appointment or go without the medicine they need because their family can't pay."
"I'm challenging everyone, from my state and federal counterparts, to local governments and community-based organizations, to health centers and school districts, to faith-based groups and Indian tribes, to take this conversation about children's coverage to the next level-to find and enroll those 5 million kids," she added.
Connecting Kids to Coverage Challenge
Sebelius in February announced a new initiative aimed at enrolling children eligible for Medicaid and CHIP. She challenged advocates and policymakers to enroll those eligible for the programs but not enrolled and set forth ways that could be achieved.
The initiative, dubbed Connecting Kids to Coverage Challenge, dovetails with the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009.
The act gave states additional tools to help increase children's enrollment in Medicaid and CHIP. The tools included outreach and enrollment grants and bonus payments to states that adopt five of eight enrollment and retention strategies and states that experience Medicaid enrollment increases that exceed target growth rates, according to the Urban Institute report.
States also were given "Express Lane" options, which allow them to use administrative data from other programs such as the Special Supplemental Nutrition Program for Women, Infants, and Children to facilitate enrollment, the report said.
The act also allowed states to use federal dollars to cover legal immigrant children who had been in the United States fewer than five years, and it provided states with additional federal funds to cover more children, the report said.
"By February 2010, one year after CHIPRA became law, a number of states had either expanded eligibility for coverage or introduced improvements to their enrollment and retention processes," the report said.
"By April 2010, the federal government had awarded $50 million in outreach grants, including $40 million to organizations in forty-two states and an additional $10 million for targeting Native American children," the report said.
"These policy changes are expected to change the composition of the population of children enrolled in public coverage and raise participation rates among children who are already eligible," it added.
CHIPRA and the Patient Protection and Affordable Care Act (Pub. L. No. 111-148) provide $120 million for grants designed to promote enrollment and retention strategies that will increase the prevalence of health coverage, according to HHS.
17 Groups Signed On
Sebelius said 17 national organizations and a number of states have agreed to sign on to the "Connecting Kids" challenge. The organizations, ranging from the United Way to the American Academy of Pediatrics, represent a broad base of organizations who are working to enroll children in health insurance, HHS said.
The Urban Institute report said the recession and state budget problems could hamper state efforts to promote greater enrollment and retention among eligible children.
The new health care law will help boost coverage, but "it is not clear how much higher participation can be in the states that already have rates greater than 90 percent, given the dynamic nature of family circumstances and eligibility for public coverage," the report said.
"Without strong economic growth, states may be reluctant to seek aggressively to increase enrollment among eligible children in the near term, or even to maintain recent coverage improvements," the report stated. "The recently enacted extension of enhanced federal Medicaid matching rates through the first half of 2011 may encourage states to implement new policies or maintain existing policies aimed at increasing Medicaid/CHIP participation among children," it added.
"Absent increases in Medicaid/CHIP participation in the ten states that account for 61 percent of all eligible uninsured children, there would still be close to three million uninsured children nationally who are eligible for Medicaid/CHIP even if the remaining forty states were able to achieve participation rates close to 100 percent," the report said.
"Moreover, because California, Florida, and Texas together account for 1.8 million of the total eligible uninsured children, increasing participation in those three states will be critical to reaching the national goal," it added.
Support From Federal Government
In a commentary accompanying the report, Sebelius said the federal government "will provide support and technical assistance to build on efforts already under way in several states to streamline the enrollment process. We are also working with partners across the country to explore ways to expand the use of telephones, text messaging, and other technologies in outreach and enrollment."
Sebelius said the federal government also is working with states and community organizations to identify the most effective ways to reach out to families, and then enroll their children "where they live, learn, play, work, worship, and receive health care."
"We are striving to make enrollment assistance an ongoing and routine activity," she stated.
The Urban Institute study is available at http://content.healthaffairs.org/cgi/content/full/hlthaff.2010.0747v2
The commentary on the issue by Sebelius can be found at http://content.healthaffairs.org/cgi/content/full/hlthaff.2010.0852v1.
More information on Sebelius's "Connecting Kids to Coverage Challenge" program can be found at http://insurekidsnow.gov
