1. National: Effortless Enrollment
Traditional, paper-based enrollment strategies have failed to reach nearly 10 million uninsured Americans who are eligible for Medicaid and the Children's Health Insurance Program (CHIP) but are not enrolled. Automatic enrollment, the process of electronically identifying eligible beneficiaries and enrolling them by default, is a promising new strategy that can help close these gaps. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) authorizes a new state option for automatic enrollment which, if implemented to the fullest extent, can be the basis for covering nearly all eligible families in an effortless enrollment system that does not require any forms to be submitted by the beneficiary.
This paper proposes a policy of effortless enrollment that uses existing information from the tax system and other secure government databases to enroll eligible families in Medicaid and CHIP without the need for those families to complete an application or renewal form. States already use tax data to verify eligibility in public programs, so using this information to determine eligibility promises to be both accurate and feasible. If fully realized, the effortless enrollment policy is expected to cover more than 8 million uninsured children and adults, while saving about $3.2 billion in administrative costs each year.
By examining enrollment in Medicaid and CHIP, two of the most complicated means-tested health insurance programs, this paper offers a model that can be used to expand health insurance to all. Opt-out policies that leverage existing information will not only reduce the hassles of health insurance enrollment for everyday Americans, but also can reduce unnecessary administrative costs for the government, thus allowing more taxpayer money to be spent on care that people need. Overall, by reducing bureaucracy while increasing access to benefits, effortless enrollment provides a new paradigm for efficient and effective government. [Robert Nelb, 05/09]
2. Colorado: Federal Funds Help Enroll More Kids
Gov. Bill Ritter signed a bill that supporters said would enact the largest expansion of health coverage for the uninsured in Colorado since the state started its Medicaid programs in the 1960s. "This historic legislation will significantly address the crisis of the uninsured while also reducing uncompensated care and cost-shifting in our health care system," Ritter, a Democrat, said. "This legislation would be groundbreaking in a good economy, but it means even more in a down economy, as Colorado families struggle to make ends meet." Under the bill, Medicaid eligibility for coverage for children and pregnant women is increased from the current level of 205 percent of the federal poverty level, or $45,202 for a family of four, to 250 percent, or $55,125 for the same family. [Tim Hoover and Jennifer Brown, The Denver Post, 04/22/09]
3. Texas: State Again Fails to Provide for Its Children
Texas missed an opportunity to offer health insurance to 80,000 uninsured children. This missed opportunity occurred despite Texans consistently ranking affordable health coverage for children as a top policy priority, with the Children's Health Insurance Program (CHIP) garnering overwhelming approval.
Costs weren't the issue either. State budgeters listened to economists, who said programs like CHIP mean more money in taxpayers' pockets. CHIP draws federal dollars back to Texas, saves costs otherwise spent on costly emergency room care, and brings productivity gains when kids get healthy more quickly and their parents return to work. That's why the state's largest chambers of commerce and top business leaders were among the most vociferous advocates for a CHIP proposal during the legislative session.
The bipartisan proposal would have allowed families--who have no employer-sponsored, public or affordable private health care options for their kids--to purchase CHIP coverage for their children on a sliding-scale basis. Similar versions of the proposal passed in each chamber of the Legislature, gaining bipartisan sponsors and support in a total of four roll-call floor votes. How then can it be that, five months after the federal government passed a sweeping expansion of the CHIP program, not even one more Texas child qualifies for the program? How is it that so many bills passed this session, and yet this politically popular and critically important policy expired?
Here in the state with the country's highest rate of uninsured children, where one in every five kids goes uninsured, legislative leadership failed to get the bill passed--not because they lacked reasons or opportunities, but because they didn't put children first. The CHIP proposal became a casualty in an unrelated political battle, but top leaders could have prevented that by allowing nothing to come before the one group with whom our collective future truly rests--our children. Gov. Rick Perry acknowledged in a recent Associated Press report that he can add the call for a CHIP buy-in program to the agenda if there's a special session, though he indicated a reluctance to do so. For the sake not only of those 80,000 children, but for all Texans, we hope he'll change his mind.
It's time for Texas to start putting its dollars into the things that make children into productive, healthful adults and stop spending in ways that make them likely to wind up bound for prison. The next time Texas has a decision to make, top leaders would do well to put kids first. It is the only way to ensure Texas' overall health and prosperity, not only today but also well into tomorrow. [Eileen Garcia-Matthews, Anne Dunkelberg and Laura Guerra-Cardus, Austin American-Statesman, 06/05/09]
4. New York: Child Health Plus Expansion Approved by President
Approximately 70,000 uninsured New York children will become eligible for health insurance thanks to President Barack Obama's approval of the state's Child Health Plus program expansion. In New York, Child Health Plus--which covers children in poor families who are not eligible for Medicaid but do not have or cannot obtain affordable health insurance--is partially funded by the federal Children's Health Insurance Program (CHIP). In February, Obama signed into law a $32.8 billion CHIP reauthorization and expansion, which was supported by the Diocese of Rochester's Public Policy Committee. Obama's approval of New York's Child Health Plus expansion retroactive to September 2008 makes the state eligible to receive $64 million in new federal funding to expand the program, according to a statement by Gov. David Paterson.
The approval for additional federal funding comes nearly two years after former President George W. Bush denied New York's request for federal matching funding to support expansion of Child Health Plus. Following that denial, Gov. Paterson proposed and the state legislature agreed to expand the program with state funding effective September 1, 2008. In March 2009, the state Department of Health submitted a new request for federal funds. Expansion of Child Health Plus was included in the 2007-2008 state budget, which increased the income eligibility for the program from 250 percent to 400 percent of the federal poverty level, making approximately 70,000 additional uninsured children eligible for coverage.
To qualify for the program, the annual income eligibility for a family of three is now $73,000; it previously was $46,000, according to Paterson's statement. "This is a win for New York's children and another example of President Obama's commitment to providing access to affordable health insurance to all Americans," the governor said in his statement. "This federal funding will provide fiscal relief and allow us to reach more children at a time when access to affordable health insurance is more critical than ever for New York's families."
In addition to approving the expansion, Paterson said that the president agreed to allow New York to add two new exceptions to the six-month waiting period for families who drop employer coverage to enroll their children in Child Health Plus. Now, children under age of five will be exempt from the waiting period and an additional exception would be granted for parents who can no longer afford the cost of private health insurance if that cost exceeds five percent of a family's income. As of May 2009, Child Health Plus covered 386,000 children in New York. Since the expansion to 400 percent of the federal poverty level last September, an additional 22,000 children have been enrolled. [Catholic Courier, 06/12/09]
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