A Continuing Program for Increasing Insurance Coverage Among Low-Income Families

Shortly after CHIP legislation was passed, the Robert Wood Johnson Foundation (RWJF) began an ambitious, decade-long effort to increase the health insurance coverage of low-income children nationwide. In 1999, RWJF implemented Covering Kids: A National Health Initiative for Low-Income, Uninsured Children (CKI), which supported state and local organizations aiming to increase enrollment of children in Medicaid and CHIP. Covering Kids & Families® (CKF)—which reached out to parents as well as children—succeeded CKI in 2002. From 2002 to 2006, RWJF distributed $44 million in CKF grants to organizations in 46 states to work on increasing the numbers of children enrolled in CHIP and Medicaid.

RWJF wanted to know the most effective ways of enrolling children and families in public coverage, and how it could improve the CKF program and design new programs, if needed, when CKF ended. To meet these goals, RWJF contracted with Mathematica Policy Research and its partners, The Urban Institute and Health Management Associates, to evaluate CKF. The evaluation included a formative component to help the Foundation and the NPO improve the program, and a summative component to assess the effects of CKF on policy and procedures and the effects of policy and procedures on coverage.

The findings were that broad-based cooperation on policy and procedural change—among advocacy groups, providers, state Medicaid and CHIP officials and other stakeholders— can be achieved and that such cooperation can be fundamental to increasing insurance coverage among children. Furthermore, many of these changes endured well beyond the CKF grant period, and some (such as eliminating face-to-face interviewing requirements) have become the national norm. Moreover, the evaluation found ample support for the notion that policy and procedure engineering can significantly increase enrollment. Among the key process influences on enrollment found were elimination of face-to-face interviews and state use of centralized enrollment processing.