First-Year Report on the Field Evaluation of the Maximizing Enrollment for Kids Program

The Program Being Evaluated

As a means of improving enrollment and retention of children eligible for Medicaid and CHIP, the Robert Wood Johnson Foundation (RWJF) has funded a major new grant program, Maximizing Enrollment for Kids (MaxEnroll), which provides funding and technical assistance for up to four years in eight states. Launched in 2007 under the direction of the National Academy for State Health Policy (NASHP), MaxEnroll will help states improve their systems, policies and procedures by: (1) providing them with an in-depth assessment of the strengths and weaknesses of their current Medicaid and CHIP enrollment and retention systems; (2) assisting them with implementation strategies to cover more eligible but unenrolled children; and (3) measuring their progress. The program will also help to establish and promote best practices among states in this area.

The eight states funded by the MaxEnroll program, and participating in the evaluation, include: Alabama, Illinois, Louisiana, Massachusetts, New York, Utah, Virginia and Wisconsin. These states were chosen to receive funding through a competitive grant application process.

About the Evaluation

The evaluation of MaxEnroll assesses three key research questions:

  1. Did the program have an impact on the number of children enrolled in Medicaid and CHIP?
  2. What policy and procedural changes led to the greatest change in enrollment?
  3. What features of the state’s policy-making environment made success more or less likely?

The evaluation will be divided into two parts: a quantitative evaluation and a qualitative field evaluation.

Quantitative Evaluation: The quantitative evaluation, led by Christopher Trenholm, Ph.D., of Mathematica Policy Research Inc., will consist of an analysis of state data to examine trends in eligibility determination, enrollment, retention and disenrollment over the course of the program. The objective is to measure the cumulative impact of the program on Medicaid and CHIP enrollment, as well as to estimate the relative effects of each of the different policy and procedural changes. Key variables of interest may include: overall enrollment, completed applications, transfers from CHIP to Medicaid, spells of enrollment, retention rates, new applicants versus re-entries, reasons for denials, and reasons for disenrollment.

The data will be examined using time series methods. The analytical approach will take advantage of the long-time series of enrollment data and the fact that the implemented MaxEnroll policies and procedures are able to be pinpointed. The time series approach will be able to tell the stakeholders about the magnitude and sustainability of enrollment shifts that accompany policy changes.

Qualitative Field Evaluation: Conducted by Larry Brown, Ph.D., and Richard Nathan, Ph.D., through the Columbia Mailman School of Public Health, the second component of the evaluation will be a qualitative field study that examines the effectiveness of the MaxEnroll approach, specifically focusing on the obstacles states face as they implement policy and procedural changes and what things can be done to improve the process. This aspect of the project will focus on interviews and surveys of grantees and other state policy-makers, as well as technical assistance (TA) providers, to elicit a greater understanding of why the approach is–or is not–working.

Products and Dissemination

Both evaluation teams will work closely with RWJF, NASHP, the grantees and the TA teams, providing all parties with “real-time,” ongoing feedback about the program. Reports and issue briefs will be made available throughout the evaluation process.