Maximizing Kids' Enrollment in Medicaid and SCHIP

There is significant interest in reducing the number of uninsured children in the United States. A key part of achieving this goal is ensuring that all uninsured children who are eligible for Medicaid and the State Children’s Health Insurance Program (SCHIP) enroll and maintain coverage for as long as they qualify. Although the proportion of eligible children who are enrolled in Medicaid and SCHIP increased between the late 1990s and the early part of this decade, today nearly two-thirds of the uninsured children in the United States remain eligible for Medicaid or SCHIP but are not enrolled.

Many states are working actively to increase enrollment of eligible children in public health coverage programs and want to adopt new strategies to do so. States are seeking the most effective approaches for enrolling eligible children. To assist states, the National Academy for State Health Policy (NASHP) has worked to offer information and analysis that states can apply as they develop and implement new policies in this arena. In 2006, NASHP convened a symposium of state and national child health coverage experts from the public and private sectors to focus on lessons learned over the decade since SCHIP was enacted. From these conversations, NASHP identified seven key themes that participants stressed were essential to advancing continuous coverage of children through Medicaid and SCHIP. These ideas were summarized in a 2006 NASHP issue brief, Seven Steps Toward State Success in Covering Children Continuously (Seven Steps).

Key Findings:

  1. Keep enrollment and renewal procedures simple;
  2. Community-based outreach is key to increasing enrollment;
  3. Use technology to coordinate programs and reduce administrative burdens;
  4. Change agency culture to promote enrollment goals;
  5. Engage leaders who champion the goal of covering children;
  6. Engage partners to help achieve coverage goals;
  7. Use marketing to promote enrollment in public programs.

This paper revisits the ideas summarized in the Seven Steps brief to provide more concrete information for states seeking to take the next step in enrolling more uninsured children who are eligible for Medicaid or SCHIP, but not enrolled.