New Denial and Disenrollment Coding Strategies to Drive State Enrollment Performance

Collecting, analyzing and using data to monitor enrollment and retention can be a powerful tool in helping states assess and improve their administration of public and publicly subsidized health insurance affordability programs like Medicaid, the Children’s Health Insurance Program (CHIP), the Basic Health Program and state health insurance exchanges. The Maximizing Enrollment program has been working intensively with a handful of states to help them increase their use of such data to enroll eligible individuals and help them stay enrolled. From this work, Maximizing Enrollment provides recommendations for a method of classifying denials and disenrollments, discusses why this is a powerful tool to understand the effect of policy changes, and shows how states can bridge from their current complex coding systems to a more streamlined system. The lessons learned by these states can help to inform other state and federal policy-makers’ decisions about how to measure performance of enrollment initiatives.

Maximizing Enrollment is a national program of the Robert Wood Johnson Foundation that focuses on helping eight states increase enrollment and improve coverage for eligible individuals. This brief is the second in a series presenting recommendations on how states can better use data to monitor and improve policy implementation and program performance.