Maximizing Enrollment: Transforming State Health Coverage

An RWJF National Program

Dates of Program: May 2008 to February 2015

Description: With the National Academy of State Health Policy serving as national program office, Maximizing Enrollment sought to help eight participating states strengthen and simplify their public health coverage systems, policies, and procedures and develop new approaches to maximize the enrollment and retention of eligible children in Medicaid, CHIP (the Children’s Health Insurance Program), and other state-funded health coverage programs. Maximizing Enrollment also documented and shared best practices among the participating states and nationwide.

“The agencies were organized as gatekeepers, ensuring that people who weren’t eligible didn’t get on the rolls. So having the state reorient itself was really powerful and different. That became a theme that only got stronger as the program went along.”—Maximizing Enrollment Co-Director Alice Weiss

After passage of the Children’s Health Insurance Program Reauthorization Act and the Affordable Care Act, Maximizing Enrollment was expanded to include enrollment of eligible adults and to support efforts to prepare state systems to implement the new laws’ requirements.

Key Results

  • States used grants of up to $1 million each, along with technical assistance, to improve policies and practices related to the coverage application process, eligibility determinations, renewals and transfers of coverage, communication with consumers, and business processes. Examples include:

    • Implementation of Express Lane Eligibility for applications and renewals
    • Coordination and integration of information across systems to streamline applications and eligibility determinations
    • Adoption of new technology to expedite workflow
    • Efforts to develop an agency culture that encouraged the expansion of coverage to more individuals
    • Improved capacity to analyze data and monitor trends

The number of children enrolled in Medicaid and CHIP increased by more than 812,000 cases across participating states during the program’s duration.

However, the magnitude of the difference between increases in these states and those not part of the program was small and not statistically significant, and could have been caused by many possible factors. Evaluators at Mathematica Policy Research found that several confounding variables, including an economic recession and passage of several major federal laws, made it difficult to determine the program’s impact.

Facing greater demand for services and fewer resources as the program unfolded, states had to do more with less. “The only way to meet the need was to use technology and their systems in the best way they could.”—MaxEnroll Deputy Director Maureen Hensley-Quinn

“Maximizing Enrollment needed to help states focus on some of the internal processes and systems that were less ‘sexy’ things that hadn’t caught the kind of attention that outreach or marketing campaigns had.”—MaxEnroll Co-director Catherine Hess