Kaiser Commission Reports on States’ Online Processes for Medicaid and CHIP Applications

According to a Henry J. Kaiser Family Foundation report from the Kaiser Commission on Medicaid and the Uninsured, states offering a single online application process for Medicaid, the Children’s Health Insurance Program (CHIP), and insurance exchanges reduce barriers to access, decrease their administrative burden, and position themselves for compliance with provisions of the Affordable Care Act that require states to implement an online application process for these programs by 2014. A review of the application processes available as of February 2011 for Medicaid and CHIP in the United States identified 32 states accepting electronic applications and 18 allowing online renewal. The authors defined an online application as one available to the public via the Internet and submitted electronically (signature page could be mailed or faxed). They also interviewed state officials about the creation, promotion, and use of their online programs. In most states (29 of 32), applicants could create an online user account that let them complete the application when convenient. The actions available to registered users varied by state, however, with only 16 states allowing them to track their application status, report changes, and, after enrollment, select providers, view benefits, and make premium payments. Medicaid/CHIP applications in 25 states included “help tabs, buttons, links, or pop-up windows” to assist users; 22 states provided a general help section. In 25 states, applications implemented dynamic questioning, where the follow-up questions provided depended on prior responses, thereby reducing completion time. Despite incorporating time-saving measures, all states’ applications were longer than needed, often requesting information not required by federal law, such as the immigration status and social security number of a child applicant’s parents, or returning error messages that halted progression if a user failed to supply information the application deemed optional. The proportion of Medicaid and CHIP enrollees per state taking advantage of an online application process ranged from 10% to 70%. In Michigan, for example, 71% of CHIP applications were submitted electronically compared with 24% in Nevada. The authors speculated that Michigan’s training of healthcare providers and guaranteed provider payments contributed to its program’s success, whereas Nevada was hindered by its requirement that eligibility workers re-enter application information and its weak efforts to promote the program. Factors deterring Medicaid and CHIP applicants from applying online include language barriers, incompatible browsers or settings, and lack of Internet access. The authors said the Federal Communications Commission estimates “only 40% of low-income citizens have broadband Internet access in their homes.” Despite the benefits to users and state agencies in allowing application to Medicaid and CHIP online, the authors concluded, “there will always be a necessity for other modes of application…including face-to-face, telephone, and mail-in, in addition to online.” For states developing or modifying an online application process, the authors suggest letting individuals create online accounts, balancing the information needed with the need to simplify the application, and making help information accessible. Alternatively, the Secretary of Health and Human Services will be making an online form available for interested states.