Medicaid and CHIP in 2011: A Kaiser Report

The Henry J. Kaiser Family Foundation has released a report on Medicaid and the Uninsured titled Performing Under Pressure: Annual Findings of a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP, 2011-2012. The report was issued in January 2012. According to the report’s authors, because the weak economic recovery added few jobs with access to employer-based insurance, Medicaid and the Children’s Health Insurance Program (CHIP) were key sources of coverage in 2011 for children and, in some cases, for their parents. State budgets were stretched thin due to decreases in growth of state revenue in addition to the strain created by the mid-year expiration of the temporary increase in the federal share of Medicaid provided through the American Recovery and Reinvestment Act of 2009. The Patient Protection and Affordable Care Act (ACA) requires states to maintain eligibility levels and enrollment and renewal procedures, which was the major contributing factor to Medicaid and CHIP eligibility remaining largely stable in 2011. In addition, 11 states made targeted eligibility expansions. Some of the expansions made use of new options available through the ACA and the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA); others allowed the states to receive federal matching funds for coverage that had been solely state funded. Eight of the 11 eligibility expansions involved coverage for children. West Virginia expanded children’s CHIP eligibility from 250% to 300% of the federal poverty level (FPL). Illinois, Texas, and Vermont implemented the option available through CHIPRA to cover legal immigrant children without a 5-year wait, and 5 states (Alabama, Georgia, Kentucky, Pennsylvania, and Texas) applied the new option in the ACA to allow qualifying state employees access to affordable coverage for their children through CHIP. Half of the states and the District of Columbia cover uninsured children in families with income ≥250% of the FPL ($46,325 for a family of 3 in 2011) and 18 of those cover uninsured children ≥300% of the FPL ($55,590 for a family of 3). Twenty-three states and the District of Columbia cover legal immigrant children without the 5-year waiting period, and 9 states make coverage available to children of state employees who are eligible for CHIP. Twenty-five states made improvements in their use of technology to increase the efficiency of enrollment and renewal processes. This effort to utilize new technologies to streamline processes reduces paperwork requirements for both the families applying for coverage and for agency employees assigned to process the applications. Increasing use of technology also helps states prepare for changes in eligibility that will take effect under the ACA in 2014, according to the Kaiser report. The improvements in processes also enabled 7 new states to join the 16 that were earning between $1.3 million and $28.3 million in CHIPRA performance bonuses, which reward states that are successful in enrolling eligible children through Medicaid. During 2011, 13 states utilized an electronic data match with the Social Security Administration to more efficiently and accurately verify citizenship for children; a total of 44 states now use this option. Express Lane Eligibility (ELE) was implemented or expanded in 5 states, making a total of 9 states using the ELE plan. Finally, 5 states improved their online capabilities, enabling electronic submission of applications. States also concentrated their efforts on the coverage renewal, streamlining the process to increase retention of eligible children and families. Five states sent out a form prepopulated with the family’s information that did not require the family to take any action other than returning a signed copy of the form if the information was still accurate; 8 states implemented online or telephone options for renewal of coverage. Although states had the flexibility to impose additional cost-sharing requirements on enrollees, most did not do so in 2011. Beyond routine rate adjustments, only 1 state increased premiums or enrollment fees.