ISSUES IN DEVELOPING PROGRAMS FOR UNINSURED CHILDREN:
A RESOURCE BOOK FOR STATES

By The Lewin Group

ForThe Office of the Assistant Secretary for Planning and Evaluation, Office of Health Policy, U.S. Department of Health and Human Services

March 2, 1998

Table of Contents

INTRODUCTION

A. Purpose of the Resource Book

B. The Enactment of Title XXI of the Social Security Act and States' Need for Information

C. Methodology

D. Structure of the Resource Book

E. Programs Included in this Review

I. ELIGIBILITY CRITERIA AND THE VERIFICATION PROCESS

A. Overview

B. Eligibility Requirements

1. Age

2. Income

3. Residency

4.Access to Coverage

5. Periods of Uninsurance

C. Eligibility Verification Process

D. Length of Enrollment and Recertification

II. THE ENROLLMENT PROCESS

A. Coordination with Medicaid

1. Spend-down Requirements

2. Barriers to Coordination

B. Coordination with Other State Programs and Private Providers

III. COLLECTION OF PREMIUMS AND COPAYMENTS

A. Overview

1. Price Sensitivity

2. Type of Cost Sharing to be Implemented

B. Procedures for Collecting Premiums

C. Procedures for Collecting Copayments

D. Issues Related to the Non-payment of Premiums

IV. OUTREACH AND MARKETING

A. Overview

B. Successful Strategies

1. Understanding the Target Population

2. Use of Multilingual Materials

3. Word-of-Mouth

4. Impact of Geographic Differences on Marketing Efforts

5. Mass Marketing versus Local Marketing

C. Coordination With Other Programs for Outreach and Identification of Potential Enrollees

1. Coordination

D. Preparation of Materials

1. In-House Marketing Efforts

2. Use of Contractors

E. Outreach and Marketing Budgets

1. Use of Requests for Proposals (RFPs)

2. Coordinated Outreach Efforts

V. COORDINATION AND LINKAGES OF SERVICES AND PROGRAMS

A. Referral to Medicaid When Applying to the Children's Health Insurance Program

B. Electronic/Administrative Coordination of Enrollees' Eligibility With Medicaid

C. Referral to Medicaid or Other Programs for Inpatient Care or Other Benefits Not Provided by the Program

D. Coordination with Medicaid as Families' Income Changes

E. Coordination of Adult and Child Services

F. Coordination of Provider Network With Other Children's Programs

G. Coordination of Care for Children With Special Health Care Needs With the Maternal and Child Health Bureau

H. Coordination With Other Programs to Enroll Children in the Children's Health Insurance Programs

APPENDIX A: Overview of Review for This Resource Book

APPENDIX B: State Program Contacts

APPENDIX C: Resource Kits by State