In contrast to families applying for TANF/FSP/Medicaid, those applying for SCHIP (and in some places, Medicaid-only) typically do not need to rely on the welfare office as their only point of entry. Instead, there are typically multiple points of entry into the SCHIP program. Exhibit 3-2 demonstrates both the array of places and types of organizations that facilitate application for SCHIP benefits. For example, in Arlington, Raleigh, and Seattle, SCHIP applications are disseminated through the schools. Dallas, New York, and Sedalia rely on community-based organizations to help reach and enroll children in SCHIP through a variety of means including attendance at health fairs and dissemination of materials in health clinics, schools, and throughout the community. As described later, the SCHIP programs in Arlington, Dallas, and Seattle have centralized processing centers that take application requests, determine eligibility and process applications for SCHIP for the entire state.
Access to SCHIP
In all sites, Medicaid and SCHIP mail-in applications for children are permitted. Two study sites (Sedalia and Seattle) rely on pre-existing office-based Medicaid enrollment processes, but applications may also be sent by fax, by mail, or dropped off in-person. In New York, efforts to coordinate Medicaid and SCHIP led to a streamlined approach that currently includes a single joint application and the use of community-based facilitated enrollers who take applications for both programs.
Interest in improving access to and enrollment in Medicaid has also led to a variety of strategies to increase the points of program entry either by out-stationing workers capable of conducting eligibility screenings or eligibility determinations in locations that are more convenient and accessible to the community. Medicaid programs have used this general outreach approach since the late 1980s when Medicaid first expanded coverage to pregnant women and children. To reach this new population, Medicaid agencies began placing out-stationed eligibility workers at hospitals and federally qualified health centers.5 In the study sites, Medicaid eligibility workers are out-stationed at health clinics in Dallas and Raleigh, and at hospitals in Arlington, Dallas, New York, Raleigh, and Seattle.
This trend is much more pronounced since the implementation of SCHIP. In many places, the SCHIP application and eligibility determination process has been deliberately moved away from the traditional welfare agency setting and placed where eligible individuals are likely to be, namely in their local neighborhoods and communities. Efforts to increase the points of access for the SCHIP program has also led to the use of non-welfare agency staff to accept applications.
Overall, there have been extensive outreach efforts to increase awareness and enrollment in Medicaid/SCHIP. Outreach efforts may be designed to reach the entire community, or may target specific neighborhoods, ethnic groups, or other segments of the population. The study sites provide many examples of the wide array of Medicaid/SCHIP outreach efforts taking place through community-based organizations (CBOs), schools, health care providers (including hospitals, public health clinics, and Medicaid managed care plans), and media campaigns (see box, “Reaching Out to Potential Medicaid/SCHIP Applicants: Examples of Outreach in Six Study Sites”). The most effective outreach efforts were typically identified as those conducted through public schools, pediatricians’ offices and health clinics. In addition to conducting outreach, we identified CBOs in all study sites that provided one-on-one assistance to families with some aspect of the application process — usually for Medicaid/SCHIP applications but also, to a lesser extent, for food stamp and TANF applications (see box, below).
Reaching Out to Potential Medicaid/SCHIP Applicants:
Examples of Outreach in Six Study Sites
Community-Based Organizations. CBOs provide outreach (including application assistance) in many of the sites in our study and are considered particularly effective with reaching out to immigrant and non-English speaking communities, especially when they employ staff that speak the same language and share similar cultural backgrounds as their clients. In Sedalia, a community-based organization, the Pettis County Community Partnership (PCCP), uses VISTA volunteers (some Anglo and some Latino) from the local community to conduct outreach about different programs and services through Head Start, the schools and a local health center. In Seattle, the county public health agency subcontracts with a variety of CBOs to conduct both outreach and application assistance.
Schools. School-based outreach is viewed by many as another particularly effective type of outreach. School nurses, school-based health fairs, parent-teacher nights, and school lunch mailings are used in some sites to disseminate information about Medicaid/SCHIP and identify uninsured children. In Raleigh and throughout Missouri, information about SCHIP is provided in the school lunch program application. School nurses in Raleigh have been particularly successful in conducting SCHIP outreach, according to local administrators. School nurses in Arlington, who are actually Department of Human Services employees, also conduct SCHIP outreach. Since 1998, public and private agencies in Washington State have partnered to find ways to increase access to Medicaid/SCHIP through school lunch applications. These ongoing efforts led to a 2001-2002 school year pilot to share students’ school lunch eligibility information with the state Medicaid agency (Papsdorf 2001).
Media Campaigns. Many sites are using various forms of media to promote awareness about SCHIP, as well as food stamps and other types of public assistance. Media campaigns have been used in all sites. For example, Texas has a statewide media campaign, including radio and television advertisements, printed media, and the creation of a toll-free hotline and telethons. New York has used Public Service Announcements (PSAs) to create awareness of low-income medical assistance programs.
Health Care Providers. Outreach efforts are frequently conducted through community health care clinics, which are considered particularly effective settings to reach immigrant communities. In New York City, the considerable outreach and marketing expertise of private health plans has been used to increase enrollment in publicly funded medical assistance programs. Health plan staff attend health fairs, visit local welfare and health departments, meet with and educate providers, and network with community-based organizations.
Public Agencies. More than 20 New York City agencies, including the New York City Housing Authority, are identifying and enrolling uninsured New Yorkers in public health insurance (including Medicaid, SCHIP, and Family Health Plus) through the City’s Health*STAT initiative.
Outreach and application assistance services in the study sites often include a component designed to reach non-citizens and limited English speakers. These targeted efforts typically include disseminating materials about program benefits and eligibility translated in different languages, targeting areas with high concentrations of immigrant families, and using bilingual speakers to provide application assistance. It was often stressed by practitioners that applicationassistance provided through bilingual staff in community-based settings was a particularly effective means for facilitating immigrant and LEP access to benefits.
One-on-One Help for Applicants:
Examples of Application Assistance in Six Study Sites
The Pettis County Community Partnership (PCCP) in Sedalia, funded by the State of Missouri, links low-income communities to needed benefits and services. PCCP provides numerous services to Sedalia’s growing Latino community, including translation, interpretation and application assistance for health and social services. PCCP employs a full-time, state-funded interpreter and houses a part-time interpreter who is paid by a local church. These interpreters take applications at PCCP and accompany applicants to the welfare office in Sedalia. According to PCCP staff, Latinos usually feel more comfortable applying for Medicaid/SCHIP benefits at PCCP because the welfare office cannot provide assistance with interpretation. The interpreters at PCCP complete Medicaid/SCHIP forms; mail them to the DFS office; and then follow-up on applications with welfare office eligibility workers. The PCCP interpreter and other staff members also educate the Latino community about benefit eligibility and public charge issues, to reduce their fears about applying for Medicaid/SCHIP.
Facilitated enrollers in New York City help individuals complete the Medicaid/SCHIP application by walking them through the process and identifying all necessary forms and documentation. Outreach workers from a variety of organizations in Dallas also provide Medicaid/SCHIP application assistance — for example, the Children’s Medical Center in Dallas employs outreach workers to provide hands-on SCHIP application assistance in areas with large numbers of uninsured children. In Arlington, the Pediatric Clinic for low-income families has a part-time Spanish-speaking bilingual case manager who prescreens clients for Medicaid/SCHIP eligibility and provides application assistance to those who appear eligible.
The Community Food Resource Center in New York employs pre-screeners who work throughout the City to identify and assist individuals who are potentially eligible for food stamps. Pre-screeners refer applicants to their local food stamp office to apply for benefits, advise them about necessary documentation, and help them complete the food stamp application. In Arlington, the Hispanic Committee provides low-income Hispanic families application assistance for the complete package of TANF/FSP/Medicaid benefits as well as Medicaid/SCHIP benefits.