State outreach efforts also gave rise to coordination issues which contributed to families' confusion over the identities, requirements, and relationships between SCHIP and Medicaid. As discussed in Chapter VI, the four study states with separate programs designed marketing campaigns to promote public awareness of SCHIP, while also implementing ambitious community-based initiatives to recruit "hard-to-reach" families with uninsured children at the local level. The programs were given catchy sounding names--Healthy Families, Child Health Plus, TexCare, etc.--and marketing campaigns presented positive and colorful images of healthy mothers, infants, and children, using upbeat slogans like "Growing Up Healthy," and "A Healthier Tomorrow Starts Today." Print materials distributed to community-based organizations reproduced these images, logos, and slogans.
Importantly, however, three of the four study states did not prominently promote Medicaid in their marketing materials; only California'sHealthy Families/Medi-Cal for Children campaign explicitly placed Medicaid on an equal footing with SCHIP. In Texas, the TexCare Partnership was created as an "umbrella" identity through which SCHIP and Medicaid could be promoted, but the Medicaid connection is not prominently advertised. For years, New York kept the identities of Child Health Plus and Medicaid separate, and the same is true for Colorado.
According to case study respondents interviewed for this study, these arrangements arose for a variety of reasons. Some state officials noted that Medicaid was not aggressively promoted for fear of "turning off" families who might hold negative opinions of Medicaid, either because of previous negative experiences with the Medicaid enrollment process or, among immigrant Hispanic families, who feared that Medicaid enrollment may adversely affect their or their child's ability to obtain citizenship. In Colorado and Texas, community-based application assistors defended the marketing emphasis on SCHIP, noting that they could use SCHIP to begin a conversation about health insurance coverage and then talk about Medicaid when appropriate. In California, staff of some (but not all) health plans and community-based organizations noted that they tend to market Healthy Families and avoid directly discussing Medi-Cal, for fear of losing families. Notably, officials in every state with a separate program were quick to point out that they believed their SCHIP campaigns effectively promoted enrollment in both programs, largely because of their use of joint applications. By responding to an advertisement or flyer and calling a program hotline, families can request and receive a joint SCHIP/Medicaid program application and, upon completing it, obtain either SCHIP or Medicaid coverage for their child/children.
State and local officials who we interviewed for the study had mixed opinions about the appropriateness of single-program marketing. Some were pragmatic, believing that the states would attract more families by promoting a new and "baggage-free" product, while taking comfort in the likelihood that these efforts would also succeed in reaching families with Medicaid-eligible children. Other case study respondents, however, disagreed with this approach, suggesting that it promoted SCHIP in a very positive light, while ignoring Medicaid; these respondents consistently believed that the much larger Medicaid program should be promoted equally.
The ultimate impact that these marketing messages have had on families is unclear. It was reported that some parents were confused (and sometimes angry) when they responded to SCHIP advertising, submitted a program application, and then learned that they were being reviewed for Medicaid eligibility. Some parents in the focus groups did not understand and did not like having their children switched from SCHIP to Medicaid.
New York offers an example of how marketing efforts might evolve in the future. There, after maintaining totally separate identities for Child Health Plus and Medicaid for years, the state renamed Medicaid Child Health Plus "A," while the SCHIP program assumed the name Child Health Plus "B." As a result, New York officials hoped that Medicaid would accrue all the positive benefits of SCHIP marketing, and that the two programs would begin to be perceived by consumers as one. Many advocates and other study participants in most of the states supported this approach. The case study respondents commonly expressed that, ultimately, states should promote "health insurance," and not "SCHIP" or "Medicaid."