SCHIP eligibility redetermination processes were similar in five of the six study states. Four states offer 12-month continuous eligibility, and one follows a 12-month redetermination cycle under SCHIP (Table 8). The redetermination process begins when computer-generated letters are mailed to parents (usually at the beginning of their child's 10th month of eligibility), notifying them that it is time to renew their child's coverage and (usually) enclosing a blank application form. Parents are asked to complete the form and submit it, along with selected documentation. Reminder notices usually are sent out in Month 11 to nonresponding families. In addition, vendor, state, county, community-based organization, or, in some states, health plan marketing staff, make several attempts to contact families (by phone or mail) before the child's coverage period ends. Applications received by the due date are reviewed for continued eligibility (and referred to Medicaid if family income has dipped to Medicaid-eligible levels). Children are disenrolled if their parents do not submit complete applications.
In Missouri, state officials described county social services offices as "chronically understaffed"; therefore, eligibility redetermination (formally on a 12-month cycle) is not conducted on schedule. Rather, staff prioritize redeterminations, focusing first on families in which changes are known to have occurred (for example, adolescents aging out of the program), and on families more likely to experience a change in income or family circumstances (including families in lower-income groups and those with certain types of jobs). Meanwhile, children's enrollment continues until staff have time to redetermine their eligibility.
Although states have streamlined the SCHIP renewal process, the renewal process is not as simple as the initial application process (Table 12). In every study state, SCHIP renewal can be completed by mail. California and Texas have streamlined their processes the most; vendors in these states produce preprinted renewal applications based on information from the previous application. Parents are asked only to indicate changes and to submit verification for any items that have changed. Louisiana officials reported that they had recently developed a shorter and simpler renewal form for LaCHIP that they believe will be easier for families to complete.
As was the case with initial application procedures, states' SCHIP eligibility redetermination rules and procedures were often simpler than those used for Medicaid. First, SCHIP redetermination forms are often shorter and less complex than those for Medicaid. Second, while all states permit SCHIP renewals to be completed by mail, New York requires in-person interviews for Medicaid redeterminations. (Texas has a similar requirement for adults.) Third, no states preprint their renewal applications for Medicaid. Most commonly, in states with separate programs, Medicaid programs require verification of family income, children's ages, social security numbers, residence, and immigration status--while SCHIP requires only verification of income, unless other items have changed.
|State||Mail-In Redetermination||Pre-Printed Form||Same Form As Application||Income Verification Requireda||Other Verification Required|
Source: Information obtained during each site visit.
aVerification required only if circumstances have changed.
bTexas now allows mail-in redetermination for children, but not adults, in its Medicaid program, as a result of recent simplification.