Interim Evaluation Report: Congressionally Mandated Evaluation of the State Children’s Health Insurance Program. A. Background and Policy Development


With the explicit goal of expanding health insurance coverage for children, Title XXI brought the implicit charge to states to undertake strategies that would facilitate children's enrollment into the program. Indeed, during each state's SCHIP design phase, officials focused considerable attention on making enrollment simple and devising streamlined enrollment procedures. Their goals were to make it easy for eligible families to enroll and to reach SCHIP enrollment targets on schedule. In addition, states are required by federal law to have "screen and enroll" procedures in place, to ensure that only those eligible for SCHIP are actually enrolled in SCHIP, while those eligible for Medicaid are identified and enrolled in that program.

The states' goal was to make the application process simple. States designed SCHIP application processes to make it easy for families to sign up. Adopting streamlined procedures was one way separate programs tried to model themselves after private insurance. In the two Medicaid expansion programs studied, too, considerable support emerged for simplifying existing eligibility determination procedures. In Missouri, for example, a user-friendly enrollment system was seen as crucial to attracting higher-income families typically unfamiliar with government programs.

All of the study states have embraced the idea that families should be able to get help applying for SCHIP or Medicaid. The states have introduced both telephone-based and in-person assistance in communities throughout their states, and modified a variety of eligibility requirements, such as removing assets tests and reducing the amount of documentation families must provide in support of their applications. Still, while many of the simple procedures adopted under SCHIP have "spilled over" to Medicaid policy, coordination of SCHIP and Medicaid in states with separate programs remains a challenge.

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