Issues in Developing Programs for Uninsured Children: A Resource Book for States. B. Coordination with Other State Programs and Private Providers


States have found the coordination among children’s health insurance programs and other social service and health programs to be more difficult. Programs in which uninsured children commonly access health services (i.e., WIC, Head Start, and community health centers) are often administered by an office other than Medicaid or the state children’s health insurance program. Other children access health care through private physicians or hospital emergency rooms. These variable points of access to the system have made it difficult for states to identify eligible children. Most of the children’s health insurance programs examined in this report suggested that other social service agencies in their state were fairly consistent in educating families about insurance programs and distributing applications. However, few states had established a formal referral process to ensure the application of children into the appropriate program through some type of follow-up provision.

  • The Florida Healthy Kids program has approached the issue of locating eligible children by basing the program enrollment process in the public schools. Brochures and applications are distributed to all children in school throughout all of the counties participating in the Healthy Kids program. Children enrolled in school and eligible for the National School Lunch Program (children in families with an income below 185%FPL) are automatically eligible for the program with a full or partial subsidy. In addition, all children enrolled in school are permitted to enter the program; however, the amount of subsidy (based on a sliding scale from 0-100%) is dependent upon family income. To facilitate the verification process, the school districts provide Healthy Kids with a database containing information regarding school enrollment and participation in the National School Lunch Program.
  • Colorado has worked to establish a more formal linkage between enrollment in CCHP and other state social service programs by developing a brief enrollment form for families currently eligible for any one of six other state programs. Programs include: WIC, the Health Care Plan, the state prenatal program, the Colorado Indigent Care Pool and three additional food assistance programs. CCHP relies on the staff of these other programs to verify the eligibility, income and assets of the child’s family. The enrollment staff of CCHP then processes the short application and enrolls eligible children into the program. CCHP is in the process of developing an internet-based enrollment system that will provide clinics, private providers and other social service staff with the ability to process the enrollment over the computer.
  • Massachusetts has coordinated with hospitals in the state to refer potentially eligible children to the Children’s Medical Security Plan because emergency rooms were identified as a common place for uninsured children to seek primary health care services. As a result, children arriving at emergency rooms for health care are screened for insurance status. Children without insurance are then referred to CMSP.

Table 6:
Enrollment Coordination with Other State Programs and Private Providers Table

State and Program Potential Applicants Referred by Other State Programs? Common Enrollment Form Used in Conjunction with Other State Programs? Applicants Can Be Enrolled by Private Providers?
CaliforniaKids Yes. Program partners with school nurses, Head Start, Healthy Start and AIM programs. No. No. All applications must be processed by CaliforniaKids.
Colorado Children’s Health Plan (CCHP) Yes. Children enrolled in HCP, WIC, the state prenatal program or one of three food programs can be automatically enrolled in CCHP. Yes. Short enrollment form developed to screen families for eligibility into CCHP, HCP, WIC, Colorado Indigent Care Pool, and three food programs. No. However, Colorado is exploring the potential implementation of an internet-based enrollment system as part of the new Children’s Basic Health Plan. This would allow private physicians and hospitals to actually process CBHP applications over the computer.
Florida Healthy Kids Yes. Healthy Kids has had an informal arrangement with Florida’s MCH programs to coordinate care for children who require more extensive health care services. Healthy Kids is currently trying to formalize this process. No. No.
Children’s Medical Security Plan (CMSP) Yes. WIC and school health nurses are trained to target uninsured children and refer them to program. No. When children come to the emergency room for care, they are asked if they have insurance. If not, they are referred to CMSP.
Massachusetts Children’s Medical Security Plan (CMSP) Yes. WIC and school health nurses are trained to target unisured children and refer them to program. No. No.
MinnesotaCare Yes. County health departments make referrals to MinnesotaCare on an informal basis. No. No.
New York Child Health Plus Yes. Other state programs refer to program on an informal basis. No. No. Private providers distribute information with the names and numbers of the CHP plans in the child’s area. The family is responsible for contacting the plans for an application.
Pennsylvania Children’s Health Insurance Program (CHIP) Yes. Department of Health screens for CHIP eligibility through its toll-free Healthy Babies hotline. BC/BS Caring Programs also make referrals to CHIP. No. No.
Tennessee TennCare Yes. The state MCH Department is very active in making referrals to TennCare. All county clinic nurses attend a training class on TennCare. No. No.
Washington Basic Health Plus Yes. The Washington Basic Health Plan refers eligible children to the Basic Health Plus Program. (About 40% of their applicants are referred this way.) WIC program also refers families. Yes. Children and their parents enroll into the Basic Health Plan and Basic Health Plus (Medicaid program for children) with the same application form. No.