Issues in Developing Programs for Uninsured Children: A Resource Book for States. D. Coordination with Medicaid as Families' Income Changes


The actual income of low-income families tends to fluctuate a great deal, causing children's eligibility for various state programs to change from year to year. In an effort to provide continuity of care for this population, three of the six states with stand-alone programs examined in this study have instituted protocols for referring children between Medicaid and separate children's health insurance programs.

  • In Colorado, the new Colorado Basic Health Plan (to be established in July 1998) will assign the same enrollee number to their enrollees as was assigned to them by the Medicaid program. Therefore, both agencies will have a list of recipients with identical identification numbers. The goal is to create a seamless system and to prevent children from "falling out" of that system.
  • In Massachusetts, there is two-way communication regarding applications and denial of eligibility between the Children’s Medical Security Plan (CMSP) and Medicaid. If a child applies to CMSP, but is eligible for Mass Health (Medicaid), the child is enrolled in CMSP under presumptive eligibility and given an application to apply for Medicaid. The Medicaid office is informed of the enrollees eligibility for Mass Health so that they might be included in any outreach and enrollment efforts. This has been the established protocol as the CMSP application is much easier to complete than the Mass Health application, thus reducing the period of uninsurance of children waiting for enrollment in Mass Health. In addition, children denied eligibility for Mass Health are referred to CMSP.
  • In New York, the State Department of Social Services (DSS) coordinates with Child Health Plus on referrals between Medicaid and other children's programs. County DSS offices refer children and families to Child Health Plus. In addition, DSS provides guidance regarding assessment of Medicaid and/or Child Health Plus eligibility and procedures for terminating Child Health Plus when Medicaid eligibility is established.