Issues in Developing Programs for Uninsured Children: A Resource Book for States. A. Overview


The success of children’s health insurance programs hinges on the program’s ability to enroll the eligible children. States’ experiences demonstrate that while some portion of the eligible population is generally easy to reach, there are others who are considered "hard to reach." In particular, the "hard to reach" populations present specific challenges for outreach and marketing efforts that may need to be specifically targeted, non-traditional, and often community-based in terms of enrollment strategies. These children and their families face many barriers in obtaining health insurance coverage including:

  • confusing eligibility rules and complex application procedures;
  • cultural and language problems;
  • isolation of the target population from local and state health departments;
  • transportation problems; and
  • perception of welfare stigma often associated with state programs.

As states implement new programs under Title XXI, the issue of how best to reach uninsured children will be critical to the programs’ success. In particular, the 3.4 million children who are eligible for Medicaid but not enrolled may present major challenges to states in conducting effective outreach to uninsured children. States must explore these barriers and develop appropriate strategies to enroll eligibles. In order to reach the eligible population, successful outreach and marketing campaigns need to be continuous, widespread, multiform, have varied sources of information and be geared to a specific population [Williams, S., (December 8, 1997). Child Health Gains May Hinge on Aggressive Outreach. Medicine and Health Perspectives. 51(47), 1-4.]. For example, TennCare targets the African-American community in Shelby County by having local religious leaders educate their congregations about the program.

This section presents strategies that are currently being used by the nine study states to enroll eligible, uninsured children: successful strategies; outreach and marketing methods; preparation of marketing materials; coordination with other programs; and budgets. Samples of marketing/promotional materials are presented in Appendix C.