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SCHIP: What's Happening? What's Next?
Linking SCHIP & Medicaid Enrollment
Cindy Mann, J.D., Senior Fellow, Center for Budget and Policy Priorities, Washington, DC.
Gregory A. Vadner, M.P.A., Missouri Department of Social Services, Jefferson City, MO.
David Parrella, Ph.D., Connecticut Department of Social Services, Hartford, CT.
Sandra Shewry, M.S.W., M.P.H., California Managed Risk Medical Insurance Board, Sacramento, CA.
Ms. Mann began this session explaining what a coordinated system for State Children's Health Insurance Programs (SCHIP) and Medicaid means for families navigating the maze of programs. A coordinated system would ensure that families would not have to figure out which program is right for their children, would not have to submit multiple applications, and, once ineligible for one program, children would automatically be enrolled in the other and would experience no lapse in coverage. However, there is tension between Medicaid and SCHIP.
Families have reported that they do not want to be enrolled in Medicaid and have noted that they do not like to go to the welfare office, go through a face-to-face interview, report monthly to continue eligibility, or confront the stigma that goes along with carrying a Medicaid card. Suggestions for States to eliminate these barriers and coordinate SCHIP and Medicaid include:
- Offering a continuous eligibility period (6-12 months).
- Avoiding outreach messages that reinforce the welfare stigma.
- Changing the Medicaid card to look like a commercial product.
- Providing mail-in applications.
- Not requiring face-to-face interviews.
Additional strategies include using the same income counting rules, asset rules, verification requirements, and delivery system.
States have approached linking SCHIP and Medicaid in different ways. Ms. Mann has categorized them into three models:
- One program in which States have "layered" the two programs, with SCHIP funding on top of Medicaid (Oregon and Massachusetts).
- Two programs with programmatic and operational links (Maine and Kansas).
- Two programs administered by separate entities but linked though the application process and the screen-and-enroll process (California, Florida, and Pennsylvania).
The three State respondents and other State participants made clear that what is effective in one State may not be effective or even possible in another. Trying to fit the same SCHIP program into each State and local entity is almost impossible. And although coordinating and linking SCHIP and Medicaid (or other programs) sounds like the best case scenario, it could be setting SCHIP up for failure. A State's SCHIP program not only has to fit the needs and wants of the Federal Government, it also has to fit the culture of the State as expressed through its legislature.
Mann C, Cox L, Ross DC. Making the link: State practices and design options for coordinating health care coverage for children. Rockville (MD): Agency for Health Care Policy and Research, 1999 May.