Increasing Access To Health Insurance For Children and Families

published in: Health Insurance

Increasing Access To Health Insurance For Children and Families
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Increasing Access To Health Insurance For Children and Families: Innovative Health Plan Outreach and Enrollment Efforts. Since health insurance is frequently an issue during family

IncreasIng access to HealtH Insurance for cHIldren and famIlIes: InnovatIve HealtH Plan outreacH and enrollment efforts
nIHcm foundatIon Issue BrIef feBruary 2009
The U.S. Census Bureau estimates that the number of people who are without health insurance fell from 47 million in 2006 to 45.7 million in 2007. This decline in the number of uninsured was due to an increase in the number of people covered by government programs. Additionally, after two years of increase, the number of uninsured children under age 18 decreased from 8.7 million in 2006 to 8.1 million (or approximately 11 percent of children) in 2007.1 The reauthorization of the Children’s Health Insurance Program (CHIP)a in February 2009 will provide coverage for an additional four million uninsured children by 2013 and continue to provide coverage for seven million children. President Obama also lifted a prior directive limiting middle-class families’ abilities to enroll in the public program. Under the restrictions, states had to enroll at least 95 percent of poor children eligible for public insurance before they could begin covering children in families with incomes above 250 percent of FPL. Additionally, these higher-income children had to be uninsured for a year before they could enroll. These modest improvements will contribute to the ability of public programs to reduce the number of uninsured in the United States, however, access to affordable health insurance coverage continues to elude many Americans and remains an important public policy concern. The majority of the uninsured have incomes below 200 percent of the federal poverty level (FPL), however, the uninsured are present in all socio-economic categories including moderate and even higher incomes. This heterogeneity of the uninsured illustrates the need for multiple approaches to extending insurance coverage. Outreach for public programs can reach low-income families, while the creation of affordable private market solutions can target moderate- and higher- income persons who are not eligible for public coverage. Trends in the sources of health insurance coverage within families must also be considered when developing strategies to increase access to health insurance for children and families. Families are increasingly combining health insurance coverage from multiple sources — both public and private — as a result of the decline in the numbers receiving employer-sponsored insurance (ESI).2 As the unemployment rate continues to rise, even fewer families will have access to ESI going forward. Research also suggests that enrollment rates among children in public programs increase when their parents are also eligible, pointing to the need for less restrictive eligibility requirements for adults.3 Outreach and enrollment strategies are recognized as critical to increasing access to health insurance for the uninsured. Experience from the Robert Wood Johnson Foundation’s Covering Kids and Families initiative suggests that outreach efforts are most successful when they are conducted by organizations that are trusted by community residents, accessible and convenient to the targeted population, and coordinated with outreach efforts of state government and community organizations.4 Despite these general guidelines, however, data are generally lacking to identify the specific outreach activities that are most effective at increasing enrollment.5 Since outreach and enrollment efforts frequently involve multiple sectors across the health care system and the community, health plans and their foundations can play a significant role. Efforts to conduct outreach and improve enrollment are pervasive throughout health plan business and philanthropic activities. In this paper we will examine innovative health plan efforts to increase enrollment in Medicaid and CHIP as well as to create and market more
a The Children’s Health Insurance Program Reauthorization Act of 2009 indicates that the Children’s Health Insurance Program should be referred to as CHIP rather than SCHIP, which was commonly used previously. In this report we use CHIP and SCHIP interchangeably to represent CHIP.

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