Priorities for Expanding Medicaid
Here's how states can make the most of the Childrens' Health Insurance provisions of the new Title XXI of the Social Security Act:
TAKE FULL ADVANTAGE OF AVAILABLE FEDERAL FUNDS TO COVER ALL ELIGIBLE UNINSURED CHILDREN.
There are over 10 million children without health insurance for 12 months or longer in a two-year period and, despite a strong economy, the number is growing.
Uninsured children receive significantly less medical care than insured children. Lack of medical care not only may jeopardize children's health, education and welfare, but also may be more costly to society in the long run.
State government can expand children's health insurance by paying only 15 to 35 percent of total program costs. Depending on the state, one dollar of state funds will be matched by $1.85 to $5.23 in federal dollars in 1998.
EXPAND MEDICAID TO AT LEAST 200 PERCENT OF FEDERAL POVERTY GUIDELINES ($26,660 FOR A FAMILY OF THREE IN 1997).
USE NEW MEDICAID OPTIONS THAT WILL IMPROVE CONTINUITY OF CARE FOR CHILDREN.
Select the 12-month eligibility option that guarantees children 12 months of continuous coverage regardless of fluctuations in family income.
Select the presumptive eligibility option that authorizes qualified medical providers, and eligibility workers in WIC, Head Start and certain child care programs to make preliminary eligibility decisions and enroll children in Medicaid immediately pending the regular application process.
ADOPT INNOVATIVE STRATEGIES TO IMPROVE APPLICATION PROCESSING, OUTREACH, AND COORDINATION WITH OTHER CHILDREN'S HEALTH PROGRAMS.
Streamline application processing by shortening forms, accepting mail-in applications without face-to-face interviews, eliminating asset tests, speeding up processing, and placing eligibility workers at convenient locations.
Enlist the help of the community in devising new outreach strategies geared to diverse population. Advertise widely on billboards, television and radio. Use community health advocates, children's agencies and parents' networks to spread the word. Give the Medicaid program for children a name that the public will not associate with welfare, like Vermont's Dr. Dynasaur.
Integrate enrollment in Medicaid and other children's health programs. Use one simple application form for different programs. Identify children with special health needs during enrollment and help their families make effective use of all available support services.
ASSURE THAT DELIVERY SYSTEMS HAVE THE CAPACITY TO PROVIDE ACCESS TO HIGH QUALITY, APPROPRIATE CARE FOR AN EXPANDED POPULATION OF ELIGIBLE CHILDREN.
Expand participating primary care providers and specialists for the expanded number of eligible children.
Increase provider and plan payment rates if necessary to assure an adequate number of participating providers.
Monitor standards for reasonable access to providers and services.
ASSURE THAT SUFFICIENT DATA ARE GATHERED AND EVALUATED TO ENABLE THE STATE TO ASSESS AND IMPROVE THE PROGRAM.
Evaluate what is working and what is not, and be prepared to adjust subsidies, benefits, contracting and enrollment procedures, and other aspects of the program as needed to meet its objectives.
Consumers, advocacy organizations, providers and other stakeholders must be involved in the on-going implementation, evaluation and improvement of the program.
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