Medicaid Enrollment: Is the First Step the Hardest?
September 10, 2010
Judith D. Moore
To receive Medicaid benefits, the first step a potential beneficiary must take is to enroll through a process that determines eligibility for the program under federal and state rules. In many states, enrollment systems are complex, difficult and cumbersome. But procedures vary widely from state to state, and some have simplified their enrollment processes, streamlining both initial eligibility determination and recertification. Such modernization and streamlining of administrative processes will be necessary to sign up the millions of uninsured Americans who will be covered by Medicaid or receive subsidies for health coverage under the provisions of the Patient Protection and Affordable Care Act. The act requires that states implement online applications, as well as electronic coordination between Medicaid, CHIP, health insurance exchange, and subsidy programs. This Forum session addressed the current status of Medicaid eligibility and enrollment processes and considered the need for changes in the future. Speakers described how states have approached this process in the past, discussed what has been learned about streamlining and simplifying enrollment, and considered changes that are necessary to effectively implement the health care reform legislation.
Carol Steckel, Commissioner, Medicaid Agency, State of Alabama, and President, National Association of Medicaid Directors; Cindy Mann, Deputy Administrator, Centers for Medicare & Medicaid Services, and Director, Center for Medicaid, CHIP, Survey and Certification, U.S. Department of Health and Human Services; Claudia Page, Co-Director, Social Interest Solutions, Oakland, CA
For more information on this topic, see the following:
- Julia Paradise and Michael Perry, “Optimizing Medicaid Enrollment: Perspectives on Strengthening Medicaid’s Reach under Health Care Reform,” Kaiser Commission on Medicaid and the Uninsured, April 2010.
- Victoria Wachino and Alice Weiss, “Maximizing Kids’ Enrollment in Medicaid and SCHIP: What Works in Reaching, Enrolling and Retaining Eligible Children,” National Academy for State Health Policy, February 2009.
- Jennifer Edwards et al., "Maximizing Enrollment for Kids: Results from a Diagnostic Assessment of Enrollment and Retention in Eight States,” National Academy for State Health Policy, February 2010.
- Tricia Brooks, “Data Reporting to Assess Enrollment and Retention in Medicaid and SCHIP,” Georgetown University Health Policy Institute Center for Children and Families, January 2009.
- Children’s Partnership, “Building Efficient and Effective Medicaid and CHIP Enrollment Systems: Core Requirements to Ensure the Greatest Value for Children and Families,” October 2009.
- Beth Morrow and Dawn Horner, “Harnessing Technology to Improve Medicaid and SCHIP Enrollment and Retention Practices,” Children’s Partnership and Kaiser Commission on Medicaid and the Uninsured, May 2007.
- Stan Dorn, “Applying 21st Century Eligibility and Enrollment Methods to National Health Care Reform,” Urban Institute, December 2009.
- Stan Dorn, “Express Lane Eligibility and Beyond: How Automated Enrollment Can Help Eligible Children Receive Medicaid and CHIP,” Urban Institute, April 2009.