Coordinating Publicly Funded Healthcare Coverage for Children

Strategies

A review of State policies and practices suggests that certain strategies can promote coordination and simplify administration for States with two child health programs. States can adopt most of these strategies without making major changes in their child health programs. Other changes might require more significant administrative and programmatic adjustment.

No one strategy is essential to a coordinated system, and no one strategy is sufficient to assure coordination, nor do different names necessarily mean that coverage cannot be well coordinated.

Strategies that could promote coordination are listed here:

• One Program/One Name. State Children's Health Insurance Program (SCHIP) and Medicaid essentially operate as one program with one name. A unified outreach strategy is used to market coverage options.
• One Agency to Determine Eligibility. Eligibility for both programs is determined by the same agency.
• Simplified Joint Application and Single Point of Entry. A simplified joint application is used for both programs. Additionally there is a single point of entry into coverage, that is, one agency or private entity receives all applications and screens them to determine if children appear to be eligible for coverage under Medicaid or the separate SCHIP program.
• All Applications Forwarded to the Proper Agency. "Opt-in" and "opt-out" choices, which tend to be confusing to applicants, are eliminated. All applications are automatically forwarded to the proper agency or a private entity for a final determination of eligibility.
• Age-based Eligibility Rules Ended. Age-based eligibility rules for children are eliminated so that children in the same family are eligible for the same program.
• Verification Requirements Simplified and the Same for Both Programs. Both programs rely on the same streamlined verification requirements.
• Income and Asset Rules Aligned. Both programs use the same rules to calculate financial eligibility.
• Easy Transitions When Eligibility is Determined. Both programs adopt eligibility review systems (redetermination procedures) in which children who become ineligible for one program are automatically screened for the other program and enrolled, when appropriate, without having to reapply.
• Continuous Eligibility. Both programs allow continuous eligibility, so that children can retain coverage for a specified period regardless of changes in family circumstances.
• Common Service Delivery System. Both programs use the same health care plans and providers so that children who transfer from one program to the other can continue to be cared for by the same provider.
• Other Aspects of Coordination. Many other aspects of program rules and policies could affect coordination strategies.

Each of these strategies is discussed in the following sections. Within each section, specific policies and procedures that have been implemented by States are identified. In addition, at the end of this report, the systems for coordinating enrollment and eligibility reviews that have been adopted by five States are described more fully in order to present a picture of how these policies and procedures fit together in a given State and to present a range of State approaches to coordination.

Previous Section       Contents       Next Section