CHIRI™ Impact in the State of Kansas

Research conducted as part of the Child Health Insurance Research Initiative (CHIRI™), funded by the Agency for Healthcare Research and Quality (AHRQ), The David and Lucile Packard Foundation, and the Health Resources and Services Administration, resulted in policy changes to the delivery system and enrollment process for low-income children in Kansas.

Research by investigators at the Kansas Health Institute affected two programs:

• HealthWave, Kansas' State Children's Health Insurance Program (SCHIP).
• Medicaid.

Researchers from the Kansas Health Institute worked closely with staff from the Kansas Department of Social and Rehabilitation Services (SRS), and several policy changes occurred:

• Kansas integrated Medicaid and HealthWave under a single delivery system to ensure continuity of care as enrollees move between them. Previously, Kansas had separate delivery systems for HealthWave and Medicaid, with different plans and providers serving the two programs. Researchers' findings of substantial overlap between the populations served by the two health insurance programs sped Kansas' implementation of an integrated delivery system. For example, 70 percent of new HealthWave enrollees had been previously insured by Medicaid, and about a third of HealthWave disenrollees went directly to Medicaid. According to Bob Day, director of Medicaid/HealthWave, the change to a single delivery system is expected to make enrollment "seamless" at the local level, thereby drastically reducing gaps in children's health insurance coverage.
• Kansas moved HealthWave and Medicaid case management processes to a central "clearinghouse." The researchers found high levels of disenrollment. Of children enrolled in these programs, 30 percent left them within a year despite eligibility for 12 months of continuous coverage. An investigation of this premature disenrollment indicated that administrative actions were responsible for a proportion of these disenrollments. These actions by caseworkers in SRS field offices included using information gathered for other purposes to update HealthWave and Medicaid enrollees' income information, and changing renewal dates to coincide with renewal dates for other public programs. These findings contributed to Kansas' decision to move HealthWave and Medicaid case management processes out of the SRS field offices and transfer them to a central enrollment contractor or "clearinghouse." The clearinghouse does not administer any other public programs, and consequently experiences a much lower rate of premature disenrollment.
• Kansas provided retroactive coverage to renewing enrollees. The third policy change was partly due to research findings on disenrollment at renewal time and subsequent re-enrollment. Responding to data on breaks in coverage at the time of re-enrollment, Kansas enacted a new re-enrollment policy in October 2001. Children who complete the re-enrollment process within a month of their renewal date are allowed to receive coverage retroactively back to their renewal date.

Current as of March 2003

Internet Citation:

CHIRI™ Impact in the State of Kansas. March 2003. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/chiri/chiriks.htm