States using health IT to boost Medicaid sign-ups

A 50-state survey, however, reported continued gaps in coverage of parents and childless adults despite state efforts to improve enrollment.

By — Posted Feb. 1, 2013

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Parents and adults without children continue to face difficulties in getting signed up for Medicaid despite otherwise successful state efforts to use health information technology tools and simplify enrollment procedures, according to a 50-state survey released Jan. 23 by the Kaiser Commission on Medicaid and the Uninsured.

States are facing important changes to their programs before the Affordable Care Act’s Medicaid expansion starting in 2014, said Diane Rowland, the commission’s executive director. She’s also the executive vice president of the Kaiser Family Foundation. Many states are weighing their options on expanding their programs up to an effective rate of 138% of poverty, but at least 20 plan to do so, Rowland said during a Washington briefing to discuss the survey’s findings. (link)

The survey demonstrates that many states already have taken innovative steps to modernize their programs and improve access before 2014, Rowland said. A majority of states provide online applications for Medicaid and the Children’s Health Insurance Program, and more than half allow families to renew their coverage online — including eight that started doing so in 2012. Many have invested in document imaging systems to transition to a paperless environment, making it easier to share information across the state, the study said.

In Alabama, the same application is used for Medicaid and CHIP, and all pediatricians know how to help patients apply online, said Marsha Raulerson, MD, a pediatrician in Brewton, Ala. She’s the chair of the federal government affairs committee for the American Academy of Pediatrics. State budget cuts recently halted formal outreach activities for CHIP, which had done a great deal to get many children enrolled in Medicaid as well as CHIP. Yet “the number of children on CHIP in Alabama is at an all-time high” because of continuing efforts to simplify enrollment, she said.

American Medical Association policy has encouraged state and county medical associations to support initiatives for enrolling children in Medicaid and CHIP, and it has advocated for sufficient funding to support enrollment in these programs.

Enrollment options

All states offer the option to enroll or renew either through the mail or in person, but fewer provide both online and telephone options. While most have eliminated face-to-face interviews and asset tests for children’s coverage, 27 states still have asset tests in place for parents. Starting in 2014, ACA requirements bar states from using these types of interviews or tests for eligible applicants.

Eligibility levels for pregnant women and children were relatively generous in 2012, reflecting the ACA’s requirements for states to maintain coverage. Half of all states, as well as the District of Columbia, cover children in families at or above 250% of poverty, the survey stated.

The conclusions weren’t as promising for parents and childless adults: Eligibility for these groups average just 61% of poverty, compared with 235% of poverty for children. Several states recently have scaled back their coverage of parents, according to the report’s authors.

The ACA’s new coverage expansions for Medicaid should help to increase eligibility for childless adults and parents, the survey stated. But for states that don’t expand, options for coverage would be more limited for these populations. Those above 100% of poverty could qualify for federal subsidies on the states’ health insurance exchanges, but individuals below 100% would have no subsidized insurance options if they aren’t already eligible for Medicaid.

Alabama is one state whose leaders have decided against expansion. Dr. Raulerson said it ranks at the very bottom in terms of covering adults under Medicaid.

“After you turn 19, your chances of getting on Medicaid are slim to none,” she said, despite the fact that research has shown that expanding Medicaid to adults would boost the economy and bring more federal funding to the state. “I’m hoping our governor and Legislature will change their minds, because my patients need health care and can’t get it.”

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