»PREVENTING COVERAGE LAPSES IS KEY TO CONNECTING FAMILIES WITH CARE
By Stacey Moody
An old, familiar children’s ballad goes like this:
There's a hole in my bucket, dear Liza, dear Liza,
There's a hole in my bucket, dear Liza, a hole.
Then fix it, dear Henry, dear Henry, dear Henry,
Then fix it, dear Henry, dear Henry, then fix it.
With what shall I fix it, dear Liza, dear Liza?
With what shall I fix it, dear Liza, with what?
~Traditional
As the ballad continues, Liza provides common sense responses to Henry's questions about how to solve this perplexing problem. The failing bucket is an apt, if troubling, metaphor for one facet of Colorado's Medicaid and CHP+ outreach and enrollment maze.
Despite the availability of Medicaid and CHP+, more than half of Colorado's 170,000 uninsured children are eligible for, but not enrolled, in the programs. Recognizing the importance of health care coverage in the lives of children and families, many decisionmakers in the state are zeroing in on how to close this gap, including Governor Ritter, legislators, health care and community agencies, health care providers, foundations and advocates.
Recently, Colorado Covering Kids and Families published findings from a study funded by The Colorado Trust – The Maze: The Barriers that Keep Colorado's Eligible Children and Families Out of Medicaid and CHP+ and Recommendations to Create a Direct Path to Enrollment – that examined the barriers to Medicaid and CHP+ coverage. Why? Because before you can solve a problem, you've got to understand the nature of it and no one has ever attempted to create a comprehensive portrait of this critical and complicated process. Plus, a thorough understanding of Colorado's enrollment barriers provides the framework for developing and testing strategies to increase enrollment.
Accessing Medicaid or CHP+ coverage iscomprised of four steps: outreach, eligibility determination, enrollment and renewal. Barriers exist in each stage of the process, but critically important is renewal – if we're going to invest resources in removing barriers, this is where we'll get the biggest return on our investment.
There is a tacit assumption underlying our desire to enroll kids who are eligible that, once covered by Medicaid or CHP+, they are taken care of. In fact, lapses in coverage are all too common. In too many cases, outreach and enrollment resources are used to re-enroll the same children over and over. Those precious resources could be used more wisely in connecting those in need of coverage who have not had previous contact with these programs.
If we don't have an effective means to retain those who are eligible and, more importantly, to provide continuity of care for these children and families, then we are defeating our purpose.
According to our study and the 2008 CHP+ audit, a startling one-quarter of eligible children either did not reapply, or experienced a lapse in coverage between April 1, 2006 and March 31, 2007. The burden to renew is on the covered individual or parent. When the system is working, a renewal packet is sent prior to the 12-month enrollment expiration date by the county Medicaid eligibility office or CHP+.
The information requested can be very confusing for families. Add to that the fact that 65 different sites re-determine eligibility for the two programs and you've got a multitude of points in the system where something can go awry.
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