The Colorado Trust

BACK

Consider this Pueblo County family's experience. The children have been covered by CHP+ since 2005. In 2008, when the family submitted the required renewal application, they had no income due to a loss in their family business and were advised that they would likely be income-eligible for Medicaid. After submitting the renewal application, the mom received several notices from the state but did not respond to the confusing CHP+ letters because she thought her kids were enrolled in Medicaid and thus these letters no longer applied to her.

When the mom tried to fill an asthma prescription for one of her kids, the pharmacist told her that the child was not covered by Medicaid. Fortunately for this family, they had worked with Pueblo StepUp, a community health service organization of Centura Health, which intervened and contacted the county's Medicaid technician to explain the family's self-employment income, correct the case and get the children enrolled in Medicaid.

The renewal process does not need to be this complicated and confusing. Colorado has the opportunity to create a streamlined renewal process that will help close gaps in coverage and, happily, we are making progress in this area:

• A recently passed regulation requires a simpler, internal ex parte renewal, whereby administrators must rely on existing information from other public programs (e.g., food stamps) and databases to confirm continued eligibility for coverage at their annual renewal rather than requiring the client to complete a renewal form.
• Certain Colorado counties are already leading the way in developing more integrated systems at the community level to ensure children and families have the support they need to apply, determine eligibility, enroll and renew.
• In 2008, the state legislature approved funding for online enrollment, a customer call center, and the infrastructure and training to support it.

Those who may fear changing our antiquated and dysfunctional system need only look outside Colorado to others who have gone before us. For example, Louisiana has substantially improved retention rates while keeping the burden on families to a minimum. Their state agency relies on an ex parte renewal process and, when additional data is needed, eligibility technicians telephone the client or parent. The result? Louisiana has reduced renewal denials of eligible children from 22% to less than 1%.

The current process for renewal in Colorado, like Liza's leaky bucket, is overwhelming and burdensome for all who have a stake in it – from the family denied coverage at the door of the provider, to the provider trying to absorb a sick patient without coverage, to the eligibility determination technician with an unmanageable caseload. As Liza subtly suggests to Henry, a little common sense can go a long way. If we think about simplifying, streamlining and using available technology appropriately, we can solve the renewal conundrum. We all have a part in fixing what's broken and we can do that by working together.

Straightening out this path in the maze will be a giant step toward reaping returns on previous investments made to ensure enrollment for all Coloradans who are eligible for Medicaid and CHP+.

Colorado Covering Kids and Families is a statewide coalition led by the Colorado Community Health Network.