News > United Hospital Fund Report Offers Options to Help Public Insurance Programs Cover More People While Functioning More Effectively

A report prepared for the United Hospital Fund’s Medicaid Institute™ by Georgetown University’s Center for Children and Families explores a series of federal administrative and legislative changes that states can seek to improve their current public health insurance programs and increase participation. These possible changes are particularly relevant in the context of the national health reform debate, as current proposals expand Medicaid eligibility and mandate that individuals have coverage.

According to the report, over the past two years, New York has enacted significant reforms to expand eligibility and eliminate administrative barriers to enrollment, and these reforms represent most of what can be accomplished independently at the state level. To go further requires strong federal partnership and action, either through waivers or statutory change.

The report discusses a range of reform options that states can pursue, including modifying eligibility factors such as income measurement, asset tests, and documentation requirements; enrollment and renewal procedures, such as streamlining with technology-based data systems and state-level point of entry; and continuous coverage options, such as continuous coverage from birth to age five and optional two-year renewal. Systems improvements that could build a stronger and more efficient Medicaid program are also explored.

Over the past decade, states have expanded public program eligibility and removed barriers to enrollment and renewal, resulting in increased participation rates and declining uninsured rates among children. From 2001 to 2005, participation rates for children in Medicaid and CHIP—the portion of eligible uninsured children who were enrolled—grew from 66 to 78 percent. New York’s 2007 public program participation rate among children was 85 percent—well above the national average. To close the remaining coverage gap for children as well as for adults (whose participation rates are lower) will require further reform to enrollment and renewal practices. The options described in this report are particularly relevant now, given the interest in covering the uninsured, the prospects for federal reform, and agreement among policymakers and stakeholders that covering eligible uninsured children and adults is a top national priority. Whether or not health reform is adopted, measures like those described in this report will be needed if the systems for securing and retaining coverage are to function at optimal levels.

The report Improving Enrollment and Retention in Medicaid and CHIP: Federal Options for a Changing Landscape is available on-line. The report was prepared for the Fund’s Medicaid Institute by Georgetown University’s Center for Children and Families. While paying special attention to New York, the report is expected to be useful to policymakers in every state.

About the United Hospital Fund: The United Hospital Fund is a health services research and philanthropic organization whose mission is to shape positive change in health care for the people of New York.

About the Medicaid Institute™: The Medicaid Institute at United Hospital Fund provides information and analysis explaining New York’s Medicaid program, with the goal of helping all stakeholders redesign, restructure, and rebuild the program.