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Retaining Eligible Children and Families in SCHIP and Medicaid

Date post: 17-Jan-2016
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Retaining Eligible Children and Families in SCHIP and Medicaid. A Review of Research Prepared by Lake Snell Perry & Associates. Agenda. Overview of the project Factors that affect retention Ways to improve retention Communication strategies Q & A. Description of the Project. - PowerPoint PPT Presentation
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Page 1: Retaining Eligible Children and Families in SCHIP and Medicaid
Page 2: Retaining Eligible Children and Families in SCHIP and Medicaid

Retaining Eligible Children

and Families in SCHIP and

Medicaid

A Review of Research Prepared by Lake Snell Perry & Associates

Page 3: Retaining Eligible Children and Families in SCHIP and Medicaid

Agenda

• Overview of the project

• Factors that affect retention

• Ways to improve retention

• Communication strategies

• Q & A

Page 4: Retaining Eligible Children and Families in SCHIP and Medicaid

Description of the Project

LSPA reviewed existing research and interviewed experts to inform states, grantees and others about the challenge of retention in SCHIP and Medicaid

Page 5: Retaining Eligible Children and Families in SCHIP and Medicaid

Methodology

• 51 studies were collected and reviewed

• 24 in-depth telephone interviews were conducted – 16 with leading experts– 8 with Medicaid/SCHIP directors

Page 6: Retaining Eligible Children and Families in SCHIP and Medicaid

What We Learned about the Field

• Retention is a new topic

• Most studies are about retention in SCHIP, not in Medicaid

• Most of the research focuses on retaining children, not adults

• Most of the studies are state-specific

Page 7: Retaining Eligible Children and Families in SCHIP and Medicaid

Studies and Experts Agree on

the Factors That Affect

Retention

Page 8: Retaining Eligible Children and Families in SCHIP and Medicaid

Procedural Barriers

Studies show a large drop in enrollment during renewal periods due to:

– Complex renewal forms– Too much documentation – Frequent renewal– Face-to-face interviews– Administrative errors– Language barriers

Page 9: Retaining Eligible Children and Families in SCHIP and Medicaid

Cost-Sharing

• Families sometimes have difficulty paying SCHIP premiums

• The inflexibility of the payment rules may be a bigger problem

• Overall impact of cost-sharing – does it lead to disenrollment or do families prefer paying?

Page 10: Retaining Eligible Children and Families in SCHIP and Medicaid

Awareness Gaps

Families have gaps in their knowledge about SCHIP and Medicaid. Many are unaware:

– That they need to renew regularly– Of income eligibility levels– That their premium amount for SCHIP is

adjustable

Page 11: Retaining Eligible Children and Families in SCHIP and Medicaid

Life Circumstances

• Busy and fluctuating personal and economic lives

• Families move in and out of employment frequently

• Lives are “less predictable”

• They “forgot” or “did not get around to it”

Page 12: Retaining Eligible Children and Families in SCHIP and Medicaid

Valuing Health Coverage

• Most studies argue that low income families place a high value on health coverage, particularly for their children

• Others suggest that coverage is not always seen as “necessary”

Page 13: Retaining Eligible Children and Families in SCHIP and Medicaid

Perceptions of the Programs

• Stigma may not be a big factor in retention

• SCHIP and Medicaid often get high satisfaction rates

• Some negative attitudes about the programs, particularly Medicaid

Page 14: Retaining Eligible Children and Families in SCHIP and Medicaid

Delinking Problems

• Children may be wrongly losing Medicaid coverage when their parents lose public assistance

• According to one state study, 51 percent of children lose Medicaid coverage each year after leaving cash assistance

Page 15: Retaining Eligible Children and Families in SCHIP and Medicaid

Health Status

• Families with more health needs are more likely to stay enrolled

• At least one study did not find that children with more health needs stay enrolled

• Bottom line – more research is needed

Page 16: Retaining Eligible Children and Families in SCHIP and Medicaid

Race, Gender and Income

• This is a new area of study• One study showed that lower-income families

were more likely to lose SCHIP coverage than higher income families

• A few studies found that African-American children were less likely to remain enrolled

• One study found that boys were slightly less likely than girls to lose coverage

Page 17: Retaining Eligible Children and Families in SCHIP and Medicaid

Vital Role of Third Parties

• Many experts say that community-based organizations, schools, employers, doctor offices, health plans and others can play a vital role in retention

• Caseworkers also play a vital role

Page 18: Retaining Eligible Children and Families in SCHIP and Medicaid

Studies and Experts Identify

Many Ways to Improve

Retention

Page 19: Retaining Eligible Children and Families in SCHIP and Medicaid

Simplify the Renewal Process

• Consider passive renewal

• Require annual renewal as opposed to quarterly or every 6 months

• Limit face-to-face interviews

• Allow for self-declaration of income

• Use pre-filled renewal forms

Page 20: Retaining Eligible Children and Families in SCHIP and Medicaid

Simplify the Renewal Process

• Use shorter, simpler renewal forms

• Send renewal forms in self-addressed, stamped envelopes

• Allow renewal forms to be accepted at numerous sites

• Enable families to renew off-cycle when it may be more convenient

Page 21: Retaining Eligible Children and Families in SCHIP and Medicaid

Reach Out to At-Risk Families

• Contact families due for renewal to encourage them to renew

• Follow up with families that do not return their renewal forms

• Improve communication notices reminding families it is time to renew

• Keep addresses up to date

Page 22: Retaining Eligible Children and Families in SCHIP and Medicaid

Reach Out to At-Risk Families

• Increase reminder notices prior to the renewal deadline

• Create toll-free renewal information lines in different languages

• Provide reminder notices in multiple languages

• Train caseworkers to better assist families to complete the renewal process

Page 23: Retaining Eligible Children and Families in SCHIP and Medicaid

Offer Renewal Assistance

• Provide renewal assistance to first-timers

• Use “community-based application assistors” to help with renewal

• Reach out to community-based partners to help with renewal

• Pay community-based organizations for each renewal they assist

Page 24: Retaining Eligible Children and Families in SCHIP and Medicaid

Relax Premium Payment Rules (SCHIP)

• Help families who miss payments stay enrolled

• Create a universal premium amount to avoid confusion

• Allow for automatic paycheck deductions

• Shift to an annual payment with a reasonable cost

Page 25: Retaining Eligible Children and Families in SCHIP and Medicaid

Coordinate Program Databases

• Coordinate the databases of SCHIP and Medicaid to track movement between programs

• Reduce the number of renewals a family must complete by coordinating among food stamps and TANF

Page 26: Retaining Eligible Children and Families in SCHIP and Medicaid

Other Ideas

• Measure the effectiveness of renewal strategies

• Evaluate reasons for disenrollment to determine the real causes for loss of coverage

Page 27: Retaining Eligible Children and Families in SCHIP and Medicaid

Other Ideas

• Get enrolled families to use their coverage so they will value it more

• Complete the delinking of TANF and food stamp procedures from Medicaid

Page 28: Retaining Eligible Children and Families in SCHIP and Medicaid

Communication Strategies:

What States Are Doing

Page 29: Retaining Eligible Children and Families in SCHIP and Medicaid

What Some States Are Doing

• Mailing postcards in advance of renewal

• Redesigning the renewal notice to include a renewal checklist

• Creating a two-sided renewal form – one side English, the other Spanish

• Using bright colored paper for renewal notices (“if it is blue, it is time to renew”)

Page 30: Retaining Eligible Children and Families in SCHIP and Medicaid

What Some States Are Doing

• Mailing SCHIP newsletter with retention messages to enrolled families

• Developing a renewal mailing that is different from other packets (i.e. bright yellow stickers on renewal mailings)

• Creating a refrigerator magnet urging families to renew that includes the renewal date

Page 31: Retaining Eligible Children and Families in SCHIP and Medicaid

What Some States Are Doing

• Using the SCHIP logo (instead of the Department of Health Logo) on program mailings

• Creating a training video for outreach workers that includes renewal tips

• Using premium payment coupons that include printed reminders about renewal

Page 32: Retaining Eligible Children and Families in SCHIP and Medicaid

Available Resources

Page 33: Retaining Eligible Children and Families in SCHIP and Medicaid
Page 34: Retaining Eligible Children and Families in SCHIP and Medicaid

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