Foster Public-Private Coverage Solutions - What the Government Should Do - Enroll Those 'Missing Out'


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Help States Enroll Low-Income People in Medicaid and SCHIP

SCHIP should be reauthorized and expanded to ensure children currently eligible are able to enroll. In order to enroll the millions of adults and children who could be covered by Medicaid and/or SCHIP under current rules, the federal government should provide states with increased funding to improve their outreach programs. For example, states should provide brokers with a finder's fee for enrolling individuals eligible for Medicaid and SCHIP. In addition, states should be allowed to automatically enroll children into public programs who qualify for other programs (e.g., food stamps, free or reduced school lunches, and others.).

States should be encouraged to share best practices in effective outreach initiatives. There should be special emphasis on multi-lingual projects. In addition, states should be encouraged to streamline enrollment requirements. Possible actions could include:

  • simplifying enrollment forms and processes
  • eliminating burdensome requirements for verifying income and residency
  • decreasing the number of face-to-face interviews for periodic re-determination of eligibility
  • increasing Medicaid/SCHIP eligibility staff in hospitals and clinics

How it might work

Joe is a father of four who earns $25,000 a year as a truck driver for a small company that does not offer health coverage. His entire family is eligible for public coverage, but Joe did not realize it. When he contacted a broker to try to purchase non-group health insurance for his family, the broker helped him enroll his family in Medicaid.

Empower States to Enroll Medicaid/SCHIP Beneficiaries in Employer Plans

States should pay the employee premium for children of working parents whose children are eligible for Medicaid and/or SCHIP, as an alternative to obtaining coverage through public programs when employer coverage is available.

In addition, states should be allowed to pay the premium not only for the SCHIP-eligible children but also for low-income parents who are not otherwise eligible for public programs.

One reason some families are not enrolled in Medicaid and SCHIP programs is the perception of a "stigma" related to enrollment in a public program. Many of these families have employer coverage available to them, but they cannot afford their share of the premium. Currently, states must meet special rules or obtain special waivers from the federal government to enroll children in their parent’s employer plan.

Requiring states to purchase employer offered coverage has many advantages. These families would be enrolled in private plans — covered by the same policy as their coworkers, they would most likely have access to a broader network of physicians, and the states would be able to leverage their funds by paying only the employee share of the premium instead of the full cost of the public program.

How it might work

Courtney is a single mother of two young children earning $15,000 a year. Her children are covered through SCHIP, but she is not eligible for the program. She works for a hotel that offers health coverage, but she cannot afford to pay $200 per month for her premium. Under this proposal, the federal government would pay for Courtney and her children to receive coverage from her employer.