Findings of Kaiser report reveal progress, pitfalls
Major findings of a recent report by the Kaiser Commission on Medicaid and the Uninsured include the following:
1. Some 32 states, including Washington, DC, took actions to increase access to health coverage for low-income children, pregnant women, and parents. Of the 32, 26 states authorized or adopted income eligibility expansions, 11 states reduced procedural barriers, and seven states reduced financial barriers to Medicaid and SCHIP. While most activity was focused on children, there also were modest improvements for pregnant women and parents.
2. Some 26 states improved access to children's health coverage. Of the 26 states, 12 raised or authorized raising SCHIP income limits to 300% of the poverty line or higher, more than doubling the number of states setting eligibility at that level. Plus, nine states simplified enrollment procedures and seven states reduced coverage financial barriers.
3. Some 14 states enacted moderate children's coverage expansions focused on particularly vulnerable populations such as infants or children discharged from foster care at age 18. The changes included modest income eligibility expansions, increasing the SCHIP asset limit, and allowing children who are discharged from foster care at age 18 to retain Medicaid through age 21.
4. No state cut back income eligibility for children, but a few states restricted eligibility. Thus, three states froze children's enrollment and two states imposed or lengthened waiting periods. The analysts say experience from states that have had enrollment freezes indicates that most children who are closed out of coverage have no alternatives and remain uninsured, missing out on needed health care including prompt medical treatment, medication, preventive exams, and immunizations.
5. States claim progress in adopting simplified enrollment and renewal procedures in children's Medicaid and SCHIP, particularly emphasizing strategies reducing paperwork and jump-starting enrollment. Nine states took steps to simplify enrollment and renewal procedures for children Several basic simplified strategies such as disregarding assets in determining eligibility, allowing enrollment and renewal without an in-person interview, and limiting renewal frequency to once a year, have been adopted for children almost universally. Only Georgia retracted a simplified procedure in its children's health coverage program during the survey period.
6. The Medicaid citizenship documentation requirement continues to impede state simplification efforts by complicating enrollment, especially for children.
7. Seven states reduced or eliminated premiums for children's health coverage, but another seven states either imposed new premiums or increased the amount of existing premiums.
8. Twelve states and the District of Columbia enacted modest coverage expansions for pregnant women and parents and no state retracted eligibility for these adults. Nine states increased eligibility for pregnant women, either by expanding income eligibility or by adopting the option to cover unborn children in SCHIP. Six states took steps to expand health coverage for parents.
9. Income eligibility for parents still lags behind eligibility for children, although the disparity was reduced a bit in 2007.
10. Efforts to simplify enrollment and renewal procedures for parents continued, but the report says it remains harder for an eligible parent than for an eligible child to obtain and keep coverage. Research indicates that efforts to cover low-income parents in programs like Medicaid and SCHIP increase the enrollment of eligible children. Also, when their parents are insured, children gain better access to health care and improve use of preventive health services. The analysts say efforts to expand parent coverage will help advance enrollment of children as well, while limits on parent coverage could pose a barrier to enrolling more children.
Major findings of a recent report by the Kaiser Commission on Medicaid and the Uninsured include the following:You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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