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What are the key barriers to enrollment and retention and how can health IT help?

One key issue regarding children's health insurance is instability of coverage. This issue is often referred to as "churning," and is the phenomenon of children losing and then regaining coverage within a short period of time. Such revolving coverage can lead to increased long-term costs due to (a) the administrative burdens associated with re-enrollment and (b) the cost of healthcare provided in inappropriate settings or increased cost of care due to lost opportunities for prevention or early treatment. Causes of churning include shortened continuous eligibility timeframes, complicated renewal procedures, changes in eligibility requirements, and changes in family status. 

Another key issue is ensuring that eligible children are identified and enrolled in public insurance systems. Families may not be aware of coverage eligibility for their children, and in many cases applications for enrollment are burdensome and require face-to-face interviews with paper-based, eligibility verification requirements.

Health IT can assist in addressing both of these issues. Churning can be prevented in certain cases by automating renewal processes. Identification of uninsured children meeting public insurance eligibility criteria is improved when States use the Internet to deliver program and eligibility information. Enrollment of uninsured, eligible children is facilitated by offering online applications and automating eligibility verification.

Related Resources for Understanding the Issues and How Health IT Can Help:

• Report: Express Lane Eligibility and Beyond: How Automated Enrollment Can Help Eligible Children Receive Medicaid and CHIP (PDF - 340KB)
• Report: Emerging Health Information Technology for Children in Medicaid and SCHIP Programs
• Report: Instability of Pubic Health Insurance Coverage for Children and their Families: Causes, Consequences, and Remedies (PDF - 340KB)
• Report: Harnessing Technology to Improve Medicaid and SCHIP Enrollment and Retention Practices (PDF - 1.4MB)

Because Medicaid and CHIP are administered at the State level, many of the initiatives focusing on the use of health IT to address barriers to enrollment and retention are established by States or at the State level. The remainder of this module provides information and resources related to several of these efforts.