What can we learn from States that have used health IT to improve enrollment and retention?
Evaluations of specific health IT efforts affecting enrollment and retention of children in public insurance programs are sparse. A recent report sponsored by the Robert Wood Johnson Foundation titled Maximizing Kids' Enrollment in Medicaid and SCHIP: What Works in Reaching, Enrolling and Retaining Eligible Children (PDF - 824KB) notes that while use of health IT in this area is emerging and promising it is not well documented.
The health-e app program in California provides an interactive Web-based application intended to further simplify and expedite public insurance enrollment. An evaluation of the health-e-app pilot program titled, Business Case Analysis of health-e-app (PDF - 924KB), published by the Lewin Group with support from the California HealthCare Foundation and the Medi-Cal Policy Institute. The health-e-app pilot reduced time requirements for eligibility determinations, leaving more time for application assistants to provide client education. User satisfaction with the application was very high and data quality increased as well. One lesson highlighted in the health-e-app pilot evaluation is the need for uniformity. Within States, counties can have varying social service application requirements. Such differing requirements can result in delayed coverage to individuals not meeting their county's documentation requirements even though the health-e-app application was complete. For an analysis of online applications in four States, you can access this report (PDF - 248KB) by the Center for Impact Research.
Automatic enrollment is the method by which individuals and families are assigned to the program for which they qualify without filling out a new application; information already in a State's possession (e.g., from the Food Stamp Program) is used to determine eligibility. A recent Urban Institute report (PDF - 2.51MB) indicates automatic enrollment can greatly increase take up rates. For lessons learned on auto enrollment efforts, see an earlier Commonwealth Fund report entitled Automatically Enrolling Eligible Children and Families into Medicaid and SCHIP: Opportunities, Obstacles, and Options for Federal Policymakers (PDF - 264 MB). This report points out that in States with separate Medicaid and CHIP programs, the programs may have different computer systems, which complicates determination of existing coverage for a child who is about to be "auto-enrolled." Auto enrollment works best when State systems are easily queried and can exchange data and income eligibility requirements are consistent across systems.
Recognizing the need to improve enrollment and retention efforts, the Robert Wood Johnson Foundation established the initiative Maximizing Enrollment for Kids: Making Medicaid and CHIP Work. The purpose of the program is to help States increase enrollment and retention of eligible children in Medicaid and CHIP and establish and promote best practices among States.
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