Outreach and Enrollment
The Center for Medicaid and CHIP Services (CMCS) works with states to identify and enroll people who are eligible for Medicaid or the Children’s Health Insurance Program but who are not enrolled. Extensive outreach is being done to enroll eligible children in coverage in the Connecting Kids to Coverage Challenge. The Affordable Care Act of 2010 expands Medicaid eligibility to more low-income Americans beginning in January 2014. As CMCS implements these eligibility changes, outreach materials will be posted here to support states in reaching newly eligible but uninsured Americans.
States may authorize “qualified entities” — health care providers, community-based organizations, and schools, among others — to screen for Medicaid and CHIP eligibility and immediately enroll eligible children.
Presumptive eligibility lets children receive Medicaid or CHIP services without waiting for their application to be fully processed. Qualified entities can also help families gather documents to complete the full application process, reducing the administrative burden on states to get missing information.
Express Lane Eligibility (ELE)
States may rely on eligibility information from “Express Lane” agency programs to streamline and simplify enrollment and renewal in Medicaid and CHIP. Express Lane agencies may include Supplemental Nutrition Assistance Program (SNAP), School Lunch, Temporary Assistance for Needy Families, Head Start, and Women, infant, and children's program (WIC) , among others. States can also use state income tax data to determine eligibility for children. Seven states use Express Lane Eligibility to facilitate enrollment. See Express Lane Eligibility federal policy guidance.
States may provide children with 12 months of continuous coverage through Medicaid and CHIP, even if the family’s income changes during the year.
Guaranteeing ongoing coverage ensures that children get appropriate care, and helps doctors develop relationships with children and their families. This option eliminates cycling on and off of coverage during the year. This also reduces state time and money that would be spent on unnecessary paperwork and preventable care needs.
33 States use continuous eligibility to keep eligible children enrolled in Medicaid and/or CHIP.
Lawfully Residing Immigrant Children and Pregnant Women
States may provide Medicaid and CHIP coverage to children and pregnant women (up to age 19 for CHIP or up to age 21 for Medicaid) who are lawfully residing in the United States, including those within their first 5 years of having certain legal status. Previously, federal law required a 5-year waiting period before many legal immigrants could enroll in Medicaid and CHIP, although many states offered health coverage to these populations with state-only funds.
Twenty-two states cover lawfully residing immigrant children and pregnant women.
Social Security Data Match
People who apply for Medicaid or CHIP must present proof of citizenship and identity. CHIPRA lets states verify citizenship by matching applicants with a Social Security database.
This option built upon the existing state-Social Security relationship through the State Verification and Exchange System (SVES) and took effect January 1, 2010. As of April 2011, states can match Social Security data in real time rather than in nightly batches.
Currently, thirty-three states are participating the Social Security data match to verify citizenship.
Visit insurekidsnow.gov to find outreach strategy materials that will help you play your critical role in increasing awareness and understanding of children’s health insurance programs.