rolled, enrolled in a separate state SCHIP program, or privately insured. Currently, little information is available about the insurance status of children leaving the SCHIP program, who may leave for many reasons, including that they are no longer eligible because of income or age. They may be enrolling in Medicaid because their family income has fallen, or they may be covered by private insurance because their family income has risen. Alternatively, they may become uninsured either because they are no longer eligible for SCHIP or Medicaid and have no private insurance option, or because they were unable to complete the paperwork needed for renewal.
It is important to distinguish among these reasons for disenrollment, because policy makers would interpret coverage under private insurance as a success, but failure to renew due to paperwork burden as a failure. Hill listed some of the factors that hinder the redetermination process. Among them are the reliance on a mail-based system, rather than on personal contact, that many times left the recipient confused; the requirement to resubmit documentation that had already been submitted on initial enrollment; lack of coordination with Medicaid when income dropped, leaving the family eligible for Medicaid rather than for SCHIP; and automatic disenrollment in some state programs when there was no response to the renewal notice.
In Hill’s five-state survey, the major reason for discontinuation at the time of redetermination was failure of the family to respond to renewal notices. This reason accounted for as much as 41 percent of all discontinuances in North Carolina. In Michigan, in contrast, renewal forms are sent out 50 days before they are due. Denise Holmes found that only 6.3 percent (77 families out of 1,219) failed to return their forms and most of these families had obtained private insurance. A major reason for the high rate of return was that candidates for renewal received application forms that were already filled out from previous information so that the applicant merely had to indicate any changes that had occurred and sign the form.
Several strategies were mentioned by participants in the workshop for increasing retention in SCHIP. They included:
Sending out notices well in advance (Hill mentioned 60-90 days).
Simplifying the language on the form—for example, using the word “renewal” rather than “redetermination” or “reenrollment.”
Sending forms that are already completed and requesting only changes and a signature.