eligible for Medicaid or CHIP. In an effort to address these gaps, CHIPRA provided states with new tools to address shortfalls in enrollment as well as access and quality. CHIPRA included new outreach and enrollment grants and bonus payments to states that adopted five of eight enrollment/retention strategies and that experienced Medicaid enrollment that exceeded targeted growth rates.1 States were also given greater options to use “express lane” eligibility strategies to facilitate eligibility determination and enrollment and were given new options for meeting documentation requirements. CHIPRA allowed states to use federal dollars to cover legal immigrant children who had been in the United States less than 5 years (previously coverage for such children had to be funded exclusively with state funds). In her presentation at the workshop, Genevieve Kenney pointed out that, just a year later, data from the Georgetown Center for Children and Families indicate that as many as 15 states actually have expanded eligibility to higher income levels since CHIPRA was passed. Another 19 are now using federal dollars to cover legal immigrant children, and almost 20 have adopted some type of major change in their enrollment and retention processes aimed at increasing participation.

CHIPRA also provided states with additional federal allotments for their CHIP to cover the costs of enrolling more eligible children and of expanding eligibility (e.g., to higher income groups). In addition, CHIPRA included a number of provisions designed to improve access to care and the quality of care for the children served by Medicaid and CHIP.

CHIPRA had two expected outcomes that help define the context for measurement, according to Kenney and Lynch (see Chapter 8). The first is the expected decrease in the number of uninsured. There was indeed an enrollment increase, about a year later, of 2.6 million children (over the period October 1, 2008, to September 30, 2009) (U.S. Department of Health and Human Services, 2010a, p. 1). The second was an expected decline in private coverage, which would partially offset the positive impact on coverage to the extent that CHIP gains were accompanied by cuts in private insurance coverage.

In their paper, Kenney and Lynch suggest that an independent source

1

The strategies are (1) adopting 12-month continuous eligibility for all children, (2) eliminating the asset test for children, (3) eliminating in-person interview requirements at application and renewal, (4) using joint applications and supplemental forms and the same application and renewal verification process for the two programs, (5) allowing for administrative or paperless verification at renewal through the use of prepopulated forms or ex parte determinations, (6) exercising the option to use presumptive eligibility when evaluating children’s eligibility for coverage, (7) exercising the new option in the law to use the Express Lane Eligibility option, and (8) exercising the new options in the law in regard to premium assistance (Georgetown Center for Children and Families, 2009).



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