Medicaid

Health insurance has become an increasingly important way to provide children with access to adequate health care. Yet in 1996, 10.6 million children were uninsured. Congress has sought to insure more children by committing more than $20 billion to fund state expansions of children's health insurance--either through the Medicaid program or through insurance programs developed by the states. However, many uninsured children who are eligible for Medicaid are not enrolled. This report (1) examines the demographic and socioeconomic characteristics of children who qualify for Medicaid and identifies groups in which uninsured children are concentrated and to whom outreach efforts might be targeted; (2) determines the reasons these children are not enrolled in Medicaid; and (3) identifies strategies that states and communities are using to boost enrollment.

GAO noted that: (1) the demographic and socioeconomic characteristics of uninsured Medicaid-eligible children suggest that outreach strategies could be targeted to specific groups; (2) in 1996, 3.4 million Medicaid-eligible children--23 percent of those eligible under the federal mandate--were uninsured; (3) the majority were children of working poor or near poor, and their parents were often employed by small firms and were themselves uninsured; (4) uninsured children who are eligible for Medicaid are more likely to be in working families, Hispanic, and either U.S.-born to foreign-born parents or foreign born; (5) state officials, beneficiary advocates, and health care providers whom GAO contacted cited several reasons that families do not enroll their children in Medicaid; (6) lower income working families may not realize that their children qualify for Medicaid, or they may think their children do not need coverage if they are not currently sick; (7) under welfare reform, the delinking of Medicaid and cash assistance may cause some confusion for families, although GAO found that states were making efforts to retain a single application and eligibility determination process to avoid this problem; (8) in addition, many low-income families believe that Medicaid carries the same negative image of dependency that they attach to welfare; (9) immigrant families, many of whom are Hispanic, face additional barriers, including language and cultural separateness, fear of dealing with the government, and changing eligibility rules; (10) the enrollment process for Medicaid can involve long forms and extensive documentation, which are intended to ensure program integrity but often are a major deterrent to enrollment; (11) recognizing these impediments, some states have undertaken education and outreach initiatives and have tried to change the image of the program and simplify enrollment to acquire only necessary information; (12) these efforts include mass media campaigns and coordination of effort with community organizations and provider groups; (13) some states have made the enrollment process more accessible for working families, using mail-in applications or enrollment at sites chosen for their convenience; (14) several states have changed the name of the program to minimize its identification with welfare and other assistance programs; (15) many states provide Spanish-language applications and some are working with community groups; and (16) some states have also simplified the enrollment procedure by shortening the enrollment form and reducing the documentation requirements.