A new report by The Commonwealth Fund sheds light on why a large majority of New York City children who are eligible for Medicaid and Child Health Plus (CHP) remain uninsured, even as New York is set to expand coverage widely to more low-income families. Insuring the Children of New York City's Low Income Families: Focus Group Findings on Barriers to Enrollment in Medicaid and Child Health Plus, reveals that parents face substantial obstacles in getting their children on Medicaid and keeping them on, and have minimal awareness of New York State's Child Health Plus (CHP) program.
Nearly three of four uninsured New York City children under 18, or approximately 275,000 individuals, are eligible for publicly subsidized health insurance but are not enrolled. To discover why so many parents are not enrolling their children in these programs, the Global Strategy Group, Inc., with the support of The Commonwealth Fund, conducted focus groups with parents of eligible children and with Medicaid and CHP eligibility workers in city and community-based organizations. Global Strategy also interviewed executives in six health plans that participate in the programs.
Medicaid Enrollment Process Is Confusing and Unnecessarily Burdensome
The report describes barriers built into the Medicaid enrollment system that deter parents who want to enroll their eligible children from doing so. Parents told of problems such as lost days of work because of face-to-face interview requirements, confusing information about required documents, language barriers, and an automated Medicaid hotline that gives conflicting information about eligibility rules. Eligibility workers also expressed frustration with the enrollment process.
"In light of questions about whether welfare reform efforts in New York City are discouraging Medicaid enrollment, we should evaluate Medicaid's processes and make changes to ensure that it reaches the families it was designed to help," said Karen Davis, president of The Commonwealth Fund. "A streamlined application process and better outreach to low-income families would be important steps toward ensuring that all children in New York City have access to basic health care."
Child Health Plus a Well-Kept Secret
Discussions with parents and enrollment workers revealed a surprisingly low level of awareness of CHP, the state's program to provide health care coverage to children in low-income families who are not eligible for Medicaid. Lack of awareness was especially notable among families who were not receiving public assistance, a primary source of information about Medicaid. Medicaid eligibility workers also lack awareness of CHP. When focus group parents were aware of CHP, they said enrollment into that program was much easier than enrolling into Medicaid, and they were satisfied with the quality of services.
"Thousands of low-income children are needlessly going without health coverage simply because parents are unaware of the existence of Child Health Plus, or don't think their children are eligible," said Donna Lawrence, executive director of the Children's Defense Fund in New York. "Outreach should be stepped up and information made available to low-income working parents who do not come into contact with the social service system. Schools, workplaces, daycare centers, grocery stores, and laundromats are likely places to reach out to families."
Parents of Uninsured Children Report Lack of Access to Health Care
Barriers to enrollment ultimately lead to lack of access to health care for children in low-income families. Parents whose children do not have insurance coverage often wait until their children are in crisis to seek medical help. As one parent stated, "…if something happened to my child, I fear I would have no way to get special care for him." Other parents echoed this attitude, saying their inability to pay for care leads them to postpone visits to the doctor in hopes their children will get well without treatment. Many parents whose children are eligible for coverage but are uninsured said they rely on emergency room care.
Solutions Include Building Awareness and Removing Barriers
Based on these findings, the report recommends ways to improve enrollment rates in both Medicaid and CHP. Recommendations include training eligibility workers, advertising in a variety of places to reach low-income parents, and providing direct mailings of Medicaid and CHP information. Removing barriers to enrollment is also a crucial step: improving staffing and accuracy of information, eliminating duplication of applications and required documentation, extended business hours for enrollment to accommodate working parents, and presumptive eligibility are some suggested strategies.
"New York has decided that it makes sense, in both economic and human terms, to provide health care coverage to low-income children. But passing new legislation is only a partial solution," said David Sandman, program officer at The Commonwealth Fund. "The problem of hundreds of thousands of uninsured children without health care in New York City will only be solved by developing new outreach strategies and revamping the enrollment processes for the programs we already have."
