Many babies born to mothers who are covered by Medicaid are automatically eligible
for that health insurance coverage during their first year of life. In a
handful of states, the same is true for babies born to women covered by
the Children's Health Insurance Program.
Yet,
this approach is routinely undermined by another federal policy that
requires babies' eligibility for these programs to be re-evaluated on
their first birthday. Although they're likely still eligible for
coverage, many of these toddlers don't get it because of a tangle of red
tape.
People often cycle in and out of Medicaid and CHIP,
state/federal health programs for low-income residents, as their income
or family circumstances change. Such churning is a long-recognized problem. The requirement that people renew their coverage annually may also cause hiccups.
"Many people lose Medicaid coverage for procedural reasons," says Shelby Gonzales,
a senior health policy analyst at the Center on Budget and Policy
Priorities. "But there are all sorts of things that are unique about
babies turning 1" that present extra challenges.
"You hate any baby to lose coverage," says Jill Hanken,
a lawyer with the Virginia Poverty Law Center who has worked on this
issue. "A 1-year-old needs to have consistency with their health care
and visits with the pediatrician." Regular well-baby visits ensure kids are developing properly and get scheduled vaccines, among other things.
One
potential snag in retaining toddlers' coverage is that their first-year
review is pegged to their date of birth, which is generally different
from the annual renewal date for other family members' coverage.
In
other instances, states that don't seek babies' Social Security numbers
until they turn 1 may have a tougher time getting the income and other
data they need to process the renewal. And some states mistakenly ask
for documentation proving the baby's citizenship, which is not required
if Medicaid or CHIP paid for the birth.
Antiquated computer
systems sometimes automatically drop babies after their first birthday
unless a renewal has been processed. This can be a problem in states
that are behind in renewals, which is not uncommon, Gonzales says; some
states have scrambled to implement the many requirements of the health
law.
It's hard to quantify the extent of the problem
nationally. An analysis of data from the 2014 American Community Survey
of 700,000 children found that children between the ages of 1 and 2 were
less likely than infants to be covered by Medicaid or CHIP. That
suggests "some children may be losing Medicaid/CHIP coverage at their
first birthday," says Genevieve Kenney, a co-director and senior fellow at the Urban Institute's Health Policy Center.
The
experience of the state of Connecticut offers a window on the problem.
Connecticut Voices for Children, a policy research and advocacy
organization, has tracked the issue closely
for several years. In 2008 and 2009, 42 percent of babies who had been
considered automatically eligible for Medicaid at birth lost their
coverage at the end of the month they turned 1. That's compared with
roughly 6 percent of babies who were in other Medicaid coverage groups,
such as those whose mothers had employer-sponsored insurance.
By 2013, when Connecticut Voices revisited coverage gaps,
Medicaid and CHIP coverage retention when infants turned 1 had improved
significantly. Still, nearly 23 percent of babies with guaranteed
coverage for their first year were uninsured after their first birthday.
That was true for less than 2 percent of other babies in the state.
During
that time the state had revised confusing notices to families that, for
example, announced that coverage was ending for infants because, "You
are not the right age to be eligible for this program." Advocates also
played a role in improving the troubling statistics by working to alert
pediatricians and community services providers about the problem.
Though coverage for 1-year-olds has improved, "the problem still persists," says Mary Alice Lee,
senior policy fellow at Connecticut Voices for Children. Advocates hope
that a new eligibility management system, scheduled to roll out next
year, will make a difference.
Elsewhere, advocates in Virginia
are also awaiting a computer system fix so that infants who were
guaranteed Medicaid coverage for the first year aren't automatically
canceled after their birthday. In the meantime, Hanken says, the state
changed its policy so that the determination of a newborn's Medicaid
eligibility at 1 year of age is a streamlined renewal, instead of a
totally new application for coverage.
"We're about halfway to a solution," Hanken says.
Outdated technology is no excuse for states not addressing this longstanding problem, says Tricia Brooks, a senior fellow at Georgetown University's Center for Children and Families.
These
newborns are easily identified, Brooks says, so "if nothing else,
[state officials] could go in on a manual basis and trigger a review."
http://www.npr.org/sections/health-shots/2016/07/12/485722217/red-tape-leaves-some-low-income-toddlers-without-health-insurance
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