Demographics of Nonenrolled Children Suggest State Outreach Strategies

HEHS-98-93: Published: Mar 20, 1998. Publicly Released: Apr 20, 1998.

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Pursuant to a congressional request, GAO reported on children who are eligible for Medicaid but are not enrolled, focusing on: (1) the demographic and socioeconomic characteristics of children who qualify for Medicaid, and identifying groups in which uninsured children are concentrated and to whom outreach efforts might be expected; (2) the reasons these children are not enrolled in Medicaid; and (3) strategies that states and communities are using to increase employment.

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.

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