Medicaid and the State Children's Health Insurance Program (SCHIP) play an
important role in reducing the number of lower-income uninsured children and
adults in communities across America. These public health care programs provide
a payment source for persons who otherwise are unable to pay. When the
uninsured are unable to pay all their medical bills, the financial burden falls
on the providers of services and on the community.
The Southern Institute on Children and Families, a respected national leader in
access to health coverage for lower-income families, has established a
strategic business center focused on improvements in health coverage
eligibility processes under Medicaid and SCHIP. The Process Improvement Center
assists customers in improving the accuracy, efficiency and
the eligibility process within public benefit
programs that support
lower-income children and families.
The combination of strict eligibility requirements and complex enrollment
procedures often makes public coverage difficult to obtain and even more
difficult to maintain over time. Many lower-income families are denied Medicaid
and SCHIP benefits at application. Some have their coverage stopped during the
eligibility period, and others lose their coverage at their regularly scheduled
review. Studies have found that nearly half of these denials and closures are
not for reasons related to family eligibility but are due to procedural
problems within the application and renewal processes.
Persons who are uninsured for the full year pay only 35 percent, on average, of
the overall cost of medical services they receive.1 Health care providers such
as hospitals and community health centers are seeking to reduce the number of
uninsured because of health disadvantages and the rippling financial impact of
treating patients without health insurance or any other means for payment.
Managed care providers are seeking to reduce "churning," i.e. patients cycling
on and off health care coverage, allowing them to provide uninterrupted health
1Institute of Medicine, Insuring America’s Health, (Washington,
DC: The National Academic Press, 2004), 50.