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 Eligibility Process Improvement Center assists customers in improving the accuracy, efficiency and effectiveness of 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 care.
The Eligibility Process Improvement Center assists state and local eligibility offices in streamlining their application and renewal processes for Medicaid and SCHIP. In addition to having a solid, practical foundation in these programs, our staff has experience and knowledge in process improvement methodology and group facilitation. The center makes use of a Process Improvement Collaborative to affect Medicaid and SCHIP eligibility process improvement. Read more here...
The center's staff makes use of a Collaborative to affect improvement in the eligibility process. The Collaborative is a 12-month engagement between the center and up to 15 teams of public program and related private business leaders who share a common goal of rapidly achieving Medicaid and SCHIP eligibility process improvements. Read more here...
1Institute of Medicine, Insuring America’s Health, ( Washington, DC: The National Academic Press, 2004), 50.
