Enrolling eligible but uninsured children in Medicaid and the State Children's Health Insurance Program (SCHIP): A multi-district pilot program in Michigan schools

Abstract

According to U.S. Census figures and the Michigan Department of Community Health (2011), there are approximately 5% - 6% of children in the State of Michigan who are uninsured and it is estimated 70% of these uninsured children may be eligible for State subsidized health insurance. While the percent of uninsured children in Michigan consistently rates well below the national average, it is concerning the rate of uninsured children in Michigan is relatively stable. There are strong financial and social incentives to design outreach efforts to reach all children in the State and make these efforts an "everyday event."

This research examines the question of whether or not a school-based outreach program is effective in reaching children who are eligible for State subsidized health insurance but are uninsured and will test the following two hypotheses:

Ho1: Incorporating health status outreach into routine school district operations does not identify a statistically significant number of uninsured children.

Ho2: There is no statistical difference in the number of applications received from a school-based outreach program during the pilot period.

The pilot program takes place in six of the eleven school districts that operate in Van Buren County, MI. School districts were provided two health insurance status collection forms. Form A is designed to be distributed with the Free and Reduced Lunch Application. Form B is designed to be distributed as part of the student registration packet and welcome material. The completed Form A and Form B are sent to a State of Michigan registered application assisting agency for SCHIP application assistance and enrollment.

As a result of the survey, 156 children were identified as not having health insurance. This represents more than 44% of the 358 children who are eligible for State subsidized health insurance, in the participating school districts, but are uninsured. Enrolling these children will help the State of Michigan to meet targeted enrollment gains and earn CHIPRA performance bonus payments. The additional funds from higher CHIPRA bonus payments could be used to provide the resources to fund the following specific recommendations:

1. The Michigan Department of Community Health should lead the effort to work with the Michigan Department of Education to modify the Free and Reduced Lunch Application to capture whether or not the applicant has health insurance.

2. The Michigan Department of Community Health should lead the effort to incorporate into the direct certified free and reduced lunch eligibility process a systematic check as to whether or not the applicant has State subsidized health insurance.

3. The Michigan Department of Community Health should provide resources from the expected performance bonus to work with schools across the State to implement these changes. (Abstract shortened by UMI.)