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End-of-Life Choices

Trends in end-of-life care show that not only does the care given vary widely from region to region and hospital to hospital, but also patients often don't get the care they prefer. What can be done?

Care Management Puzzle

Chronic diseases and the cost of care are rising. Are disease management programs improving outcomes for patients with complex, chronic conditions?

No Middleman

Under the "direct primary care" model, patients pay a monthly fee for basic medical services. Learn about the history and current landscape of physician practices offering this arrangement.

Childrens Health Coverage

Friday, September 03, 2010

Millions of Eligible Kids Not Enrolled in CHIP, Medicaid, Study Finds

About five million uninsured U.S. children qualify for the Children's Health Insurance Program or Medicaid but are not enrolled in either program, according to a study published Friday in the journal Health Affairs, Reuters reports.

The study, conducted by the Urban Institute Health Policy Center, found that about 7.3 million children nationwide were uninsured on an average day in 2008. About 65% of the uninsured children qualified for CHIP or Medicaid. Families that earn too much to qualify for Medicaid but cannot afford private coverage can enroll their children in low-cost health insurance through CHIP.

The report also found that 39% of the eligible uninsured children live in California, Florida or Texas. More than half of U.S. children live in these three states, according to the study.

Implications

The study recommended that officials pursue policy changes and new initiatives to enroll more eligible children in CHIP and Medicaid.

HHS Secretary Kathleen Sebelius said the study provides the department with valuable information on where uninsured children live. She said, "This new data will help us to focus our efforts and our grant funding where they are most needed" (Allen, Reuters, 9/3).

Sebelius Commentary

In a Health Affairs commentary piece accompanying the Urban Institute study, Sebelius describes the Obama administration's plans for enrolling more uninsured children in CHIP and Medicaid. She writes, "As we implement the Affordable Care Act, we do not have to wait -- indeed, we have a moral obligation to move forward -- to close this gap in health coverage among children" (Sebelius, Health Affairs, 9/3).

Reader Comments:
  • 4
  • 09/03/2010
  • james mcniff

New york has some of the best benefits for a medicaid patient but still had 50% of potential patients are not enrolling..My job at a large medical center was to assist patients in the enrollment process however waiting for the patient to respond was not working..I have now tripled my community medicaid enrollments by committing resources and working very closely with the state but i had to first sell this concept internally..the question asked of me....why should we spend money on this project when the state is supposed to be doing this and it reduces charity?..my answer was it was good for the patient and provider(did need to show ROI)and we could not wait for the government ..

  • 3
  • 09/03/2010
  • Bruce Jugan

The government can not enroll people in free health insurance. Perhaps HHS should do what all of the commercial health insurance companies do: pay a commission to licensed agents to enroll people. Problem solved.

Coverageforall.org has done a fantastic job identifying all of the government programs available for health insurance in addition to commercial coverage. What they have found is that nobody answers the phone at Medicare offices. By and large, most enrollment in Medicare and SCHIP is done by providers at the point someone needs coverage - this is to ensure the provider gets paid. Licensed agents reach out to people when they are healthy and get them enrolled - which is much better for the system. Licensed agents also cost nothing until they actually enroll someone - unlike a big government agency that has huge fixed costs- regardless of their success. We need to think outside of the box and trust the private sector to do something that is is clearly capable of doing.

  • 2
  • 09/03/2010
  • Corey Shank

Presumptive eligibility, can really only be about presuming financial information is correct (taking family's statement of household income)...Medicaid cannot presume the demographic eligibility, and therefore verification of citizenship, age, and such is still required. I am not certain hospitals are pressured to write kids' accounts off to charity, rather than help them get on public programs (Medi-Cal), each process is considered community benefit.

However, there should be a tighter relationship among physician offices, hospitals, and other agencies in order to be more proactive in providing outreach and education to families. As opposed to waiting for them to seek health services.

  • 1
  • 09/03/2010
  • james mcniff

If states really want to increase enrollment they should allow providers the right to enroll under presumptive eligibility..This would expedite patients into a primary care system which improves their health outcomes.However there are forces that are creating disincentives to make this happen.
1)pressure on hospitals to write off accounts as charity care(IRS AND PUBLIC SCRUTINY) and not invest in the enrollment process(in particular community medicaid)..
2)states have no incentive to increase enrollment..the reason providers need to have more power in the process ..



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