Eligibility

As states work to insure more children in challenging economic times, a new report funded by the Robert Wood Johnson Foundation (RWJF) explores how states can identify and enroll eligible but uninsured children by borrowing automated strategies that have proven effective in helping eligible people receive other public and private benefits. Authored by Urban Institute researcher Stan Dorn in collaboration with the National Academy for State Health Policy (NASHP), the report details how auto-enrollment strategies have the potential to identify, enroll and retain large numbers of eligible children while reducing state administrative costs. The report explains how the recently enacted Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) makes these strategies substantially easier for states to implement while establishing powerful new financial incentives for states to reach the greatest possible number of eligible children.

Early prenatal care plays a critical role in the health of pregnant women and their babies. Access to early prenatal care can lead to better birth outcomes, healthier babies, and reduced health care costs. Presumptive eligibility in Medicaid has become an important strategy for improving access to prenatal care for low-income pregnant women. Presumptive eligibility is an option that states can use to allow authorized providers to begin treating pregnant women when they first seek prenatal care rather than several weeks later after a final determination has been made regarding their Medicaid eligibility.

Twenty-seven states have received Medicaid 1115 demonstration waivers to provide family planning services to individuals not otherwise eligible for Medicaid or the State Children’s Health Insurance Program (SCHIP). Two other states have applied for waivers. This updated State Health Policy Monitor examines the status of these waivers, and provides a brief overview of eligibility guidelines and benefits.  Additional NASHP publications examine specific waiver design features, and explore topics such as cost savings and the impact on health outcomes.

This summary is intended to assist professionals who work in systems serving children, such as juvenile justice and child welfare. For more information about Medicaid and its key concepts as they relate to the juvenile justice system, see A Medicaid Primer for Juvenile Justice Officials. Illinois integrates operation of its State Childrens Health Insurance Program (SCHIP) with Medicaid funded and state-only programs. As of December 2006, there were 1,873,000 adults and children enrolled in the Medicaid program, and as of June 2007 there were 175,145 children enrolled in SCHIP. In federal fiscal year 2005, Illinois made approximately $10.8 billion in Medicaid expenditures and $494 million in SCHIP expenditures. (These figures include spending for both adults and children.) The federal government supplied 50 percent of the funding for Medicaid expenditures and 65 percent for SCHIP expenditures.