As the pandemic continues and more individuals lose jobs and health insurance, the demand for Medicaid and Children’s Health Insurance Program (CHIP) coverage is rising. Kentucky and Virginia – stripped of their traditional, in-person enrollment strategies – have adapted their outreach efforts to help make enrollment as easy as possible for adults and children to ensure access to critical coverage and care.
A recent survey of Medicaid programs shows that between February and May 2020 all but three states experienced notable increases in enrollment.Through waivers and state plan amendments, states have the opportunity to adopt a wide range of flexibile strategies to facilitate and maintain enrollment.
However, social-distancing, tele-work, and strained state budgets have introduced new challenges for state Medicaid and CHIP agencies. A number of state Medicaid agencies have implemented furloughs or reassigned staff to contract tracing and other essential tasks related to the pandemic. Without the ability to conduct traditional outreach campaigns, which are often linked with large community gatherings and one-on-one enrollment support, state Medicaid agencies have needed to quickly pivot their outreach strategies to connect with individuals who are newly eligible for coverage.
Streamlining Enrollment and Enhancing Partnerships
Kentucky has experienced one of the most significant increases in Medicaid enrollment. Between February and May, 2020, Kentucky’s Medicaid and CHIP enrollment increased by nearly 7 percent. While some of the growth can be credited to the maintenance of effort (MOE) provisions required to secure enhanced federal Medicaid funding through the Families First Coronavirus Response Act, Kentucky has taken significant steps to enroll eligible individuals and families. State officials report that a key aspect of their successful enrollment strategy has been adopting presumptive eligibility (PE) policy flexibilities allowed by the public health emergency. By designating the state Medicaid agency as a qualifying entity to determine presumptive eligibility based on individuals’ modified adjusted gross income, and condensing its 20-page application into a one-page online form, Kentucky has enrolled over 137,000 individuals under presumptive coverage. To keep these individuals covered once their eligibility period ends, Kentucky Medicaid agents track these applications to identify when individuals’ PE periods are drawing to a close. They then make direct outreach calls to these enrollees to assist them in completing a full Medicaid application.
States have also leveraged interagency partnerships to target their outreach strategies to individuals who may be eligible for Medicaid coverage. To connect with individuals who may have lost employer coverage due to the pandemic, both Kentucky and Virginia have contacted thousands of individuals who have applied for state unemployment insurance. The states also added easily accessible links to their unemployment agency websites to help individuals to apply for health coverage.
In Virginia, partnership efforts have been bolstered through a renewed connection with the Virginia Health Care Foundation’s (VHCF) Project Connect, which funds local outreach efforts to enroll individuals in Medicaid and CHIP. Through this partnership, representatives from Virginia Medicaid and VHCF have provided support at virtual job fairs and rapid response online events, and they plan to continue to collaborate to serve those who have been affected by COVID-19’s economic consequences.
Like Kentucky, Virginia has also experienced a significant increase in Medicaid enrollment in recent months, and state officials credit the persistence and creativity of their community outreach coordinators as critical to their enrollment success. They have redesigned their approach to safely conduct outreach and enrollment support by leveraging existing community contacts to distribute informational materials electronically and organizing online meetings with community groups. The outreach coordinators have also sought to develop new partnerships with charity, community, and faith-based organizations, retailers, and hospitality groups, as well as schools and colleges. In some rural areas with lower COVID-19 infection rates, the coordinators are beginning to conduct some outreach efforts at churches, fast food chains, and other retailers.
A crucial focus of this work in both states has been developing targeted outreach strategies and building relationships with communities of color who have been disproportionately affected by the economic and health impacts of COVID-19. Virginia has developed ad campaigns designed specifically to reach Latinx families. Kentucky relies on its data analytics team to guide the state’s outreach efforts and recently launched a marketing campaign targeting seven counties with the highest Black, uninsured population.
Modifying Back-to-School Outreach Efforts
For children, who represent 51 percent of total Medicaid and CHIP enrollment, access to health coverage is of paramount importance to ensure that developmental milestones are met and vaccines are administered. Traditionally, school partnerships have provided Medicaid and CHIP agencies with the ability to identify eligible children and families and to distribute resources from a trusted source. A report conducted by the Urban Institute at the Robert Wood Johnson Foundation in 2016 found that almost half of individuals who are eligible for Medicaid or CHIP live in families with at least one school-aged child, making schools a valuable venue to conduct outreach for both children and adults.
Historically, the back-to-school season provided an opportunity for Medicaid and CHIP programs to convene large enrollment events where promotional flyers and branded materials are distributed to children and parents. However, this year, without traditional events such as summer camps or sports registration, there are fewer chances to connect with families to provide coverage options and underscore the importance of care.
In addition to hosting events, Medicaid and CHIP agencies often provide schools with informational packets to slip into student’s backpacks or include with school registration materials. But with fewer students returning to traditional classroom settings and tighter restrictions on the number of individuals allowed into schools, these tested outreach methods have needed to be re-examined and reformulated.
To minimize physical contact, Kentucky has limited school outreach to a group of professionals from the Division of Family Resource and Youth Service Coalition (FRYSC) within the Cabinet for Health and Family Services. Representatives from FRYSC have established relationships with schools and are able to distribute outreach materials without prolonged contact at socially distanced drive-through school events. In recent weeks, FRYSC representatives have begun distributing materials, which include more than 200,000 protective face masks displaying KCHIP marketing for children.
In Virginia, the Medicaid agency has revamped its back-to-school campaign by investing in digital resources for students and families. Working with schools, VA Medicaid has created widgets that will send parents from school webpages to the Medicaid and CHIP back-to-school pages. Their reformulated back-to-school websites acknowledge the constraints caused by the pandemic and include information for parents about how to enroll their children in health coverage in both English and Spanish as well as outreach resources for schools, such as social media messaging. When the back-to-school campaign formally ends in December, these dedicated back-to-school pages will be built into their website and remain active throughout the year.
The state is also coordinating with a digital engagement contractor to send text messages aimed at parents and advocates to encourage enrollment in CHIP and Medicaid. In addition to outreach efforts through school’s web pages, Virginia Medicaid printed 1.3 million copies of its enrollment materials to cover every school-age child in every public school in the state. Prior to the pandemic, Virginia Medicaid requested that the materials be distributed in back-to-school informational packets, but this year, due to the variability in which districts are electing to return to school, it asked teachers and administrators to distribute the material in any way they saw fit.
In response to the limitations of the pandemic, states have demonstrated flexibility in their approaches to outreach and enrollment. Kentucky’s efforts highlight the importance of making enrollment as easy as possible for individuals. Virginia state officials noted that despite the challenges and constraints, COVID-19 has provided the state with an opportunity to reassess and improve its outreach strategies. As Medicaid programs continue to serve as one of the primary safety nets for millions of Americans whose livelihoods have been uprooted by the economic consequences of the pandemic, states are creatively adapting their outreach and enrollment efforts to help ensure access to coverage and care.