Application and enrollment processes for low-income children’s insurance programs (Medicain and CHIP) are complex and confusing. As part of the Covering Kids (CK) National Program Project, funded by the Robert Wood Johnson Foundation, a survey of consumers and enrollees were conducted to assess barriers to children enrollment in New Jersey and identify needs for process simplification and improvements. Using quota sampling method, families were recruited from local community pilot sites, WIC sites, Boards of Social Services, and a random pool of enrollees. In total 625 parents participated in survey and completed a self-administered instrument in English and Spanish on barriers with application and determination process, required documents, treatment by staff, stigma, reasons for denials or withdrawals, HMOs and service utilization issues, redetermination and appeals process. Consistent with national reports, about two-third did not apply because they were unaware of the program or doubted to be eligible. Preliminary analysis showed of those applied and/or enrolled, majority were in Plan A (Medicaid and Extension). The most frequently reported problems included 800#, too much information requested, many documents required, difficulty getting documents, time allowed to get documents, length of approval and difficulty checking the status of application. Difficulties with HMOs included comparison of benefits and selection of insurance plan, choice and location of providers, scheduling appointments and waiting time in office. Based on findings, a series of strategies will be developed and submitted to the state, policy makers and legislature to make needed process, procedural, policy and legislative changes to simplify the process.
Learning Objectives: At the conclusion of the session, the participant will be able to:
Keywords: Access and Services, Children
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.