In the Summer of 1999, the Texas Children’s Health Insurance Program (CHIP) Coalition members became aware of significant problems with the Medicaid eligibility process, especially for working families. The coalition found that the Medicaid application process places the people most in need of services in the position of having to work the hardest to obtain the benefit. On the other hand, the CHIP process is very streamlined; it is a one page, mailed-in application, with a mailed response, and requires very little documentation. Texas is one of only five states in the nation that has not simplified the Medicaid application.

The coalition found that as the new CHIP application was being tested, people’s reactions to it stood in marked contrast with their previous experiences in trying to get Medicaid for their children. The CHIP application process was repeatedly praised for its simplicity and for how fast eligibility determinations are made.

Furthermore, coalition members found that provisions make it very easy for families to lose these services once they do qualify. Family size, age, and income are part of the funding and eligibility formulas. These are very confusing, so that one child in a family may be eligible for Medicaid, but another child in the family may only be eligible for CHIP. Medicaid eligible children do not qualify for CHIP, and must go through a time-consuming and tedious process to demonstrate eligibility.

For over 600,000 uninsured children in Texas, Medicaid is the only option for access to proper health care. Only two in ten children in Texas are covered as dependents under their parents’ insurance coverage. Many more are eligible, but the costs make it prohibitive for families to enroll them. It is clear that Texas will not be able to significantly reduce the large number of its uninsured children until the Medicaid process is simplified to be more like the CHIP process.

Many Legislators believe that the issue of health care for children was resolved during the last legislative session; however, the current requirements under both the Medicaid and CHIP programs make either eligibility for benefits very difficult to attain or medical services difficult to maintain.

Many of the children who apply for CHIP are referred to Medicaid because they meet the Medicaid eligibility guidelines (approximately 70,000 since June of 2000) but only 10% of these have made it through the eligibility process and are receiving benefits. Approximately 170,000 children have been certified for CHIP in the last 6 months. A Medicaid caseworker can do three to four applications in a day, and then the process has to be repeated again in six months because of the re-certification requirements. So, the success rates of the Medicaid and CHIP programs from the time of inquiry to the certification for benefits are very different. It takes about ten minutes to apply for CHIP if you have all of the necessary information.

The Texas CHIP Coalition has put together a series of Principles to present to the 77th (2001) Texas Legislature, including the following:
• SIMPLIFY the application for Children’s Medicaid so it is like CHIP. The TexCare Partnership application and process would apply to both Medicaid and CHIP, so that Department of Humans Service (DHS) workers would only need the TexCare application to determine if the child is eligible for Medicaid:
  1. The face-to-face interview at the time of application would be replaced with mail-in or telephone applications, and the required documentation would be reduced to match CHIP requirements. The DHS board has proposed, but not implemented, mail-in or telephone re-certification for Children’s Medicaid.
  2. The assets test would be eliminated.
  3. 12 months continuous eligibility would be implemented.
• Provide RESOURCES to ensure improved access to Children’s Medicaid and CHIP, including:
  1. Adequate appropriations to allow for enrollment growth in Children’s Medicaid and CHIP.
  2. Sufficient numbers of well-trained DHS Eligibility Caseworkers to handle larger numbers of Medicaid applications, including out-stationing more DHS workers at health centers, hospitals, malls, schools, and other key public places.
  3. Increase reimbursements to attract and retain sufficient numbers of healthcare providers in Medicaid and CHIP.
• Increase OUTREACH and public awareness for Children’s Medicaid and CHIP, including:
  1. Triple the funding for outreach to $15 million and double the funding for marketing to $4 million, and allow these funds to be used for both Children’s Medicaid and CHIP.
  2. Extend Community Based Organizations’ application assistance to both Children’s Medicaid and CHIP.
  3. Pursue all available federal funding for outreach and increase efforts to target outreach to to specific, hard-to-reach populations.

In late September 2000, the CHIP Coalition released the "Every Child Equal: What Texas Parents Want from Children's Medicaid" report that provides information from a series of focus groups with low income parents across Texas, summaries of other states' experiences, and policy options for Texas decision makers. The full report is available at http://www.cppp.org or by calling the Center for Public Policy Priorities at (512)320-0222. An accompanying video, "A Wise Investment," may be obtained from muren@seton.org or by calling (512)324-1913. More information on simplifying Medicaid eligibility for Texas children may also be obtained from the Texas CHIP Coalition at their website, http://www.main.org/txchip, or by calling (512) 320-0910.