Health Insurance Enrollment Targeted

President Clinton today will propose spending an additional $2.7 billion over the next five years to boost participation of children from low-income families in a government health insurance program.

Enrollment in the State Child Health Insurance Program has doubled in the last year to 2 million, according to a report by the Department of Health and Human Services, also slated for release today.

“We need to finish the job and really focus on enrollment,” said a senior White House official.

President Clinton’s proposals, which will be submitted as part of his 2001 budget request, will make it easier for states to enroll children in the insurance program while they are in school. A recent study by the Urban Institute found that 4 million uninsured children are enrolled in the school lunch program, which also serves low-income kids. Federal law, however, prohibits the lunch program from sharing information with Medicaid and the children’s insurance program.

Clinton is requesting a change in the law that would permit states to enroll children already in the lunch program in Medicaid or the children’s health insurance program temporarily while their applications are being processed.

He would also give states more flexibility to expand the number of sites they could use for enrollment.

“The job isn’t just educating parents that the programs exist; we need to make sure that signing up is compatible with the lives of working families,” said Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured.

A Kaiser study scheduled for release later this week surveyed 1,000 low-income parents whose children were not enrolled but were eligible for government-subsidized health insurance. Their major complaint was the difficulty in taking time off work to enroll their children.

“They want to be able to sign up in day-care centers, schools or doctors’ offices and not have to go to a welfare office, where they have to sit all day without an appointment,” Rowland said.

“If you’re going to make these kinds of programs work, you’re going to have to find less-than-conventional ways to find the kids,” agreed Chip Kahn, president of the Health Insurance Assn. of America, who wants to see the program expanded to cover the parents as well as their children.

The children’s insurance program offers federal subsidies to states of up to 85% of the cost of health insurance for children of the working poor. States pay the balance, and in some states beneficiaries also pay part of the cost.

The program started after new welfare rules were passed by Congress in 1996 and as the numbers of uninsured working families grew.

Millions of families had incomes below or just above the federal poverty line of about $16,700 for a family of four and were eligible for Medicaid, an older federal-state health insurance program aimed at the nation’s poorest citizens. Millions of others had incomes too high to qualify for Medicaid but still could not afford private health insurance.

The children’s health insurance program is smaller than Medicaid, which covers about 21 million poor children. Officials said that when the administration’s plan is fully implemented, it should provide health insurance for an additional 5 million children. The majority of them would be covered under the children’s insurance program, although some would enroll in Medicaid if eligible.

However, the two programs now reach only some of those who are eligible for coverage. There are an estimated 11 million children without health insurance in the United States, according to the Kaiser panel.

An estimated 8 million of those children qualify for government-supported health insurance, but long application forms; enrollment offices that are open only during the day, when many parents are working; and other barriers have made it difficult to enroll.

The study attributes the latest enrollment increase to the growing number of states that make their programs available to children in families with incomes up to 200% of the poverty level--that is, nearly $34,000 for a family of four.

Thirty states cover children in such families and five states have increased the level to 300%. California’s level is 250%.