COVERAGE: Details, Details, Details

The devil, we're told, is in the details. We would have said Prada, but if you asked where the details matter most, we think you can make a strong argument for the programs of Medicaid and SCHIP.

First, there's the combination of state and federal funding that makes budgeting Byzantine. Add an array of eligibility, enrollment, and verification requirements. The result is a labyrinth fit for a Minotaur, yet often overwhelming to the populations these programs are intended to serve.

Which is why at a Kaiser Family Foundation briefing Friday on Children's Health Coverage: What's Next, we felt a little like Anne Hathaway, post makeover, in the Devil Wears Prada, suddenly seeing the real impact of details and policies on these programs.

KFF's Julia Paradise (slides) began the day reviewing work from the foundation on the impact of health coverage on low and middle income families. Some quick facts:

• Three-quarters of low-income working families with an uninsured child had no access to employer-sponsored health insurance (ESI). Of those low-income respondents with access to ESI, but not enrolled, 81 percent said they could not afford it.
• Uninsured, low-income children have less access to care than their insured peers, and were five times more likely to delay or skip care due to cost. The rates were similar for middle-income children (200-299 percent of FPL) without insurance.
• Compared to those covered by private insurance, low-income children covered by public programs like SCHIP and Medicaid received essentially equal access to care--such as having a usual source of care or receiving well-child visit.

Having established the importance of Medicaid and SCHIP in providing coverage to an underserved population, Donna Cohen Ross of CBPP and Caryn Marks of KFF, presented an update on the status of the programs' enrollment and eligibility polices in all 50 states for 2009 (slides).

The whole report is worth a read, and next week we'll talk about some state efforts to simplify the enrollment, eligibility, and administration process. For right now, here's a nice summary of changes in policies regarding access to Medicaid and SCHIP over the past year:

The rest of the event provided a series of real world perspectives from individuals directly involved with Medicaid and SCHIP.

• John Folkemer, the Maryland State Medicaid director, spoke about his state's efforts to expand coverage to adults and improve outreach in general. The variety of funding tMaryland pulled together to finance the expansion was impressive, although the current fiscal crisis has put further implementation on hold.
• Jay E. Berkelhamer, MD, a past president of the American Academy of Pediatrics, provided a physician perspective, noting that CHIP has been extremely successful and that it should be reauthorized quickly. He also urged us to do more to ensure that all children are covered and receive the care they need. (slides)
• Susan Johnson, Director of the King Country Health Action plan, offered a perspective from the West coast, describing Washington state efforts to streamline the enrollment and renewal process through administrative simplification, technological investments, and public outreach.