In 2018, the number of children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) declined 2.2 percent. It is not known if these children moved to other sources of health coverage, like employer-sponsored insurance, or became uninsured until publication of the US Census Bureau’s American Community Survey this fall. However, last year’s decline is significant because there has not been a drop in child enrollment in Medicaid and CHIP since 2007.

Many states are re-assessing their approaches to Medicaid and CHIP outreach and enrollment and are interested in learning new, promising practices from others. The Centers for Medicare & Medicaid (CMS) recently awarded $48 million in outreach grants to 39 recipients in 25 states, including New Jersey’s Department of Health and Human Services, to enhance and improve enrollment of children in public coverage. Currently, CMS is accepting applications to distribute an additional $6 million in grant funds to states and community-based organizations to increase enrollment of American Indian and Alaska Native children in Medicaid and CHIP.

The federal grants are designed to help states generate effective outreach and enrollment strategies that all states can learn from and adapt for their own programs. The following highlights some of the ways that states are using community and school partnerships, social media, and other targeted outreach initiatives to ensure that families who may have eligible children are aware of these coverage programs.

Community Partnerships

While many states collaborate with community organizations to help enroll children in Medicaid and CHIP, Wisconsin’s outreach efforts via community partnerships are robust in scope and execution. The state takes a multi-pronged approach by engaging the Community Healthcare Access Program (CHAP), Covering Wisconsin (CWI), and the Milwaukee Enrollment Network (MKEN) to distribute information about health insurance – including CHIP – at local churches, daycare programs, neighborhood community events, and other social functions. CHAP has become an important health care coverage resource for Wisconsin families over the program’s 11-year history by using mobile hot spots, which allow enrollment workers to efficiently set up and manage events while streamlining the process of disseminating information to consumers and enrolling eligible children.

CWI employs focus groups so officials can better understand how to package information in consumer-friendly ways. Based on focus group feedback, CWI has created clear and concise informational materials targeted to specific audiences with easy-to-follow steps for families to sign up for Medicaid and CHIP. CWI also trains employees at local health centers and schools about how to educate residents (including parents) about available health insurance options.

MKEN, a coalition of about 100 organizations operating in Milwaukee County, targets low-income consumers and special populations by conducting outreach at job fairs, schools, pharmacies, and other community-based events. By conducting outreach through multiple organizations, Wisconsin leverages these partnerships to efficiently target multiple populations who may be eligible for Medicaid or CHIP.

School-based Outreach Efforts

Virtually every state has some form of “back-to-school” program at the core of its outreach efforts, and state health officials often coordinate with school administrators and nurses to enroll eligible children in Medicaid and CHIP. Connecticut’s health insurance exchange, Access Health CT, partners with the Department of Social Services and the Department of Education to identify uninsured students in the public school system and conduct targeted outreach to their families. A new state law mandates that each regional education board report every student’s insurance status. As a result of having various departments and agencies work together and mandating insurance status reporting, Connecticut has developed a comprehensive and coordinated approach to reach school-aged children who may qualify for Medicaid or CHIP coverage. Florida’s KidCare builds and maintains partnerships with school nurses and administrators to disseminate information about CHIP to the parents of potentially eligible children.

Medicaid and CHIP programs in many other states, including in North Carolina, Virginia, Arkansas, Massachusetts, and Missouri, partner directly with school nurses. School nurses are often privy to the insurance status of students, which helps them identify children who might be eligible for Medicaid or CHIP so they can provide their parents with information about the coverage. Wyoming has even recruited school counselors and psychologists to assist in monitoring insurance status and conducting CHIP outreach.

Social Media Campaigns

With the rise of social media use, many states have incorporated Facebook, Twitter, and Instagram in their outreach efforts. Social media as a tool for Medicaid and CHIP outreach is a cheap, effective method for engaging with low-income families. The nature of the platform also comes with built-in analytics, allowing states to observe the impact of their efforts, such as how many people were reached and how many interacted with the platform.

In May through July of 2018, Pennsylvania conducted an outreach campaign called “CHIP Strong,” and the social media portion of the initiative ran on Facebook, Instagram, and Twitter. Analytics from the campaign showed promising results. The campaigns generated:

• 16,627,352 impressions and 23,468 link clicks with an overall click through rate of 0.30 percent;
• 1,534 new page fans on Facebook; and
• 34 new Twitter followers and 131 conversations, all of which helps spread information about the coverage programs.

Arkansas also makes use of Twitter and Facebook to advertise its ARKids First program. State officials have found social media outreach to be particularly effective for targeting low-income parents. Florida uses the built-in analytics of social media platforms to assess data about how many people viewed an advertisement, how many people clicked on it, and the zip codes that enrollees live in to help target their efforts.

Targeted Outreach Initiatives

Many states tailor their outreach initiatives to ensure they are connecting with all potentially eligible families. For example, Florida’s KidCare program targets its outreach efforts by analyzing publicly available data from sources, such as the US Census, to identify uninsured or underinsured residents in certain counties for whom outreach and coverage educational materials may have the greatest impact. North Carolina uses a data-driven approach in its Division of Health Benefits’ enrollment dashboard. The real-time data collected through the website is organized by county, and enables comparison between regions, allowing for more precise targeting to populations eligible for Medicaid and CHIP.

Some states with significant Native American populations develop specific outreach partnerships to engage them. Of the 573 federally recognized tribes, 231 are in Alaska, so the state developed partnerships with Tribal Health Organizations to help spread the word about CHIP and Medicaid programs. Alaska initiated Tribal Medicaid Administrative Claiming (TMAC) in 2016 to strengthen the relationship between Alaska’s Department of Health and Social Services, promote access to Medicaid and Denali KidCare to Native Americans, and reimburse Tribal Health Organizations for performing Medicaid and Denali KidCare outreach and linkage activities.

Oklahoma’s Health Care Authority has a Tribal Government Relations Unit, which is responsible for working with tribal governments and their related health systems. Unit staff often attend tribal health fairs and other outreach events to enroll tribal citizens in public coverage and disseminate other health information. North Carolina also invests heavily in outreach to its eight Native American tribes by conducting outreach at various community events, including the Unity Indian Conference.

As this snapshot of programs demonstrates, state Medicaid and CHIP agencies use a wide range of thoughtful, tailored outreach strategies. States are continually working to find new ways to reach eligible children and efficiently target their outreach initiatives. The new federal outreach grants will help support states and community-based organizations to test new strategies to reach and enroll children in Medicaid and CHIP.