If you build it will they come? Outreach Lessons From CHIP

By Carla Plaza
November 2012

If you build it will they come? If history repeats itself, they will, but not without intentional, focused efforts to reach, assist and enroll individuals and families into health care coverage. Prior to the enactment of the Children’s Health Insurance Program (CHIP), very little emphasis was placed on marketing public health insurance and reaching out to families to enroll their children into coverage. However, that changed with the implementation of CHIP. It can be said that CHIP’s proactive approach in finding and enrolling uninsured children also contributed to increased enrollment of eligible children in Medicaid.

Over the years, states have developed and refined a range of outreach strategies. With open enrollment periods for health insurance exchanges scheduled to take effect in less than a year, in October 2013, these lessons from CHIP may be helpful to states building exchanges or planning to expand their Medicaid programs. A recent NASHP publication highlights these key lessons:

  • Target Efforts to Reach and Enroll Consumers – Although states initially used traditional mass-media advertising to generate awareness about their state’s CHIP, as CHIP programs matured, tailored and personal outreach strategies proved to be more effective in enrolling children.
  • Engage and Leverage Partnerships – CHIP programs acquired vast networks of partners, including other state agencies, foundations, health care providers, schools, and community based organizations, to help target their efforts to reach and enroll children. States could consider leveraging these partnerships to reach the parents and guardians of these children, who will likely be eligible for Medicaid or exchange-subsidized coverage.
  • Embrace and Evolve Web-based Tools and Opportunities – With the rise in use of the Internet, CHIP programs turned to websites to help support their outreach, marketing and enrollment efforts. Furthermore, the increasing use and reliance on mobile devices, including smart phones and tablets to access the Internet, will require states to further evolve and adapt their outreach and enrollment strategies. For instance, the Center for Medicare and Medicaid Services (CMS) plans to use the launch of its first-ever mobile site linked to the InsureKidsNow website to learn how families use mobile devices to get information about children’s coverage.
  • Keep it Simple – Many CHIP programs adopted a “less is more” approach in their initial outreach and marketing campaigns by not overloading their ads with program details. In addition, some states eventually took the opportunity to create new consumer-friendly brand identities, such as Illinois’ All Kids and Oregon’s Healthy Kids, to encompass their children’s coverage programs.
  • Grow and Sustain Awareness and Enrollment Through Adequate and Stable Funding – Fluctuations in outreach support, in terms of additional investments or budget cuts, have consequences for finding and enrolling eligible children. For example, in Oregon, additional investments in outreach may have contributed to reducing the uninsured rate of children by nearly 50 percent over the past two years.

At the 2012 NASHP Annual State Policy Conference, Cathy Kaufmann, the Administrator of Oregon’s Healthy Kids, the state’s children’s coverage program, shared some additional lessons. Oregon has learned through its efforts to reach and enroll an additional 114,000 children over the past two years:

  • Don’t spend a dime until you test your messages – Through testing, Oregon found that positive messaging works better than negative messaging.
  • Culturally aware outreach and marketing can help reduce health coverage disparities – Enrollment rates increased by 34 percent for Hispanics and 70 percent among Asian/Native Hawaiian children.
  • Outreach is hard work, harder than everyone thinks – Outreach work requires a lot of technical assistance, and successes may not be measurable.
  • Dedicate staff focused on outreach with measurable goals – Oregon hired individuals to work with specific outreach partners, such as schools, in order to provide them with the support needed to reach eligible children.
  • Work with partners in addition to those who are not paid grantees or assisters – It is critical to build and extend the network of partners beyond those who might be receiving a monetary incentive from the state to enroll children.
  • Focus on messaging for eligibility staff in addition to messaging for future enrollees – It is important to make sure that field staff are aware of changes to CHIP programs, such as increasing eligibility, so they can better assist potential enrollees.

Oregon also is planning to build its exchange navigator program from its existing Healthy Kids outreach grantees. Ms. Kaufmann also shared that Oregon plans to apply the CHIP outreach and application assistance lessons learned to outreach efforts for the Medicaid expansion and the state’s exchange.

Let us know what lessons your state has learned in its efforts to reach and enroll children! Post your thoughts in the comments below.



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