New York Examines Beneficiary Retention Problems in Public Health Insurance Programs
As New York State prepares to launch a new health care program for poor adults who earn too much to qualify for Medicaid (see story 6), critics are drawing attention to the state's recertification process used to determine if persons already enrolled in its existing public health insurance programs continue to be eligible, the New York Times reports. The state offers some of the "most generous health benefits" in the country and is "aggressive" in its recruiting efforts, but "burdensome rules" for renewing the same insurance benefits have caused many people to drop the programs or to temporarily lose coverage during the lengthy recertification process. While there are no firm numbers on how many beneficiaries lose coverage each year, about half of the three million people enrolled in a public health program do not recertify. Only about 1% of beneficiaries do not recertify because they "no longer meet the low income requirements." Experts say obstacles to recertification include a face-to-face interview requirement, the "daunt[ing]" task of producing the required income documentation, a general lack of understanding about the process and the application process itself. For example, the initial application for the state's CHIP program, Child Health Plus, is two pages in length; the recertification application is eight pages. According to the Times, this process is further complicated by the fact that the federal government requires that Medicaid-eligible children not be enrolled in Child Health Plus, meaning those children must transfer programs when they recertify.
Policy experts and lawmakers are beginning to discuss how to streamline the recertification process and ease the transfer from state insurance programs to Medicaid. To simplify the transition, the state has paid community groups "tens of thousands of dollars" to travel around the city and assist beneficiaries in recertification and enrollment. Saying that the recertification process, which is intended to "limit fraud," is a "carryover from an outdated welfare mentality" from the days when health benefits were linked to the cash benefits, state Assembly Health Committee Chair Richard Gottfried has suggested that the state use the free school lunch program as an example f determining or insurance eligibility, as it has "no asset test requirements." New York City officials are trying to link Medicaid enrollment with recertification for "concrete benefits" such as public housing and food stamps. In addition, the city is lobbying the state to drop the face-to-face interview requirement and change the recertification process to every other year, rather than every year. New York City officials and health plan administrators also are urging the state to adopt the practice of "presumptive eligibility" for recertification under which the state "assume[s] a family's income status has not changed" and continues benefits. Currently, New York state families are dropped from coverage until they prove their income status during the recertification process. John Signor, a spokesperson for the state Health Department, said the state is "looking for ways to make the [recertification] process easier," but added that dropping the annual process would "pose its own problems" because the state would continue to pay managed care companies for those beneficiaries who had moved out of state. But "experts" say that "ironing out recertification is more pressing than ever" as New York prepares to launch its Family Health Plus program for low-income adults. "We want to make sure that beyond simply begin enrolled [in public health programs], people are getting a fairly good experience," state Sen. Kemp Hannon (R), chair of the state Senate Health Committee, said (Steinhauer, New York Times, 12/31).