Bill: Remove Red Tape in ARKids First (SB65)

Lead sponsors: Sen. Jimmy Jeffress, Rep. Clark Hall

Over half of the state's uninsured children are already eligible for ARKids First, but problems with enrollment and renewal keep them off the program and uninsured. We need to cut the red tape in ARKids First to make enrollment and renewal easier for families reduce state expenses. Streamlined enrollment and renewal procedures can save Arkansas money and resources and ensure continuity of health care for children.

Each year, bureaucratic red tape pushes 20,000 qualified children off ARKids First: Many children fall through the cracks during re-enrollment for ARKids First because of paperwork and procedural requirements, not changes in eligibility. ARKids First requires families to re-enroll in the program each year by returning a form mailed to the home address on record. Between 2007 and 2009, 49 percent of children leaving ARKids First rolls were dropped for paperwork or procedural reasons-such as when a family does not return a renewal form or has moved and the form gets lost in the mail. On average, more than 20,000 children annually lose ARKids First coverage and access to the health care they need to keep them healthy. This isn't necessarily because they were no longer eligible, but because their parents simply did not return a form on time or provide other required information. SB65 would make it easier to keep kids covered and healthy by:

Expanding paperless renewal options: Right now, families re-enroll their children in ARKids First by submitting a paper form; instead, we can use paperless or "administrative renewal" procedures to verify an enrolled child's ongoing eligibility for ARKids First. This system would use administrative databases (such as income records in workforce services databases) to determine eligibility when families are renewing. This could be easily integrated into the Access Arkansas online system. Parents would be asked to report changes to their income as they happen and would avoid having to submit forms each year to prove eligibility. Louisiana made similar changes in its renewal system and has seen results from it. They now lose less than one percent of enrolled kids from paperwork-related renewal problems, compared with 49 percent of enrolled kids who are lost each year from paperwork problems in Arkansas. (1)

Offering 12 continuous months of coverage. Under ARKids First B, enrolled children currently keep coverage for a year, regardless of income changes during that year. This ensures that income fluctuations do not disrupt coverage. This bill would transfer children in ARKids First A to ARKids First B for the remainder of the 12 month enrollment period if their income changes.  (2)

Starting Express Lane enrollment. Case workers can use approved applications from other programs-such as free school lunch applications-to approve ARKids First enrollment, so families don't have to submit the same information many times to apply for related programs.

What will it Cost? UPDATED (3-11)!  DHS estimates this bill to cost roughly $1.6 million in state dollars, which would bring an additional $6 million in federal match.   Enrolling and keeping more kids on the program will cost more money, but these are children the state has already decided to serve.

This does not reflect possible administrative savings that other states have experienced from decreased processing time among state workers, not to mention time and resources saved by the medical providers who lost time and money for lost appointments or helping families get re-enrolled. Louisiana, for example, experienced $19 million in savings annually. Adding red tape in Georgia renewals cost the state $17 per enrollee. 

Making these changes would allow Arkansas to compete for federal bonus funds. In December, 15 states received between $3.5 million (Louisiana) and $55 million (Alabama) in bonus funds for making these changes and reaching eligible, uninsured kids.  

Research Says...

Arkansas is a leader in covering children. We were one of the first states to create a children's health insurance program for low- and middle-income families when ARKids First started in 1997. Since then, we've cut the number of uninsured Arkansas children in half to under 10 percent today. It's time to finish the job and make sure all Arkansas children are covered.

ARKids First works and is serving families during the economic crisis. Health insurance impacts the economic stability of families as well as their health. ARKids provides affordable and quality health care, especially important as more and more families face economic uncertainty recently. During the recession, ARKids has done its job, serving 30,000 more children whose families need the support as they lose health care coverage from employers or coverage becomes unaffordable.

Every dollar the state spends on Medicaid yields over $6 in the economy. A recent report by the Walton College of Business stresses the economic impact of Medicaid spending in Arkansas. The report considers the relationship between Medicaid and the state economy, along with the opportunities that new dollars will bring to the state (GDP increase in the healthcare sector, job opportunities, etc.). It concluded that for every dollar the state puts into Medicaid, the state received an estimated $6.31 in economic benefit and output. (3)

Improving the enrollment and renewal process for families can be done without risk of fraud. Many states that have found ways to make enrollment easier for families have not sacrificed program integrity. They use state databases and other information to their fullest. In fact, Louisiana has made many of these enrollment simplifications and has the lowest error rate in the country at 1.56 percent. (4)

When children are healthy, families and communities thrive. Children with health insurance are more likely to receive the health care they need to become healthy, educated and productive citizens. Parents can ensure their children receive quality routine health care, as well as needed help in a medical emergency. When children are covered, it also impacts education and future workforce development. Good health is linked with school performance and children with health insurance are more likely to access health services. (5) Studies in Missouri and California found that when uninsured children received health insurance, school absences decreased and they were more likely to pay attention in class and keep up with school activities. (6)

For more information, contact Elisabeth Burak at (501) 993-1585 Ext. 119 or Elisabeth.burak@aradvocates.org

(1) Georgetown Center for Children and Families (2009). The Louisiana Experience: Successful Steps to Improve Retention in Medicaid and CHIP. Washington DC: Georgetown University. Available at http://ccf.georgetown.edu/index/cms-filesystem-action?file=postcards/the%20louisiana%20experience.pdf

(2) Cohen Ross, D. et al (2009). Findings of a 50 State Survey of Eligibility Rules, Enrollment and Renewal Procedures, and Cost- Sharing Practices in Medicaid and CHIP for Children and Parents During 2009. Washington, DC: Kaiser Commission on the Medicaid and the Uninsured. Available http://www.kff.org/medicaid/upload/8028.pdf

(3) University of Arkansas Sam M. Walton College of Business (2010). The Economic Impact of Medicaid in Arkansas. Available http://www.aradvocates.org/assets/PDFs/walton-Medicaid-impact-report-2010.pdf

(4) J. Ruth Kennedy, LA Department of Health and Hospitals (2009). Saving Trees in Louisiana: Keeping Eligible Children Enrolled in Medicaid and CHIP with Paperless Renewals. CHIPRA Children's Outreach Summit, power point presentation, November 4, 2009, Chicago, IL.

(5) Schwarz, C. and Lui, E. (2000). The Link Between School Performance and Health Insurance: Current Research. San Francisco, CA: Consumers Union.

(6) Center for Family Policy and Research (2003). Children's Health Insurance. Columbia, MO: Center for Family Policy and Research and Child Health Assessment Project (2002). Data Insights Report No 10. Available http://www.mrmib.ca.gov/MRMIB/HFP/PedsQLYr2CHHS.pdf