Medicaid Bonuses to Reward States for Insuring More Children

The Obama administration plans to announce Monday that it will make $206 million in bonus Medicaid payments to 15 states — with more than a fourth of the total going to Alabama — for signing up children who are eligible for public health insurance but had previously failed to enroll.

The payments, which were established when Congress and President Obama reauthorized the Children’s Health Insurance Program in 2009, are aimed at one of the most persistent frustrations in government health care: the inability to enroll an estimated 4.7 million children who would be eligible for subsidized coverage if their families could be found and alerted. Two of every three uninsured children are thought to meet the income criteria for government insurance programs.

To make enrollment easier, Alabama has eliminated asset tests for children, ended requirements for an in-person interview and allowed children to remain eligible for a year without renewal. It also sends out renewal forms with blanks filled in when data is known, and allows applicants to verify their forms with an electronic signature. The state has adopted “express lane eligibility” so that Medicaid application processors can use income findings from other safety net programs to validate eligibility.

A study published in the journal Health Affairs estimated the national participation rate among children eligible for Medicaid and the Children’s Health Insurance Program at 82 percent in 2008. Thirteen states had rates below 80 percent, with Nevada at only 55 percent. Ms. Sebelius said in an interview that it would be “a huge win for kids” if the rate could be pushed to 90 percent.