Evaluation of Illinois' Outreach Efforts to Maximize Enrollment In Their Medicaid/Chip AllKids Program

Background and Purpose: Approximately 40 percent of the 45 million uninsured Americans are eligible for coverage by Medicaid or SCHIP but are not enrolled. Those eligible fail to enroll for several reasons, including language and literacy barriers, lack of information, welfare stigma, and application complexities. Given these reasons, states have undertaken multifaceted approaches to increase enrollment, such as community-based recruiting in neighborhoods, churches, and schools; and collaborating with local nonprofit organization to provide individualized help to applicants. The Robert Wood Johnson Foundation (RWJF) awarded funding to eight state Medicaid programs to support the “Maximizing Enrollment” initiative with the goal of understanding best practices in outreach, and funded an evaluation study to examine the initiative's success. This paper presents qualitative findings from an evaluation of Illinois' outreach efforts to maximize enrollment of eligible children in the Medicaid/SCHIP program, AllKids.

Methods: In-person interviews and meeting with seven key stakeholders and administrators of the AllKids program in Illinois were conducted at several time points over a two-year period beginning in 2009. The same core group of Medicaid administrators was interviewed in both years; however various stakeholders changed as relevant representatives from stakeholder groups varied over time. This allowed for continuity and institutional history, while also allowing for variability in points-of-view to emerge as policy and processes changed. The interviews typically lasted 60-90 minutes. Respondents were asked open-ended questions about the organization of AllKids, problems and possible solutions for enrollment and retention, and funding arrangements. Most of the interviews were digitally recorded. For others, copious notes were taken during and after the interview. Using Grounded Theory, interview data was coded openly and thematically by both authors for emerging themes. Prevalent themes were then compared, revised and validated using a systematic process of review.

Results: Two major factors led to successful outreach efforts in Illinois: inter-agency cooperation and strong collaboration with community-based nonprofit organizations to enhance enrollment application processes. Since AllKids is implemented within two sister government agencies responsible for administering Medicaid (the Illinois Department of Health and Family Services and the Illinois Department of Human Services), the collaboration between the two was crucial for successful program implementation. Additionally, Medicaid's use of community-based nonprofit organization as liaisons between government and clients served as an important public-private collaboration to improve enrollment and retention. Yet, the current state budget deficit continues to be a significant barrier to maximizing enrollment, severely constraining funding to state offices and collaborating non-profit organizations, and preventing the development of an integrated electronic infrastructure.

Conclusions: Findings suggest that an important next step for improving Medicaid enrollment rates in Illinois will be the development of an integrated electronic infrastructure that be used in conjunction with community-based to expedite enrollment. Since the costs for infrastructure development are insurmountable in fiscally-stressed states, they are unlikely to happen without mandates by state health care reform implementation, in addition to collaborative, public-private investment. In addition, efforts that improve continued public-private collaboration are warranted to maintain community-wide relationships strained by the state budget crisis.