More Health Care Plays

Enrolling the uninsured in available health insurance programs is one of the major challenges in achieving universal health care coverage. Across the country, over 60 percent of uninsured children are eligible for either Medicaid or the State Children's Health Insurance Program (SCHIP), but are not enrolled. Not only does this mean that millions of people suffer from health problems that could have been mitigated with timely care, but it means that everyone loses the opportunity to save money with preventive care.

The problem with getting more people covered through available programs is that many people are thwarted by needless bureaucratic barriers and do not enroll. One remedy is to modernize these programs with information technologies that make government services user-friendly, allowing citizens to cut through the government agencies electronically, and find uniform information and services at every location.

"We must do everything we can to make it easier for families to enroll children in the health insurance programs available to them." -- U.S. Rep. Adam Schiff, California

California's innovative approach to online enrollment offers an excellent example of using technology to increase people's access to health care. First piloted in San Diego, then-Gov. Gray Davis successfully launched a first-in-the-nation online application, dubbed "Health-e-App." Developed in partnership with the California HealthCare Foundation and the Medi-Cal Policy Institute, the bilingual and audio-capable online application guides citizens through a streamlined application process for Medicaid and SCHIP eligibility and provides real-time preliminary eligibility determination. Currently, Health-e-App is available statewide for pregnant women and children's applications to Medi-Cal (California's Medicaid program) and Healthy Families (California's SCHIP program).

Building on the success of the Health-e-App technology, the California HealthCare Foundation and The California Endowment jointly funded One-e-App, an innovative Web-based system for connecting families with a range of publicly funded health and human service programs. Communities can use One-e-App to screen individuals and families for programs such as Medi-Cal, Healthy Families, their own local children's health insurance expansion programs, and adult indigent programs, and individuals can submit their applications to those programs electronically. One-e-App provides a cost-effective, one-stop approach that improves the efficiency and user-friendliness of the application process for families seeking coverage and for agencies. With One-e-App, counties can better serve uninsured individuals and families and maximize the use of state and federal resources. One-e-App is currently being used in five California counties and is in development in Los Angeles.

According to the California HealthCare Foundation, Medicaid or SCHIP could potentially cover 75 percent of the state's two million uninsured children under current eligibility rules. At the same time, Health-e-App gives consumers more choice and the benefits of competition among health care providers tailored to the specific location, health needs, and language of each family.

Arizona, Georgia, Pennsylvania, Hawaii, Indiana, Texas, South Dakota, New Mexico, Massachusetts, Michigan, Nevada, Utah, Vermont, West Virginia, and Washington have also implemented online application systems for the uninsured. In Georgia, for example, the "smart" software will stop incomplete applications from advancing to new sections with key prompts, and automatically stop ineligible applicants, such as non-custodial parents and non-Georgia residents, from submitting the application. Twenty-three percent of Georgians who applied indicated that they likely would not have applied if they had not been able to apply online. In Pennsylvania and Washington, the idea of online enrollment has expanded to make access to a range of government services more centralized. The states' online enrollment application provides not only services for children and pregnant women, but also access to determine eligibility for other assistance programs, such as food stamps and cash assistance. For more ideas, state and local officials should look to the regional pilot programs recently instituted in Louisiana, Maryland, New Jersey, and Nevada.

States made significant progress clearing similar bureaucratic barriers as they implemented welfare reform and SCHIP. As a result, long application forms, complex eligibility requirements, and mandatory visits to the welfare office are disappearing or gone. Today, it is time to ramp-up efforts to modernize our health insurance programs with the information technology needed to give the nation's most vulnerable people access to health care.

Resources for Action

The One-e-App website provide a one-stop-shopping source for information about One-e-App, including the history of the initiative, a demo of the online experience, updates about its implementation, and an analysis of the benefits.
www.oneeapp.org

Georgia's PeachCare for Kids
www.peachcare.org/

Pennsylvania's COMPASS (Commonwealth of Pennsylvania's Access to Social Services)
www.compass.state.pa.us

Texas' TexCare
www.texcarepartnership.com

Washington state Department of Social and Health Services
http://www1.dshs.wa.gov/

Additional Reading

"Enrollment Hits the Web: States Maximize Internet Technology in SCHIP and Medicaid," NGA Center for Best Practices, Issue Brief, May 29, 2002
www.nga.org/Files/pdf/SCHIPTECH053002.pdf

"Idea of the Week: Online Enrollment for the Uninsured," DLC New Dem Daily, January 26, 2001
www.ndol.org/ndol_ci.cfm?contentid=2940&kaid=131&subid=20775

The Lewin Group, Business Case Analysis of the Health-e-App
www.chcf.org/documents/policy/HealtheAppBCAExecSummary.pdf

Kirsten Wysen, A State Guide to Online Enrollment for Medicaid and SCHIP, National Academy for State Health Policy, January 2003
http://www.nashp.org/Files/guide
_to_online_enrollment_kw.pdf

Contacts

Claudia Page
Director
The Center to Promote HealthCare Access
1333 Broadway, Suite 1020
Oakland, CA 94612
(510) 834-1300
cpage@oneeapp.org

David B. Kendall
Senior Fellow for Health Policy
Progressive Policy Institute
4021 Heritage Way
Missoula, MT 59802
(406) 543-2265
(772) 679-0652 (fax)
dkendall@ppionline.org