by Tricia Brooks

A recent survey by Lake Research Partners refreshes our knowledge of barriers to enrollment in Medicaid and CHIP. Commissioned by CMS for its Connecting Kids to Coverage initiative, the survey interviewed nearly 2,000 parents with income at or below 250% of the poverty level; about one-third each with uninsured children, children enrolled in Medicaid/CHIP, or children covered by employer insurance. Almost a quarter of respondents were Spanish speakers and as a result, the findings provide insight into the differences in approaches needed to reach English versus Spanish speaking families.

Understanding what motivates parents to enroll their children is helpful to fine-tuning outreach strategies. Integrating effective marketing messages that cite "peace of mind," access to services and affordability are most likely to prompt parents to take action.

* Peace of mind - A large majority (71%) of parents cite peace of mind as the top reason to enroll their children in coverage.

* Access - Other top motivators include having a regular doctor for their child (70%) and access to services such as prescription drugs (69%), dental care (68%) and vision care (65%).

* Affordability - Finding out about the affordability of the program also prompts families to take action. Having a clear sense of income eligibility, such as noting the top income level for a family of four, helps clarify for parents if their children are eligible for coverage.

Identifying and addressing barriers to enrollment are critical to develop an effective outreach and marketing strategy for Medicaid and CHIP.  While the top issues come as no surprise, having persisted over time, the survey reinforces the ongoing need to streamline policy and sustain outreach.

* Difficult enrollment process - Just over half of parents (51%) without children currently enrolled believe the process is somewhat or very difficult.

* Income too high - Almost half (43%) of parents without enrolled children think their family's income is too high and a quarter (24%) say they aren't sure. Even 21% of families with income below the poverty level believe their income is too high.

* Uncertainty about how to apply - More than one-third of families with uninsured children (37%) don't know where/how to apply.

While most parents prefer online, phone and mail applications, parents in the lowest education and income groups also like the ability to apply in person at a government office. There were distinct differences noted on this point in the opinions of English-speaking parents compared to Spanish-speakers. Notably, 62% of Spanish-speaking parents say they would be more likely to enroll at a government office compared to only 26% of English-speaking parents. Of all the enrollment options, the highest percentage of Spanish speaking parents (72%) liked enrolling by mail. Spanish-speakers also say they would be more likely to apply if in-language applications and assistance would be available, and if they would not be questioned about their own immigration status (which is not relevant to their child's eligibility).

Outreach, education and enrollment options are important means to advancing children's health coverage. However, we know that retention of eligible children is also a high priority considering that more than one-third (35%) of uninsured, eligible children were enrolled in the previous year. The biggest surprise in the survey (at least for me) is that only two-thirds (67%) of parents who have had a child enrolled in Medicaid or CHIP were aware of the need to renew their child's coverage. Clearly this is an area we must continue to address in our efforts to keep all eligible children enrolled.

While many of the survey's findings reaffirm what we know about barriers and opportunities to improve enrollment, it points to the need to continue to press forward with ongoing outreach, education and procedural improvements to ensure that every eligible child is enrolled and retains their coverage. Businesses conduct market research on an ongoing basis to improve their results. We should expect nothing less of our public programs if we want them to perform efficiently and cost-effectively. Thanks to CMS for commissioning this important market research on something far more valuable than selling widgets - that is, ensuring the health of America's children.

Cross posted from the Say Ahhh! blog