Access to Health Care Coverage for Children Improves:
Medicaid Simplification Should Help Trend Continue

By Melanie R. Margolis

The federal government and the states have been working to improve access to health care through the Children’s Health Insurance Program (CHIP) and Medicaid programs. CHIP is a program intended to insure children in families with income too high to qualify for Medicaid but not high enough to afford to buy health insurance. Newly released figures from the U.S. Department of Health and Human Services indicate that approximately 4.6 million children were covered under CHIP during fiscal year 2001, representing a 38% increase from 2000. Only 3.3 million children were covered under CHIP during fiscal year 2000. See Currently, the estimated number of children in Texas enrolled in CHIP is 516,631. Regularly updated information concerning application, enrollment, and eligibility determination activity in Texas is available at Medicaid simplification is expected to help continue to improve children's access to health care.

Medicaid simplification was one of the hottest topics in the 77th Texas Legislature. After extensive negotiation, Senate Bill 43 passed the Legislature and was signed into law by Governor Perry. The Medicaid simplification law called for combining the CHIP and Medicaid applications and streamlining the approval processes for Medicaid eligibility. After months of work, the Texas Health and Human Services Commission recently issued its proposal for implementing Medicaid simplification in Texas. For more information, see

The CHIP application and the children's Medicaid application have become a joint application. A draft of the joint application is available on the Internet at Essentially, the CHIP application has been expanded, and the joint application now includes the assets questions and additional questions for Medicaid, which will no longer be asked as a second step. This joint application process is expected to improve and speed the processing of all applications, whether applicants ultimately enroll in CHIP or Medicaid. A social security number (SSN) or documentation of application for a SSN is required on the joint application. A SSN is considered necessary for the application process between CHIP and Medicaid to be "seamless."

Some advantages under the new simplification rules include: i) initial applications and renewals for children's Medicaid may be processed by mail or telephone; and ii) children under 19 are certified for 6-month periods and remain continuously eligible regardless of changes in household composition, income, and resources. A Medicaid renewal form asking the same questions as the CHIP form will be sent to enrolled families in the 4th month of their 6-month continuous eligibility period. Families will be able to state on this form that there have been no changes, and they will be able to return it without having to fill out the entire form.

Generally, parents or guardians whose children are newly Medicaid-certified after January 1, 2002, are subject to an orientation requirement, the purpose of which is to explain Medicaid coverage to families. Parents or guardians of newly certified Medicaid children must attend an "in-person" health care orientation (HCO). The script to be used for the HCOs is available at This material will be used by the Texas Department of Health Texas Health Steps (THSteps) staff and contractors and participating community-based organizations (CBOs) for the HCOs. The THSteps Division is seeking CBOs that serve a Medicaid-eligible population to participate in the implementation of this requirement. The form by which CBOs can indicate interest in participating is available at

On January 14, 2002, HHS sent a letter to state health officials, online at, to transmit to them a new guide on Medicaid eligibility policy to assist states with child health programs that are working on coordinating Medicaid simplification and those states providing coverage for children through Medicaid expansions. The guide is entitled "Continuing the Progress: Enrolling and Retaining Low-Income Families and Children in Health Care Coverage." It is available at