That means that current CHIP families and all new enrollees must go through DHS instead of their CHIP health insurance plan to determine eligibility. DHS now determines who qualifies for CHIP and processes all new applications and renewals. The transition of eligibility processing and determinations from the CHIP MCOs to caseworkers in local DHS County Assistance Offices (CAOs) came on the heels of the unwinding process of Medicaid continuous coverage—and unsurprisingly, complications arose. First, problems are likely to occur with any significant IT transition. However, many unanticipated system errors arose, which DHS had to fix or is still attempting to resolve. Some of the system problems have caused enrollment challenges. It is unclear how many children lost coverage—or experienced even temporary gaps in coverage—during the months after the transition because DHS stopped releasing its typical monthly data reports. It also took until October for the DHS unwinding data tracker to populate the number of CHIP referrals. As noted in a prior section, the number is much lower than expected. Second, and a hurdle predicted well ahead of time, is that the CAO caseworkers, who already have full workloads with the unprecedented task of Medicaid unwinding along with other benefit programs, added more work onto their plates by processing CHIP applications and renewals amid staffing shortages. This results in long wait times on phones to try and solve problems. It is clear that the complexity of the CHIP eligibility systems transition overlapping with the Medicaid unwinding has caused an unnecessary burden, mainly falling on CHIP families who have experienced added barriers to gaining or restoring coverage for their children.
The first years of a child’s life are ones of rapid development and need for regular access to health care. Continuous eligibility in early childhood provides consistent coverage and continuity of care by keeping children enrolled, regardless of their family’s fluctuations in monthly income, disruptions due to difficulty navigating the renewal process, or other changes that cause a loss of eligibility. States also aim, with multi-year coverage, to reduce the administrative burdens of processing terminations and subsequent reenrollment. Medicaid enrollment churn and administrative burden is an issue of growing concern in Pennsylvania and nationally, as the unwinding of the pandemic-era provision illustrates reenrollment takes a toll on eligible individuals, particularly children. Children’s Health Insurance Program (CHIP) Eligibility Systems Transition This spring, a significant operational change that had been in the works long before the pandemic occurred in the Children’s Health Insurance Program. Disappointingly, it happened during the same month as the Medicaid unwinding got underway. Despite advocates’ concerns about the timing and urging the state to exercise its flexibility to delay, DHS moved forward in April with an IT eligibility systems transition. DHS should demonstrate its commitment to the health of Pennsylvania’s youngest children by providing continuous Medicaid coverage from birth through kindergarten.
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November 2023
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