Missing Babies: Best Practices for Ensuring Continuous Enrollment in Medicaid and Access to EPSDT
States have used various strategies for implementing this special infant enrollment protection to assure these infants keep and maintain coverage. Over the years, however, Medicaid’s increasing operational and technical complexity—resulting in part from lack of administrative oversight and changes in health care delivery such as managed care— have made implementation of continuous infant enrollment more challenging. As a result, states’ approaches to implementation vary widely, and not all are effective. Every state can do a better job implementing this policy. The aim should be to: 1) have every baby with a Medicaid/CHIP financed birth leave the birth facility (e.g., hospital, birthing center) with a card or written document that shows the eligibility/identification number to be used for infant care, 2) require no action by the family during first year to ensure continuous coverage, and 3) use enrollment procedures that are streamlined, clear, and have administrative check points around at both the time of birth and the time of the first birthday.
Based on a scan of state policies and procedures nationwide, the best practices identified in this report emphasize effective administration and communication along the continuum from prenatal period through the first birthday. These include: clear consumer-facing information on state websites, preassigned infant coverage cards given to the mother during prenatal period; mechanisms for families and providers to verify eligibility, training of navigators and out-stationed eligibility workers, and better use of data systems. The report includes examples of Medicaid managed care contract language and sample communication messages for families and providers.
Publication Date: January 2021
Source: Georgetown University Health Policy Institute-Center for Children and Families, Johnson Group Consulting, Inc.
Focus Area(s): Healthy Beginnings Supported Families
Impact Area(s): State, County, City
Topic: See What's Working Build a State Effort
Type: Models That Work