In Focus: Supplemental Nutrition Assistance Program (SNAP)

Oct 29, 2015  |  PERMALINK »

Targeted Medicaid Enrollment Reaches More Children

By Suzanne Wikle

The rate of children without health insurance has hit an all-time low of 6 percent, according to a new report from the Center for Children and Families. The drop is largely attributable to the Affordable Care Act (ACA) and to states’ efforts to increase enrollment. States that have opted to expand Medicaid to low-income adults saw the largest improvement in children’s coverage, even though most uninsured children were already eligible for health insurance under Medicaid or the Children's Health Insurance Program (CHIP) prior to ACA. The report uses American Community Survey data from 2014, the first full year of ACA implementation.

All Medicaid expansion states saw a decline in uninsured children, with an average decrease nearly twice that of non-expansion states. Much of the increase in children’s enrollment, especially in Medicaid expansion states, is likely due to enrollment of children who were already eligible. This is often referred to as the “welcome mat” effect. Multiple factors drive this effect, including increased awareness of Medicaid and automatic enrollment of children when their parents apply. Rhode Island and Colorado, two of the states with the greatest declines, were participants in the Work Support Strategies initiative, a targeted effort to coordinate programs to maximize enrollment of eligible children and adults.

In addition to the welcome mat effect, states can explore using three targeted enrollment options. As outlined in May 2013 guidance and extended as part of the August 2015 guidance, states can request a waiver to use Supplemental Nutrition Assistance Program (SNAP) data to identify those who are likely eligible for Medicaid. States may also use the waiver to identify newly eligible parents of children enrolled in Medicaid. Six states (AR, CA, IL, NJ, OR, WV) have used these strategies to enroll a total of 726,584 people.

A newer option provided to states in August 2015 allows the use of SNAP data to identify a smaller group of people who are certainly eligible for Medicaid. States must submit a State Plan Amendment to employ this strategy, which can be used on an ongoing basis for Medicaid enrollments and renewal s.

States that have not expanded Medicaid for adults can still use a version of targeted enrollment known as “Express Lane Eligibility,” which automatically determines children eligible for health insurance based on SNAP receipt.

West Virginia’s data demonstrates the impact of targeted enrollment strategies.

In 2013, prior to ACA implementation, West Virginia had a relatively low rate of uninsured children at 5.3 percent. This makes their  post-ACA rate (3 percent in 2014) all the more remarkable.  As the rate of uninsured children declines, it’s typically more difficult to identify those who are eligible yet uninsured, and broad public awareness or outreach strategies become less effective.

West Virginia coupled its Medicaid expansion with the state waiver targeted enrollment option. The state used SNAP data to identify people likely eligible for Medicaid, as well as targeted parents of children already enrolled in Medicaid.

Because income eligibility limits are similar for Medicaid and SNAP, the SNAP strategy employed by West Virginia is an effective way for states to identify who is likely to be eligible for Medicaid, conduct outreach to those individuals, and receive their consent for enrollment. This strategy may be especially effective at identifying children who are not enrolled in Medicaid despite traditionally being eligible. Using SNAP and other targeted strategies, West Virginia successfully enrolled 70,574 people in Medicaid.  Among all states, West Virginia saw the largest percent decline in the number of uninsured children from 2013 to 2014 (43.7 percent).

More states should follow the lead of West Virginia and use existing data to identify those who are likely eligible for Medicaid but not enrolled in the program.

Sep 30, 2015  |  PERMALINK »

Food Insecurity in the Spotlight

By Randi Hall and Nune Phillips

Far too many households in the United States have limited access to adequate food due to lack of money and other resources—this is known as food insecurity. According to this year’s Household Food Security in the United States report published recently by the U.S. Department of Agriculture, 48.1 million people in the United States (15.4 percent) lived in food-insecure households in 2014, an insignificant decline from 15.8 percent in 2013. Just as families with children are most likely to be poor in the U.S., households with children are also more likely to have food insecurity than those without (19.2 percent vs. 14 percent). Food-insecure households are also more likely to be headed by a single mother and to live below 130 percent of the poverty threshold. Moreover, 6.9 million households experience “very low food security”—they worry about running out of groceries before being able to buy more, or cut or skip meals and purposely go hungry. 

Food assistance programs such as the Supplemental Nutrition Assistance Program (SNAP) are vital to reducing persistent hunger among low-income households. In recognition of the increase in food insecurity brought on by the Great Recession, the American Recovery and Reinvestment Act increased the monthly SNAP benefit through November 1, 2013. However, since this higher benefit ended, families with young children are 17 percent more likely to experience food insecurity for both the household and the children. According to the Supplemental Poverty Measure (an experimental poverty measure that counts non-cash benefits to determine alternative poverty thresholds), SNAP alone kept 4.7 million people above the poverty line in 2014.

Millions of SNAP recipients will miss meals if their food assistance benefits are delayed, decreased, or otherwise negatively impacted. Over the next ten weeks as the FY 2016 federal budget operates under the temporary Continuing Resolution (CR), Congress will be deliberating a more permanent budget and must ensure SNAP is secure. Adequate and accessible nutrition is vital to human development, and children and families should not have to bear the consequences of Congressional inaction.  

Sep 4, 2015  |  PERMALINK »

CMS Announces New State Option to Streamline Medicaid Enrollment and Renewal

By Suzanne Wikle

On August 31, the Centers for Medicare and Medicaid Services (CMS) announced a new opportunity for states to use existing data to determine Medicaid eligibility. The new guidance provides states with an exciting new option to use income data from SNAP (or other means-tested programs) to determine Medicaid eligibility, both initially and upon renewal.  Adopting this strategy will reduce administrative burdens on states and recipients, allowing states to offer a streamlined application process to many individuals who are receiving SNAP but not Medicaid, both of which are important work support programs.

The new option provided in this guidance only applies to a subset of SNAP recipients who are certain to be income-eligible for Medicaid based on their gross SNAP income and household composition.  This new tool for states to increase Medicaid enrollment is especially exciting because it can be used for both enrollment and renewal, does not require a waiver, and is available on an ongoing basis. With the new guidance, CMS continues to provide states with tools to simplify Medicaid eligibility determinations, enrollment, and renewals.

This guidance expands upon an option originally provided to states in guidance issued in May 2013. In the six states that opted to use “strategy 3” from the 2013 guidance, which allows states to enroll most SNAP recipients under age 65 into Medicaid,  the use of SNAP data led to more than 700,000 Medicaid enrollments.  However, this strategy can only be used for initial enrollment, requires states to obtain a waiver, and was originally scheduled to expire in December 2015. In the new guidance CMS indicates it will continue to approve waivers beyond the original 2015 expiration date for “strategy 3” and other options provided in the 2013 guidance to the extent “necessary to ensure that states establish income and eligibility determination systems that protect beneficiaries” or in a state that has newly expanded Medicaid eligibility through the Affordable Care Act (ACA).

As states continue to tackle the job of implementing the ACA, using new options to streamline and simplify enrollment procedures across programs will be imperative to achieving efficiency and reducing burdens, both for caseworkers and those receiving the benefits.  This week’s guidance from CMS provides states with one more tool to streamline access to work support programs. With numerous additional states adopting Medicaid expansion since the 2013 guidance, this new option has great potential to build upon “strategy 3” and reach millions of uninsured Americans eligible for Medicaid.

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