Because many misperceptions about Medicaid and SCHIP exist, it is important that you are knowledgeable about health care coverage options in the AI/AN community, that you are familiar with the local entities that deliver health care services and that you have a general knowledge of the community and its history. If families try to enroll in a program based on inaccurate information, frustration levels could rise, the enrollment process might be abandoned and the children who need health care coverage might not get the health care they need.
The steps below will help you reach your goal of enrolling families and children in low-cost or free health care coverage programs.
Each state administers its Medicaid program and SCHIP differently, so it is important to understand the application process and basic eligibility requirements for your state. For information on your state's Medicaid and SCHIP, visit the Centers for Medicare & Medicaid Services Web site at www.cms.hhs.gov. Following are questions you should be able to answer about your state's Medicaid and SCHIP program before you begin outreach activities:
A common occurrence within the AI/AN community is that adults "adopt" their grandchildren, nieces, nephews, cousins or neighbors and consider them spiritually part of their family. However, oftentimes the child is not legally adopted. According to SCHIP eligibility requirements as of March 2006, the adult enrolling a child into the program must be the child's legally adoptive parent or have legal guardianship over the child. However, this policy does not apply to Medicaid enrollment. It is important to understand this when informing people that they may be eligible for these programs.
To better understand the uniqueness of the AI/AN community, first locate the community's children's health leaders. Introduce yourself and listen to what they tell you. You may encounter a sense of mistrust of outsiders. This mistrust is based on historical events. Be aware of the tensions that remain and stay abreast of current controversies. While these controversies may not be relevant to health care, they may still affect a family's desire to participate in a government program. Bringing cultural sensitivity to your work is critical to conducting successful outreach and building trust with AI/AN families.
Inform state agencies and providers that might be affected by your outreach work. Will your local eligibility determination office be prepared for the influx of applications that may result from your outreach efforts? Have you been in contact with the administrators of the IHS, Medicaid program and SCHIP in your state? Never assume that your colleagues know about, or can handle, families wanting to enroll. Make sure they know what you are doing and can handle additional applicants.
A common experience when AI/AN parents apply for Medicaid or SCHIP is that the agency assumes they have full health care coverage through the I/T/U system. The agency might then incorrectly deny the family's application, which affects the trust level between the tribal community and the agency. It is important to make sure state agencies know that you are beginning this outreach campaign to AI/AN communities. You must also make sure that they inform state eligibility workers that AI/AN families are in fact eligible, even if they receive services through the I/T/U programs.
It is important that everyone involved in distributing information about Medicaid and SCHIP remain informed and educated about changes in coverage and program guidelines. Keep up to date on policy changes by staying in touch with the office that administers the Medicaid and SCHIP programs in your state.