Tracking Your Success
Retention: Ideas for Improvement

Updated: 6.1.06

Simplify the renewal process:
Experts recommend that states consider: annual renewal (as opposed to quarterly); reducing face-to-face interviews; allowing families to self-declare income (instead of having to provide paycheck stubs); providing pre-filled renewal forms; creating simpler renewal forms; sending self-addressed, stamped envelopes that families can use to return their renewal forms; and, in some cases, passive renewal (the process in which families must only provide information if their income or other family circumstances have changed, otherwise they are assumed still eligible). Allowing "off-cycle" renewal for families who do not have income changes to report but want to renew before their year is up for convenience has also been recommended.

Reach out to families at risk of losing coverage:
Many states are already implementing a number of the following ideas: contacting families in danger of losing coverage to encourage them to complete the renewal forms; improving renewal notices so that they are clearer and will grab the families' attention; keeping addresses up to date; sending out reminder notices before renewal deadlines; providing toll-free information lines in multiple languages so that families can call with questions about renewal; and developing renewal notices in multiple languages.

Provide renewal assistance:
Experts recommend that states offer the same kind of assistance that many already provide to families when they enroll in Medicaid and SCHIP. This would involve community-based "renewal assistors" to help families complete forms and to answer questions about the renewal process. Experts also recommend engaging physicians, hospitals, employers, health clinics, schools, managed care plans and other community-based organizations in the renewal process and in providing assistance to families who might lose coverage.

Coordinate programs and databases:
A number of experts believe there are many potential benefits from states improving their databases so that they can better track the movement of families between various programs. They also recommend creating database systems that will automatically allow different programs to share information about enrolled families so that household changes only need to be reported once. This may cut down on the number of renewals in which families must participate, which will lead to higher retention.

Relax premium payment rules for SCHIP:
Experts believe that retention will improve if states build in more flexibility to help families who occasionally miss premium payments. Some states have already switched to an annual premium payment to address this problem, while others use automatic payment deductions and have created a universal premium amount (i.e., everyone pays $15 each month).

Measure the effectiveness of renewal strategies:
Some experts believe that it is still unclear how changes such as passive renewal and self -declaration of income really affect retention.

Survey families who lose coverage:
Some experts suggest that states conduct their own disenrollment surveys to better understand the reasons why families lose coverage. They point to data that shows that programs and families often give different reasons for disenrollment. Conducting these studies could help states improve their data systems and better understand reasons for disenrollment.

Encourage current enrollees to use necessary health services:
A few researchers say there is a correlation between use of health services and retention in Medicaid and SCHIP. They assert that if families use necessary services, they are more likely to value the program and therefore stay enrolled.

Continue delinking Medicaid from welfare and food stamps:
Some experts explain that some states still need to do a better job of ensuring that all families are offered Medicaid or SCHIP regardless of their involvement with existing programs like TANF and food stamps.

For a full report on ideas for improvement in Medicaid and SCHIP retention, download the Covering Kids & Families Communications Strategies for SCHIP and Medicaid Retention guide.