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The Kaiser Commission on Medicaid and the Uninsured study of advertising for state Children’s Health Insurance Programs (CHIP) points out that in addition to effective advertising, states must work to eliminate barriers that may keep parents from enrolling their children. While marketing strategies focus on portraying coverage in an appealing manner, studies have shown that negative stereotypes of Medicaid are not reported by parents to be the most serious barrier to enrolling children. Rather, in focus groups and surveys, parents repeatedly report that enrollment problems are the primary barriers to enrolling their children in Medicaid or CHIP. "States must continue to simplify the enrollment process and develop additional strategies to broaden coverage if efforts to increase [CHIP] enrollment are going to be successful," the report states. Four barriers that parents have identified are:
1. They don’t believe the program is for them. Some parents say they do not think their children will qualify and thus have not tried to enroll them. They assume that they earn too much because they are workers and believe that the program is for poorer families.
2. They are not aware of the program. Parents are not part of any system where they would naturally learn about CHIP and Medicaid. Another group in this category involves those who do not speak English. Since broadcast and print ads still are primarily in English, such parents may have less opportunity to learn about the programs.
3. There is not enough information readily available. Some parents say that all they know about CHIP or Medicaid is the name of the program. They say that ads don’t provide details they want such as what it covers, income eligibility, and costs. Without knowing more details, some parents are reluctant to call a toll-free number or contact the program.
4. The enrollment process is burdensome. Parents say they must complete too much paperwork, miss time from work, go to the welfare office, fill out a complicated application, answer intrusive questions, and wait for many hours to enroll their children.
The commission suggests that states consider improving the enrollment process to live up to its advertising that it is quick and simple. Ideas include having mail-in enrollment forms or taking enrollments over the telephone; immediate enrollment with forms to be completed later; enrollment offices open after working hours or on weekends; automatic enrollment for children entering a school lunch program; enrolling at a doctor’s office or clinics; and providing help from someone who speaks the parent’s language.
"One specific suggestion made by states is to have trained assistants to help parents complete the application at all enrollment sites," the report says. "State officials claim that this is a successful way to help parents accurately complete the application, thereby reducing the number of applicants turned down because of incomplete forms."