March 22, 1999
Dear TANF Administrators, State Medicaid Directors, and CHIP
Directors:
Through an ongoing strategy to reform welfare, the Administration has
fought to continue efforts to support low-income families, especially
those trying to make the transition from welfare to self-sufficiency.
As part of these efforts, it is critical that progress is made towards
increasing the number of Americans with health insurance. The
delinkage of Medicaid from cash assistance and declining welfare
caseloads have created both challenges and opportunities for providing
this support for working families. It is important that we use
effective strategies and find new ways to reach children and families
outside, as well as through, the welfare system.
In order to help policy-makers overcome these challenges, and to
realize the potential of these opportunities, we have developed the
enclosed guide, "Supporting Families in Transition: A Guide to
Expanding Health Coverage in the Post-Welfare Reform World." This
guide contains information regarding processes and procedures that
will help ensure as many children and families as possible obtain
health insurance.
In a letter we sent you on June 5, 1998
(http://www.hcfa.gov/medicaid/wrdl605.htm), we encouraged you to
coordinate both the administration of, and eligibility for, your TANF
and Medicaid programs. In that letter, we highlighted states’
responsibilities to establish and maintain Medicaid eligibility for
families and children affected by welfare reform, and we also outlined
the broad flexibility the statute affords you to expand eligibility.
Through the enclosed guide, we are providing additional information to
help you accomplish these important goals.
In addition to explaining state options and suggesting appropriate
strategies, the guide summarizes the application and enrollment
requirements for the Medicaid program. Two of the most critical
requirements are that States must:
· Provide Medicaid applications upon request. Based
on Medicaid regulations (42 CFR 435.906), the Department of Health
and Human Services (DHHS) has determined that states using joint
TANF-Medicaid applications must furnish a Medicaid application
immediately upon request and may not impose a waiting period before
providing the application for Medicaid.
· Process Medicaid applications without delay. States
must assure that an application for Medicaid is processed quickly
and not delayed by any TANF requirement. In states where TANF
application or eligibility is delayed (i.e., families receive
diversionary assistance or face any other initial administrative
steps), the state must process the joint application immediately to
determine Medicaid eligibility.
Page 2 – Dear Administrators and Directors
In addition to issuing the guide, we will be expanding our technical
assistance efforts to states to ensure that TANF programs are designed
and implemented so that children and their families are informed about
Medicaid and CHIP and enrolled when eligible. To focus our efforts
more effectively, we will work with states to review their welfare and
Medicaid eligibility and enrollment procedures. This process will help
us assist state agencies in improving their practices, it will further
help us by identifying successful models of coordination that can be
shared with other states.
We recognize the new needs for outreach, accessibility, and
coordination that have arisen from the delinkage of Medicaid from the
welfare system, and the growing number of working families unlikely to
enter the welfare office but likely to be eligible for Medicaid. In
light of these new challenges, we are committed to working with you to
establish the most effective Medicaid application and enrollment
procedures for low-income families with children.
We look forward to continuing this very important work with you and to
charting the gains we make together in improving the health coverage
of all low-income children and families, and in supporting the
transitions of families from welfare to self-sufficiency. In the
meantime, please contact your HCFA or ACF Regional Administrator or
your Regional Director with any questions or for additional
information.
Sincerely,
Olivia Golden
Assistant Secretary
Administration for Children and Families
Nancy Ann Min DeParle
Administrator
Health Care Financing Administration
Last Modified on Friday, September 17, 2004
|