The Medicaid Eligibility Maze: Coverage Expands, but Problems Persist

This report examines Medicaid eligibility policies and operations in five states – California, Colorado, Florida, Minnesota and Wisconsin – following initial changes introduced by the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 and the new Children’s Health Insurance Program (CHIP). The study findings suggest that eligibility policy expansions alone may not prevent Medicaid enrollment declines. The report discusses several problem areas affecting Medicaid eligibility and enrollment operations including challenges in severing Medicaid and welfare, complex rules and procedures, and systems and communication inadequacy.