Maximizing Private Coverage

Another effective strategy used by states to reduce underinsurance is to provide support and advocacy for families in understanding and using their health care benefits – either with the state Medicaid program or with their private insurance plan.

In Illinois, the Title V program has hired former staff members of health insurance companies who travel to regional CYSHCN offices and work with care coordinators, showing them how to help people maximize their private benefits and advocate with Medicaid to pay for needed services.

In Vermont, Title V staff works directly with privately insured families to advocate for coverage of services that are prescribed by a physician or referrals to out-of-net­work providers that were initially rejected by the insurer.

Advocacy and Benefits Counseling (ABC) for Health, a Wisconsin-based, nonprofit, public interest law firm, provides direct benefits counseling services to families having problems with health care coverage, adequacy of benefits, or access to services. ABC for Health has developed a model for training culturally competent and family-centered benefits counselors.