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If you build it, they will come … at least some of the time.

The number of children eligible for Medicaid and the Children’s Health Insurance Program (CHIP)  but not enrolled fell to 4.3 million in 2009 from 4.7 million the prior year, according to out today.  The drop is significant because it occurred even as the number of children eligible for the programs rose by 3 million as a result of the economic downturn.

Researchers and federal officials attributed part of the improvement in uninsured kids to the March 2009 reauthorization of the CHIP program, which spurred states to increase eligibility in the program as well as provided new federal funding to increase outreach and streamline enrollment efforts.  “Without the CHIP reauthorization we would not have seen these gains, “ said Genevieve Kenney, a study author and a health economist with the Urban Institute. The report comes from the Urban Institute and the Robert Wood Johnson Foundation.

On Thursday, the U.S. Department of Health and Human Services $40 million in additional outreach and enrollment grants to in 23 states. More than $40 million had already been awarded in 2009 and 2010.

The latest round of grants will focus on using technology to ease renewals and help enroll teens, among other things.

All but six states made gains in 2009 in increasing the children’s participation rate in Medicaid and CHIP, state and federal health insurance programs for the poor and disabled.

Still, there’s a huge variation in how well states make sure eligible kids are enrolled. The worst performing state was Nevada, which only had a 63 percent participation rate. Massachusetts had the highest rate at 96 percent.

Three states—Texas (693,000), California (661,000) and Florida (381,000)—account for 40 percent of the 4.3 million eligible but uninsured children.

There’s a good reason some states haven’t tried hard to get these kids into Medicaid and CHIP: It costs states money. And with their Medicaid expenses already skyrocketing, there’s pressure to not make the problem worse.

But the Obama administration has started offering states millions of dollars if they increase participation rates in the programs. The incentive funding and the outreach grants have helped Oregon cut their eligible but uninsured rate in half.

Meanwhile, Texas Medicaid officials say they are working on the problem.

“We’ve strengthened our outreach for Children’s Medicaid and CHIP, and that’s helping us reach more kids,” said Stephanie Goodman, spokeswoman for the Texas Health and Human Services Commission. “We know that there are still many more children who would qualify for those programs if they applied, so we’ll continue to look for new ways to reach those families.”

States, Community Groups Efforts to Sign Up Uninsured Children — June 6, 2010