Covering kids a state and national overview
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COVERING KIDS: A STATE AND NATIONAL OVERVIEW. Catherine A. Hess Senior Program Director National Academy for State Health Policy. Non-partisan non-profit dedicated to helping states achieve excellence in health policy & practice.  

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COVERING KIDS: A STATE AND NATIONAL OVERVIEW

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Covering kids a state and national overview

COVERING KIDS: A STATE AND NATIONAL OVERVIEW

Catherine A. Hess

Senior Program Director

National Academy for State Health Policy


Covering kids a state and national overview

  • Non-partisan non-profit dedicated to helping states achieve excellence in health policy & practice.

  • Conduct policy analysis and research, interactive forums and assistance for executive & legislative branch state policymakers/administrators

    • Conference Oct 14-16, Denver

  • Offices in Portland, ME & DC

[email protected], 2007


Covering kids a state and national overview

  • Child health specific coverage work support from Packard, Atlantic Philanthropies, Kellogg and RWJ

  • 10 years supporting and reporting on state SCHIP implementation, now strong focus on reauthorization

  • Newer and growing focus on covering all kids

[email protected], 2007


Then and now a success story

Then and Now- A Success Story

  • In 1997, 23 % of low income children were uninsured

  • In 2004, 15% were uninsured, a drop of about one-third

[email protected], 2007


Ingredients of state success 1

Ingredients of State Success : #1

Seven Steps, drawn from state and national policy experts

#1 Keep enrollment and renewal procedures simple, especially

  • 12 month continuous eligibility

  • Administrative (passive) renewals

[email protected], 2007


Covering kids a state and national overview

[email protected], 2007


Seven steps for state success 2

Seven Steps for State Success : #2

#2 Community- Based Efforts Are Key to Enrollment

  • CA Childrens Health Initiatives evaluations- coordinated CBO work

  • MA experience- churning when CBO outreach cut

  • IL pays CBOs for each application leading to a new member

[email protected], 2007


Seven steps for state success 3

Seven Steps for State Success : #3

#3 Use technology-coordinate programs, reduce admin. burdens

  • CA Express Lane

  • MA Virtual Gateway

  • PA Compass

  • AL ADI

  • UT Clicks

[email protected], 2007


Seven steps for state success 4

Seven Steps for State Success : #4

#4 Change Agency Culture

  • Make goals clear

  • Change language

  • Provide training

  • Provide tools and create systems

[email protected], 2007


Seven steps for state success 5

Seven Steps for State Success : #5

#5 Engage Leaders Who Can Articulate a Clear Vision

  • Governors

    • Kids popular, relatively inexpensive

  • Community Leaders

[email protected], 2007


Seven steps for state success 6

Seven Steps for State Success : #6

#6 Engage partners, e.g.

  • Schools- incentives in federal nutrition and education programs

  • Managed Care Organizations- bottom line interest

  • Philanthropy- local and state foundations can help with research, planning, marketing

[email protected], 2007


Seven steps for state success 7

Seven Steps for State Success : #7

#7 Marketing Is Essential

  • To policymakers

  • To public

  • To eligible families

[email protected], 2007


Much more to be done

Much more to be done!

  • 9 million kids uninsured

    • Kids uninsurance rose in 2005

    • 6% (MA) to 20%+(TX)

    • Higher rates among adolescents, racial and ethnic minorities > need targeting?

    • 3 out 4 eligible for Medicaid/SCHIP

    • 96% are citizens

[email protected], 2007


Growing number of states aiming to go all the way

Growing Number of States Aiming to Go All the Way

[email protected], 2007


Getting to all some challenges identified by states

Getting to All: Some Challenges Identified By States

  • Complexity of multiple programs

  • Marketing, outreach and enrollment: How to target/what works?

    • All kids message counters stigma around enrolling in public programs

    • Citizenship documentation negative impact on simplified eligibility/enrollment

  • Non-citizen children

[email protected], 2007


Getting to all some challenges identified by states1

Getting to All: Some Challenges Identified By States

  • Crowd-out/ go-bare periods

  • Medical provider payments

  • Insurer concerns: adverse selection

  • What is all? 95%?

  • Benefit packages- Tension b/t Medicaid & Commercial

  • Sustainability SCHIP uncertainties

[email protected], 2007


Top 3 issues in schip reauthorization

Top 3 Issues in SCHIP reauthorization

  • Money

  • Money

  • Money

  • $13- 15B needed over 5 years to maintain current enrollment levels

  • If frozen at $5B baseline, 36 states might have shortfalls by 2012

  • Pay go rules require offset; fear that this could come from Medicaid

[email protected], 2007


If schip funded at baseline of 5b yr

If SCHIP funded at baseline of $5B/Yr

[email protected], 2007


Other potential reauthorization issues

Other potential reauthorization issues

  • Formula and redistribution

  • Populations covered

  • Access to Quality Care/Performance

  • Premium assistance/wrapping around limited private plans/ESI interface

  • State employee coverage

  • Medicaid interface

  • Citizenship documentation

  • PERM

[email protected], 2007


Reauthorization timetable prospects

Reauthorization timetable/prospects

  • ????

  • Presidents budget out February 5 will play a role in setting the stage

  • Clock runs out on 07 shortfall temporary fix on May 4 (not all states may make it)

  • Budget resolution should be April 15

  • Clock runs out Sept. 30 on current law

[email protected], 2007


Summary

Summary

  • SCHIP has been successful in increasing public coverage (SCHIP and Medicaid financed) of kids in time of declining ESI

  • States have learned a lot about how to structure programs, work with partners, and get and keep kids enrolled

  • Growing number of states are aiming to cover all kids, taking on more challenges

  • Successful SCHIP reauthorization is critical to maintaining and making further progress in states in covering kids

[email protected], 2007


Nashp contacts resources

NASHP CONTACTS/RESOURCES

  • Catherine Hess

    Senior Program Director

    [email protected]

  • John McInerney

    Program Manager

    [email protected]

  • Alan Weil

    Executive Director

    [email protected]

  • National Academy for State Health Policy

    www.nashp.org

  • Chip Central

    www.chipcentral.org

[email protected], 2007


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