June 25, 2006 Tricia Brooks President & CEO

1. SCHIP at 10 Critical Knowledge Gaps and Emerging Issues June 25, 2006 Tricia Brooks President & CEO

2. About NH Healthy Kids Corp. • Legislatively created non-profit modeled after Florida Healthy Kids Corp. • Mission • to provide access to affordable health coverage for uninsured children; to facilitate programs of preventive health • Began covering kids in 1995 with HMO model built on a PPO network • Became vehicle for expanding coverage through SCHIP in 1999

3. NHHK’s Role in Medicaid & SCHIP • Coordinate outreach & public education • Train & support application assistors • Provide direct customer service to applicants & facilitate application process • Administer SCHIP • Enrollment broker, premium collections • Subcontract managed care contracts with unique NHHK negotiated reimbursement • Facilitate Program Evaluation • Family surveys • Studies of access to and use of healthcare services

4. The Healthy Kids Programs • Medicaid – Healthy Kids Gold (185% FPL) • Free coverage for lowest-income families • Fee-for-service benefit plan managed by DHHS • SCHIP – Healthy Kids Silver (300% FPL) • $25 or $45 pmpm premiums • Managed care plan administered by NH Healthy Kids Corp. • Buy-In – Healthy Kids Silver (400% FPL) • $146 pmpm (no government subsidies) • Indirectly subsidized by provider partnerships and donation of insurance administration

5. The Healthy Kids Public-Private Partnership Has Made a Difference!

6. Enrollment & Retention • Abundant information on outreach and retention strategies that encourage and inhibit enrollment • Cumulative impact of many changes • Not clear where we get the biggest bang for the buck • Lack of political will to remove barriers and provide adequate funding • But still, how low can we go? Is 5% it?

7. Premiums • Premiums based on ability to pay, or related to livable wage studies • Cost is not always the barrier • Cultural differences in valuing insurance • Healthy child vs. premium cost • Access to low-cost safety net providers • Stigma and prior experience with system • Need to better understand the perspective of families who are not enrolled

8. Quality of Care • Standardize quality measures • Set performance goals • Preventive care • Immunizations • Screenings • Primary care • Management of chronic conditions • Hospital use – ambulatory sensitive care conditions • Reward high performing states

9. SCHIP Impact • Long term return of investing in children’s health care • Legislators want to know how much money we save when kids are covered • Impact of different delivery models on access and quality of care • Fee for service • Managed care • Primary care management models • Educate and provide incentives to parents and providers on appropriate use of services

10. SCHIP Expansion Opportunities • Expand buy-in programs • Take advantage of SCHIP group rates • Lower shared administrative costs • Child-friendly benefits • Provide wrap-around services for underinsured • Potential way to address crowd-out • Expand up the age scale • Reauthorization offers opportunity to move toward universal kids’ coverage

11. Deficit Reduction Act • Verification of citizenship and identity • Barrier to enrollment & retention • Transitions from SCHIP to Medicaid • Increase administrative costs • Cost-sharing for Medicaid’s lower income families • Need to quickly measure the impact of DRA • Coverage • Benefits • Cost

12. Medicaid, SCHIP and the Healthcare System • Too often look at Medicaid and SCHIP as separate and distinct programs • Healthcare cost drivers are systemic problems • Must look for systemic solutions • Re-framing the issues in our communications and advocacy • Research literacy for public policy makers at the local level

13. Contact information Tricia Brooks New Hampshire Healthy Kids 25 Hall Street Concord, NH 03301 tbrooks@nhhealthykids.com 603-228-2925 x. 230 www.nhhealthykids.com