HRSA State Planning Grant Program: State Activities Alice Burton

1. HRSA State Planning Grant Program: State Activities Alice Burton Director, State Coverage Initiatives Michigan HRSA SPG Advisory Group September 19, 2005

2. HRSA State Planning Grant Program • Since 2000, 52 states and territories received grants • Surveys, focus groups, taskforces • Since 2004, $400K Pilot Planning Grants to develop specific models • Grant funding for planning, not for implementation

3. Federal planning resources declining at a critical time Note: High Risk Pool funding is balance of 04 Funding

4. HRSA SPG Funded State Activities • Greater understanding of need for state data and inadequacy of current federal data sources • Each grantee convened stakeholders and initiated process to develop solutions • Analysis and development of options

5. States already paying for the uninsured Over $300 million (40% of services) paid by state and local gov’t Source: The Cost of Not Having Health Insurance in the State of Maryland, DHMH, 2003

6. Health care costs impact state economy Source: Iowa State Planning Grant Program, July 2004

7. General Strategies to Expand Coverage • Expanding Medicaid and SCHIP to new populations and creating new private sector partnerships • Making new private insurance options more affordable • Comprehensive (access, cost and quality) approaches • Improving access through the safety net

8. First round of HRSA SPG Pilot Activities • CT – Premium Assistance and subsidy programs • DE – Sustain coverage in small group market & SCHIP expansion to parents • GA/IL – Community-based coverage models • IN – Medicaid (vs. safety net) coverage for parents with tax • KS – Examining different reinsurance models • OK – Medicaid program for working uninsured • WV – Develop models for age 50-64 population • US VI – Pooling mechanism for small business

9. Problem 99% of large firms offer, but only 63% of small firms do 8 out of 10 uninsured from working families Poor are twice as likely to be uninsured Strategy Public-private partnerships, many focus on small business Medicaid and SCHIP options attractive because of federal matching funds Coverage strategies focus on common problems

10. A small portion of workers decline employer sponsored insurance SOURCE: Kaiser Comissionon Medicaid and Uninsured, Key Facts, December 2003

11. Changing nature of Medicaid coverage • Opportunity for federal financing of Medicaid • More states charge premiums • Different benefits - Utah Primary Care Network • Addressing problem of working uninsured • Illinois expands coverage and enrolls families in employer sponsored insurance or Medicaid • Maine enrolls working families through DirgioChoice • New Mexico and Oklahoma propose Medicaid program for low-income workers through employers

12. Efforts to make insurance more affordable • Building purchasing power • Limited benefits • At least 11 states have passed minimum benefit legislation – 4 in 2004 • Consumer directed health care • Legislation to allow qualifying High Deductible Health Plans to be sold in the state • Prevention strategies – encouraging healthy behaviors

13. Lessons so far • Need federal funding - states do not have revenue base to fund coverage on their own • Incremental strategies need to have vision • Uninsured is a dynamic group – insurance initiatives should be as seemless as possible • Getting employer participation requires long-term partnership to build trust • Building sustainable programs requires working within the market environment • Focus - choice of options can be overwhelming

14. State Coverage Initiatives (SCI) • An Initiative of The Robert Wood Johnson Foundation • Direct technical assistance to states: • State specific help, research on your questions – call (202) 292-6700 • Meetings for state officials • Web site: http://statecoverage.net • Publications • Grant funding