COVERING KIDS: A STATE AND NATIONAL OVERVIEW

1. COVERING KIDS: A STATE AND NATIONAL OVERVIEW Catherine A. Hess Senior Program Director National Academy for State Health Policy

2. 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 NASHP@January, 2007

3. 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 NASHP@January, 2007

4. 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 NASHP@January, 2007

5. 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 NASHP@January, 2007

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7. Seven Steps for State Success : #2 #2 Community- Based Efforts Are Key to Enrollment • CA Children’s Health Initiatives evaluations- coordinated CBO work • MA experience- churning when CBO outreach cut • IL pays CBOs for each application leading to a new member NASHP@January, 2007

8. 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 NASHP@January, 2007

9. Seven Steps for State Success : #4 #4 Change Agency Culture • Make goals clear • Change language • Provide training • Provide tools and create systems NASHP@January, 2007

10. Seven Steps for State Success : #5 #5 Engage Leaders Who Can Articulate a Clear Vision • Governors • Kids popular, relatively inexpensive • Community Leaders NASHP@January, 2007

11. 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 NASHP@January, 2007

12. Seven Steps for State Success : #7 #7 Marketing Is Essential • To policymakers • To public • To eligible families NASHP@January, 2007

13. 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 NASHP@January, 2007

14. Growing Number of States Aiming to Go All the Way NASHP@January, 2007

15. 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 NASHP@January, 2007

16. 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 NASHP@January, 2007

17. 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 NASHP@January, 2007

18. If SCHIP funded at baseline of $5B/Yr NASHP@January, 2007

19. 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 NASHP@January, 2007

20. Reauthorization timetable/prospects • ???? • President’s 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 NASHP@January, 2007

21. 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 NASHP@January, 2007

22. NASHP CONTACTS/RESOURCES • Catherine Hess Senior Program Director Chess@nashp.org • John McInerney Program Manager jmcinerney@nashp.org • Alan Weil Executive Director Aweil@nashp.org • National Academy for State Health Policy www.nashp.org • Chip Central www.chipcentral.org NASHP@January, 2007