Narrative and Finish Line: A Quick 13 State Tour

Getting to the Finish Line ConferenceJuly 17, 2008

Goals for the year aheadBuild support in new legislature for continued growth in SCHIP enrollmentRevamp outreach campaign to enroll more eligible, uninsured children Reduce “churn” in enrollment through systems improvements

ChallengesOngoing budget crisisElimination of state outreach fundsChanges in legislative and executive (?) leadership

OpportunitiesStrong network of partners across the state SCHIP record of success for working families

Achievement in Child Coverage

Protected KidsCare and KidsCare Parents from eligibility rollbacks and cuts despite $2 billion deficit

Goals for the year aheadImprove collection and reporting of data related to enrollment and reenrollmentDecrease # eligible uninsured kids lost through reenrollment barriers Expand ARKids eligibility to 300% FPLCreate buy-in program for children in families above 300%

ChallengesSCHIP reauthorization uncertaintyLukewarm support from GovernorConservative budgeting despite surplusFirst close examination of enrollment/re-enrollment in several years, some reeducation necessary

OpportunitiesVery strong support for ARKidsStrong network of partners across the state Motivated legislative championsBetter than expected budgetGood relationships with DHS/Medicaid

Achievement in Child Coverage Reduced the rate of uninsured kids from 21% to 11% since

the inception of ARKids Enacted and maintained many policy changes in ARKids

that have helped to maintain enrollment Self-declaration of income 12 month continuous (B/SCHIP only) Decrease in ARKids B/SCHIP waiting period from 12 to

6 months Removal of assets test Streamlining efforts with Food Stamps

Goals for the year aheadDefend against “one step back” policies such as Semi-Annual reporting for children in Medi-CalEnsure health coverage for all children regardless of immigration status – through broad state health care reform, stand-alone bill, or ballot initiativePartner with allies to collect over 100 family stories in strategic areasSupport SCHIP reauthorization effort by educating CA Congressional delegation

ChallengesSCHIP reauthorization and CMS directive uncertaintyInconsistent support from GovernorUnprecedented state budget deficitDifficulty finding viable financing mechanism for coverage expansionLocal Children’s Health Initiatives running out of funding

OpportunitiesStrong network of partners across the state Key legislative champion ascends to Senate leadership postCompelling media ‘hook’ of children losing coverage

Achievement in Child Coverage

Won insertion of expansion to ALL children up to 300% FPL in 2007/08 Governor’s health care reform package, with early start date for children (package narrowly failed January 2008)

Goals for the year aheadReform the system to work better for kids and familiesGenerate awareness and engage public support

ChallengesMajor fiscal restraintsState leadership's non-committment to the Initiative's policy options and timelineInitiative's leadership comprised of multiple organizations

Opportunities2010's recent successesGovernor's promise to cover all kidsInitiative's leadership comprised of multiple organizations

Achievement in Child Coverage Simplification of the current eligibility determination system for

public health coverage programs (administrative verification of income)

Expansion of CHP+ (SCHIP) to 225%FPL Implementation of Presumptive Eligibility for kids Establishment and expansion of medical home initiative for kids

and performance standards for Medicaid and CHP+ services Additional new policies created by state based on 2010

recommendations Growing recognition of the 2010 All Kids Covered Initiative by

stakeholders

Goals for the year aheadProtect full coverage of All Kids for non-citizen childrenIncrease enrollment through engaging community-based alliesPromote All Kids as a successful government role in health coverage

ChallengesGovernor’s unpopularityAttacks from the right of non-citizen coverageState budget woes

OpportunitiesGrowing campaign for healthcare for all Possible positive federal role

Achievement in Child Coverage

Increased positive support and ownership of All Kids among politicians other than the governor

Goals for the year aheadImplement the policies from the 2008 legislationAssure funding for children’s health coverage stays in the budgetIncrease advocacy support among other groups

ChallengesSCHIP reauthorization uncertaintyCompetition with adult health care reformFunding, due to the budget and the flooding

OpportunitiesStrong legislative support for kids coverageMomentum is on our side right now

Achievement in Child CoverageWe moved a draft bill with language about

mandatory coverage for children into a bill with expanded eligibility and improved retention and renewal strategies, and got nearly unanimous legislative support for it.

Goals for the year aheadExpand eligibility from 200%-300% FPLAdvance simplification agenda for enrollment, renewal, and retentionBuild coalitions for local outreach

ChallengesState leadership hesitating on expansionsTight State FY2010-2011 budget climateNeed to build public and political will on immigrant coverage agenda

OpportunitiesStrong network of partners across the state Motivated legislative championsAugust 17th directive not applicable to OH

Achievement in Child CoverageWon Children’s Buy In down to 250% FPLFacilitated cabinet level conversations

across all OH agencies serving childrenFormed successful CKF coalitions in

Columbus-area and in Mahoning Valley

Goals for the year aheadTo pass the Governor’s Healthy Kids Plan and provide health care coverage for more than 100,000 currently uninsured Oregon kidsReauthorize SCHIP in the first 100 days of the new administrationMaintain and expand moratorium on harmful CMS directives

OpportunitiesHealthy Kids Plan is Governor’s top priorityGovernor is proposing that 66,000 currently eligible, but un-enrolled kids be covered by administrative rule change with general fundsOregon Health Fund Board, proposal to cover children as first stepSCHIP support from 6 of 7 congressional members

ChallengesGovernor is a lame-duckFunding mechanism for the Healthy Kids Plan has not been completely detailedPreviously strong legislative supporters, now hesitantGrowing resistance in the advocacy communityLoss of timber revenueHarmful ballot measuresGrowing number of underinsured kids

Achievement in Child Coverage12-month continuous eligibility winResurrection of the Healthy Kids PlanShortened, simplified application processState commitment to train community

partners in outreach and application assistance

Goals for the year ahead Maintain current RIte Care eligibility levels and benefits package for children and parents. Expand RIte Care eligibility from 250% FPL to 300% FPL. Create buy-in program for children in families above 300% FPL.Document cases of enrollees who are sanctioned or lose coverage for unpaid premiums.

Challenges Global Medicaid waiver Continued projected budget deficits

Opportunities Strong statewide network of partners, bolstered by new RIte Care Works Coalition Motivated legislative champions

Achievement in Child CoveragePrevented cuts to RIte Care eligibility for

citizen children (maintained at 250% FPL) and minimized cuts to parents (rolled back from 185% FPL to 175% FPL, rather than 133%, sparing 6,400 parents)

Goals for the year aheadFix eligibility system and increase outreach12 month coverage for Children’s MedicaidExpand eligibility to 300% FPL (sliding scale)Create full cost buy-in above 300% FPL

ChallengesCost of AgendaUnknown Speaker and Committee chairsConcerns with growing government programSCHIP reauthorization uncertainty

OpportunitiesStrong network of partners across the state Motivated health championsSupport from Chambers of CommerceIncreased attention on health care issues due to presidential elections

Achievement in Child CoverageEnrolled 10% of uninsured Texas children in

under 10 monthsHospital and Chamber endorsement of full

agenda for 2009Development of strong economic argumentDevelopment of a statewide grasstops and

grassroots plan of action

Goals for the year ahead Begin discussion around removal of five year

waiting period for legal immigrants Move forward with legislation to improve CHIP

enrollment and retention—P/E, express-lane, income eligibility to 250% FPL, and/or Buy-In

Carry out effective electoral advocacy Secure funding and initiate Latino outreach

within Utah Mexican Hometown Clubs

Challenges CHIP enrollment is slow Health System Reform task force is proving somewhat

ineffective

Opportunities Strong bi-partisan support for children’s

health care Big successes from last session will be

easy to capitalize on for this year

Achievement in Child Coverage Removed enrollment cap from CHIP Formed health system reform taskforce Mandated coordination for CHIP outreach

between Health Dept., Dept. Workforce Services, and State Board of Ed.

Mini-grants for minority outreach

Goals for the year aheadBuild public support for Cover All Kids Enroll 50% of eligible uninsured kidsExpand eligibility to 300% FPLCreate affordable buy-in program for children in families above 300%

ChallengesTough elections & legislative environment SCHIP reauthorization uncertaintyDRA Citizenship Verification barriers

OpportunitiesStrong network of partners across the state Motivated legislative champions

Achievement in Child Coverage Won public support for an expansion for all

children, and an entitlement for care Ensured that federal citizenship verification

did not result in terminations

Goals for the year aheadContinued strong outreach for BadgerCare Plus Identifying and removing barriers to participationImproving coverage of immigrant children

ChallengesEnrollment far exceeds expectations, and WI budget is in the redOpposition to coverage of immigrants

OpportunitiesCommitment of Governor and many legislators to continue expanding access to insurance Strong network of partners across the state

Achievement in Child Coverage Enactment and implementation of BadgerCare Plus

without changes because of Aug. 17 directive.

16% increase in enrollment during the first 4 months (49,000 more kids).

Kids eligible regardless of income, but 83% of the initial increase was among kids below 200% of FPL