The State of the States: A Quick Tour Getting to the Finish Line Conference July 14, 2009 AKAK

Alabama

January 2009: Celebrated 10 Years of KidsCare! The cupboard is bare – largest income tax decline of any state since ’08 However, new money available for outreach thanks to First Things First Two newspapers stop printing Agency changes – e-app & streamlining Looking forward: “Medical choice” initiative on ballot attempts to thwart reform Protecting what we have with health reform

- Implementation and outreach push in 2009 and Governor Beebe told DHS to take steps necessary to implement option to cover legal immigrant kids under the five-year ban - Need to shift the default focus of DHS to getting kids enrolled rather than concern about error rates - Tour of the state with more footraces to the finish line to promote enrollment - ARKids Summit planned for Fall 2009

California broke Gov wants to terminate CHIP The budget, it hurts

Achievement: Won temporary roll back of Mid-Year Status Reporting for children in Medi-Cal due to MOE language in stimulus Challenges: A massive budget deficit, $24 billion and growing Governor’s 180° turn – proposal to eliminate CHIP Opportunities: Strong allies, public support and interest from media National health care reform November 2010 ballot initiative Schwarzenegger termed out in 2010

CROSSING THE FINISH LINE TOGETHER. SCORING A WIN FOR EVERY COLORADO CHILD.

Who We Are All Kids Covered strives - especially during tough economic times - to reduce the number of uninsured children in Colorado. As a non- partisan coalition of more than 30 organizations statewide, we advocate for sound policy and build public will.

The Landscape in Colorado Eight out of 10 kids are now covered Still, more than 150,000 Colorado children are uninsured Colorado ranks a dismal seventh in the nation for the percentage of children in the state without health insurance last in the nation for covering children who are living in poverty. Research has shown that nearly half of all uninsured children in Colorado are already eligible for public health programs, yet these 78,000 children are not enrolled. 25 percent of the children who are enrolled are likely to be dropped during re-enrollment periods due to complicated paperwork

2009 Victories House Bill Medical Program Re-enrollment: Establishes a process for telephone and online re- enrollment into Medicaid and CHP+. Ensures that eligible children continue to receive quality care. House Bill Children’s Access to Care: Ensures uninterrupted access to services for kids by providing 12 months of continuous eligibility for children enrolled in Medicaid. Provides more families with access to public health coverage by increasing eligibility for children in CHP+ from 205% to 250% of the Federal Poverty Level and increasing eligibility for parents in Medicaid from 60% to 100% of the Federal Poverty Level. House Bill Coverage for Moms and Kids: Provides benefits under Medicaid and CHP+ to pregnant women and children who are legally present individuals. Waives the 5- year waiting period for such services.

Reform Colorado’s system that provides medical assistance for kids in need –Update the eligibility determination process to create a seamless program for children and families. –Implement reforms approved over the last three years that improve children’s access to health coverage programs –presumptive eligibility for kids –12-month continuous eligibility for children in Medicaid –promoting “Healthy Communities” -- a new state outreach plan Reduce red tape so that families can get – and keep – health coverage –Implement administrative verification of family income and a renewal system that eliminates procedural denials and closures in Colorado. –Secure administrative verification of a child’s identity and place of birth, thereby eliminating a common barrier to enrollment for families. How All Kids Covered Will Get to The Finish Line

Assure long-term program availability for Colorado kids –Secure enhanced federal funding opportunities for CHP+ and Medicaid. –Sustain public programs after federal stimulus funding is no longer available. –Maintain provider reimbursement rates. Advocate for children’s health coverage expansions –Monitor the implementation of the Colorado Healthcare Affordability Act (HB ). –Enhance the dental benefit under CHP+ to improve kids’ access to needed dental care. –Add dental benefits for pregnant women under Medicaid and CHP+. –Offer options to cover kids and pregnant women not reached by other public coverage expansions. Promote access to quality care –Create coordinated systems of care for children that enable families to benefit from a medical home. –Allow the state to track health outcomes of children involved in public insurance programs

Connecticut’s HUSKY Program HUSKY A (Medicaid): 230,493 children and 114,808 parent/caregiver relatives HUSKY B (separate CHIP): 15,192 children Large budget deficit projected for FY – Governor proposed benefit cuts, increased cost-sharing, elimination of outreach funding – Legislature passed budget with less draconian cuts, covered in part with tax increases – Governor vetoed budget Advocates working on HUSKY defense!

Responses from Legislators, Policy Makers, and Lobbyists about Kid’s Coverage Children can get as much physical therapy as they want! (Benefit package) Families should practice paying for private coverage. (Monthly premium costs for families) Iowa will become an immigration Mecca because of this coverage. (Covering all kids) We're going to destroy private coverage like they did in Hawaii. (Increasing eligibility to 300% FPL)

“Show Me” Challenges in Missouri Finish Line Conference Center for Children and Families (CCF) July 14-15, 2009

You can lead a mule to water… Governor proposed a modest expansion— covering 35,000 more parents through Medicaid involving no State General Revenues. Missouri House of Representatives still voted against it, and no coverage expansion was adopted.

Some Things Just Plain Defy Logic… Governor proposed to cover 27,000 more kids, primarily by rolling back CHIP premiums. A key legislator compared this proposal to “slavery” because it “enslaved” the taxpayers who have to pay for someone else’s children’s healthcare.

So What’s Next? General Assembly reconvenes January 2010 It’s not known if the expansions proposed in the last session will be submitted again in the next Session…

The Missouri General Assembly… You never know what will happen.

“Show-Me” Challenges in Missouri Finish Line Conference Center for Children and Families (CCF) July 14-15, 2009

New Jersey

SCHIP EXPANSION ABOVE 200%: NOW YOU SEE IT, NOW YOU DON’T THE -25% PROPOSAL AND THE +6% SOLUTION WELCOMING IMMIGRANT CHILDREN : THE SEARCH FOR THE RIGHT WORDS

We had some gains. the sound of falling coins stifled the voices The leaders have gone— where the budget hole was the patch not good The evening news, Our children waiting nothing to hear

This year in Oregon it happened, at long last. After years of trying, the Healthy Kids Program passed! 80,000 more kids will soon be enrolled, but there is one loss to share, truth be told: Our policy director is leaving to be the manager of the new Office of Kids, Healthy. With her on the inside and CFFO/OHAC on the out Oregon soon will be able to shout: “All of our uninsured kids are now covered, Now let’s insure their fathers and mothers!”

38,000 2,164 4,625 1,640 28

Our Wins: - Conversation has progressed - Lots of new people engaged - Media coverage - Strong advocacy infrastructure Our Challenge: Building momentum for Our Lessons: -Engage multiple partners with multiple voices in multiple ways -Take nothing for granted. -Be ready to adjust and readjust Our Questions: - How do you encourage media to ask the tough questions? - How do you keep your WHOLE agenda moving? - How do you take advantage of elections?

Karen Crompton Executive Director Korey Capozza Sr. Health Policy Analyst

▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬ CHIP and Medicaid Enrollment Maximizing Enrollment –RWJ Grant –1040 Express Lane A New Political Landscape Utah Health Systems Reform ▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬

Virginia

West Virginia