Building on Outreach Success for 2014 Cathy Kaufmann, M.S.W. Administrator Office of Client & Community Services, Oregon Health Authority

Expanded state health coverage program for Oregon children passed by 2009 Legislature. Target was to enroll 80,000 more children Goal is 95% of Oregon kids have health coverage. New Office of Healthy Kids created to administer this program Healthy Kids Program

Healthy KidsConnectOregon Health Plan Medicaid / CHIP CHIP

Through August 2012, we’ve enrolled about 114,000 more children. 42% caseload increase. Total enrollment now about 384,000 or 40% of all Oregon kids. Oregon’s child uninsurance rate cut in half in less than 2 years, from 11.3% to 5.6% (Comparing ACS to OHIS data) Received a total of $32 million in CHIPRA bonus awards from CMS for exceeding Medicaid enrollment goals. How did we do?

Enrollment Increases by Race/Ethnicity % of Total Pop. Current Enrollment (Aug. 2012) % of Enrollment Change over Baseline (July 2009) % Change African-American2.4%14,5763.8%2, % American Indian/ Alaska Native 1.3%6,3461.7% % Asian/ Native Hawaiian / OPI 4.2%11,5093.0%4, % White68.4%205, %63, % Hispanic, Latino19.5%112, %28, % Other, unknown4.2%33,4668.7%14,12173%

Improved access all types of care and subsequently improved the likelihood of feeling as though care needs were being met. Increased likelihood that children were receiving routine care. Families with children insured with Healthy Kids had significantly less medical debt and experienced less financial strain than at baseline. Previous disparities by race/ethnicity in all measures were either no longer evident or reduced. What difference has it made?

Outreach Targeted Outreach Grants (about $80k per year) 27 grants awarded to organizations around the state. Additional outreach grants to 18 safety net providers and public health departments through CHIPRA Outreach Grant. Application Assistance Program ($75 per application) over 100 assisters in this program to date. Continue to recruit assisters in identified areas of need. Volunteer Partners Holding informational sessions and trainings around the state. Move messages through parters: blasts, newsletters, mailings, web page links, etc.

Targeted Outreach Campaigns Culturally relevant marketing materials Fund bi-cultural, bi-lingual outreach staff in communities through grants Translations that work -- materials and advertising made for (not adapted to) the communities we need to reach School- Based Campaign Staff focused on school-based outreach, building connections Campaign for Teens Sports / Coaches Campaign Provider Campaign Health clinics very successful partner

Marketing Focus on simple branding across all parts of program - - it’s all Healthy Kids. Tested materials and messages with families, with particular emphasis on moderate income families. Attractive, positive ads in newspapers, magazines, on trains, busses, benches, billboards, radio, movie theaters, shopping malls and websites. Also sponsor rodeos, youth sports tournaments, county fairs, etc. New and improved website, facebook, twitter, myspace, etc.

Eligibility System Improvements Worked with Center for Health Literacy to redo application. Easier to understand, better layout, simpler questions. Policy changes to streamline eligibility: 12-month eligibility / reduced waiting period (2 months instead of 6) Moved to one-month income determination Simplified process for renewal Express Lane Eligibility for SNAP and Free and Reduced Lunch Focus on internal messaging campaign for eligibility staff

The most valuable lessons we learned Don’t spend a dime until you test your messages. Positive messages work better than negative messages. (What coverage gets you rather than what can go wrong without it.) Culturally aware outreach and marketing can help reduce disparities. Outreach is hard work. Harder than everyone thinks. Requires a lot of T.A. and success might not be measured in application assistance. Dedicated staff focused on outreach with measurable goals. Work with partners who aren’t paid grantees or assisters, too. Focus on messaging for eligibility staff, too.

What we’re planning for 2014 One truly seamless eligibility system with the Oregon Health Exchange Corporation. Medicaid and CHIP clients will pick a plan just like those who qualify for tax credits. Shared marketing plan that will drive all consumers to one web site and help line. Behind the scenes, one agency processing all paper applications. Build on existing Healthy Kids outreach grantees to create navigator program and application assistance and education for the Exchange and Medicaid expansion. Getting those Healthy Kids parents enrolled right away!