The Connecticut Experience-Medicaid Patricia Baker Connecticut Health Foundation May 13, 2004

Preservation of Medicaid as we know it Medicaid in the form of a block grant supported by Bush Administration hopes to control costs and undermine entitlements  Bush block grant proposal strongly and visibly supported by our Governor  CT Health Foundation and Anthem Foundation Commissioned report by the Health Policy Institute of Georgetown and Child Health Council now CT Voices for Children to examine impact of changes on CT  Providers and others were in state of denial- Report presented in June 2003

Preservation of Medicaid Block grant comes to CT  Late night negotiations on budget implementer bill yields agreement by a select few in leadership to pursue waiver that includes premiums on Medicaid children,parents, elderly and medially needy at the 50% poverty rate and above, co pays, and the elimination of EPSDT- August 30, 2003

Preservation of Medicaid CT Health Foundation convened original work group to determine what the foundation and original policy experts should do in light of passage of budget implementer. Legislative monitor explaining we must act to inform policymakers regarding impact in a user friendly way Board memos updating them of actions and why it is important to act

Preservation of Medicaid Goal: Waiver provisions would be repealed Our role:  Analyze the impact of proposed changes producing hard numbers  Consider target audience regarding format and distribution of public information if we are to be effective  Dissemination is equally important to content in order to accomplish goal  Activist role in connecting dots

Preservation of Medicaid Format-Policy Briefs  5 Briefs –breaking down each issue including economic impact of changes on the whole state- 5 th added when pursuit of a global cap came to light. All are posted on websites  Timing of release scheduled to build momentum going into the session and throughout the session

Preservation of Medicaid Making the dots connect:  Medicaid defense coalition  Ct Academy of Pediatrics  Outreach to unlikely suspects  Media  Educate both sides of the aisle

Preservation of Medicaid We Won!!!  Going into the session, there were enough cosponsors on the repeal bill to pass the legislation, but mostly one party support.  Education of legislators both policy implications and context of real people’s lives is necessary-some legislators saw us at the line if not over so there is risk with activist role  2005budget sees allocation to reverse cuts  Budget Implementer has specific language against the pursuit of a global cap

Lessons Learned/Issues to Consider GIH policy calls help-I was inspired by our first call when MA spoke of their experience defending the Medicaid budget Financing drives program priorities, but there is not an automatic connection for all board and staff To be successful think of it in terms of an initiative fight with concrete outcomes so strategy and tactics follow vs. shed some light onto the problem

Lessons Learned/Issues to be Considered Imperative to connect the dots from research and analysis to convening, to legislative monitoring, to media to public education to advocacy- Work group spoke every 2-3 weeks from September to May. Must marry thoroughness and impeccable data with quick turnaround and nimbleness- One more “Woe is me” story will not carry the day Waiver process is a very secretive - executive branch to executive branch discussion, need to monitor and bring out into light of day

Lessons Learned/Issues to be Considered Leadership is key, need legislative champions including unlikely suspects Timing, dissemination, and promotion are key to success Use every strategy available to the foundation, research, publications, communication, grantmaking, convening, etc.

Lessons Learned/Issues to be considered Grassroots are essential and weak, need to think long-term about what we can do. People want top down strategy to take care of the basics. Medicaid is very complicated and make no assumptions that folks understand it including the committees of cognizance Medicaid does need reform, and we must ask ourselves what can we do to promote a positive reform in our state.

Lessons Learned/Issues to be considered Must pay attention to the internal side of the shop as well as external  Is the Board behind the campaign; do they understand the implications  Effort very time intensive, what capacity do you have internally, what do you have externally, can you act quickly, must make it a top priority to win  Are people prepared to see foundation in the center of controversy  Name will be in papers, must ensure credibility by having the best analysis possible