Narrative and Finish Line: A Quick 13 State Tour Getting to the Finish Line Conference July 17, 2008

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

 Challenges  Ongoing budget crisis  Elimination of state outreach funds  Changes in legislative and executive (?) leadership  Opportunities  Strong 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 ahead  Improve collection and reporting of data related to enrollment and reenrollment  Decrease # eligible uninsured kids lost through reenrollment barriers  Expand ARKids eligibility to 300% FPL  Create buy-in program for children in families above 300%

 Challenges  SCHIP reauthorization uncertainty  Lukewarm support from Governor  Conservative budgeting despite surplus  First close examination of enrollment/re-enrollment in several years, some reeducation necessary  Opportunities  Very strong support for ARKids  Strong network of partners across the state  Motivated legislative champions  Better than expected budget  Good 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 ahead  Defend against “one step back” policies such as Semi- Annual reporting for children in Medi-Cal  Ensure health coverage for all children regardless of immigration status – through broad state health care reform, stand-alone bill, or ballot initiative  Partner with allies to collect over 100 family stories in strategic areas  Support SCHIP reauthorization effort by educating CA Congressional delegation

 Challenges  SCHIP reauthorization and CMS directive uncertainty  Inconsistent support from Governor  Unprecedented state budget deficit  Difficulty finding viable financing mechanism for coverage expansion  Local Children’s Health Initiatives running out of funding  Opportunities  Strong network of partners across the state  Key legislative champion ascends to Senate leadership post  Compelling 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 ahead  Reform the system to work better for kids and families  Generate awareness and engage public support

 Challenges  Major fiscal restraints  State leadership's non-committment to the Initiative's policy options and timeline  Initiative's leadership comprised of multiple organizations  Opportunities  2010's recent successes  Governor's promise to cover all kids  Initiative'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 ahead  Protect full coverage of All Kids for non-citizen children  Increase enrollment through engaging community-based allies  Promote All Kids as a successful government role in health coverage

 Challenges  Governor’s unpopularity  Attacks from the right of non-citizen coverage  State budget woes  Opportunities  Growing 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 ahead  Implement the policies from the 2008 legislation  Assure funding for children’s health coverage stays in the budget  Increase advocacy support among other groups

 Challenges  SCHIP reauthorization uncertainty  Competition with adult health care reform  Funding, due to the budget and the flooding  Opportunities  Strong legislative support for kids coverage  Momentum is on our side right now

 Achievement in Child Coverage  We 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 ahead  Expand eligibility from 200%-300% FPL  Advance simplification agenda for enrollment, renewal, and retention  Build coalitions for local outreach

 Challenges  State leadership hesitating on expansions  Tight State FY budget climate  Need to build public and political will on immigrant coverage agenda  Opportunities  Strong network of partners across the state  Motivated legislative champions  August 17 th directive not applicable to OH

 Achievement in Child Coverage  Won Children’s Buy In down to 250% FPL  Facilitated cabinet level conversations across all OH agencies serving children  Formed successful CKF coalitions in Columbus-area and in Mahoning Valley

 Goals for the year ahead  To pass the Governor’s Healthy Kids Plan and provide health care coverage for more than 100,000 currently uninsured Oregon kids  Reauthorize SCHIP in the first 100 days of the new administration  Maintain and expand moratorium on harmful CMS directives

 Opportunities  Healthy Kids Plan is Governor’s top priority  Governor is proposing that 66,000 currently eligible, but un-enrolled kids be covered by administrative rule change with general funds  Oregon Health Fund Board, proposal to cover children as first step  SCHIP support from 6 of 7 congressional members

 Challenges  Governor is a lame-duck  Funding mechanism for the Healthy Kids Plan has not been completely detailed  Previously strong legislative supporters, now hesitant  Growing resistance in the advocacy community  Loss of timber revenue  Harmful ballot measures  Growing number of underinsured kids

 Achievement in Child Coverage  12-month continuous eligibility win  Resurrection of the Healthy Kids Plan  Shortened, simplified application process  State 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 Coverage  Prevented 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 ahead  Fix eligibility system and increase outreach  12 month coverage for Children’s Medicaid  Expand eligibility to 300% FPL (sliding scale)  Create full cost buy-in above 300% FPL

 Challenges  Cost of Agenda  Unknown Speaker and Committee chairs  Concerns with growing government program  SCHIP reauthorization uncertainty  Opportunities  Strong network of partners across the state  Motivated health champions  Support from Chambers of Commerce  Increased attention on health care issues due to presidential elections

 Achievement in Child Coverage  Enrolled 10% of uninsured Texas children in under 10 months  Hospital and Chamber endorsement of full agenda for 2009  Development of strong economic argument  Development 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 ahead  Build public support for Cover All Kids  Enroll 50% of eligible uninsured kids  Expand eligibility to 300% FPL  Create affordable buy-in program for children in families above 300%

 Challenges  Tough elections & legislative environment  SCHIP reauthorization uncertainty  DRA Citizenship Verification barriers  Opportunities  Strong 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 ahead  Continued strong outreach for BadgerCare Plus  Identifying and removing barriers to participation  Improving coverage of immigrant children

 Challenges  Enrollment far exceeds expectations, and WI budget is in the red  Opposition to coverage of immigrants  Opportunities  Commitment 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