1. Quality Improvement/ Disparities/Access Group IV

2. Context We believe all children should have access to health care Health insurance enables access to health care Currently SCHIP and Medicaid are two public programs that provide health care coverage for low income children 9M children are currently uninsured and out of these 6M qualify for coverage but unenrolled –Medicaid to more individuals below the federal poverty level ($20,200 for a family of four in 2008) who are parents or caretaker relatives of children eligible for Medicaid. But the states have chosen not to do so.

3. All United States Populatio n Number (in thousands)Employer Individua l Medicaid / Other Public Uninsure d SCHIP Children78,42555.40%4.40%27.10%1.40%11.70% Low- Income Children *33,34024.10%3.60%51.90%1.40%19.10% Parents67,03168.30%4.40%9.00%1.50%16.80% *Low-income" is defined as under 200 percent of the Federal Poverty Level.

4. Problem Statement Two-thirds of uninsured children in the US are eligible for SCHIP or Medicaid but are NOT enrolled

5. Conceptual Framework for Evaluating the Consequences of Uninsurance: A cascade of effects (IOM 2003) Focus area

6. Rationale Parents/families unaware of eligibility status –Johnnie has a health problem but his parents are unaware he is eligible for public health insurance coverage

7. Rationale Difficulty in enrollment process –Johnnie’s parents find the application process too difficult and lacked documentation for the asset test

8. Rationale Difficulty in retention –Johnnie’s dad gets a small raise and he loses his public health insurance program and is uninsured

9. Proposed Solutions Increase awareness of SCHIP/Medicaid program –Parents/families of potential enrollees Streamline enrollment procedure Improve retention

10. Stakeholders Interest Groups –Families USA –Children’s Defense Fund Pharma Taxpayer Associations Voters National Governors Association National Conference on State Legislators Heritage Foundation Children Parents/Families Health care providers State Education Day Care Private Insurers State Government Employers

11. Stakeholders How are they impacted? –Improved access to primary care Improved health for children Improved continuity of care Decreased emergency room visits Decreased hospitalizations –Improved workforce productivity for parents –Improved educational performance of children –Increased utilization and cost (+ / -) Opportunity cost (+ / -) –State, special interest groups, employers

12. Plan of Action Increase awareness of public health insurance programs Promote state-based outreach activities to increase enrollment –Increase federal match to states for meeting enrollment targets –Disseminate to states “models of excellence”

13. Plan of Action Streamline enrollment process –Link/coordinate enrollment with other federal/state programs –Develop common application form –Omit asset test (+ /-) –Disseminate “models of excellence”

14. Plan of Action Improve retention of health insurance coverage for children –Mandate one year continuous enrollment

15. Implementation Strategies Coalition building –State Governors –Legislators –Special interest groups Identify champions in Congress –Senator Rockefeller Media coverage/moving public opinion

16. Johnnie now has health insurance

17. Resources http://ccf.georgetown.edu/index/data- healthcoverage#ushttp://ccf.georgetown.edu/index/data- healthcoverage#us http://www.kff.org/medicaid/upload/2177_06.pdfhttp://www.kff.org/medicaid/upload/2177_06.pdf Hidden Costs, Value Lost: Uninsurance in America http://www.nap.edu/catalog/10719.html http://www.nap.edu/catalog/10719.html