1. Strategic Engagement of Policymakers Is Key to Advancing a Children’s Health Care Coverage Policy Agenda Prepared by: Ian Hill and Sara Hogan (Urban Institute) Debra Draper and Laurie Felland (Health Systems Change) Presented to: Grantmakers in Health Funded by: The David and Lucile Packard Foundation 3 August 2010 THE URBAN INSTITUTE

2. 2 In-Depth Case Studies of Finish Line Grantees and States Two interview teams: –Policy/program: Urban Institute –Advocacy/stakeholder: Health Systems Change Establish understanding of state initiatives Learn about process of implementation Identify lessons learned, prominent themes, and successful strategies to inform Foundation and states

3. THE URBAN INSTITUTE 3 Strategic Engagement of Policymakers 1.Understanding States’ Political Environments 2.Developing Relationship-Building Strategies - Identifying, nurturing, supporting political champions - Linking grassroots advocacy and policymakers - Using effective messaging - Establishing selves as “Go To” organization - Sharing ownership of agendas and successes

4. THE URBAN INSTITUTE 4 Why Do We Care? Grantees Accomplishing Results Eligibility Expansion Buy-In Program Simplify Enrollment/Renewal Other Arkansas200 -> 250%* Online enrollment & renewal* Legally-resident immigrant children* Colorado205 -> 250% CSHCN < 400% 12 mos. continuous eligibility Online enrollment & renewal Pregnant women (250%) Parents (100%) Childless adults (100%) Legally-resident immigrant children* Iowa200 –> 300% 12 mos. continuous Presumptive eligibility Joint applications Express lane eligibility Paperless renewal Premium assistance Reduced verification Pregnant women (300%) CSHCN (300%) Legally-resident immigrant children Dental ‘wrap-around’ Translation services * Pending

5. THE URBAN INSTITUTE 5 Accomplishing Results (cont.) Eligibility Expansion Buy-In Program Simplify Enrollment/RenewalOther Ohio200 -> 300%* 12 mos. continuous eligibility* Telephonic renewal* Express lane eligibility* Rhode Island Restored coverage for legal resident immigrant children (lost in 2007) Repealed family premiums from 133-150% FPL and premium increases >150% FPL (passed in 2007) Texas 12 mos. continuous eligibility Restored income disregards Broadened assets test Removed 90-day waiting period Increased eligibility staffing Washington250 -> 300% Express lane eligibility Apple Health outreach * Pending

6. THE URBAN INSTITUTE 6 Understanding States’ Unique Political Environments State Term Limits Part-Time Legislature Governor Party Affiliation Legislature Majority Party Affiliation ArkansasYes Democrat ColoradoYes Democrat IowaNoYesDemocrat OhioYesNoDemocratSplit Rhode Island NoYesRepublicanDemocrat TexasNo Republican WashingtonNoYesDemocrat Note: Information presented as of the conclusion of the 2008–2009 legislative session.

7. THE URBAN INSTITUTE 7 Identifying, Nurturing, and Supporting Political Champions Find well-respected champions to “carry the torch” Champions can exist all levels: Governor’s office, state legislature, executive branch agencies The type of champions to target can vary by state –Ohio: Governor Ted Strickland –Iowa: state Senator Jack Hatch –Colorado: Joan Henneberry, Director of Department of Health Care Policy and Finance

8. THE URBAN INSTITUTE 8 Creating Critical Links Between Grassroots Advocacy and Policymakers Build broad-based, statewide, coalitions with diverse stakeholders –Eg: In Washington, Children’s Alliance staffs the Health Coalition for Children and Youth, and effectively capitalizes on strengths of it s more than 40 member organizations Harness coalition members’ particular strengths and perspectives, but present a unified front –Eg: In Texas, three groups—Children’s Defense Fund of Texas, Center for Public Policy Priorities, and Texans Care for Children—each bring unique strengths Bringing in outside experts to learn from other states’ best practices –Eg: Iowa’s Child and Family Policy Center co-sponsored summit with state Department of Human Services that included a presentation by Louisiana CHIP director

9. THE URBAN INSTITUTE 9 Using Effective Messages to Appeal to Policymakers Moral imperative/fairness: “it’s the right thing to do” Near universal coverage is attainable: “let’s finishing what we’ve started.” Education: “Unhealthy children face more learning challenges.” Cost: “Children are a wise investment” Economic: “Healthy, educated children grow to become productive workers.”

10. THE URBAN INSTITUTE 10 Establishing State-Based Advocacy as “Go To” Organizations for Policymakers Create reputation for generating accurate, objective, accessible and timely data –Eg: Rhode Island KIDS COUNT Factbook Use variety of methods to disseminate information –Eg: Colorado grantee partnered with The Colorado Health Institute to develop briefs on uninsured children for annual pre-session legislative briefing

11. THE URBAN INSTITUTE 11 Sharing Ownership of Agenda and Successes with Policymakers Important strategy for establishing collaborative partnerships with policymakers –Eg: Arkansas policymakers and advocates have an “open door” policy with one another that helps establish a collaborative agenda –Eg: Washington grantee recognizes its “Champions for Children” twice a year at a spring Voices for Children luncheon and Breakfast with Champions held in the fall

12. THE URBAN INSTITUTE 12 Conclusions Strong relationships with policymakers are core to expanding health care coverage for children Understanding and capitalizing on the uniqueness of individual states’ political environments is an important first step Developing and pursuing a variety of relationship-building strategies comes next Reaching “finish line” of health care coverage for all children remains a work in progress, and so is the development of strategies that effectively engage policymakers and garner their support

13. THE URBAN INSTITUTE 13 Resources and Contact Information “Strategic Engagement of Policymakers is Key to Advancing a Children’s Health Care Coverage Policy Agenda.” Debra Draper, Ian Hill, Laurie Felland, and Sara Hogan. Insuring America’s Children Evaluation Brief Number 3: May 2010. “State-Based Advocacy as a Tool for Expanding Children’s Coverage: Lessons from Site Visits to Six IAC Grantee States.” Ian Hill, Debra Draper, Sara Hogan, and Allison Liebhaber. Insuring America’s Children Evaluation Brief Number 2: May 2010. Ian Hill: ihill@urban.org;ihill@urban.org Laurie Felland: lfelland@hschange.orglfelland@hschange.org