1. HRSA State Planning Grants Readiness To Act Rachel L. Police AcademyHealth

2. Program Goals & Timeline Announced in 2000, SPG program designed to help states create plans to provide access to health coverage for all citizens. SPG program goals included: – Assist states in collection and analysis of data on uninsured – Develop sustainable health coverage policy options – Work with key constituency groups and public to reach consensus on viable insurance expansion options SPG program could benefit both grantee/non grantee states as well as Department of Health & Human Services.

3. Program Goals & Timeline First round of HRSA state planning grants awarded in 2000 to 11 states. SPG awarded over five years (2000-2005) of program to 47 states and 4 territories, the latest grant going to Alaska in 2005. HRSA initiated Pilot Planning Grant program in 2004. These grants provided funds to states that had already developed policy options through SPG funds. HRSA Pilot Grants were awarded to 17 states and 2 territories.

4. State Activities Conducted household and employer surveys Held individual and employer focus groups Collected both quantitative and qualitative research findings on: – Uninsured population: barriers to care, failure to enroll, where uninsured currently access care etc. – Healthcare environment: employer-based coverage, safety net access, crowd-out, current market trends etc. Wrote nearly 300 reports on their uninsured populations and ways to solve coverage gaps – List of reports in notebook. Can also access online at www.statecoverage.net www.statecoverage.net – Reports still trickling in from states who received grants in 2004 & 2005.

5. Community Building States used several strategies to gain stakeholder and community consensus-key to policy development & implementation. SPG Lead Agencies: Medicaid agencies, research centers, health departments, insurance divisions. Agency selected reflective of political environment. Key Stakeholders: Both public & private sector involvement including dept of health & insurance, hospitals, advocates, labor unions, universities etc. Analysis & Selection of Policy Recommendations: Most states established steering or oversight panels made up of demographically diverse members to review and recommend coverage options.

6. Policy Options Considered Medicaid/SCHIP Expansions: 41 states Group Purchasing arrangements: 24 states Limited Benefit/bare bones: 21 states Premium Assistance: 19 states Safety Net Strategies: 16 states High Risk Pools: 15 states Outreach to eligible but not enrolled: 11 states Tax Credits for individuals/employers: 10 states Employer mandates/“Fair Share”: 9 states Individual mandates: 7 states

7. Policy Options Implemented Medicaid/SCHIP Expansions: 29 states Group Purchasing arrangements: 9 states Limited Benefit/bare bones: 12 states Premium Assistance: 10 states High Risk Pools: 10 states Outreach to eligible but not enrolled: 4 states Safety Net Strategies: 4 states Tax Credits for individuals/employers: 3 state Employer mandates/”Fair Share”: 4 states Individual mandates: 1 state

8. HRSA Notables SPG grants served as one of the catalysts for innovative state health coverage reform including: Maine Dirigo Health Reform Vermont Catamount Health Utah Primary Care Network

9. Lessons from the States Changes in coverage strategy needed to be incremental Needed to involve a diverse community of stakeholders, both public & private and foster competition State agencies needed to communicate and cooperate with each other Coverage was a shared responsibility (individuals, employers, providers and government) Tying access expansions to cost containment measures and quality enhancements was critical to the political acceptability of reform proposal AND critical to a sustainable system The general public must be included in the reform debate in a meaningful way; it can’t just be an “insiders game” where public officials and stakeholders argue about options. Given that the policy process is so dynamic, it is important that coverage models are fluid and alternatives can be quickly generated. Needed to educate and include any and all state agencies which may be “touched” by problems related to the uninsured or proposed solutions.

10. HRSA: The Technical Roadmap There are 4 components necessary to affect change in the health policy arena: Leadership Political Will Financing Technical & Organizational Structures SPG program served as technical and organizational backbone of support for other 3 areas. Provided solid analytical structure/methodology and support. Provided a “roadmap” to state health policy process.

11. HRSA: Readiness to Act HRSA program contributed to creation of an environment of understanding Began and encouraged open dialogue between states; a sharing of ideas on what “works” HRSA served as organizational/technical catalyst to initiate policy process. Was the HRSA State Planning Program a success? – How should program success be defined and measured? – SPG program had lasting “intangible” effect on state community building and policy development.

12. Modest Funding, Ambitious Goals Total HRSA SPG spending 2000-2005: $76 million Total CAP grant spending 2000-2005: $525 million The Office of Management and Budget wrote a report in which they claim the SPG program – No benchmark for data collection & analysis – Program has not made progress on long term goals of increasing health coverage – No clear need for SPG program