1. COVERING KIDS: A STATE AND NATIONAL OVERVIEW Catherine A. Hess Senior Program Director National Academy for State Health Policy

2. NASHP@January, 2007  Non-partisan non-profit dedicated to helping states achieve excellence in health policy & practice.  Conduct policy analysis and research, interactive forums and assistance for executive & legislative branch state policymakers/administrators Conference Oct 14-16, Denver  Offices in Portland, ME & DC

3. NASHP@January, 2007  Child health specific coverage work support from Packard, Atlantic Philanthropies, Kellogg and RWJ  10 years supporting and reporting on state SCHIP implementation, now strong focus on reauthorization  Newer and growing focus on covering all kids

4. NASHP@January, 2007 Then and Now- A Success Story  In 1997, 23 % of low income children were uninsured  In 2004, 15% were uninsured, a drop of about one-third

5. NASHP@January, 2007 Ingredients of State Success : #1 Seven Steps, drawn from state and national policy experts #1 Keep enrollment and renewal procedures simple, especially  12 month continuous eligibility  Administrative (passive) renewals

6. NASHP@January, 2007

7. Seven Steps for State Success : #2 #2 Community- Based Efforts Are Key to Enrollment  CA Children’s Health Initiatives evaluations- coordinated CBO work  MA experience- churning when CBO outreach cut  IL pays CBOs for each application leading to a new member

8. NASHP@January, 2007 Seven Steps for State Success : #3 #3 Use technology-coordinate programs, reduce admin. burdens  CA Express Lane  MA Virtual Gateway  PA Compass  AL ADI  UT Clicks

9. NASHP@January, 2007 Seven Steps for State Success : #4 #4 Change Agency Culture  Make goals clear  Change language  Provide training  Provide tools and create systems

10. NASHP@January, 2007 Seven Steps for State Success : #5 #5 Engage Leaders Who Can Articulate a Clear Vision  Governors Kids popular, relatively inexpensive  Community Leaders

11. NASHP@January, 2007 Seven Steps for State Success : #6 #6 Engage partners, e.g.  Schools- incentives in federal nutrition and education programs  Managed Care Organizations- bottom line interest  Philanthropy- local and state foundations can help with research, planning, marketing

12. NASHP@January, 2007 Seven Steps for State Success : #7 #7 Marketing Is Essential  To policymakers  To public  To eligible families

13. NASHP@January, 2007 Much more to be done!  9 million kids uninsured Kids’ uninsurance rose in 2005 6% (MA) to 20%+(TX) Higher rates among adolescents, racial and ethnic minorities > need targeting? 3 out 4 eligible for Medicaid/SCHIP 96% are citizens

14. NASHP@January, 2007 Growing Number of States Aiming to Go All the Way

15. NASHP@January, 2007 Getting to All: Some Challenges Identified By States  Complexity of multiple programs  Marketing, outreach and enrollment: How to target/what works? “All kids” message counters stigma around enrolling in public programs Citizenship documentation negative impact on simplified eligibility/enrollment  Non-citizen children

16. NASHP@January, 2007 Getting to All: Some Challenges Identified By States  Crowd-out/ go-bare periods  Medical provider payments  Insurer concerns: adverse selection  What is “all”? 95%?  Benefit packages- Tension b/t Medicaid & Commercial  Sustainability – SCHIP uncertainties

17. NASHP@January, 2007 Top 3 Issues in SCHIP reauthorization 1. Money 2. Money 3. Money  $13- 15B needed over 5 years to maintain current enrollment levels  If frozen at $5B baseline, 36 states might have shortfalls by 2012  “Pay go” rules require offset; fear that this could come from Medicaid

18. NASHP@January, 2007 If SCHIP funded at baseline of $5B/Yr

19. NASHP@January, 2007 Other potential reauthorization issues  Formula and redistribution  Populations covered  Access to Quality Care/Performance  Premium assistance/wrapping around limited private plans/ESI interface  State employee coverage  Medicaid interface  Citizenship documentation  PERM

20. NASHP@January, 2007 Reauthorization timetable/prospects  ????  President’s budget out February 5 – will play a role in setting the stage  Clock runs out on ‘07 shortfall temporary fix on May 4 (not all states may make it)  Budget resolution should be April 15  Clock runs out Sept. 30 on current law

21. NASHP@January, 2007 Summary  SCHIP has been successful in increasing public coverage (SCHIP and Medicaid financed) of kids in time of declining ESI  States have learned a lot about how to structure programs, work with partners, and get and keep kids enrolled  Growing number of states are aiming to cover all kids, taking on more challenges  Successful SCHIP reauthorization is critical to maintaining and making further progress in states in covering kids

22. NASHP@January, 2007 NASHP CONTACTS/RESOURCES  Catherine Hess Senior Program Director Chess@nashp.org  John McInerney Program Manager jmcinerney@nashp.org  Alan Weil Executive Director Aweil@nashp.org  National Academy for State Health Policy www.nashp.org  Chip Central www.chipcentral.org