1. The Last Piece of the Puzzle

2. CHIPRA as a First Step CHIP reauthorization was a major step forward but it was never intended to be the broader reform needed to ensure all children have high-quality, affordable health coverage.

3. Gaps in Coverage Children = 78.6 million Source: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2008 ASEC Supplement to the CPS.

4. Gaps in Care Insured children receive the recommended care that they should only about half of the time. A third of insured children with special health care needs have inadequate coverage.

5. Public Program Eligibility and Take Up for Children Source: Background estimates for Julie Hudson and Thomas Selden, "Children's Eligibility and Coverage: Recent Trends and a Look Ahead," Health Affairs 26(5): w618-w629 (September 2007). Take-up Rate 70.5%78.3%66.4%

6. A Tale of Two Families Sarah Yakima, Washington

7. A Tale of Two Families Emily Albany, Ohio

8. Key Proposals 1.Building Affordable Coverage Pathways for All of America’s Children 2.Beyond Insurance – Ensuring Children Get the Care They Need 3.Creating a Family-Friendly, “No Wrong Door” Enrollment and Renewal Process 4.Strengthening Financing for Public Programs

9. Family-Friendly, Simplified Enrollment and Renewal is Key Pursue automatic enrollment and renewal where possible Create “no wrong door” system for Exchange subsidies, CHIP, and Medicaid Reduce red-tape barriers to coverage by using new technology to verify eligibility No child born in a U.S. hospital should leave without coverage Some states, for example Wisconsin, have online systems in place that simplify the process.

10. Family-Friendly, Simplified Enrollment and Renewal is Key Elizabeth Bible Amarillo, Texas For the last six months, she has filed three complete applications, but each was lost. Her children remain uninsured. Source: Children’s Defense Fund, “In Harms Way: True Stories of Uninsured Texas Children” (April 2009).

11. Family-Friendly, Simplified Enrollment and Renewal is Key State renewal requirements often generate large disenrollment, mostly attributable to: The frequency of reviews Procedural complexity Confusing renewal forms Burdensome verification requirements Source: D. Horner, “Program Design Snapshot: 12-Month Continuous Eligibility,” Center for Children and Families (March 2009).

12. The Last Piece of the Puzzle Public support for covering all children remains remarkably strong Children’s issues should be an integral part of the broader health reform debate With appropriate resources and good policy we can put the last pieces of the puzzle in place to secure high-quality, affordable health coverage for all children.