HRSA State Planning Grant Program: State Activities

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HRSA State Planning Grant Program State
Activities Alice Burton Director, State
Coverage Initiatives Michigan HRSA SPG Advisory
Group September 19, 2005
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HRSA State Planning Grant Program

• Since 2000, 52 states and territories received
  grants
• Surveys, focus groups, taskforces
• Since 2004, 400K Pilot Planning Grants to
  develop specific models
• Grant funding for planning, not for implementation

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Federal planning resources declining at a
critical time
FY 05 House rec. FY 06 Senate rec. FY 06
HRSA SPG 11 m 0 0
HCAP 82 m 0 60 m
High Risk Pool 14.4 m 0 0
Note High Risk Pool funding is balance of 04
Funding
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HRSA SPG Funded State Activities

• Greater understanding of need for state data and
  inadequacy of current federal data sources
• Each grantee convened stakeholders and initiated
  process to develop solutions
• Analysis and development of options

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States already paying for the uninsured
Over 300 million (40 of services) paid by
state and local govt
Source The Cost of Not Having Health Insurance
in the State of Maryland, DHMH, 2003
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Health care costs impact state economy
Source Iowa State Planning Grant Program, July
2004
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General Strategies to Expand Coverage

• Expanding Medicaid and SCHIP to new populations
  and creating new private sector partnerships
• Making new private insurance options more
  affordable
• Comprehensive (access, cost and quality)
  approaches
• Improving access through the safety net

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First round of HRSA SPG Pilot Activities

• CT Premium Assistance and subsidy programs
• DE Sustain coverage in small group market
  SCHIP expansion to parents
• GA/IL Community-based coverage models
• IN Medicaid (vs. safety net) coverage for
  parents with tax
• KS Examining different reinsurance models
• OK Medicaid program for working uninsured
• WV Develop models for age 50-64 population
• US VI Pooling mechanism for small business

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Coverage strategies focus on common problems

• Problem
• 99 of large firms offer, but only 63 of small
  firms do
• 8 out of 10 uninsured from working families
• Poor are twice as likely to be uninsured

• Strategy
• Public-private partnerships, many focus on small
  business
• Medicaid and SCHIP options attractive because of
  federal matching funds

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A small portion of workers decline employer
sponsored insurance
SOURCE Kaiser Comissionon Medicaid and
Uninsured, Key Facts, December 2003
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Changing nature of Medicaid coverage

• Opportunity for federal financing of Medicaid
• More states charge premiums
• Different benefits - Utah Primary Care Network
• Addressing problem of working uninsured
• Illinois expands coverage and enrolls families in
  employer sponsored insurance or Medicaid
• Maine enrolls working families through
  DirgioChoice
• New Mexico and Oklahoma propose Medicaid program
  for low-income workers through employers

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Efforts to make insurance more affordable

• Building purchasing power
• Limited benefits
• At least 11 states have passed minimum benefit
  legislation 4 in 2004
• Consumer directed health care
• Legislation to allow qualifying High Deductible
  Health Plans to be sold in the state
• Prevention strategies encouraging healthy
  behaviors

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Lessons so far

• Need federal funding - states do not have revenue
  base to fund coverage on their own
• Incremental strategies need to have vision
• Uninsured is a dynamic group insurance
  initiatives should be as seemless as possible
• Getting employer participation requires long-term
  partnership to build trust
• Building sustainable programs requires working
  within the market environment
• Focus - choice of options can be overwhelming

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State Coverage Initiatives (SCI)

• An Initiative of The Robert Wood Johnson
  Foundation
• Direct technical assistance to states
• State specific help, research on your questions
  call [phone]
• Meetings for state officials
• Web site http//statecoverage.net
• Publications
• Grant funding