Insuring America

1
Insuring Americas Children Findings from Site
Visits to Six Grantee States
Prepared by Ian Hill, Debra Draper, Allison
Liebhaber, Sara Hogan Presented at Finish Line
Grantee Annual Meeting Funded by The David and
Lucile Packard Foundation 15 July 2009
2
Outline of Presentation

• Background on Insuring Americas Children
• Overview of evaluation and case study methods
• Results from 6 site visits
• Next Steps/looking forward

3
Insuring Americas Children States Leading the
Way

• Provides financial and technical support to
  state-based advocacy organizations working to
  advance universal childrens coverage
• 8 states awarded Narrative Communications grants
• 8 states awarded Finish Line grants
• Technical assistance provided by Spitfire
  Communications and Georgetown Universitys Center
  for Children and Families

4
Insuring Americas Children Grantee States

Finish Line states - studied Finish Line
states - not yet visited Narrative
Communication states
5
Insuring Americas Children Evaluation

• Three-year partnership of Mathematica Policy
  Research, Inc., the Urban Institute, and the
  Center for Studying Health System Change
• Goals of evaluation
• Monitor childrens coverage and access nationally
• Analyze salience of/progress toward universal
  coverage in selected states
• Assess the impact of selected innovative
  expansions/policies

6
In-Depth Case Studies of Finish Line
Grantees/States

• Establish baseline understanding of state
  initiatives
• Learn about process of implementation
• Develop early lessons for Foundation and states
• Two interview teams
• Policy/program Urban Institute
• Advocacy/stakeholder Health Systems Change

7
States Tackle Universal Coverage from Different
Starting Points
Percent Uninsured Children Upper Income Limit Coverage of Legally-Resident Children State-Only Coverage of Undocumented Kids Presumptive Eligibility 12-month Continuous Eligibility
Arkansas 8 200 No No No Yes/No
Colorado 14 205 No No Yes Yes/No
Iowa 6 200 No No No Yes/No
Ohio 8 200 No No No No
Texas 22 200 Yes No No Yes/No
Washington 7 250 Yes Yes No Yes
8
Similar Childrens Agendas among Grantees
Eligibility Expansion Buy-In Program Simplify Enrollment/ Renewal Immigrant Children
Arkansas 300 gt300 12 mos. continuous eligibility
Colorado 250 Eligibility modernization 12 mos. continuous eligibility
Iowa 300 Presumptive eligibility Passive renewal Cover undocumented kids
Ohio 300 gt300 Advance dialogue re undocumented kids
Texas 300 gt200 12 mos. continuous eligibility Increased outreach application assistance Fix eligibility system
Washington 300 gt300
9
Grantees Face Numerous Challenges

• Worsening fiscal climate
• Securing and maintaining political support
• Responding to counterproductive federal policies
• Combating long-standing state procedural
  obstacles
• Overcoming data limitations

10
Accomplishing Results
Eligibility Expansion Buy-In Program Simplify Enrollment/Renewal Other
Arkansas 200 -gt 250 Online enrollment renewal Legally-resident immigrant children
Colorado 205 -gt 250 CSHCN lt 400 12 mos. continuous eligibility Online enrollment renewal Pregnant women (250) Parents (100) Childless adults (100) Legally-resident immigrant children
Iowa 200 gt 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
11
Accomplishing Results (cont.)
Eligibility Expansion Buy-In Program Simplify Enrollment/Renewal Other
Ohio 200 -gt 300 12 mos. continuous eligibility Telephonic renewal Express lane eligibility
Texas 12 mos. continuous eligibility Restored income disregards Broadened assets test Removed 90-day waiting period Increased eligibility staffing
Washington 250 -gt 300 Express lane eligibility Apple Health outreach
Pending
12
Effective Advocacy Strategies

• Building broad-based coalitions
• Cultivating diverse/respected champions
• Flexibly using effective/impactful messaging
• Encouraging a cultural shift in public programs
• Becoming the go to organization for
  information/data
• Taking advantage of federal-level changes

13
Lessons Learned

• Achieving reform requires persistence/long-term
  commitment
• Coalitions must involve grass roots, as well as
  state-level, stakeholders
• Advocates must have unified voice
• Creativity/flexibility required in changing
  environment

14
Lessons Learned

• Strong data are critical to supporting objectives
• Passing legislation is just a first step
• Advancing the dialogue on immigrant children is
  an important first step

15
Next Steps in the Evaluation

• Gathering and monitoring coverage/access data
• Conducting bellwether interviews
• Identifying targeted impact studies