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NARRATIVE AND FINISH LINE: A QUICK 13 STATE TOUR Getting to the Finish Line NARRATIVE AND FINISH LINE: A QUICK 13 STATE TOUR Getting to the Finish Line Conference July 17, 2008

ØGOALS FOR THE YEAR AHEAD ØBuild support in new legislature for continued growth in ØGOALS FOR THE YEAR AHEAD ØBuild support in new legislature for continued growth in SCHIP enrollment ØRevamp outreach campaign to enroll more eligible, uninsured children Ø Reduce “churn” in enrollment through systems improvements

ØCHALLENGES ØOngoing budget crisis ØElimination of state outreach funds ØChanges in legislative and executive ØCHALLENGES ØOngoing budget crisis ØElimination of state outreach funds ØChanges in legislative and executive (? ) leadership ØOpportunities ØStrong network of partners across the state Ø SCHIP record of success for working families

ØACHIEVEMENT IN CHILD COVERAGE ØProtected Kids. Care and Kids. Care Parents from eligibility rollbacks ØACHIEVEMENT IN CHILD COVERAGE ØProtected Kids. Care and Kids. Care Parents from eligibility rollbacks and cuts despite $2 billion deficit

ØGOALS FOR THE YEAR AHEAD ØImprove collection and reporting of data related to enrollment ØGOALS FOR THE YEAR AHEAD ØImprove collection and reporting of data related to enrollment and reenrollment ØDecrease # eligible uninsured kids lost through reenrollment barriers ØExpand ARKids eligibility to 300% FPL ØCreate buy-in program for children in families above 300%

ØCHALLENGES ØSCHIP reauthorization uncertainty ØLukewarm support from Governor ØConservative budgeting despite surplus ØFirst close ØCHALLENGES ØSCHIP reauthorization uncertainty ØLukewarm support from Governor ØConservative budgeting despite surplus ØFirst close examination of enrollment/re-enrollment in several years, some reeducation necessary ØOpportunities ØVery strong support for ARKids ØStrong network of partners across the state ØMotivated legislative champions ØBetter than expected budget ØGood relationships with DHS/Medicaid

ØACHIEVEMENT IN CHILD COVERAGE Ø Reduced the rate of uninsured kids from 21% to ØACHIEVEMENT IN CHILD COVERAGE Ø Reduced the rate of uninsured kids from 21% to 11% since the inception of ARKids Ø Enacted and maintained many policy changes in ARKids that have helped to maintain enrollment Ø Self-declaration of income Ø 12 month continuous (B/SCHIP only) Ø Decrease in ARKids B/SCHIP waiting period from 12 to 6 months Ø Removal of assets test Ø Streamlining efforts with Food Stamps

ØGOALS FOR THE YEAR AHEAD ØDefend against “one step back” policies such as Semi. ØGOALS FOR THE YEAR AHEAD ØDefend against “one step back” policies such as Semi. Annual reporting for children in Medi-Cal ØEnsure health coverage for all children regardless of immigration status – through broad state health care reform, stand-alone bill, or ballot initiative ØPartner with allies to collect over 100 family stories in strategic areas ØSupport SCHIP reauthorization effort by educating CA Congressional delegation

ØCHALLENGES ØSCHIP reauthorization and CMS directive uncertainty ØInconsistent support from Governor ØUnprecedented state budget ØCHALLENGES ØSCHIP reauthorization and CMS directive uncertainty ØInconsistent support from Governor ØUnprecedented state budget deficit ØDifficulty finding viable financing mechanism for coverage expansion ØLocal Children’s Health Initiatives running out of funding ØOpportunities ØStrong network of partners across the state ØKey legislative champion ascends to Senate leadership post ØCompelling media ‘hook’ of children losing coverage

ØACHIEVEMENT IN CHILD COVERAGE ØWon insertion of expansion to ALL children up to 300% ØACHIEVEMENT IN CHILD COVERAGE ØWon insertion of expansion to ALL children up to 300% FPL in 2007/08 Governor’s health care reform package, with early start date for children (package narrowly failed January 2008)

ØGOALS FOR THE YEAR AHEAD ØReform the system to work better for kids and ØGOALS FOR THE YEAR AHEAD ØReform the system to work better for kids and families ØGenerate awareness and engage public support

ØCHALLENGES ØMajor fiscal restraints ØState leadership's non-committment to the Initiative's policy options and timeline ØCHALLENGES ØMajor fiscal restraints ØState leadership's non-committment to the Initiative's policy options and timeline ØInitiative's leadership comprised of multiple organizations ØOpportunities Ø 2010's recent successes ØGovernor's promise to cover all kids ØInitiative's leadership comprised of multiple organizations

ØACHIEVEMENT IN CHILD COVERAGE Ø Simplification of the current eligibility determination system for public ØACHIEVEMENT IN CHILD COVERAGE Ø Simplification of the current eligibility determination system for public health coverage programs (administrative verification of income) Ø Expansion of CHP+ (SCHIP) to 225%FPL Ø Implementation of Presumptive Eligibility for kids Ø Establishment and expansion of medical home initiative for kids and performance standards for Medicaid and CHP+ services Ø Additional new policies created by state based on 2010 recommendations Ø Growing recognition of the 2010 All Kids Covered Initiative by stakeholders

ØGOALS FOR THE YEAR AHEAD ØProtect full coverage of All Kids for non-citizen children ØGOALS FOR THE YEAR AHEAD ØProtect full coverage of All Kids for non-citizen children ØIncrease enrollment through engaging community-based allies ØPromote All Kids as a successful government role in health coverage

ØCHALLENGES ØGovernor’s unpopularity ØAttacks from the right of non-citizen coverage ØState budget woes ØOpportunities ØCHALLENGES ØGovernor’s unpopularity ØAttacks from the right of non-citizen coverage ØState budget woes ØOpportunities ØGrowing campaign for healthcare for all ØPossible positive federal role

ØACHIEVEMENT IN CHILD COVERAGE Ø Increased positive support and ownership of All Kids among ØACHIEVEMENT IN CHILD COVERAGE Ø Increased positive support and ownership of All Kids among politicians other than the governor

ØGOALS FOR THE YEAR AHEAD ØImplement the policies from the 2008 legislation ØAssure funding ØGOALS FOR THE YEAR AHEAD ØImplement the policies from the 2008 legislation ØAssure funding for children’s health coverage stays in the budget ØIncrease advocacy support among other groups

ØCHALLENGES ØSCHIP reauthorization uncertainty ØCompetition with adult health care reform ØFunding, due to the ØCHALLENGES ØSCHIP reauthorization uncertainty ØCompetition with adult health care reform ØFunding, due to the budget and the flooding ØOpportunities ØStrong legislative support for kids coverage ØMomentum is on our side right now

ØACHIEVEMENT IN CHILD COVERAGE ØWe moved a draft bill with language about mandatory coverage ØACHIEVEMENT IN CHILD COVERAGE ØWe moved a draft bill with language about mandatory coverage for children into a bill with expanded eligibility and improved retention and renewal strategies, and got nearly unanimous legislative support for it.

ØGOALS FOR THE YEAR AHEAD ØExpand eligibility from 200%-300% FPL ØAdvance simplification agenda for ØGOALS FOR THE YEAR AHEAD ØExpand eligibility from 200%-300% FPL ØAdvance simplification agenda for enrollment, renewal, and retention ØBuild coalitions for local outreach

ØCHALLENGES ØState leadership hesitating on expansions ØTight State FY 2010 -2011 budget climate ØNeed ØCHALLENGES ØState leadership hesitating on expansions ØTight State FY 2010 -2011 budget climate ØNeed to build public and political will on immigrant coverage agenda ØOpportunities ØStrong network of partners across the state ØMotivated legislative champions ØAugust 17 th directive not applicable to OH

ØACHIEVEMENT IN CHILD COVERAGE Ø Won Children’s Buy In down to 250% FPL Ø ØACHIEVEMENT IN CHILD COVERAGE Ø Won Children’s Buy In down to 250% FPL Ø Facilitated cabinet level conversations across all OH agencies serving children Ø Formed successful CKF coalitions in Columbus-area and in Mahoning Valley

ØGOALS FOR THE YEAR AHEAD ØTo pass the Governor’s Healthy Kids Plan and provide ØGOALS FOR THE YEAR AHEAD ØTo pass the Governor’s Healthy Kids Plan and provide health care coverage for more than 100, 000 currently uninsured Oregon kids ØReauthorize SCHIP in the first 100 days of the new administration ØMaintain and expand moratorium on harmful CMS directives

ØOPPORTUNITIES ØHealthy Kids Plan is Governor’s top priority ØGovernor is proposing that 66, 000 ØOPPORTUNITIES ØHealthy Kids Plan is Governor’s top priority ØGovernor is proposing that 66, 000 currently eligible, but un-enrolled kids be covered by administrative rule change with general funds ØOregon Health Fund Board, proposal to cover children as first step ØSCHIP support from 6 of 7 congressional members

ØChallenges ØGovernor is a lame-duck ØFunding mechanism for the Healthy Kids Plan has not ØChallenges ØGovernor is a lame-duck ØFunding mechanism for the Healthy Kids Plan has not been completely detailed ØPreviously strong legislative supporters, now hesitant ØGrowing resistance in the advocacy community ØLoss of timber revenue ØHarmful ballot measures ØGrowing number of underinsured kids

ØACHIEVEMENT IN CHILD COVERAGE Ø 12 -month continuous eligibility win Ø Resurrection of the ØACHIEVEMENT IN CHILD COVERAGE Ø 12 -month continuous eligibility win Ø Resurrection of the Healthy Kids Plan Ø Shortened, simplified application process Ø State commitment to train community partners in outreach and application assistance

Ø GOALS FOR THE YEAR AHEAD Ø Maintain current RIte Care eligibility levels and Ø GOALS FOR THE YEAR AHEAD Ø Maintain current RIte Care eligibility levels and benefits package for children and parents. Ø Expand RIte Care eligibility from 250% FPL to 300% FPL. Ø Create buy-in program for children in families above 300% FPL. ØDocument cases of enrollees who are sanctioned or lose coverage for unpaid premiums.

Ø CHALLENGES Ø Global Medicaid waiver Ø Continued projected budget deficits Ø Opportunities Ø Ø CHALLENGES Ø Global Medicaid waiver Ø Continued projected budget deficits Ø Opportunities Ø Strong statewide network of partners, bolstered by new RIte Care Works Coalition Ø Motivated legislative champions

Ø ACHIEVEMENT IN CHILD COVERAGE Ø Prevented cuts to RIte Care eligibility for citizen Ø ACHIEVEMENT IN CHILD COVERAGE Ø Prevented cuts to RIte Care eligibility for citizen children (maintained at 250% FPL) and minimized cuts to parents (rolled back from 185% FPL to 175% FPL, rather than 133%, sparing 6, 400 parents)

ØGOALS FOR THE YEAR AHEAD ØFix eligibility system and increase outreach Ø 12 month ØGOALS FOR THE YEAR AHEAD ØFix eligibility system and increase outreach Ø 12 month coverage for Children’s Medicaid ØExpand eligibility to 300% FPL (sliding scale) ØCreate full cost buy-in above 300% FPL

ØChallenges ØCost of Agenda ØUnknown Speaker and Committee chairs ØConcerns with growing government program ØChallenges ØCost of Agenda ØUnknown Speaker and Committee chairs ØConcerns with growing government program ØSCHIP reauthorization uncertainty ØOpportunities ØStrong network of partners across the state ØMotivated health champions ØSupport from Chambers of Commerce ØIncreased attention on health care issues due to presidential elections

ØACHIEVEMENT IN CHILD COVERAGE Ø Enrolled 10% of uninsured Texas children in under 10 ØACHIEVEMENT IN CHILD COVERAGE Ø Enrolled 10% of uninsured Texas children in under 10 months Ø Hospital and Chamber endorsement of full agenda for 2009 Ø Development of strong economic argument Ø Development of a statewide grasstops and grassroots plan of action

ØGOALS FOR THE YEAR AHEAD Ø Begin discussion around removal of five year waiting ØGOALS FOR THE YEAR AHEAD Ø Begin discussion around removal of five year waiting period for legal immigrants Ø Move forward with legislation to improve CHIP enrollment and retention—P/E, express-lane, income eligibility to 250% FPL, and/or Buy-In Ø Carry out effective electoral advocacy Ø Secure funding and initiate Latino outreach within Utah Mexican Hometown Clubs

ØCHALLENGES Ø CHIP enrollment is slow Ø Health System Reform task force is proving ØCHALLENGES Ø CHIP enrollment is slow Ø Health System Reform task force is proving somewhat ineffective ØOpportunities Ø Strong bi-partisan support for children’s health care Ø Big successes from last session will be easy to capitalize on for this year

ØACHIEVEMENT IN CHILD COVERAGE Ø Removed enrollment cap from CHIP Ø Formed health system ØACHIEVEMENT IN CHILD COVERAGE Ø Removed enrollment cap from CHIP Ø Formed health system reform taskforce Ø Mandated coordination for CHIP outreach between Health Dept. , Dept. Workforce Services, and State Board of Ed. Ø Mini-grants for minority outreach

ØGOALS FOR THE YEAR AHEAD ØBuild public support for Cover All Kids ØEnroll 50% ØGOALS FOR THE YEAR AHEAD ØBuild public support for Cover All Kids ØEnroll 50% of eligible uninsured kids ØExpand eligibility to 300% FPL ØCreate affordable buy-in program for children in families above 300%

ØCHALLENGES ØTough elections & legislative environment ØSCHIP reauthorization uncertainty ØDRA Citizenship Verification barriers ØOpportunities ØCHALLENGES ØTough elections & legislative environment ØSCHIP reauthorization uncertainty ØDRA Citizenship Verification barriers ØOpportunities ØStrong network of partners across the state ØMotivated legislative champions

ØACHIEVEMENT IN CHILD COVERAGE Ø Won public support for an expansion for all children, ØACHIEVEMENT IN CHILD COVERAGE Ø Won public support for an expansion for all children, and an entitlement for care Ø Ensured that federal citizenship verification did not result in terminations

ØGOALS FOR THE YEAR AHEAD ØContinued strong outreach for Badger. Care Plus ØIdentifying and ØGOALS FOR THE YEAR AHEAD ØContinued strong outreach for Badger. Care Plus ØIdentifying and removing barriers to participation ØImproving coverage of immigrant children

ØCHALLENGES ØEnrollment far exceeds expectations, and WI budget is in the red ØOpposition to ØCHALLENGES ØEnrollment far exceeds expectations, and WI budget is in the red ØOpposition to coverage of immigrants ØOpportunities ØCommitment of Governor and many legislators to continue expanding access to insurance ØStrong network of partners across the state

ØACHIEVEMENT IN CHILD COVERAGE Ø Enactment and implementation of Badger. Care Plus without changes ØACHIEVEMENT IN CHILD COVERAGE Ø Enactment and implementation of Badger. Care Plus without changes because of Aug. 17 directive. Ø 16% increase in enrollment during the first 4 months (49, 000 more kids). Ø Kids eligible regardless of income, but 83% of the initial increase was among kids below 200% of FPL