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Insuring America’s Children: Findings from Site Visits to Six Grantee States Prepared by: Ian Hill, Debra Draper, Allison Liebhaber, Sara Hogan Presented.

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Presentation on theme: "Insuring America’s Children: Findings from Site Visits to Six Grantee States Prepared by: Ian Hill, Debra Draper, Allison Liebhaber, Sara Hogan Presented."— Presentation transcript:

1 Insuring America’s 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 July 2009 THE URBAN INSTITUTE

2 2 Outline of Presentation Background on Insuring America’s Children Overview of evaluation and case study methods Results from 6 site visits Next Steps/looking forward

3 THE URBAN INSTITUTE 3 Insuring America’s Children: States Leading the Way Provides financial and technical support to state- based advocacy organizations working to advance universal children’s coverage 8 states awarded Narrative Communications grants 8 states awarded Finish Line grants Technical assistance provided by Spitfire Communications and Georgetown University’s Center for Children and Families

4 THE URBAN INSTITUTE 4 Insuring America’s Children Grantee States Finish Line states - studied Finish Line states - not yet visited Narrative Communication states NH MA CT RI DE HI WA ME NJ VT NY DC MD NC PA VA WV FL GA SC KY IN OH MI TN MS AL MO IL IA MN WI LA AR OK TX KS NE ND SD MT WY UT CO AZ NM ID OR NV CA AK

5 THE URBAN INSTITUTE 5 Insuring America’s 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 children’s coverage and access nationally –Analyze salience of/progress toward universal coverage in selected states –Assess the impact of selected innovative expansions/policies

6 THE URBAN INSTITUTE 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 THE URBAN INSTITUTE 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 Arkansas8200%No Yes/No Colorado14205%No YesYes/No Iowa6200%No Yes/No Ohio8200%No Texas22200%YesNo Yes/No Washington7250%Yes NoYes

8 THE URBAN INSTITUTE 8 Similar Children’s Agendas among Grantees Eligibility Expansion Buy-In Program Simplify Enrollment/ Renewal Immigrant Children Arkansas300%>300% 12 mos. continuous eligibility Colorado250% Eligibility modernization 12 mos. continuous eligibility Iowa300% Presumptive eligibility Passive renewal Cover undocumented kids Ohio300%>300% Advance dialogue re undocumented kids Texas300%>200% 12 mos. continuous eligibility Increased outreach & application assistance Fix eligibility system Washington300%>300%

9 THE URBAN INSTITUTE 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 THE URBAN INSTITUTE 10 Accomplishing Results Eligibility Expansion Buy-In Program Simplify Enrollment/Renewal Other Arkansas200 -> 250%* Online enrollment & renewal* Legally-resident immigrant children* Colorado205 -> 250% CSHCN < 400% 12 mos. continuous eligibility Online enrollment & renewal Pregnant women (250%) Parents (100%) Childless adults (100%) Legally-resident immigrant children* Iowa200 –> 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 THE URBAN INSTITUTE 11 Accomplishing Results (cont.) Eligibility Expansion Buy-In Program Simplify Enrollment/Renewal Other Ohio200 -> 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 Washington250 -> 300% Express lane eligibility Apple Health outreach * Pending

12 THE URBAN INSTITUTE 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 THE URBAN INSTITUTE 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 THE URBAN INSTITUTE 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 THE URBAN INSTITUTE 15 Next Steps in the Evaluation Gathering and monitoring coverage/access data Conducting “bellwether” interviews Identifying targeted impact studies


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