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

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groups, taskforces  Since 2004, $400K Pilot Planning Grants to develop specific models  Grant funding for planning, not for implementation

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

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

States already paying for the uninsured Source: The Cost of Not Having Health Insurance in the State of Maryland, DHMH, 2003 Over $300 million (40% of services) paid by state and local gov’t

Health care costs impact state economy Source: Iowa State Planning Grant Program, July 2004

General Strategies to Expand Coverage 1.Expanding Medicaid and SCHIP to new populations and creating new private sector partnerships 2.Making new private insurance options more affordable 3.Comprehensive (access, cost and quality) approaches 4.Improving access through the safety net

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 population  US VI – Pooling mechanism for small business

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

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

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

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

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

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 (202) call (202) –Meetings for state officials –Web site: –Publications  Grant funding