By Dr. Liane Wong, Health Leader and Program Officer, The David and Lucile Packard Foundation

For those up-to-date Say Ahhh! readers, Adam Searing recently wrote about the more compelling reasons – namely $423.6 billion federal dollars plus billions of uncompensated care funds to hospitals – why it’s getting much harder for Governors to turn down Medicaid expansion funding. Yet even as the economic ramifications and human costs are highlighted by pro-expansion stakeholders, the role of sustained advocacy to drive this case forward and ensure effective implementation will remain of vital importance in many states.

The David and Lucile Packard Foundation and Mathematica Policy Research recently released a brief on children’s coverage advocacy during Medicaid expansion. The brief highlights three multi-issue children’s organizations in Arkansas, Pennsylvania, and Utah that are advocating increased access to health insurance for low-income children in the midst of their state’s active debate about Medicaid expansion and alternative approaches. Each of the three groups advocated that Medicaid expansion and its alternatives have significant bearing not only on health insurance access for previously ineligible adults, but also in efforts to secure coverage for children and families. Based on the experience of these organizations, key lessons were identified for states moving forward with alternative approaches to Medicaid expansion.

Key Lessons Learned

Children’s advocates need to actively engage in the Medicaid expansion debates. The Packard Foundation’s Finish Line grantees made Medicaid expansion a top priority following the June 2012 Supreme Court decision. Although Medicaid expansion is explicitly about coverage for adults, the grantees saw its strategic importance to their missions to secure coverage for children.  As one grantee noted, “adults who are insured are more likely to insure their children.”

Grantees emphasized the well-being of children as a reason to expand Medicaid in their top line messaging. Arkansas Advocates for Children and Families explained that “when low-income parents have health coverage, eligible children are more likely to enroll as well, stay enrolled, and receive preventive care and other health services.”

When alternative approaches gained traction, grantees overtly supported these approaches but also documented concerns about potential effects on children’s coverage. The state-based organizations collaborated with national and state-based advocacy partners to use the Medicaid waiver process to convey to state and federal policymakers their concerns about specific provisions of expansion proposals in their states. Finish Line grantees said they benefit from interacting with other advocacy organizations that have considered the potential effects of alternative approach provisions in other states.

Children’s advocacy organizations in states looking to pursue Medicaid expansion can look to their counterparts in Arkansas, Pennsylvania, and Utah for lessons about approaching Medicaid expansion from a child- and family-friendly perspective that ensures all children and the parents that care for them have health care coverage. The full details of these findings can be found on the Mathematica Policy Research and Packard Foundation websites.