December 14, 2011

This week, the Finish Line Flash shares a great editorial from Utah, a new report on collecting and using data to support improvements in enrollment and retention, a handy one-page flowchart showing coverage decisions under the ACA, and a brief write-up that explains the affordability test problem that causes the family penalty or “kid glitch.”

Media Materials

Utah Newspaper Takes on Red Tape—Finish Liners in Utah used CCF’s brief on children’s uninsurance rates to pitch an editorial on reducing red tape barriers to enrollment in Medicaid and CHIP.  The result was a very strong piece that compares the open availability of police and fire services to the barriers families must face in applying for health coverage.

Enrollment and Retention

Using Data—A new report from the Maximizing Enrollment project, authored by folks at Mathematica and NASHP, outlines the key data elements that states can use to help improve enrollment and retention in health coverage.  The report identifies three groups of performance measures, in increasing levels of sophistication, that can help states assess their programs’ function, plan for improvements, and measure success against goals.

Health Reform Resources

The Path to Coverage under the ACA—The Center for Healthcare Research and Transformation has put together a flowchart that shows how individuals will get coverage once the ACA is implemented.  Through a series of yes or no questions, it shows the decision tree for determining whether someone will be covered by employer coverage, a public program, exchange plans, or other sources.  While it does not include every last detail, it is nonetheless a good one-page reference for reminding ourselves of the different coverage pathways.

Fixing the Kid Glitch—First Focus has released a one and a half page Q&A document that explains the problematic proposed rule from the Treasury Department on the ACA’s affordability test.  The document explains the impact on kids and families.  It also highlights a study by researchers at UCLA and UC Berkeley that provides data that support a different and more family-friendly interpretation of the law.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

November 30, 2011

The Finish Line Flash this week highlights a new effort from Finish Liners in Texas to engage supporters with family stories and social media.  We also pass along notice of an upcoming webinar on essential health benefits and a useful paper on how states can help make health reform work for low-income children.

Engaging Grassroots Supporters

Thankful Thursdays—Finish Liners at CDF-Texas have pioneered a new effort to convey family stories and connect grassroots supporters to each other and to policymakers.  Each week on Thursday, CDF shares a new story in which a family expresses thanks for the value of Medicaid or CHIP.  The website then offers multiple ways for readers to share the story with their social media connections or to speak up to policymakers in support of kids coverage.  A great way to motivate and engage members of the community.

Events

EHB Webinar from NASHP—The National Academy for State Health Policy will host a webinar on the essential health benefits on Thursday, December 8, from 2:30 to 4:00 pm Eastern.  The webinar will feature Rhode Island Insurance Commissioner Christopher Koller, Maryland Health Care Commission Director Ben Steffen, and other experts discussing how states can plan and prepare for the federal definition of essential health benefits.  Register at https://cc.readytalk.com/cc/s/showReg?udc=7ahc1ia7uvwb

Health Reform Resources

Making Sure Low-Income Children Benefit from Health Reform—Analysts at the Urban Institute prepared at paper for the California Endowment that examines the state policy responses needed to provide the greatest benefits to low-income children from the ACA.  The paper is focused on California but is also applicable to other states.  It discusses maximizing enrollment, improving affordability, strengthening provider infrastructure, and supporting programs outside Medicaid and CHIP.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

November 17, 2011

The week, the Finish Line Flash shares news of two useful upcoming webinars and links you to a new collection of family stories from the Kaiser Commission on Medicaid and the Uninsured.

Events

Enrollment and Retention Webinar from NASHP—NASHP will hold a webinar on collecting and using data to drive improvements in states’ efforts to enroll and retain coverage for eligible individuals and families.  Part of the Maximizing Enrollment project, the webinar will cover the recommendations for performance measurement contained in a new issue brief to be released the same day.  The webinar will take place on Monday, November 21 from 3:00-4:00 pm Eastern.  Use this link to register:  https://cc.readytalk.com/cc/s/showReg?udc=s5n7k050jhd7

Insurance Brokers and Exchanges Webinar from CBPP—Another webinar, specifically for the state advocacy community, will provide a chance to learn about and discuss the role of brokers in health insurance, both in the current market and once more of the ACA is in effect in 2014.  This webinar will be held on Tuesday, November 22 from 1:00-2:30 Eastern.   Registration at:  https://www3.gotomeeting.com/register/584989870

Medicaid and CHIP 

Faces of Medicaid—The Kaiser Commission on Medicaid and the Uninsured has released Faces of Medicaid, a collection of stories from 16 Medicaid beneficiaries.  Through photos and audio clips, it relates their experiences and also provides a brief summary of Medicaid policy issues reflected in the stories.  The online resource can also be printed as a booklet.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

November 2, 2011

After a break for last month’s meeting in DC (materials available here), the Finish Line Flash returns this week with news of the HHS listening sessions on the essential health benefits package, a report on the quality of care provided to children through Medicaid and CHIP, a new resource from Community Catalyst on improving Medicaid, and a link to CCF’s final comments on the Medicaid, exchange, and premium tax credit eligibility regulations.

Events

HHS to Hold EHB Meetings in 10 Cities—To help inform its upcoming rulemaking on essential health benefits, HHS will hold ten listening sessions across the country, many of them in or near Finish Line states.  The sessions will allow the Department to gather input from a variety of perspectives on the EHBs and you can help emphasize the needs of children and families.  Click the link for a list of sessions—HHS provides the following instructions for RSVPing: To register for the event, please send an email with your name, organization, title, email address and phone number to the designated RSVP by the RSVP Due Date listed.   (NOTE: In some locations, RSVPs are needed for building security and will be accepted on a first come, first serve basis.)

Medicaid and CHIP

Children’s Care Quality Report—As mandated by CHIPRA, HHS has released the second of its annual reports on the quality of care provided to children under Medicaid and CHIP.  While reporting of child health quality measures remains voluntary for states, almost all states reported on at least some measures.  On a couple of commonly reported measures, the report provides valuable information to compare across states and over time.  Find the percentage of 3-6 year olds who received well child visits (page 43) or the change in percentage of children who received any dental care from 2000 to 2009 (page 46).

Medicaid Report Card—Community Catalyst has developed an online report card that assesses how states are doing in Medicaid improvements that protect care while lowering cost.  Currently, states are rated on three key policy areas and more are expected to be added later.  You can see if your state makes the grade, has room to improve, or misses the mark.  Any strategy your state has not fully adopted can be used as an alternative to cuts that harm beneficiaries.

Regulation Comments

Final CCF Comments—We’ve previously shared our template for commenting on HHS’s proposed regulations on Medicaid, exchange, and premium tax credit eligibility.  You can find CCF’s final submitted comments at the links.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

October 5, 2011

The Finish Line Flash this week passes along news of the upcoming second National Children’s Health Insurance Summit and shares with you three useful health reform resources—evidence that the ACA’s provision allowing young adults to remain on parents’ plans has reduced uninsurance, recommendations on the essential health benefits, and a report with state data on the Basic Health Plan option.

Events

Connecting Kids to Coverage—CMS will host the second National Children’s Health Insurance Summit on November 1-3 in Chicago.  The meeting focuses on outreach, enrollment, and retention strategies for getting and keeping children enrolled in Medicaid and CHIP.  The conference will focus on the issues being addressed by the grantees in the second round of CHIPRA Outreach grants, but attendees need not be affiliated with grantee organizations.  More information and registration is available at the link.

Health Reform Resources

HHS Finds Strong Coverage Effects for Young Adults from ACA—Using up-to-date data on coverage, HHS’s Office of the Assistant Secretary for Planning and Evaluation found that adults aged 19-25 experienced a 3.5 percentage point increase in the rate of coverage over the past year, while other adults remained flat.  ASPE attributes this change—which implies one million more individuals have coverage—to the ACA’s provision that allows young adults to remain covered by parents’ plans up to age 26.  An important piece of the argument for the ACA’s benefits.

Essential Health Benefits—The National Health Council, a coalition led by organizations representing those with chronic illnesses, has released a brief report that analyzes how the essential health benefits can best protect patients.  It includes a suggested regulatory approach that establishes three levels of protections.  The 10-page report plus suggested regulatory language is a good way to start thinking more about essential health benefits.  The issue is a critical part of health reform and will soon be ripe for advocacy—An Institute of Medicine report on the methodology for determining the essential health benefits will be released October 7 and HHS is expected to propose regulations defining the EHBs in the coming months.

Basic Health Plan Option—The Urban Institute produced an analysis with state-by-state data of the Basic Health Plan—an option the ACA gives states to provide coverage to some individuals who would otherwise be eligible for subsidized exchange coverage.  States could implement the Basic Health option in a variety of ways and the report models one of them.  It shows one potential set of outcomes for Basic Health and finds that under its assumptions, adopting the Basic Health option would make coverage more affordable for enrollees, reduce the number of uninsured, and draw greater federal funds to a state.  It would also reduce somewhat a state’s exchange enrollment and introduce greater risk to the individual market.  Estimates of these effects are available for most states.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

September 29, 2011

This week, the Finish Line Flash shares with you a great editorial from Utah that defends Medicaid, another installment of the Pennsylvania Finish Liners’ Faces and Facts series, a brief from First Focus on the impact of Medicaid block grants on kids, and a report that shows where each state stands on Medicaid managed care.

Media Materials

An Encouraging Echo from Utah—This summer, Sen. Orrin Hatch held a U.S. Senate field hearing in Utah, featuring Gov. Gary Herbert and focused exclusively on Medicaid’s costs. Voices For Utah Children’s Lincoln Nehring authored an op-ed challenging the senator and the governor to recognize Medicaid’s value. Last week, the Salt Lake Tribune agreed, acknowledging Medicaid’s cost but focusing principally on the value Medicaid delivers and the importance to kids and families of protecting the quality, cost-effective care it delivers for Utah families. This is not only a great win for the Utah Finish Line team, but also an important reminder that shaping public conversations about critical issues can actually move the debate.

Pennsylvania Finish Liners Connect Coverage to School Performance—Back in June, we shared the first edition of Pennsylvania Partnerships for Children’s Faces and Facts series, an idea borrowed from advocates in Colorado.  These e-mails are intended to take abstract concepts about kids coverage and humanize and localize them through real Pennsylvanians’ eyes.  They position Medicaid and CHIP as kids’ issues and health issues, not just budget issues.  This installment uses one child’s story to show the important connection between health coverage and school success.  Has your organization been putting family stories to use lately?  Let us know and we can share your ideas with other Finish Liners.

Medicaid

Block Grants’ Impact on Kids—First Focus this month released a brief that looks at Medicaid’s enormous success in increasing health coverage for children and examines the dangers of block grants for children, including the possibility of reduced services and increased out-of-pocket costs for parents.  As both state and federal officials discuss potentially major changes to Medicaid’s structure, this brief provides a useful summary of the real world consequences of one of the proposed changes.

Medicaid Managed Care Survey—While managed care in Medicaid is already widespread, many states are moving even more heavily toward this model as they seek to both reduce costs and improve access to care.  The Kaiser Commission on Medicaid and the Uninsured recently released a 50-state survey that both assesses the state of managed care in Medicaid and identifies current issues.  If your state is increasing its reliance on managed care, this report may be helpful by showing the models in use across the country and highlighting issues your state’s Medicaid program may encounter.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

September 14, 2011

A quick Finish Line Flash this week highlights two briefs put out this summer by Finish Liners in New Mexico on the impact of the ACA in their state.  It also alerts you to a webinar to be hosted by the Association of Community Affiliated Plans on the state option for Basic Health Plans.

New Publications

New Mexicans Show Benefits of ACA—Finish Liners from New Mexico Voices for Children have published two briefs that provide detailed quantitative estimates  of the impacts of the ACA on the state.  One examines the overall economic effects, finding significant increases in business activity and jobs.  The second focuses on the revenue increases the state government can expect as a result of the Affordable Care Act.

Health Reform Resources

ACAP Webinar on Basic Health—The Association of Community Affiliated Plans, which represents non-profit Medicaid plans, will hold a webinar on the ACA option for states to adopt a Basic Health Plan on September 22 from 2:00 to 3:30 pm Eastern.  Stan Dorn of the Urban Institute will share the results of a report on the option, including policy approaches and their effects on coverage for eligible individuals and on state exchanges.  Register for the event at https://www3.gotomeeting.com/register/527217742.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

September 7, 2011

The Finish Line Flash this week shares a handy review and analysis of recent ACA regulations, brings news of a new initiative to help states leverage the coming boost in Medicaid primary care rates, alerts you to a publication from the American Legislative Exchange Council that aims to help state legislators block the ACA, and provides a brief on how states can take action on health disparities as they implement health reform.

Health Reform Resources

Help Understanding the New Eligibility and Enrollment Rules—The Robert Wood Johnson Foundation released a new report through its State Health Reform Assistance Network that provides an overview and analysis of new proposed regulations from HHS and the IRS on state exchanges, Medicaid eligibility, and premium tax credits.  The report outlines the themes, implications, and key findings in the rules and summarizes them in plain English.

Six States Join Primary Care Rate Initiative—The Affordable Care Act will raise the payments Medicaid makes for primary care services to Medicare rates in 2013 and 2014.  The Center for Health Care Strategies recently announced that it will work with CMS and Medicaid agencies in six states to help make the most of the payment rate increase.  The participating states are Arkansas, Colorado, Minnesota, New York, Oregon, and Rhode Island.  The initiative will help states use the higher rates to contribute to payment reform initiatives, enhanced access to primary care, and other state-level primary care transformation efforts.  Something to pay attention to if you are in one of the participating states and a potential source for promising practices for your state if you are not.

State Opportunities for Action on Health Disparities—NASHP has released an issue brief that suggests ways states can address racial and ethnic health disparities through health reform.  The new brief outlines the ACA provisions that relate to disparities and provides a case study of one state’s efforts to build a focus on disparities into its implementation of ACA reforms.

ALEC Guide to Blocking the ACA—The American Legislative Exchange Council has published a guide for state legislators that suggests ways they can contribute to blocking ACA implementation.  Several states have already seen some of the suggestions put into action.  Looking through this guide may help give you an idea of what is yet to come from opponents of the ACA in your state.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

August 31, 2011

This week, the Finish Line Flash shares a useful brief on key considerations in linking Medicaid with exchanges, highlights a savvy story on Medicaid costs from Utah, and notes the new round of CHIPRA outreach grants recently awarded by HHS.

Health Reform Resources

Ten Considerations–As part of the State Health Reform Assistance Network, the Center for Health Care Strategies produced a brief that looks at the links between Medicaid and state exchanges.  It explains ten considerations for streamlining administration and facilitating transitions between the two for eligible individuals.  It notes that continuity of providers, benefits, and plans will be important for enrollees.  Other publications have raised many of these issues, but this 8 page brief brings many important points together in one place.

Media Materials

Salt Lake Tribune Looks Behind the Medicaid Numbers–Too much coverage of Medicaid budgets focuses on partisan talking points and touches only superficially on the budget realities. This great SLT article pushes behind the spin and examines why Utah’s Medicaid costs per person have actually dropped, even as increased enrollment has grown. It highlights newly-eligible cheaper-to-cover Utahns as part of that equation, providing a great reminder that our kids-are-cost-effective argument has a good chance of getting a reporter’s attention.

Outreach and Enrollment

CHIPRA Grants—Earlier this month, CMS announced the award of the latest round of $40 million in grants to support outreach in Medicaid and CHIP.  Grants from $200,000 to $2.5 million went to states, health centers, and community-based organizations.  HHS chose five areas of focus for the grants, including using technology, retaining eligible children, engaging schools, reaching children most likely to experience coverage gaps, and ensuring eligible teens get coverage.  Tricia Brooks blogged about the awards and other outreach efforts.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

August 17, 2011

The Finish Line Flash this week alerts you to new state-by-state numbers on the participation of kids in Medicaid and CHIP, conveys the good news of a Finish Liner’s leadership of her state’s Exchange board, and passes along a useful piece from Families USA on risks for Medicaid in the debt deal.

Eligible but Unenrolled

Participation Rates Up—A new analysis by the Urban Institute and the Robert Wood Johnson Foundation looked at the change in the participation of eligible children in Medicaid and CHIP between 2008 and 2009.  It found a higher participation rate nationally and in most states in 2009, reflecting both greater need for public coverage and a better job by states in getting and keeping eligible children enrolled.  The data show that across the country, 340,000 fewer eligible children were unenrolled in 2009 than a year previously, but over 4 million eligible children remained unenrolled.  Find out how your state did in the tables at the end of the report.

State Update

Colorado Finish Liner Chairs Exchange Board—Gretchen Hammer, Executive Director of the Colorado Commission for the Medically Underserved, was elected by the membership of the Colorado Health Benefits Exchange Board to serve as its chair.  Congratulations, Gretchen!

Medicaid Defense

Families USA on Medicaid in the Debt Deal—Families USA has released a brief paper that looks at the impact of the debt deal on Medicaid.  It describes the immediate effects and discusses some of the potential changes that the “super committee” could make to the program.  It provides some key message points and suggests how advocates should evaluate proposals that come out of the super committee.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

August 3, 2011

This week, the Finish Line Flash passes along a well-crafted statement on this week’s debt deal from Finish Liners in Arkansas, a strong op-ed on Medicaid from an influential member of Congress, two quick resources on the ACA’s conversion to the MAGI eligibility standard, and a request to be Liked.

Media Materials

Arkansas Finish Liners React to Debt Deal—In a blog post, Finish Liners at Arkansas Advocates for Children and Families provide a clear-eyed look at the impact of this week’s debt deal on children and families.  They note that important programs for low-income families are protected from immediate cuts, but the long-term outlook is quite challenging given the dynamics of the Joint Committee created in the agreement.  The post observes that the outcome does not achieve the balanced approach that would spread sacrifices fairly and urges policymakers to put children’s needs first in future deliberations.

Maryland Congressman Makes the Case for Medicaid—As the debt negotiations reached a critical point last week, Rep. Chris Van Hollen, ranking member of the House Budget Committee, used an op-ed to speak out on protecting Medicaid.  He employed clear messaging that identifies those the program serves and the important contribution it makes to his state’s economy.  With Medicaid in mind, he framed the debt debate as a clear choice between making the wealthiest pay their fair share and making choices that are in the best interests of American families.

Health Reform Resources

More on MAGI—Has your state’s eligibility system begun to plan for the shift away from using multiple disregards and toward using the MAGI definition of income?  It’s something each state will have to do by 2014 and is one of the things states can take care of early to smooth that year’s many changes.  For an explanation of the switch, there’s a new blog post from Tricia Brooks and a quick 2-page brief from SHADAC which also has a link to a webinar presentation.

Social Media

Like CCF—Now that you’re Friending the Finish Line, you might also want to Like CCF on Facebook.  Use the link to access our wall, and if you like what you see, click Like under our name.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

July 20, 2011

The Finish Line Flash this week shares two great op-eds placed by Finish Liners in Utah and Washington, alerts you to an important achievement in kids’ coverage from Oregon, and links you to a new paper from NASHP on coverage for kids under health reform.

State Update

Oregon’s Rate of Uninsured Kids Drops—The Oregon Health Authority announced a dramatic drop in the state’s rate of uninsured kids over the last two years—from over 11% to a new low of only 5.6%.  The drop is largely attributable to new enrollments into Healthy Kids since 2009.  We’ll have more to share from the Oregon Finish Liners soon, so stay tuned to Say Ahhh!

Media Materials

Setting the Record Straight in Utah—When U.S. Senator Orin Hatch scheduled a hearing on Medicaid and invited only two conservative governors to testify, advocates at Voices for Utah Children knew the potential for incomplete and inaccurate information about the program was high.  They drafted and placed an extremely strong op-ed that appeared in the state’s largest newspaper the day after the hearing.  In it, Lincoln Nehring shows that the share of the state’s budget that goes to Medicaid has not grown in recent years, even as the program covers more people.  And he points to the recent studies showing Medicaid improves access to care and the health of beneficiaries.  The op-ed was a key piece of Voices’ response to the hearing, which also included their own media statements and outreach to local reporters.

Washington Finish Liners Collaborate with AARP—Paola Maranan, executive director of Finish Line’s own Children’s Alliance, teamed up with Ingrid McDonald of AARP Washington to give a unique, inter-generational perspective on the importance of Medicaid. The authors bring people back into this debate by showing how Medicaid helps Washingtonians of all ages and making it clear that Medicaid cuts would be only a cost shift. Their united defense of Medicaid reminds us that partnering with other groups can add valuable firepower to your advocacy.

Health Reform Resources

EPSDT, CHIP, and Health Reform—NASHP convened CMS and state officials to think through the role of children’s coverage as health reform is implemented.  They’ve released a roughly 10-page brief that lays out numerous ideas for creating a seamless coverage experience, improving the quality of care, and transforming the way primary care is delivered.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

July 14, 2011

 

This week, the Finish Line Flash shares a variety of resources on the new proposed exchange regulations from HHS, a new estimate of reductions in state spending due to the Affordable Care Act, and news of federal assistance for states seeking to better manage care for high-cost Medicaid beneficiaries.

Health Reform Resources

 

New Exchange Regulations—This week HHS released its proposal for regulations on the basic functions of state exchanges.  There are a number of resources for you to learn more about the proposed rules and how they will impact children and families.  HHS produced a fact sheet on the rules, while consumer advocate Tim Jost wrote a series of three blog posts for the Health Affairs blog.  You can also tune into the Health Reform call scheduled for tomorrow, July 15, at 1:00 pm Eastern and the CCF State Partner call set for Tuesday, July 26 at 1:00 pm Eastern.

 

New Estimate of State Budget Impacts—A number of studies have sought to establish the bottom-line impact of the ACA on state budgets.  In a new release, Urban Institute researchers have estimated the financial impact of health reform nationally and for each state for the period 2014-2019.  They find that, looking at national data, states will save between $92 and $129 billion over the six year period.  Due to limitations in state-level data, some savings had to be left out of state-level estimates. Still, state-level estimates are available (Table 8, page 12) and show each state will experience either small costs or savings as a result of the ACA, depending on how effectively the law reduces spending for uncompenstated care.

 

CMS to Assist States in Reducing Costs—CMS recently announced a new effort to provide technical assistance to states as they seek to reduce Medicaid costs for high-cost, high-need beneficiaries.  The new technical assistance resource center was announced along with a State Medicaid Director letter describing two payment models CMS wishes to test for dual eligible beneficiaries.  For the many states that are pursuing Medicaid reform or redesign, these new projects may represent good opportunities to focus efforts on the costliest Medicaid populations.  Even if they are not directed at kids and families, advocates may want to encourage their state officials to participate in these projects as beneficiary-friendly ways to contain overall Medicaid costs.

 

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

 

July 7, 2011

The Finish Line Flash this week sends along three important new resources on Medicaid and CHIP.  First, a paper from the influential National Bureau of Economic Research shows that Medicaid has significant positive effects for those who enroll.  Next, the National Health Law Program has developed a great list of beneficiary-friendly cost-containment strategies in Medicaid.  Finally, the Government Accountability Office released a CHIPRA-mandated report on children’s access to care in Medicaid and CHIP.

New Publications

 

Economists Find Range of Benefits from Medicaid Enrollment—In 2008, Oregon randomly selected 10,000 individuals from a waiting list to enroll in Medicaid.  This random selection allowed for a rigorous study of the effects of enrollment by a group of economists from MIT, Harvard University, and other organizations.  Most studies, by contrast, compare Medicaid enrollees with privately insured and uninsured individuals, sometimes leaving out unobserved differences between the groups that can muddy the results.  With this high-quality methodology, the economists found that Medicaid enrollment led to significantly better health, greater access to care, and lower out-of-pocket medical expenses and medical debt.

 

Medicaid Cost-Containment Strategies—In advocating for keeping public health coverage strong, state advocates are often confronted with the question of what to cut if not access to affordable coverage.  The National Health Law Program has compiled a useful list of Medicaid cost containment ideas that do not harm, and often improve, beneficiary care.  They range from disease and care management to prescription drug savings to pooling bargaining power with other states.  Your state may be pursuing some of these strategies already, but few if any states have implemented them all.  The document can both help respond to the question of where to cut and serve as a starting point for state policymakers tasked with finding savings.

 

GAO Study on Children’s Access—As directed by CHIPRA, the Government Accountability Office studied children’s access to physician care in Medicaid and CHIP.  While it found that more than 75% of physicians participate in their state’s Medicaid and CHIP programs, it found that many more physicians are willing to serve new privately insured children (79%) than children in Medicaid and CHIP (47%).  It also found significant challenges in access to specialty physicians—84% of physicians had difficulty referring kids in Medicaid and CHIP to specialists versus only 26 percent for privately insured children.

 

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

June 29, 2011

 

This week, a quick Finish Line Flash shares a solid op-ed from an American Academy of Pediatrics officer in Pennsylvania, a new print ad from the Partnership for Medicaid, and a handy brief on the Basic Health Plan option in the ACA.

Media Materials

Pennsylvania Pediatrician for Stable Coverage—In this op-ed in the local paper for the state capital and an important member of Congress, the vice president of the state’s AAP chapter makes a strong case for keeping the Affordable Care Act’s stability protections in place.  He employs a powerful message of success on the part of CHIP and points out that the key flexibility proposed in the State Flexibility Act is the option to cut coverage.  As a physician, he also relates his first-hand experience of children who go without coverage.

One-page Medicaid Message—The Partnership for Medicaid, a coalition of provider, health plan, and other organizations, has developed a new one-page ad to convey the importance of Medicaid.  It picks up on recent polling that shows support is strongest when advocates explain not just who Medicaid helps, but give specific examples of the services that beneficiaries receive.  By citing examples of these services for the range of populations served by Medicaid, the ad demonstrates a good, simple way to communicate Medicaid’s value.

New Publication

Basic Health Plan Brief—Health Reform GPS posted one of its Implementation Briefs focused on the ACA’s Basic
Health Plan option.  The brief lays out many of the important issues and concerns around the option for states.  While it’s unclear how many states will pursue the option, it should at least be part of the conversation as states implement the law.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

June 22, 2011

The Finish Line Flash this week sends you an effective e-mail alert from Pennsylvania, a great op-ed from Arizona, and two helpful policy briefs.  One from Kaiser examines the changes in counting income and family size that are coming to Medicaid in 2014 and the other, from NASHP, makes recommendations for how state advocates can best work with state officials to implement the Affordable Care Act.

Advocacy Examples

Making Health Care Personal—The Pennsylvania Finish Line team recently released this first installment of its “Faces and Facts” series on children’s health. The idea behind this concept is to take abstract concepts like the Medicaid stability protections and humanize and localize them through real Pennsylvania moms’ eyes. This smart idea is especially useful now, as states like Pennsylvania have many new lawmakers who are being asked to take positions on children’s health for the first time.  It positions Medicaid and CHIP as kids’ issues and health issues, not just budget issues.  Finish Line veterans may also recognize the “Faces and Facts” concept, which was pioneered by the Colorado team, who worked with Pennsylvania Partnerships for Children to transplant this good idea. The PA team plans future Faces and  Facts installments; your team might consider adopting the concept to educate your own state’s leaders.

Media Materials

Medicaid Serves Real Needs—After Senator Jon Kyl placed an op-ed in the Payson Record on Arizona’s Medicaid program, reporter Pete Aleshire responded with some points of his own. After giving a real-life example, he argued that blocking the expansion of Medicaid under the Affordable Care Act is no way to respond to the needs of the uninsured or those who Medicaid currently serves.  As Arizona advocate Matt Jewett observed, “If I didn’t know better, I’d think Ed Walz had trained Pete Aleshire on messaging.”

New Publications

MAGI and More—The Kaiser Commission on Medicaid and the Uninsured released an Explaining Health Reform brief that outlines the changes in income and family size calculations that will occur in Medicaid in 2014 under the Affordable Care Act.  It discusses how using Modified Adjusted Gross Income (MAGI) differs from current income counting rules and raises a number of policy considerations related to the change.

Working with State Officials—NASHP has published a brief with recommendations for fostering strong working relationships between consumer advocates and state officials.  The brief shares lessons learned through the Southern Health Partners initiative, which supported capacity building for consumer advocates in 11 states.  It focuses on effective ways to collaborate on exchanges and eligibility and enrollment issues as both advocates and officials work to implement the Affordable Care Act.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

June 15, 2011

This week, the Finish Line Flash links you to a great syndicated op-ed on protecting kids’ health in budget debates.  We also point you toward a new paper from First Focus that provides up-to-date data on the importance of Medicaid to kids and others, a handy list of 30 questions to ask about managed care and EPSDT from NHeLP, and a detailed analysis from Finish Liners in New Mexico on the economic impacts of the ACA in their state.

Media Materials

Don’t Balance the Budget with Cuts to Kids’ Health—In this op-ed, David Sirota lambasts those who advocate reducing the deficit by making cuts to children’s health programs. He avoids moral arguments and instead focuses his line of reasoning on the anticipated disastrous effects those cuts would have on future national deficits. This op-ed showcases one communications technique for refuting bad policy ideas, which is to explain how they would harm what your audience already values.

New Publications

Medicaid Works—In a new paper commissioned by First Focus, Leighton Ku and Christine Ferguson of the George Washington University School of Public Health and Health Services lay out the benefits of Medicaid and CHIP for children and other vulnerable populations.  They detail the role of public coverage in reducing the number of uninsured, protecting those impacted by the recession, and improving access to care as well as health outcomes.  They also show that Medicaid is already an efficiently run program that cannot sustain major cuts without hurting vulnerable populations.

Questions to Ask on Managed Care—The National Health Law Program has identified 30 questions advocates should pose to assure that Medicaid managed care contracts protect access to all of the EPSDT services to which children are entitled.  As many states seek to move even further into managed care, this is a useful document to help advocates evaluate contracts and make sure they include the important protections that federal Medicaid law provides for children.

The Economic Benefits of the ACA—Finish Liners in New Mexico authored a brief that estimates the economic gain to the state attributable to the Affordable Care Act.  Using modeling software that calculates direct, indirect, and induced economic effects, they projected that the new federal funds spent in the state due to the ACA’s Medicaid expansion and exchange subsidies will lead to over $18 billion in new economic activity from 2014-2020, supporting 38,000 new jobs in the state.  Their results suggest that the new state revenue generated by this activity could offset the costs to the state of implementing the ACA—a topic to be explored in a follow-up paper.  The brief is a great example of using data to directly address arguments that states will be unduly burdened by health care reform.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

June 8, 2011

The Finish Line Flash this week shares some in-depth (but fairly brief) analysis on health reform and Medicaid.  There’s a look at how many children will face complex coverage situations under health reform, a report on how exchanges can best assure they offer high quality plans, and a quick explanation of Section 1115 Medicaid waivers.

Health Reform Resources

Complex Coverage for Children in 2014—Researchers at the Urban Institute released a brief that identifies a number of different scenarios in which getting coverage through the exchange or Medicaid/CHIP will be challenging for kids once the ACA is fully in place.  When parents and children have different sources for their coverage, such as the exchange for parents and Medicaid for kids, complexities arise with the level of subsidies a family would qualify for.  Or when parents and children reside apart or have different citizenship status, other challenges may appear.  This brief lays out the issues and estimates the number of children affected by each.

Active Purchasing by Exchanges—Our colleagues Sabrina Corlette and JoAnn Volk at the Georgetown University Health Policy Institute recently published a paper on state exchange considerations around active purchasing.  They discuss the range of strategies that exchanges can pursue to encourage exchange plans that provide good value and high quality for enrollees.  These include the selective contracting with plans that is often termed active purchasing, but also other strategies like aligning with other large purchasers on delivery reforms and recruiting new carriers into a state.  A good resource as states move forward with exchange planning.

Medicaid Waivers

Waiver Explainer—The Kaiser Commission on Medicaid and the Uninsured produced a brief that explains the basics of Medicaid waivers authorized under Section 1115 of the Social Security Act.  It addresses five questions including how waivers are approved and financed and also includes a handy list of current waivers.  Many of you know how waivers work, but with many states pursuing new waivers, this may be a great product to share as you seek to build a stronger coalition of waiver watchers in your state.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

June 1, 2011

This week, a quick Finish Line Flash passes along news of an important victory in Colorado, a strong stand on kids coverage from Senate Majority Leader Harry Reid, and a great op-ed placed by the Finish Liners in Wisconsin.

State Update

Colorado Governor Vetoes Premium Bill—Colorado Governor John Hickenlooper this week vetoed a bill that would have instituted monthly premiums for many families in the state’s CHIP program.  The program already includes yearly enrollment fees for some families and the bill would have greatly increased the cost to participate by adding per child monthly fees.  Colorado Finish Liners pointed out that children would lose coverage if families stopped participating due to the premiums and that the monthly premiums would be costly for the state to administer.  The veto is a great win for Colorado families.

Media Materials

Senator Reid Backs Stability Protections—In a blog post that appears on the Huffington Post and MomsRising, Senate Majority Leader Harry Reid turns to the impact on children to make the case for keeping the Affordable Care Act’s stability protections in place.  In addition to relating his personal experiences, he cites the number of children who would be expected to lose coverage if states are allowed to roll back their eligibility standards and methods before 2019.  Without using the term “maintenance of effort,” Reid explains why the provision was in the ACA in the first place and why it needs to be protected.

Wisconsin Finish Liners Urge Accountability for Medicaid and CHIP Choices—Wisconsin legislators voted to let bureaucrats make decisions about how to cut costs in Badger Care Plus with no legislative oversight. In this Racine-based Journal Times op-ed, WCCF urges lawmakers to reconsider this decision. WCCF reminds readers that the responsibility for bad decisions rests squarely with legislators who let them happen, even if they try to evade accountability later.  This op-ed reminds us all that legislators will try all kinds of tricks in a tough fiscal environment to deflect responsibility for bad budget decisions, but advocates can be a bulwark against these by reminding constituents where that responsibility lies.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have

May 25, 2011

The Finish Line Flash this week passes along a short paper CCF prepared on proposed cost-sharing increases in Wisconsin, notice of a webinar on state exchanges from the Commonwealth Fund and NASHP, the results of a new poll showing strong public support for Medicaid, and a good letter from AARP that advocates for stability protections for all Medicaid populations, including children.

New Publications

The Effects of Premium Increases—CCF recently completed a brief paper on a proposal to increase premiums in Wisconsin, finding that between 49,000 and 87,000 children and parents would lose public coverage, depending on the size of the increase.  We share it as an example of the kind of timely analysis that we can either help you perform or release under our name depending on your needs.  If you would like us to look at a premium proposal or other potential policy change in your state, just ask your Finish Line team.

Poll Finds Support for Medicaid—A new Kaiser Health Tracking Poll shows that a majority of Americans oppose plans to make large cuts to Medicaid—60% favor keeping Medicaid in its current form, while only 13% favor large reductions in Medicaid spending.  Kaiser Health News writes up the results at the link.

AARP Letter on Stability Protections—AARP recently sent a letter to leaders of the Health Subcommittee of the House Energy and Commerce committee in support of maintaining the ACA’s stability protections for older Americans, people with disabilities, and children.  It further cites the success of Medicaid and CHIP in providing essential coverage to children.  The inclusion of a range of populations served by Medicaid demonstrates the value in reaching out to influential allies and asking them to join in unified messaging.  AARP has a chapter in each state and can be an important partner in keeping Medicaid and CHIP strong and available for kids and families.

Health Reform Resources

New Webinar on State Exchanges—The Commonwealth Fund and NASHP are planning a webinar on state exchange implementation for Tuesday, June 7, from 3:30 to 4:30 Eastern.  It will identify key choices for states and examine the development of the first post-ACA state exchange in California.  Speakers will include Jon Kingsdale, the founding executive director of the Massachusetts Connector, Kim Belshe, former secretary of California’s Health and Human Services Agency and California exchange board member, and others.  Register at https://cc.readytalk.com/cc/schedule/display.do?udc=69beuebq8434

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

May 19, 2011

This week, the Finish Line Flash shares with you a great one-page fact sheet from California on the effect of block grants on Medicaid, a good op-ed from Washington, and a new brief from the Kaiser Commission on the key issues around access to care in Medicaid.

Federal Budget

Medicaid Block Grant Fact Sheet—The United Ways of California produced an effective one-page fact sheet to explain why federal block grants are a bad idea for Medicaid.  It ties together block grants’ impact on children, seniors, and people with disabilities as well as the risk they impose on the state and the views of voters.

Media Materials

Washington Finish Liner Blogs to Support Kids Coverage—Jon Gould of the Children’s Alliance authored a strong op-ed highlighting the success of Washington’s Apple Health for Kids.  He takes on a proposal to “reform” the program, saying its effectiveness shows it “doesn’t need reform.  It IS reform.”  Jon placed the op-ed with a local public affairs blog—a great way to reach policy-focused readers who are engaged and active in their community.

Health Reform Resources

Access in Medicaid under Health Reform—A new brief from the Kaiser Commission on Medicaid and the Uninsured outlines a number of concerns about access to care in Medicaid as the Affordable Care Act is implemented.  The paper is the result of a roundtable of federal and state officials and experts that Kaiser convened.  It highlights the key issues and suggests ways to begin thinking about solutions to access challenges.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

May 11, 2011

The Finish Line Flash this week sends along a useful Kaiser Commission paper on the impact of Medicaid cuts proposed in the House Budget Plan.  We also link you to good editorials from Utah and Florida, a new brief from CCF on presumptive eligibility, and a good piece from NASHP on the lessons from Medicaid and CHIP for the affordability of coverage under the ACA.

Federal Budget

The State-by-State Effects of a Medicaid Block Grant and ACA Repeal—The Kaiser Commission for Medicaid and the Uninsured, along with the Urban Institute, released a report with estimates of the cuts to enrollment and federal Medicaid funding that would result from the House Budget Plan.  The plan calls for changing Medicaid financing to a block grant and repealing the Affordable Care Act.  The report estimates that nationwide enrollment would be 48% lower than expected by 2021 assuming proportionate cuts to each eligible population, meaning 36.4 million people would not have the Medicaid coverage they would get under current law.  The report also looks at a scenario in which seniors and people with disabilities are protected while children and other adults face disproportionate cuts.  Under these conditions, enrollment of children and non-elderly, non-disabled adults would be cut by 71% and overall Medicaid enrollment by 58%.  Find the numbers for your state in the report.

Media Materials

Utah Paper Supports Stability Protections—This Salt Lake City Tribune editorial critiques the plan authored by Utah Senator Orrin Hatch, which would allow states to cut Medicaid coverage for those who need it most. The paper logically establishes why it’s right that Medicaid expand during a recession and suggests “more intelligent” ways for states to remedy rising health care costs – all without ever using the phrase “maintenance of effort.” Advocates can make the same argument; Medicaid matters even more during tough times, and cutting care doesn’t make sense.

Florida Paper Recognizes Medicaid’s Efficiency—The Florida Times-Union considered Medicaid’s cost growth in comparison to private health insurance and was surprised to find that Medicaid compares favorably.  This leads to the recognition that higher Medicaid costs largely reflect greater need and that the state’s reform efforts should be evaluated with that in mind.  A great reminder that explaining the basics of Medicaid and its finances should be the first step in talking about reform proposals.  A few facts can help set the right context.

New Publications

Presumptive Eligibility Brief—CCF this week released a new issue brief on presumptive eligibility.  It outlines how this Medicaid and CHIP option works, looks at where states stand, and describes the issues states should consider when implementing the option.  Tricia Brooks blogged about her new paper on Say Ahhh!

Lessons from Medicaid and CHIP on Affordability of Coverage—NASHP recently released a brief that takes lessons from children’s coverage in Medicaid and CHIP to inform state implementation of the ACA.  It looks at how the affordability of coverage affects take-up and families’ experiences and makes suggestions for creating a consumer-friendly experience.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

April 28, 2011

This week’s brief Finish Line Flash shares a great piece developed by Texas Finish Liners that demonstrates strong support for Medicaid and CHIP from the business community.  We also alert you to a NASHP webinar that focuses on how advocates can best collaborate with state officials on ACA implementation.

State Update

Texas Finish Liners Highlight Business Support—Children’s Defense Fund-Texas has produced a striking four page publication to convey the strong support of Texas business partners for children’s coverage through Medicaid and CHIP.  The report makes the economic case for investing in children’s health and shares quotes from more than a dozen business leaders in support of strong coverage.  The piece shows a great way to put the words of allies to use in a way that can win over still greater support from this important constituency.

Health Reform Resources

NASHP Webinar on Advocates and State Officials—The National Academy for State Health Policy will host a webinar on how advocates and state officials can work together on health reform implementation. The webinar will feature presentations from a state official in Virginia and a consumer advocate in Louisiana on key lessons learned in building mutually beneficial partnerships, and how these partnerships can also advance health care reform implementation.  The event will take place on Wednesday, May 11 at 3:00 pm Eastern.  Register at https://cc.readytalk.com/cc/schedule/display.do?udc=heh5bqhg6fpb

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

April 21, 2011

This week, a quick Finish Line Flash shares some very positive news from Oregon and Kansas—Oregon marked the enrollment of 85,000 children since expanding Healthy Kids in 2009 while Kansas has successfully eliminated its backlog of 30,000 HealthWave applications.  We also link you to resources that demonstrate the opposition of state and county officials to Medicaid block grant proposals.

State Updates

Oregon Celebrates Coverage for 85,000 Kids—With a celebration sponsored by Finish Liners at Children First for Oregon, the Beaver State recognized the accomplishment of enrolling 85,000 children into coverage since Healthy Kids was expanded in 2009.  Healthy Kids provides coverage options for children of all incomes, ranging from Medicaid coverage to a full cost buy in for families with moderate incomes.  Especially in challenging times, it’s important to recognize our earlier successes in expanding coverage continue to pay off for kids and families.

Kansas Erases Application and Renewal Backlog—Due to increased need and limited state resources, Kansas recently experienced a backlog of over 30,000 applications and renewals in its HealthWave program.  On Say Ahhh!, Finish Liner Suzanne Wikle tells the story of how the backlog was successfully eliminated by streamlining administrative processes using lessons from other states.

Medicaid

State, County Officials Oppose Block Grants—Both state and county officials have recently spoken out against the proposal to shift Medicaid funding to a block grant to states.  National Conference of State Legislatures President Richard Moore said that “Republican and Democratic legislatures alike are in opposition to Medicaid block grants.”  Meanwhile, the National Association of Counties wrote House Budget Committee Chairman Paul Ryan and Ranking Member Chris Van Hollen to firmly oppose converting Medicaid to a block grant, warning that counties would be left “holding the bag” for medical costs.  The comments reinforce that state and local officeholders are important stakeholders in the federal debate on the future of Medicaid.  Advocates should encourage them to speak out publically in support of a strong federal Medicaid partnership.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

April 13, 2011

The Finish Line Flash this week shares more news of success from fellow Finish Liners—the elimination of “stairstep” eligibility in Colorado.  It also passes along a great blog post from CDF President Marian Wright Edelman, a timely report from CBPP on the state impact of a Medicaid block grant, and word of a webinar on state exchanges set for tomorrow.

State Update

Colorado Finish Liners Even Out the Stairstep—In many states, the income eligibility threshold for Medicaid is higher for younger children, meaning their older siblings can miss out on Medicaid’s more comprehensive benefit package.  Colorado Finish Liners successfully worked to support a change in the policy for their state—Gov. Hickenlooper recently approved a law that aligns Medicaid eligibility at 133% of the FPL for all kids ages 0-18.  Thanks to CHIPRA, the state will continue to receive the CHIP match rate for the older kids with incomes 101-133%. And thanks to the ACA and this change, that group will be eligible for increased federal match for primary care expenses in 2013 and 2014.  Congratulations Colorado Finish Liners!

Media Materials

Success of Kids’ Coverage as Foundation for Medicaid Defense—Marian Wright Edelman, president of Children’s Defense Fund, used a Huffington Post column to connect the country’s achievement in covering kids with protecting Medicaid funding.  Advocates can likewise use the success of children’s health coverage in their own states to demonstrate the importance of protecting broader investments in Medicaid and health reform. While the overall tone of this piece is more negative than we might create, its approach of making the case for Medicaid’s value for kids and the state economy provides a solid foundation for its critique of proposals to cut Medicaid.

New Publication

CBPP Estimates State Impact of Medicaid Block Grant—Researchers at the Center on Budget and Policy Priorities this week released a brief that estimates how much federal funding each state would have lost had a Medicaid block grant been in effect from 2000-2009.  House Budget Committee Chairman Paul Ryan’s budget proposal would limit growth in federal Medicaid spending to the rate of inflation plus population growth.  If that formula had been in effect over the ten years beginning in 2000, states would have received $771 billion, or 22%, less in federal funding than they did under the existing financing system.  For some states, the figure is 30, 40, or even 50%.

Health Reform Resources

State Exchange Webinar—Tomorrow, State Coverage Initiatives will hold a webinar on state exchange development.  Officials from Maryland, Missouri, and Nevada will share their experiences in working toward exchanges in their states and the issues they have dealt with regard to governance and other topics.  The webinar will take place Thursday, April 14th from 3:30 to 5:00 pm Eastern.  Register at the link above.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

April 7, 2011

The Finish Line Flash this week shares some of the great earned media the Texas Finish Liners received on their state budget debate, a California op-ed on accepting the Connecting Kids to Coverage Challenge, and an op-ed from New Mexico showing the support of the business community for a state exchange.  We also link you to a recent paper from Community Catalyst on reducing payments for potentially avoidable events as a beneficiary-friendly cost-saving strategy for Medicaid.

Media Materials

Texas Paper Recognizes Alternatives to Large Medicaid Cuts—The recent draconian Texas House spending plan drew a firestorm of criticism from the hospital community and other health advocates. This editorial commends the Texas Senate’s spending plan for being much more rational in its health care spending reductions. The editorial employs several techniques that advocates can also use in their op-eds or letters to the editor: thanking supportive lawmakers by name, explaining the human cost of policy proposals — in this case, the detrimental effects of the House plan to both Medicaid recipients and health care workers in Texas — and explaining alternative solutions, like allowing the state to save money by incentivizing high-quality patient care for better outcomes.

California County Official Cheers Challenge—In this opinion column in the Oakland Tribune, Alameda County Supervisor Wilma Chan celebrates the Alameda County Board of Supervisors’ recent decision to be the first county in the United States to accept the Secretary’s challenge to cover all uninsured children. Supervisor Chan explains the many ways that access to health care improves children’s well-being and adds that it helps the local economy through federal Medicaid matching dollars. She then lays out their next steps for enrolling uninsured children, publicly committing to increase outreach and partnerships, to look into new technologies and to cut red tape where possible. This public commitment of a county official to the cause of enrolling insured children is a good reminder why it can be important to recruit local government officials as spokespersons. They share our goal of keeping children healthy and can effectively share news and build support for this important cause, especially within their own communities where they already enjoy wide recognition.

New Mexico Local Chamber Supports Exchange—Last week, leaders from the Albuquerque Chamber of Commerce authored an op-ed to ask New Mexico Governor Susana Martinez to sign Senate Bill 38/370, a bill to create a health insurance exchange in New Mexico.  They ask that she do this because the new exchange will help New Mexico small business owners buy health insurance that they can afford for their employees.  This op-ed is a reminder that a broad range of groups are interested in the successful implementation of the Affordable Care Act.

New Publication

Catalyst Explains Promising Payment Reform—Community Catalyst recently released a short paper that identifies one way to reduce Medicaid spending while improving the care that beneficiaries receive.  By reducing payments for potentially avoidable complications and readmissions, states can both save money and begin to alter the incentives that hospitals and other providers face.  The paper outlines how states can achieve quick savings and why states should move beyond federal rules in this area.  It considers both the technical and political questions states must address in implementing this payment reform.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

March 31, 2011

This week, the Finish Line Flash brings news of encouraging progress from Arkansas and links you to three new publications—a one-pager from CCF on the non-eligibility “back door” cuts that states should avoid, a look at the health exchanges now operating in Massachusetts and Utah from Georgetown’s Health Policy Institute, and, from Families USA, a paper that outlines why not all exchange navigators should be licensed as insurance brokers.

State Update

Arkansas Finish Liners Cut the Red Tape—Gov. Beebe this week signed into law a bill that will help more Arkansas children get and keep coverage through ARKids.  Arkansas Advocates for Children and Families built support for the effort to add modified 12 month continuous coverage, expand paperless renewal options, and get the ball rolling on Express Lane Eligibility.  Congratulations to the Arkansas Finish Liners!

New Publications

Watching Out for Coverage Roadblocks—As our effort to highlight the importance of the ACA’s stability protections continues, CCF released a one page brief that examines the procedural barriers that states could erect if the MOE is weakened or eliminated.  It warns that, in the past, such roadblocks have led to significantly reduced coverage.  The brief joins an earlier report that looked more broadly at what is at stake for children and families in the debate on stability protections.

Lessons on Exchanges from Massachusetts and Utah—CCF researchers and others from the Georgetown University Health Policy Institute today released a paper that looks at the existing health insurance exchanges in Massachusetts and Utah.  While the two are often mentioned as polar opposite approaches, the paper finds that states can take lessons from both as they build their own exchanges.  Joan Alker and Sabrina Corlette blogged about their paper on Say Ahhh!

Health Reform Resources

Families Paper on Navigator Licensing—As states work on exchange legislation, an issue that could easily be overlooked is the potential requirement that the navigators created by ACA be licensed by states as insurance agents.  Some existing agents believe that navigators, who are intended to help families access coverage through the exchange and public programs, should be licensed.  Families USA has produced a paper explaining why this is not a good idea.  A good resource to have when this issue comes up in your state.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

March 23, 2011

The Finish Line Flash this week comes to you on the anniversary of the passage of the Affordable Care Act.  To celebrate, we link you to a brief from Families USA that estimates the number of individuals in each state already benefiting from the law.  We also share a two great opinion pieces from Texas, the first report of the Medicaid and CHIP Payment and Access Commission, and the new and updated State Refor(u)m website from NASHP.

New Publications

Families Estimates ACA Benefits by State—Families USA released a table that shows the major benefits of the ACA that are already in effect, including the ban on pre-existing condition exclusions for children, coverage for young adults, new Medicare benefits, and small business tax credits.  The table shows how many people in each state could potentially benefit from each of these new provisions.

MACPAC Report—The Medicaid and CHIP Payment and Access Commission was created in CHIPRA and expanded in the ACA.  This month it released its first report, which contains a wealth of information on Medicaid and CHIP, their history, and current status.  Of special note is a section called MACStats which consolidates many data sources to provide some of the most up-to-date information available on eligibility, enrollment, benefits, and spending in each state.  See Martha Heberlein’s blog post on the report at Say Ahhh!

Media Materials

Don’t Mess With the Texas Finish Line Team—The Houston Chronicle, a longstanding champion of children’s health, delivers a one-two punch on proposed cuts to Texas’ Medicaid budget. Recently, the paper ran an op-ed by CDF board member and Texas businessman Lan Bentsen, pointing out that the proposed cuts would cost the state’s economy $3 for every $1 in avoided state government spending. Then, the Chronicle followed up with an editorial reiterating the argument and concluding that state lawmakers need “remedial math.” These commentaries are not just great examples of the “smart choices” messaging at work, they’re also great reminders of the value of investing in educating and engaging an important media outlet.

Health Reform Resources

Revamped State Refor(um)—The Flash has pointed you to NASHP’s State Refor(u)m website in the past as a good source for information on state health reform implementation activities.  The site has recently been extensively redesigned to add a number of new features.  It now features a slick new interface, tracks states’ milestones in accomplishing reform implementation, and allows users to join in discussions about state activities.  Advocates and anyone else can register to participate in the site’s interactive features.  For more, see Alan Weil’s post on the site’s own blog.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

March 16, 2011

This week, the Finish Line Flash alerts you to a new brief from CCF that sets the record straight on the share of state funds that goes to Medicaid, links you to a report from The Children’s Partnership on using mobile technology to improve health coverage, and sends word of a webinar on the interactions between Medicaid and the exchanges.

New Publications

CCF Report Clarifies Medicaid’s Share of State Budgets—This week, CCF released a brief report that shows the proportion of each state’s state-fund spending that goes to Medicaid.  Lawmakers and media alike often overstate Medicaid’s share of state budgets by including federal dollars.  This report, based on data from the National Association of State Budget Officers, can be used to help put discussions of the Medicaid budget in a more accurate context.

Using Mobile Technology to Boost Coverage—The Children’s Partnership and the Kaiser Commission on Medicaid and the Uninsured this month released a snapshot that examines the possibilities and challenges surrounding the use of cell phones and other technology to connect families to coverage.  It looks at how mobile technology can potentially ease the process of applying for benefits, learning about and choosing among coverage options, receiving reminders, obtaining information about the status of an application, paying premiums, renewing eligibility, and transitioning between Medicaid and CHIP.  Check out the snapshot at the link above and Beth Morrow’s post on Say Ahhh!

Health Reform Resources

Medicaid’s Role in the Exchanges—NASHP will host a webinar on Thursday, March 31 at 3:00 pm Eastern on the role that Medicaid will play as states develop and operate exchanges under the Affordable Care Act.  Presenters from Manatt Health Solutions will discuss their upcoming paper on the topic.  Register at https://cc.readytalk.com/cc/schedule/display.do?udc=mg14d42mmk3b

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

March 9, 2011

The Finish Line Flash this week links you to a rich new source of estimates from the Urban Institute on the impact of the Affordable Care Act in each state.  We also call your attention to an upcoming webinar on best practices in storybanking and the plans to mark the one year anniversary of ACA’s passage later this month.

Health Reform Resources

New Urban Report Details ACA Impacts—The Urban Institute, along with State Coverage Initiatives and the Robert Wood Johnson Foundation, released state-by-state estimates that look at how the Affordable Care Act will alter insurance coverage, Medicaid and exchange enrollment, and federal spending.  The estimates help to quantify the gains from ACA, showing, for instance, that the uninsurance rate in Texas would drop by 16.9 percentage points, that 3.4 million Californians would be covered in the individual exchange, and that $688 million in new federal spending would flow to New Mexico, based on 2011 data.

ACA Anniversary—Whether it seems like it passed ages ago or just yesterday, the Affordable Care Act will be a year old on March 23.  State and national groups are working to mark the anniversary with a series of events during the week of March 21-25.  Each day will focus on a different topic or group of people impacted by the law and is being coordinated by a different national organization.  Please get in touch with the organizations listed below if you are planning any events or would like to find out what others are planning for each of the following days:

-March 21, Seniors. Coordinators: Alliance for Retired Americans, Bob Kearney, rkearney@retiredamericans.org; Families USA, Sara Adland, sadland@familiesusa.org.

-March 22, Small Businesses and Jobs. Coordinators:  Small Business Majority, Rhett Buttle, rbuttle@smallbusinessmajority.org; Main Street Alliance, Sam Blair, sam@mainstreetalliance.org.

-March 23, Patients’ Rights and Insurance Reforms. Coordinator: Health Care for America Now!, Margarida Jorge, mjorge@healthcareforamericanow.org.

-March 24, Women. Coordinators: National Women’s Law Center and The Partnership for Women and Families, Thao Nguyen, tnguyen@nwlc.org.

-March 25, Young Adults. Coordinators: Young Invincibles, Aaron Smith, aaron.smith@younginvincibles.org; U.S. PIRG, Sujatha Jahagirdar, sujatha@studentpirgs.org.

Storybanking

Tips for Successful Storybanking—As we work to defend against cuts to affordable health coverage for children and families, it’s very useful to share the stories of real families that would be impacted.  The Half in Ten project will host a webinar on Monday, March 14, at 2:00 pm Eastern that will provide a training on the fundamentals of storybanking and best practices for collecting and using family stories.  Speakers will include Donna Norton of MomsRising and Elizabeth Prescott of Families USA.  Register at https://halfinten.peachnewmedia.com/store/seminar/seminar.php?seminar=7240

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

March 2, 2011

This week, the Finish Line Flash passes along some important developments at the federal level—CMS issued guidance on the Affordable Care Act’s stability protections and President Obama announced his support for allowing early waivers under ACA.  We also share notice of a webinar next week on state exchange development from the National Academy of Social Insurance.

Federal Updates

Stability Protection Guidance—CMS has released guidance to states on the application of the stability protections (also known as maintenance of effort provisions) in ACA.  Among other points, the guidance clarifies that states may not require families to renew coverage more frequently.  It notes that states with budget deficits may reduce coverage for adults with income over 133% of FPL, but not if the adults are pregnant or disabled.  It further clarifies that states are not required to renew expiring waivers and gives states some discretion with regard to premium increases—they may increase premiums up to the rate of inflation.  For more, see the Say Ahhh! post by Jocelyn Guyer.

Obama Supports Earlier Waiver Authority—The Obama administration announced this week that it supports moving the earliest date for broad state waivers under the ACA from 2017 to 2014.  Current law would allow states to seek waivers from many of the law’s major provisions, including the mandate for individuals to purchase insurance and the requirement for states to operate exchanges, starting in 2017.  States, though, must prove that their waiver proposal would cover as many people as would be covered otherwise and not add to the federal deficit.  By starting the waiver authority in 2014 instead of 2017, states could potentially move directly to a waiver without implementing many of the ACA provisions that go into effect in 2014.  Changing the date will require approval from Congress.

Health Reform Resources

NASI Webinar on State Exchanges—As mentioned in the Flash and discussed on the last CCF State Partner Call, the National Academy of Social Insurance has released a toolkit on designing state health insurance exchanges.  NASI will hold a webinar with co-chairs of the panel that developed the toolkit as well as state officials involved in exchanges on Tuesday, March 8 from 12:30 – 2:00 pm Eastern.  More info and registration instructions are available at https://www.nasi.org/civicrm/event/info?reset=1&id=128

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

February 24, 2011

A quick Finish Line Flash this week shares progress on administrative simplification from Utah, brings you a great editorial on Arizona’s plans to drop coverage, and updates you on recent new guidance from HHS on children’s eligibility for the Pre-Existing Condition Insurance Plan.

State Update

Utah House Passes Income and Asset Simplification Bill—The Utah House this week passed a bill supported by Finish Liners at Voices for Utah Children that would simplify the process for verifying income and assets for applicants to Medicaid and CHIP.  The bill would allow Medicaid and CHIP to use income data from the state tax agency and asset data from financial institutions.  It builds on the success of a previous law to use similar data at renewal.

Media Materials

Good Reasons to Avoid Coverage Cuts – This editorial from The Arizona Republic makes a compassionate and economic case for protecting coverage of 250,000 childless adults that Governor Jan Brewer recently asked to drop from Medicaid. The editorial points out that eliminating coverage to these adults could cause the state to lose more than 30,000 jobs.  It reminds readers that a sharp decrease in federal funding would hurt the Arizona budget. The newspaper instead endorses a proposal from the Arizona Hospital and Healthcare Association to impose a one-year “health-care assessment” to preserve the state’s federal funding and retain adult coverage. This editorial shows a great use of the positive economic impact argument against cuts to Medicaid.

Federal Update

HHS Clarifies PCIP Eligibility for Kids—The Pre-existing Condition Insurance Plan (high risk pool) is intended to provide coverage for those who cannot obtain affordable private insurance due to a pre-existing condition.  In states where insurers have ceased offering child-only individual policies, parents may not be able to show the insurance denial or high premium offer that would make their children eligible for the PCIP.  HHS recently announced that the PCIP would accept a statement from a licensed medical provider attesting to a child’s pre-existing condition to make them eligible for PCIP.  Unfortunately, the requirement that PCIP enrollees be uninsured for six months prior to enrollment remains.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

February 16, 2011

This week, the Finish Line Flash highlights a state capitol event by Arkansas Finish Liners, shares a great editorial from Utah on the Florida court ruling, links you to a useful brief on the effects of cost-sharing, and alerts you to the brand new Innovator grants under the Affordable Care Act.

State Update

Arkansas Finish Liners Host Cut the Red Tape Event—Using a great visual of kids cutting red tape, Arkansas Advocates for Children and Families held an event at the state capitol to build enthusiasm and support for simplifying enrollment procedures in the state.  The advocates won extensive media coverage for their effort to adopt 12 month continuous coverage, express lane procedures, and administrative renewal.

Media Materials

Utah Editorial Board to Politicians: Less Politics, More Problem-Solving—The Salt Lake Tribune editorial board cuts through the political posturing that has followed the Florida federal court decision striking down the Affordable Care Act. The editorial points out that the bulk of legal rulings have come down in favor of the ACA, that higher courts may well uphold it, and that even if the law’s coverage guarantee (join me in swearing off “individual mandate”) is struck down, other critical provisions like insurance consumer protections will likely remain in place. The take-away here is an important reminder that Utah faces real problems that the ACA addresses, and political spin isn’t solving any of those problems.

Research Corner

Cost-Sharing’s Effects—A new brief from the Robert Wood Johnson Foundation lays out the existing evidence on the effects of cost-sharing on costs and health outcomes for different populations.  A key finding is that cost-sharing increases are associated with adverse outcomes for vulnerable populations even if there is no effect on the average person.  Other important results include that cost-sharing increases are unlikely to reduce overall costs since most spending goes to the sickest patients who are not sensitive to cost-sharing and that patients do not discriminate effectively between essential and non-essential spending.  In addition to the brief linked above, a full 40 page report is available.

Federal Update

Innovator Grants Announced—HHS today announced the award of more than $240 million in grants to states to serve as the leaders in information technology development related to exchanges. Kansas, Maryland, New York, Oklahoma, Oregon, Wisconsin, and a multi-state consortium of New England states received multi-million dollar awards to support their development of systems that can serve as models for other states.  All of the products and services developed under the grants will be reusable and transferable to other states.  Look for a Say Ahhh! post soon on this announcement.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

February 9, 2011

The Finish Line Flash this week passes on some follow-up materials from Monday’s Finish Line All States conference call, links you to the latest State of the States publication from State Coverage Initiatives, shares the results of successful outreach to California legislators, and highlights a great editorial from Alabama.

Finish Line Call Resources

Beno Decision and Call Recording—On Monday’s Finish Line call, Jane Perkins of the National Health Law Program mentioned the Beno decision from 1994.  In it, the court found that a California waiver of a federal MOE was invalid because HHS did not fully consider the impacts of the cuts that waiving the MOE would make possible.  Click here for the decision.  You can also find a recording of Monday’s call.

State Survey

State of the States from SCI—Last week, State Coverage Initiatives released its latest State of the States report.  It details state health reform actions from 2010, including exchange planning, other ACA implementation, Medicaid and CHIP actions, and other topics.  See page 3.6 for a table of state workgroups, committees, and task forces studying the impact of ACA and Chapter 5 for a useful and brief discussion of state exchanges.

Policy Maker Outreach

California Lawmaker Outreach Effort Pays Off—The California Finish Line team worked with partners in the state to encourage state lawmakers to spread the word about a new open enrollment period for child-only health insurance policies. The open enrollment period was created by a new state law effectively implementing the Affordable Care Act’s ban on pre-existing condition denials for kids, so it’s a great example of a state helping health reform work for kids and families. Even better, legislator e-alerts like this one from Assemblymember Wesley Chesbro are circulating throughout the state. Engaging lawmakers in this way offers a double-benefit – they may well be helpful in encouraging parents of uninsured kids to enroll in new child-only plans, CHIP or Medicaid, and they build ownership among lawmakers for the continued success of the state’s efforts to cover uninsured kids. Congratulations California team!

Media Materials

Alabama’s Success – Insuring Its Children—This editorial from the Decatur Daily uses the disappointing Commonwealth Fund scorecard ranking as a hook, yet draws attention instead to the bright spot accomplishment of insuring 94 percent of Alabama’s children. This simple, straightforward editorial highlights how covering kids is a state success story that can rise above the divisive politics surrounding health reform.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

February 2, 2011

This week, the Finish Line Flash shares a detailed new resource on health insurance exchanges, media coverage of California’s strong law on child-only plans, a new brief from Families USA that looks at how a number of states have implemented Express Lane eligibility, and a report on state revenues that shows continuing growth.

Health Reform Resources

NASI Exchange Toolkit—The National Academy of Social Insurance has released a toolkit on designing state health insurance exchanges.  The toolkit was overseen by a study panel with strong consumer representation and NASI staff contracted with Sabrina Corlette of Georgetown’s Health Policy Institute in producing it. It starts with the model state legislation drafted by the National Association of Insurance Commissioners, then provides additional options states may want to consider, with a narrative description of the concerns surrounding each alternative.  NASI also plans a series of issue briefs on related topics, the first focuses on exchange governance.

Media Materials

California Law Helps Health Reform Work for Kids—The Affordable Care Act guaranteed that children with preexisting conditions couldn’t be denied coverage, but insurance companies responded by dropping child-only coverage. This article from California reminds us that the story can have a happy ending. California’s new state law creates an open enrollment period for kids with pre-existing conditions and requires insurers to cover children. The state law was backed by advocates, including the California Finish Line team, who are now driving the effort to get the word out that the doors are open again for kids. There will always be curveballs, but this story is a reminder that we can still knock them out of the park and salvage the win.

Eligibility & Enrollment

New Express Lane Brief—A new brief from Families USA reviews the early experiences of Alabama, Iowa, Louisiana, and New Jersey as state officials work to implement Express Lane procedures under CHIPRA.  The brief also suggests how those experiences can be instructive as states move to implement health reform.

Revenue Report

State Tax Revenues Rising—A new report from the Rockefeller Institute shows that as of the third quarter 2010, state revenues had risen for three consecutive quarters.  Preliminary figures for the fourth quarter of 2010 also indicate strength, showing revenues above those collected in the same quarter in both 2009 and 2008.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

January 20, 2011

The Finish Line Flash this week links you to a useful Community Catalyst brief on state implementation of health reform, alerts you to two upcoming NASHP webinars, and shares some of the media coverage around the Kaiser/CCF state survey from one Finish Line state.

Health Reform Resources

CC’s Top Ten—Community Catalyst identified the top ten activities that consumer advocates can undertake to help support health reform implementation.  From building public support to supporting private market reforms to reducing barriers in Medicaid and CHIP, the brief describes each activity and provides links to related resources.

Learning Opportunities

NASHP Webinars—The National Academy for State Health Policy will host two webinars that may be of interest—one today and one next Thursday.  Today at 1:30 Eastern, presenters including CCF’s Jocelyn Guyer will discuss and react to Charting CHIP IV, a detailed look at state CHIP programs as of 2008.  Next Thursday the 27th at 1:30 pm Eastern, experts will discuss the implications of the Affordable Care Act for children with special health care needs.

Survey Release

Ohio Newspaper Notes Survey—As one example of the range of media coverage for the release of the Kaiser/CCF state survey, the Columbus Dispatch reports on the survey and picks up on the importance of maintenance of effort provisions in keeping Medicaid intact.  Note that the quotes attributed to Cindy Mann in the story were actually made by CCF’s Tricia Brooks.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

January 12, 2011

This week, the Finish Line Flash points you toward a new report that identifies an advocacy strategy for health reform implementation in the states, alerts you to a call on CMS’s development of a new Medicaid website, and reminds you of this week’s release of the Kaiser/CCF survey of state Medicaid and CHIP programs.

Advocacy Report

Where the Rubber Meets the Road—A new report from six organizations, including CCF, discusses the requirements for effective advocacy in the states with regard to health reform implementation.  It identifies and describes the critical implementation issues and proposes a strategy for working toward strong implementation.  Written at the request of five funders, the report can help provide some insight into the considerations of those who support our work.

CMS Call

Suggestions Solicited for Medicaid.gov—CMS is undertaking an initiative to improve Medicaid’s web presence and will host a conference call this week to provide an overview and gather feedback from stakeholders.  The call will be Thursday, January 13, from 12:30 – 1:15 pm Eastern.  Please dial 877-267-1577 and the meeting ID is 1557#.

Survey Release

50 State Survey Shows States Holding Steady—Yesterday, your inbox should have included CCF’s announcement of the release of Holding Steady, Looking Ahead, this year’s edition of the annual survey of state Medicaid and CHIP eligibility, enrollment, and renewal procedures sponsored by the Kaiser Commission on Medicaid and the Uninsured.  You can find the survey report here and a blog post from co-authors Tricia Brooks and Martha Heberlein here.  Please let your Finish Line or Narrative team members know if we can be helpful in making use of the report in your state.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.

January 6, 2011

The first Finish Line Flash of 2011 brings you two of the many media pieces on the performance bonus awards, links you to state-specific fact sheets from HHS on the potential impact of health reform repeal, and passes along news of a significant organizational change within HHS.

Performance Bonus

A Tale of Two Performance Bonus Reactions—Opinion pieces from two different states react to the CMS performance bonus awards through different lenses.  An NBC Los Angeles column by syndicated columnist (and former Republican White House staffer) Joseph Perkins reminds readers that California’s “failure” to enroll eligible kids and qualify for a performance bonus cost the cash-strapped state “upwards of $50 million.” Though he blames the “bureaucracy,” instead of the governor and legislators, his call for a renewed investment in actually covering eligible kids is exactly the reaction we’d have hoped for in a state that did not earn a performance bonus. And an editorial from the Oregonian is exactly the reaction we’d hoped for from performance bonus winners.  It celebrates the success of Healthy Kids and contrasts the old policies of cutting funds from children’s programs during a budget crisis to the state’s current commitment to cover eligible children.  Plus, the new approach earned the state a $15 million bonus. Notably, it also names the Oregon Legislature and former Gov. Ted Kulongoski, adding encouragement for Gov. Kitzhaber to keep up the good work.

Health Reform Resources

The Cost of Repeal to Your State—You’ve probably heard that the House of Representatives plans to vote on a bill to repeal the Affordable Care Act on January 12.  HHS has prepared a fact sheet for each state that details the impacts that repeal would have.  It identifies the number of individuals in each state who would be affected by the removal of important ACA benefits like dependent coverage to age 26, protections from lifetime limits and rescissions, and free coverage for preventive services.  It also highlights several of the grants the state would no longer receive under repeal.

Federal Update

OCIIO to Move into CMS—Secretary Sebelius announced this week that the main HHS office responsible for planning exchanges and overseeing insurance regulation, the Office of Consumer Information and Insurance Oversight, will become part of CMS.  Most of OCIIO’s personnel will remain, although Director Jay Angoff will shift to serving as a senior adviser to Sebelius.

As always, please feel free to contact any of us—or any of your fellow grantees using the listserve—with any questions you have.