Secrets to Success: Four States at the Forefront of Children’s Health Coverage Gains

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By Jocelyn Guyer

There are people in my family who think I am unduly obsessed with Tom Brady.  They might even accuse me of co-authoring a paper on states at the forefront of covering our nation’s children that features Massachusetts just so I could say “Just as Tom Brady is in a league of his own when it comes to quarterbacking, the Commonwealth of Massachusetts is the clear national leader when it comes to covering children.” But, the honest-to-goodness truth is that the new paper we issued yesterday with the Kaiser Commission on Medicaid and the Uninsured, “Secrets of Success: An Analysis of Four States at the Forefront of the Nation’s Gains in Children’s Health Coverage,” grew out of a discussion that CCF and Kaiser Commission on Medicaid and the Uninsured staff had together last spring.  It took place long before Tom Brady beat Tim Tebow and the Denver Broncos (soundly, I must add) and resulted in a paper that examined Massachusetts, but also three other states — Alabama, Iowa and Oregon — that are at the forefront of covering children.

Here is how it started.  We were discussing the news that Massachusetts had achieved a 99.5 percent coverage rate among children in 2010 and commenting on the extraordinary nature of this achievement.  Tricia Brooks with CCF, Samantha Artiga with the Kaiser Commission on Medicaid and the Uninsured, and I decided to jump in and try to untangle how the state got there.  At the same time, we didn’t want to leave it just at Massachusetts.  While it is in a league of its own, states around the country have made enormous strides in covering kids.  Indeed, as we’ve pointed out repeatedly at CCF, the nation now has the lowest uninsured rate of children on record despite sharp jumps in child poverty and lots of other dire economic news.  So, we selected a diverse group of four states – one state from each region of the country at the forefront of covering kids: Alabama, Iowa, Massachusetts and Oregon – to investigate the “secrets” to their success.

Even though these four states have dramatically different political and policy cultures, we heard a number of common themes when interviewing state officials and advocates from each of the four states: 

* At least one political leader in the state – and, in most instances, a number of political leaders over time – made coverage of children a top priority.

* Expansive eligibility levels for children and adoption of a broad range of simplification strategies have been key elements of achieving progress. All four states have expanded eligibility for children to 300% of the federal poverty level and have taken up many of the opportunities to streamline and simplify enrollment and renewal processes for families.

* Community partners and providers play a vital role in helping families to enroll in coverage. We heard this in each of the four states, but perhaps most strongly in Massachusetts.  Interestingly, Massachusetts lags somewhat in the extent to which it has simplified its application and enrollment process, but makes up for it in no small part by relying heavily on community partners to help people enroll in coverage.  (Hey, even Tom Brady has someone weakness – a poor running game – but he also makes up for it in other areas.)The state and advocates have a robust relationship in which they exchange information on emerging issues and ideas about how to improvement enrollment.  It also has the advantage of a strong culture of coverage, which can be directly linked to its passage of broad health reform in 2006. 

* Strong coordination between Medicaid and CHIP aid in outreach and enrollment efforts and smooth transitions between programs. Each of the four states has taken steps to promote close alignment between Medicaid and CHIP, with Massachusetts and Oregon fully unifying the two programs. 

We also talked to each of the states about where they see their remaining challenges, and what they are working on now.  In a sure sign of why they are at the forefront of covering kids, each of them had a long list of challenges they were actively working to tackle, such as the need to improve retention, to cope with ongoing growth in enrollment amidst diminishing administrative resources; updating decades-old eligibility systems; and improving communications with families and obtaining better enrollment data.  Just like Tom Brady and the New England Patriots, they do not rest on their laurels and, instead, start each week looking ahead and figuring out how to continue to get better and better.