SCHIP at 10
Critical Knowledge Gaps and
Emerging Issues
June 25, 2006
Tricia Brooks
President & CEO
About NH Healthy Kids Corp.
 Legislatively created non-profit modeled
after Florida Healthy Kids Corp.
 Mission
 to provide access to affordable health coverage
for uninsured children; to facilitate programs of
preventive health
 Began covering kids in 1995 with HMO
model built on a PPO network
 Became vehicle for expanding coverage
through SCHIP in 1999
NHHK’s Role in Medicaid & SCHIP
 Coordinate outreach & public education
 Train & support application assistors
 Provide direct customer service to applicants &
facilitate application process
 Administer SCHIP
 Enrollment broker, premium collections
 Subcontract managed care contracts with unique
NHHK negotiated reimbursement
 Facilitate Program Evaluation
 Family surveys
 Studies of access to and use of healthcare services
The Healthy Kids Programs
 Medicaid – Healthy Kids Gold (185% FPL)
 Free coverage for lowest-income families
 Fee-for-service benefit plan managed by DHHS
 SCHIP – Healthy Kids Silver (300% FPL)
 $25 or $45 pmpm premiums
 Managed care plan administered by NH Healthy
Kids Corp.
 Buy-In – Healthy Kids Silver (400% FPL)
 $146 pmpm (no government subsidies)
 Indirectly subsidized by provider partnerships
and donation of insurance administration
The Healthy Kids Public-Private
Partnership Has Made a Difference!
Percentage of Uninsured Children
United States vs. New Hampshire
16.0%
14.0%
13.7%
13.9%
11.5%
12.0%
10.8%
9.9%
10.0%
8.0%
5.2%
6.0%
4.0%
2.0%
0.0%
US
1993 when NHHK was created
NH
1997 when SCHIP was created
2003
Enrollment & Retention
 Abundant information on outreach and
retention strategies that encourage and
inhibit enrollment
 Cumulative impact of many changes
 Not clear where we get the biggest bang for the
buck
 Lack of political will to remove barriers and
provide adequate funding
 But still, how low can we go? Is 5% it?
Premiums
 Premiums based on ability to pay, or
related to livable wage studies
 Cost is not always the barrier
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Cultural differences in valuing insurance
Healthy child vs. premium cost
Access to low-cost safety net providers
Stigma and prior experience with system
 Need to better understand the perspective
of families who are not enrolled
Quality of Care
 Standardize quality measures
 Set performance goals
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Preventive care
Immunizations
Screenings
Primary care
Management of chronic conditions
Hospital use – ambulatory sensitive care
conditions
 Reward high performing states
SCHIP Impact
 Long term return of investing in children’s
health care
 Legislators want to know how much money we
save when kids are covered
 Impact of different delivery models on
access and quality of care
 Fee for service
 Managed care
 Primary care management models
 Educate and provide incentives to parents
and providers on appropriate use of
services
SCHIP Expansion Opportunities
 Expand buy-in programs
 Take advantage of SCHIP group rates
 Lower shared administrative costs
 Child-friendly benefits
 Provide wrap-around services for
underinsured
 Potential way to address crowd-out
 Expand up the age scale
 Reauthorization offers opportunity to move
toward universal kids’ coverage
Deficit Reduction Act
 Verification of citizenship and identity
 Barrier to enrollment & retention
 Transitions from SCHIP to Medicaid
 Increase administrative costs
 Cost-sharing for Medicaid’s lower income
families
 Need to quickly measure the impact of DRA
 Coverage
 Benefits
 Cost
Medicaid, SCHIP and the
Healthcare System
 Too often look at Medicaid and SCHIP as
separate and distinct programs
 Healthcare cost drivers are systemic
problems
 Must look for systemic solutions
 Re-framing the issues in our
communications and advocacy
 Research literacy for public policy makers
at the local level
Contact information
Tricia Brooks
New Hampshire Healthy Kids
25 Hall Street
Concord, NH 03301
tbrooks@nhhealthykids.com
603-228-2925 x. 230
www.nhhealthykids.com