Leveraging Federal Grant Funds to
E
Expand
d Coverage:
C
Experiences
E
i
from the HRSA SHAP Grantee States
Elizabeth Lukanen, MPH
State Health Access Data Assistance Center
University of Minnesota, Minneapolis, MN
June 27
27, 2010
AcademyHealth Annual Research Meeting
State Health Access Program (SHAP)
• Grant program supported by by the Health Resources and
Services Administration (HRSA) at Health and Human
Services (HHS)
(
)
• Targeted at states
• Focused on expanding
p
g access to health care coverage
g
• 13 states were awarded grants totaling almost $71 million
for year 1
• Authorized to run 5 years, funding appropriated annually
• Matching
g funds and p
project
j
sustainability
y beyond
y
the 5year period were required
• Technical assistance available to grantees
www.shadac.org
2
13 SHAP Grantee States
www.shadac.org
3
Overview of SHAP Activities
• Coverage Expansion Populations
–
–
–
–
Low income workers
Low income parents
L
Low
iincome adults
d l without
ih
kid
kids
Kids
• Coverage Initiatives
–
–
–
–
Multi-shares
P
Premium
i
assistance
i t
Exchanges
Targeted benefit design
• Other Activities
– Enrollment and retention activities
– Delivery system reform
www.shadac.org
4
Some Challenges Faced by SHAP
Grantee States
1 Resistance to expanding entitlement
1.
p g
programs
2. Sustainability
3. Uncertainty
y related to health reform
www.shadac.org
5
Resistance to Expanded Entitlement
Programs
Political pressure against expansion of
government funded p
g
programs
g
Some state
S
t t responses:
• Develop
e e op e
employer-based
p oye based options
opt o s
• Support public-private partnerships
• Require individual contributions
www.shadac.org
6
Sustainability
 SHAP funded for a maximum of 5 years
 State budget deficits
Some state responses:
• Medicaid waivers
• “Soft launch” programs
• Limited outreach
• Don’t target groups of likely eligible
• Create registration or waiting lists
• Graduated subsidies that reduce over time
• Refer eligible people to better funded programs
www.shadac.org
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Uncertainty Regarding Health Reform
 Uncertainly in the rules, regulations and impact of
health reform
• Some state responses:
– Fund programs that are likely to align with reform (e.g.
insurance exchange, build off ESI)
– Use program evaluation to document experience with new
enrollee populations (low income adults, small businesses)
– Focus on p
programs
g
that will remain relevant as p
part of the
safety net
www.shadac.org
8
Texas: Graduated Subsidies
Cost Sharing Account - Glide Path
• Health Care Cost Sharing Accounts
(
(CSAs)
)
• Targeted at low-income working adults
• CSAs
CSA can be
b used
d tto pay ffor monthly
thl
premiums or point-of service cost-sharing
• Available to enrollees within 3 delivery
systems
www.shadac.org
9
Texas: Graduated Subsidies
Cost Sharing Account - Glide Path (2)
• CSA accounts are funded using a five-year “glide
path” of $1200, $900, $750, $500 and $500
• The intent is to create a clear up front incentive to
participate
• The goal is to develop a “culture of insurance”
– Experience the benefit of participating in a shared risk
pool
– Continue to p
participate
p
despite
p the g
gradually
y higher
g
individual contribution
www.shadac.org
10
Washington: Insurance Exchange
Health Insurance Partnership (HIP)
• Small business exchange, focused on
businesses with low wage
g workers
• Any employee of an eligible firm can
purchase through HIP
• Subsidy for employees at/below 200% FPL
• Health plans propose plans ranging from
catastrophic to comprehensive (same plans
outside the exchange)
www.shadac.org
11
Washington: Insurance Exchange
Health Insurance Partnership (HIP)
• Board sets HIP policy including, plan
approval
pp
• Currently, employer chooses plan, but
state is developing an individual choice
model
• HIP may apply a surcharge to health plans
to pay administrative and operational
expenses
www.shadac.org
12
Minnesota: Innovative Multi-Share
Portico Healthnet
• Access to care plan for low income, uninsured
• “No wrong
g door” – screens for Minnesota health
care program eligibility
Prevention-based
based services with care management
• Prevention
• Covered: primary/specialty clinic visits, RX, lab
tests outpatient mental health,
tests,
health outpatient hospital
procedures
• Not covered: ER,
ER inpatient hosp
hosp, dental
dental, chem dep.
dep
• Under SHAP, income eligibility expanded from
275% to 350% FPL
www.shadac.org
13
Minnesota: Innovative Multi-Share
Portico Healthnet (2)
• Financing:
– Funded p
predominately
y through
g financial
partnership with14 local hospitals
– Enrollee monthly fee of $25 $55 (sliding scale)
– Copays/Coinsurance
– Grant
G t funds
f d
www.shadac.org
14
Persistent Challenges Faced by States
•
•
•
•
State budget outlooks still bleak
Health care cost will continue to rise
Political turnover likely
State responsibility for implementation of
health
ea t reform
eo
www.shadac.org
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Contact Information
Elizabeth Lukanen, MPH
Deputy Director, SHARE
SHADAC (State Health Access Data Assistance Center)
University of Minnesota, Minneapolis, MN
elukanen@umn.edu, 612-626-1537
www.shadac.org
F more information
For
i f
ti on SHAP:
SHAP http://www.shadac.org/shap
htt //
h d
/ h
www.shadac.org
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