THE URBAN INSTITUTE
States Progress in Covering Children:
Findings from the Evaluation of
Insuring America’s Children
Prepared by:
Ian Hill, Debra Draper, Sara Hogan, Allison Liebhaber
Presented at:
Children Health Services Research Annual Meeting
Chicago, Illinois
Funded by:
The David and Lucile Packard Foundation
27 June 2009
Outline of Presentation
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Background on Insuring America’s Children
Overview of evaluation and case study methods
Results from 6 site visits
Next Steps/looking forward
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Insuring America’s Children:
States Leading the Way
• Provides financial and technical support to statebased advocacy organizations working to advance
universal children’s coverage
• 8 states awarded Narrative Communications grants
• 8 states awarded Finish Line grants
• Technical assistance provided by Spitfire
Communications and Georgetown University’s
Center for Children and Families
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Insuring America’s Children
Grantee States
WA
ME
ND
MT
OR
ID
VT
MN
NH
WI
SD
MA
NY
MI
WY
NE
NV
IL
OH
IN
CO
DE
MD
WV
KS
RI
NJ
UT
CA
CT
PA
IA
MO
VA
DC
KY
NC
TN
AZ
OK
SC
AR
NM
MS
TX
AL
GA
LA
FL
AK
HI
Finish Line states - studied
Finish Line states - not yet visited
Narrative Communication states
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Insuring America’s Children
Evaluation
• Three-year partnership of Mathematica Policy
Research, Inc., the Urban Institute, and the Center
for Studying Health System Change
• Goals of evaluation:
– Monitor children’s coverage and access nationally
– Analyze salience of/progress toward universal coverage
in selected states
– Assess the impact of selected innovative
expansions/policies
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In-Depth Case Studies of Finish Line
Grantees/States
• Establish “baseline” understanding of state
initiatives
• Learn about process of implementation
• Develop early “lessons” for Foundation and states
• Two interview teams:
– Policy/program: Urban Institute
– Advocacy/stakeholder: Health Systems Change
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States Tackle Universal Coverage
from Different Starting Points
Percent
Uninsured
Children
Upper
Income
Limit
Coverage
of Legal
Immigrants
State-Only
Coverage of
Undocumented
Kids
Presumptive
Eligibility
12-month
Continuous
Eligibility
Arkansas
8
200%
No
No
No
Yes/No
Colorado
14
205%
No
No
Yes
Yes/No
Iowa
6
200%
No
No
No
Yes/No
Ohio
8
200%
No
No
No
No
Texas
22
200%
Yes
No
No
Yes/No
Washington
7
250%
Yes
Yes
No
Yes
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Similar Children’s Agendas among
Grantees
Arkansas
Eligibility
Expansion
Buy-In
Program
300%
>300%
Simplify Enrollment/
Renewal
• 12 mos. continuous
eligibility
Colorado
250%
• Eligibility modernization
•12 mos. continuous
eligibility
Iowa
300%
•Presumptive eligibility
•Passive renewal
Ohio
300%
300%
>200%
Washington
300%
>300%
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•Cover undocumented
kids
•Advance dialogue re
undocumented kids
>300%
Texas
Immigrant Children
•12 mos. continuous
eligibility
• Increased outreach &
application assistance
•Fix eligibility system
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Grantees Face Numerous Challenges
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Eroding fiscal climate
Tenuous political support
Hostile federal policy environment (initially)
Hostile public opinion surrounding illegal
immigrants
• Maintaining policy focus on children
• Limited data
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Accomplishing Results
Eligibility
Expansion
Arkansas
Colorado
Buy-In
Program
Simplify
Enrollment/Renewal
200 -> 250%*
• Online enrollment &
renewal*
• Legal immigrants*
205 -> 250%
• 12 mos. continuous
eligibility
• Online enrollment &
renewal
• Pregnant women (250)
• Parents (100)
• Childless adults (100)
• Legal immigrants
• Pregnant women (300)
• CSHCN (300)
• Legal immigrants
• Dental ‘wrap-around’
• Translation services
CSHCN
< 400%
Iowa
200 –> 300%
• 12 mos. continuous
• Presumptive eligibility
• Joint applications
• Express lane eligibility
• Paperless renewal
• Premium assistance
• Reduced verification
Ohio
200 -> 300%*
• ‘Cut Red Tape’
initiative*
• Increased eligibility
staffing
Texas
Washington
Other
250 -> 300%
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• Express lane eligibility
* Pending
• Apple Health outreach
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Effective Advocacy Strategies
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Building broad-based coalitions
Cultivating diverse/respected “champions”
Flexibly using effective/impactful messaging
Encouraging a “cultural shift” in public programs
Becoming the “go to” organization for
information/data
• Taking advantage of federal-level changes
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Lessons Learned
• Achieving reform requires persistence/long-term
commitment
• Coalitions must involve grass roots, as well as
state-level, stakeholders
• Advocates must have unified “voice”
• Creativity/flexibility required in changing
environment
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Lessons Learned
• Strong data are critical to supporting objectives
• CHIP and Medicaid alignment are critical
• Passing legislation is just a first step
• Advancing the dialogue on immigrant children is
an important first step
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Next Steps in the Evaluation
• Gathering and monitoring coverage/access data
• Conducting “bellwether” interviews
• Identifying targeted impact studies
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