Building on the Opportunities
Presented by CHIP
Reauthorization
Brian Quinn, Ph.D.
June 27, 2009
Overview
• Priority funding area for RWJF over the last 10 years
• Covering Kids & Families
• Three new Foundation programs
• Maximizing Enrollment for Kids
• Work with the American Community Survey
• State Health Access Reform Evaluations (SHARE)
• Need to address challenges going forward
Maximizing Enrollment for Kids
• New program to help eight states increase children’s
coverage in Medicaid and CHIP
• Focus on systems, policies and procedures for enrolling
and retaining children
• Four key steps
1.Apply Diagnostic Assessment Procedure (DAP)
2.Develop a workplan to highlight the most pressing
needs
3.Provide intensive technical assistance to address these
needs
4.Conduct ongoing evaluation
Maximizing Enrollment for Kids
(continued)
• Part 1 – Quantitative Evaluation
• States must submit their enrollment files
• Time series analysis will be used to:
• Measure the overall impact of the program on
enrollment and retention
• Develop quantitative evidence about the most
effective strategies
•Part 2 – Field Study
• Qualitative assessment of forces affecting the program
• Importance of informational feedback loop
American Community Survey
(ACS)
• New survey from the Census Bureau
• Includes measures on a range of social, health,
economic and demographic characteristics
• Health insurance data collected beginning in 2008
• Data will be released in August 2009
• Key advantages
• Sample size is 30 times larger than the Current
Population Survey (CPS)
• Health insurance question is point-in-time
• Not without other challenges, however
American Community Survey
(continued)
• Developing new model to provide better uninsurance
estimates and participation rates at state level
• Will also be used for impact analysis to assess effects of
policy changes
• Developing a “Virtual” CPS/ACS Data Center
• Allows researchers and policy-makers to have
interactive access to these datasets
SHARE
• State Health Access Reform Evaluation (SHARE)
• Funded 15 projects in early 2008, including:
• Use of state income tax form to identify eligible, but
unenrolled children (MD)
• Evaluation of state reforms to cover all children (IL, PA
and WA)
• Evaluation of 12-month continuous eligibility in Medicaid
(CA)
• Evaluation of outreach and enrollment strategies (CA)
• New funding available in 2010
• Likely focus on states’ roles in national reform
Challenges
• Challenge #1 – What role will kids play in the context
of national reform and how will that affect CHIPRA?
• Continued starting point for children’s coverage?
• Eligibility expansions to even higher income levels?
• Movement of CHIP and Medicaid into an exchange?
• Impact of an individual mandate?
Challenges (continued)
• Challenge #2 – How do we measure the effects of
CHIPRA in the midst of the current environment?
• Three forces:
• CHIPRA gives states the opportunity to significantly
expand coverage
• Economic downturn means that the demand for
Medicaid and CHIP coverage is on the rise
• State budget crises make it difficult to expand coverage
• Tricky to tease out the effects of CHIPRA amidst these
dynamics
Challenges (continued)
• Challenge #3 – How can we make sure we’re
addressing the most important questions?
• Economic downturn has impacted funders
• Reduces our funding in all areas
• Increased policy activity means greater competition
for limited resources
• Need for efficiency – importance for funders and
researchers to tackle the most important questions
Conclusion
• CHIPRA provides important new opportunities for
coverage expansions
• Key research is in place to assess CHIPRA’s impact
and its implementation
• But we face some significant challenges going
forward to ensure that research can inform the policy
debate about the program