Results tagged “Tricia Brooks”

One of the many lessons learned about advancing children's health coverage is how critical retention in Medicaid and CHIP is to our coverage goals. Dr. Benjamin Sommers drove this point home in a study that concluded that one-third of all eligible, uninsured children in 2006 had actually been enrolled in Medicaid or CHIP in the prior year. A recent update of Dr. Sommer's study in Health Affairs shows that we have made progress on this front with this key statistic dropping to 25% in a little over two years.

Over the years the importance of customer retention, a long-standing best practice in the business world, has gained equal footing with outreach and streamlining enrollment as effective strategies to reduce barriers to coverage. Dr. Sommer's report is good news for states that have made retention a priority and is a contributing factor in our continuing success in reducing the number of uninsured children. 

While the drop-out rate improved, there was some evidence in the study that take-up or new enrollment may have slipped. Dr. Benjamin Sommers points out that this change in trend coincided with new federal rules imposing complex paperwork requirements on states and applicants to document citizenship. The negative impact of the citizenship verification requirement on eligible, citizen children has been well documented. 

I'm optimistic that if Dr. Sommers updates his report in another three years we'll see improvement in both areas. More than one-third of states have had impressive results with a new data exchange with the Social Security Administration (SSA) to verify citizenship rather than requiring paperwork from individuals. Many more states are testing or planning to develop the SSA electronic interface as a means of documenting citizenship.

Additionally, states continue to innovate and replicate effective enrollment and retention strategies through major initiatives such as the Robert Wood Johnson funded Maximizing Enrollment for Kids and the State Health Access Grant Program.

Dr. Sommers research shows how policy and procedural decisions can make a difference, both positive and negative.  Taking stock of what is working in Medicaid and CHIP to promote enrollment and retention is essential to the expansion of coverage as we implement the Affordable Care Act efficiently, cost-effectively and with optimal results.

While there is much work to be done implementing the many facets of the health reform, creating the exchange marketplace(s) is one of the tasks that receives much of the attention. Not only is it a new concept to most states but, along with the expansion of Medicaid, it is the mechanism for insuring the 32 million Americans who are expected to gain coverage.

People tend to look to Massachusetts for lessons learned because the exchange concept in national reform is based on that state's health reform model. In fact, early this year the State Coverage Initiatives (SCI) hosted a meeting of state officials in Boston to provide the nuts and bolts of how the Massachusetts exchange known as the Health Connector works. This two-day meeting drew more than 100 participants from 42 states, including representatives from state insurance departments, Governor's offices, and the state department responsible for health programs. The SCI program, funded by the Robert Wood Johnson Foundation and administered by AcademyHealth, provides technical assistance to state leaders to help them move health care reform forward at the state level.

It's important to note that other states beyond Massachusetts have made advances in health reform that can inform our efforts moving forward. SCI documented a number of the important issues in its report,"Implementing State Health Reform: Lessons Learned for Policymakers," on the experience of five states: Massachusetts, New Mexico, Tennessee, Vermont and Wisconsin.

The report and its companion webinar focus on key questions and takeaways in a number of areas including enrollment and eligibility, marketing and outreach, staffing and coordination, and reporting and evaluation. It asks critical questions like:

• "Are current state information systems equipped to perform the necessary eligibility and enrollment functions for the health insurance expansion?"

• "To what extent can the state's current CHIP and Medicaid outreach activities be modified to include outreach and marketing for the health insurance expansion?"
  

Some states are already moving beyond forming a key group of state officials charged with beginning the planning process. Wisconsin, one of the early state implementers of health reform, has recently issued a request for proposals (RFP) to add exchange functionality to its current eligibility system. Connecticut and the District of Columbia are early adopters of the new option to cover adults (both parents and adults without dependents) now without waiting for health reform.

And speaking of waiting...let's not forget that with 5 million uninsured children already eligible for Medicaid or CHIP, kids don't also have to wait for health reform.

The National Academy of State Health Policy (NASHP) is an independent academy of state health policymakers working together to identify emerging issues, develop policy solutions, and improve state health policy and practice. Recently, its executive committee identified ten aspects of health reform that states must get right in order to successfully implement federal health reform. Like the health reform law, the top ten list covers a broad range of objectives and responsibilities:

1) Be Strategic with Insurance Exchanges

2) Regulate the Commercial Health Insurance Market Effectively

3) Simplify and Integrate Eligibility Systems

4) Expand Provider and Health System Capacity

5) Attend to Benefit Design

6) Focus on the Dually Eligible

7) Use Your Data

8) Pursue Population Health Goals

9) Engage the Public in Policy Development and Implementation

10) Demand Quality and Efficiency from the Health Care System

With the dust settling on the passage of health reform, attention is shifting from the early provisions of the law such as coverage for young adults under their parent's plan and consumer-friendly insurance reforms including eliminating pre-existing exclusions for children, lifetime caps and rescissions of policies. Many states have launched formal or informal groups to begin the planning and decision-making process. According to the National Governors Association (NGA), at least a quarter of the states have formally launched commissions, task forces or advisory groups. The lack of consumer representation on these state structures is a bit disappointing given that engaging the public has been flagged as one of the top ten critical areas.

Two of my favorites among the top ten are simplifying and integrating eligibility systems and using data to analyze and improve your programs. Those of us working on children's coverage know how important these aspects of program administration are to the ultimate success of enrolling all eligible children and families. Both rely on well-designed, high-functioning technology based on simplified processes and streamlined procedures.

The NASHP brief puts it bluntly: "36 million Americans cannot be enrolled in Medicaid or the new exchanges by relying upon what, in most states, is a county-based eligibility platform designed around the cumbersome and intrusive processes of the welfare eligibility system." Touche`!

Effective systems are expensive and time-consuming to build and implement. There is an important role here for the federal government to assist states in system procurement, to standardize data reporting requirements and to require that systems meet data reporting standards as a condition of federal funding. We cannot hope to meet our coverage goals without data to analyze how well our programs are working and identify where improvements are needed. Public reporting of data on enrollment, retention, access to care, health outcomes and much more will be the best way for Americans to know when states are truly getting it right!!

Coverage of young adults up to 26 years of age on a parent's insurance plan is one of the most popular provisions of the new health reform law and an early win for children and families. This week, three federal agencies released joint interim final regulations on this provision. The rules confirm that all individual and group health plans, including self-insured plans, must allow young adults to be enrolled as dependents on their parent's plan starting with new or renewing policies commencing after September 23, 2010.

Under the new law, insurers cannot impose restrictions that have existed previously in determining dependent status, including student status, marital status, residency or financial support by the parent. One short-term exception does apply. Until January 1, 2014, "grandfathered" health plans may reject young adults who are eligible to enroll in their own employer sponsored insurance plan.

The term "grandfathered" health plan generally describes plans in existence on the date of enactment of the health reform law. What is not clear until additional federal guidance is issued is when or how a plan might lose its "grandfather" standing and be considered a new plan for the purpose of this and other provisions of health reform.

Plans must notify subscribers of the new provision and parents will have 30 days to enroll their adult children. The law explicitly allows a parent to enroll if not currently insured or switch coverage options for all family members. However, there is no requirement for a plan that does not provide dependent coverage at all to start doing so.

Insurers must offer all the benefit packages available to other "similarly situated" dependents. For example, if an insurer offers a choice of an HMO product and an indemnity plan to a group, it cannot limit enrollment of young adults to the HMO plan. Insurers can charge more on an individual family basis if they already do so for each new dependent enrolled or they can raise rates across the board to cover the cost of including young adults in the risk pool.

The guidance also clarifies that if a state dependent coverage law imposes stricter requirements on insurers state law is not superseded by federal law. For example, if a state allows a young adult to remain on their parent's plan until age 28, the higher age limit continues to apply to state regulated health plans. Federal law would supersede state law that has less stringent provisions such as excluding young adults who are married or not claimed as a dependent on the parent's tax return.

The administration projects that 1.2 million young adults could be covered under this new provision. As widely reported, some 65 insurers have indicated they will implement the provision early by at least allowing dependents who would lose coverage as they age out or graduate to remain on their parent's plan. This is good news as we chip away at the 47 million uninsured Americans.

One of the exciting new options provided by the Children's Health Insurance Program Reauthorization Act (CHIPRA) is the ability of states to use an existing electronic data exchange with the Social Security Administration (SSA) to document citizenship. All states have entered into agreements with the SSA to use this new capability starting January 1, 2010. To date 27 states are actively using or testing the system.

The Center on Budget and Policy Priorities (CBPP) has released a report describing the early positive experience of states in using the electronic match in lieu of complex paperwork requirements to document citizenship. Author Donna Cohen Ross has followed the impact of the citizenship documentation requirement since it was implemented in 2006.

The report is the last publication written in Donna's capacity as Director of Outreach at CBPP. Later this month, Donna will join the staff in the Office of External Affairs at the Centers for Medicaid and Medicare (CMS). We are pleased to have another experienced and knowledgeable friend at CMS advocating for the systemic changes and simplification policies that will make a difference in enrolling and retaining all eligible children and individuals in Medicaid and CHIP. We wish Donna the best in her new role and thank her for this final report demonstrating successful strategies to reduce paperwork and make it easier for eligible individuals to secure Medicaid and CHIP coverage.

(Editor's Note:  Donna has been a frequent contributer to this blog and we will really miss her voice on outreach issues.)

It's appropriate that we are celebrating the passage of health reform while enjoying the first signs of spring. With snow banks receding and the sun warming, we happily anticipate the bounty of health reform as we watch the early sprouts emerge.

Ongoing state budget woes, however, remind us that a spring snowstorm can still bring a chill to the air. But like the hardy daffodil, early provisions in health reform are intended to fortify current programs so we can focus on moving forward without losing ground.

Health reform relies on Medicaid and CHIP as fertile soil to yield a bigger crop of insured low-income adults and children: 16 million more. Growth can only be assured if we protect the coverage gains states have achieved through current CHIP and Medicaid programs as we plant the seeds to provide affordable health coverage for all.

To protect current programs from the frosty state budget climate, the health reform law discourages states from pruning current eligibility levels and imposing new paperwork and other barriers to enrollment and renewal. To ensure we reap the harvest of a smooth transition to health reform, this MOE is applicable through 2014 for adults and 2019 for children.

MOE's are not new. For example, when CHIP was created in 1997, states were required to maintain their Medicaid coverage for kids in order to tap enhanced CHIP federal funding to expand coverage. States are currently subject to an MOE on Medicaid as a condition of accepting the enhanced federal Medicaid match (FMAP) through the American Recovery and Reinvestment Act (ARRA).

There is a significant penalty if states choose to disregard the MOE in health reform. Program changes in violation of the MOE will result in the loss of all federal Medicaid funding. It doesn't seem like a tough row to hoe for states to extend the MOE to their CHIP programs considering the more significant losses - that is all Medicaid funding compared to only the enhanced federal match provided through ARRA.

The MOE doesn't mean children and families can rest easy during this transition phase.  States can still scale back by eliminating optional benefits or reducing provider reimbursement rates, which can have a chilling effect on access to services like a late frost damaging fragile seedlings.

Ultimately, the Centers for Medicaid and Medicare (CMS) will determine whether or not a state is maintaining its effort. It is not yet clear how CMS will enforce the MOE for states that have not implemented an approved enrollment freeze or cap if they exceed state appropriations. While awaiting guidance from CMS, if you want to dig deeper into this issue, check out the recently released "Holding the Line on Medicaid and CHIP" memo from CCF and the Center on Budget and Policy Priorities.

March 10, 2010 was a memorable day for children's health advocates in Ohio. Ohio became the first state to join HHS Secretary Kathleen Sebelius' quest to enroll all children eligible for Medicaid and CHIP. In accepting the challenge Secretary Sebelius issued to states in November at the National Children's Health Insurance Summit to enroll all eligible children, Governor Strickland announced that Ohio will take immediate steps to adopt key policies to advance coverage. 

In a symbolic gesture, Governor Strickland and our dear friend, Cindy Mann, CMS Deputy Administrator for Medicaid and CHIP, cut a red ribbon signifying the state's commitment to remove red tape that too often hampers families from accessing public insurance programs.

The Governor revealed that Ohio will implement three specific policies: 12-month continuous eligibility, presumptive eligibility and express lane eligibility.  These policies are among the eight program features that will help states qualify for the

CHIPRA performance bonus. Implementation of these policies will position Ohio to earn a bonus given that the state's enrollment in Medicaid has increased by 20% over the past three years, which exceeds the target enrollment established in CHIPRA performance bonus provision.

The Governor's announcement came on the eve of the Ohio Covering Kids and Families (OCKF) Annual Conference during which more than 200 attendees met to learn about best practices for enrolling and retaining all children in Medicaid and CHIP. Voices for Ohio's Children, which convenes and facilitates the OCKF Coalition, hosted a legislative reception during which Cindy Mann praised Ohio's commitment to reach all eligible but unenrolled children.

The events in Ohio this week remind us that strong leadership at the state level can make a difference even in challenging economic times. We commend Governor Strickland for accepting the Secretary's challenge and hope it inspires other Governors to do the same.

Each celebration of a new year brings a renewed sense of optimism and 2010 offers tremendous promise in mitigating the chilling impact of the citizenship documentation requirement imposed by the 2005 Deficit Reduction Act (DRA) on Medicaid. The citizenship documentation requirement not only made it more difficult for eligible citizens to enroll in Medicaid but states have also spent millions of dollars in administrative costs to comply with the regulation. The title of a study by the Government Accountability Office says it well: "States Reported that Citizenship Documentation Requirement Resulted in Enrollment Declines for Eligible Citizens and Posed Administrative Burdens." 

It is indeed fitting - with the holidays focused on children and giving -  that HHS Secretary Kathleen Sebelius awarded more than $72 million in bonus payments last week to nine states for their success in enrolling low-income children in Medicaid. Like little kids during the holidays, we have awaited the announcement of these performance bonuses with excitement and gleeful anticipation. Drum roll, please.....Alaska, Illinois, Louisiana, Michigan, New Jersey, New Mexico, Oregon and Washington earned bonuses ranging from $1.5 to $9.1 million but Alabama is the big winner earning more than half ($39 million) of the total award.

The performance bonus  is one of the new tools and options created through the Children's Health Insurance Reauthorization Act  (CHIPRA). It give states a financial incentive to meet specific Medicaid enrollment targets if they also adopt at least 5 of 8 enrollment and retention simplification strategies such as 12-month continuous eligibility and streamlined administrative renewals.  

States qualifying for the bonus receive payments equal to 15% of the annual cost of Medicaid services for the number of children enrolled above the target enrollment. To meet the target, a state's average monthly Medicaid enrollment for children in federal fiscal year 2009 (FFY 09) had to be approximately 8% above the average enrollment in FFY 07 with adjustments for any change (positive or negative) in the child population.

The significantly larger award was granted to Alabama because it was the only state to qualify for the higher "tier 2" bonus level. A state qualifies for the tier 2 bonus if the average number of enrollees exceeds the base (tier 1) enrollment target by 10%. At the tier 2 level, states receive a bonus equal to a joyful 62.5% of their share of Medicaid costs for the average number of children enrolled above the tier 2 target. For Alabama, this reduces the state's share of Medicaid for children enrolled above the tier 2 target to less than 9%.

In announcing the awards, the Center for Medicaid and State Operations within CMS issued a State Official Letter (SHO) explaining the performance bonus calculations and describing the eight enrollment and retention strategies. This was the tenth in a series of SHO letters, which provide guidance to the states in implementing the provisions of CHIPRA. The public announcement of the bonuses also coincided with the re-launch of "Insure Kids Now" as a more robust website focused on Medicaid and CHIP including state specific program information.

We send our congratulations to the State Medicaid and CHIP agencies in the nine performance bonus states for a job well done and our wishes to all for a holiday season filled with warmth and laughter.

An enthusiastic crowd of more than 500 gathered in Chicago last week for the National Children's Health Insurance Summit hosted by the Centers for Medicaid and Medicare (CMS). Attendees included CHIPRA outreach grantees, individuals from community-based and provider organizations, national and state experts, and officials from federal and state government. The purpose of the event was to reinvigorate outreach efforts and share best enrollment and retention practices in Medicaid and CHIP.

HHS Secretary Kathleen Sebelius and CMS Medicaid Director Cindy Mann kicked off the event by articulating the Administration's commitment to covering children and challenging attendees to find and enroll the estimated 5 million of the 8 million uninsured children who are eligible but not enrolled Medicaid and CHIP.

New Jersey is putting this idea to the test with its new "Insured for Sure" initiative that is being piloted in nine New Jersey hospitals. Hospital staff will check the insurance status of all newborns and provide data to the Department of Health and Senior Services  (DHSS) verifying a baby's coverage under the parent's insurance. If a child is uninsured, staff will help families complete a streamlined one-page online application for NJ FamilyCare. And it gets even better, there is no need to submit paperwork.

As NJ-DHSS Commissioner Heather Howard stated in announcing the program: "Having health insurance is the first step in ensuring...a healthy start in life." Health insurance is a young family's ticket to a medical home and the health support system they need to care for their infant including those critical well baby checkups. In the first year of life alone, the American Academy of Pediatrics recommends seven well-child care visits to ensure that newborns grow and develop appropriately and get the immunizations they need to prevent childhood diseases. Sadly, studies have shown that barely a third of uninsured children get the recommended number of well-child visits.

New Jersey isn't alone in its efforts to increase the number of babies who leave the hospital with health insurance. Oklahoma developed a web-based program for hospitals to directly enroll infants born to moms covered by Medicaid in its SoonerCare program.  This program known as eNB-1 adds newborns in real time and ensures that a medical home is selected for the baby. It also provides an immediate ID number, which simplifies the billing process for hospitals.

A newborn whose delivery is covered by Medicaid or CHIP by law is automatically eligible for a full year of coverage. Period. End of discussion. Unfortunately, in the past, some of these newborns have slipped through the cracks because of reporting or paperwork requirements. CHIPRA further clarified the importance of providing infants with insurance in this all-important first year of life. In particular, CHIPRA clarified that these babies have met the citizenship documentation requirement by virtue of the fact that they were born in a U.S. hospital, thus eliminating unnecessary paperwork.

If more states launch initiatives like "Insured for Sure" and eNB-1, backed by strong technology, we truly can make significant gains in covering children when they are most vulnerable. Making sure that no newborn leaves the hospital without health insurance is an idea whose time has come.

CMS released the latest in a series of state health official letters providing guidance on CHIPRA implementation. This seventh letter focuses on the new mandatory dental provisions for separate CHIP programs, as well as the option these states have to provide a stand-alone dental plan to children who are insured or underinsured but would otherwise qualify for CHIP. Both provisions are effective October 1, 2009. These provisions do not impact states that provide CHIP coverage through a Medicaid expansion program.

The addition of dental standards is considered one of the victories in CHIPRA since receiving dental care is without a doubt critical to the healthy development of children. With tooth decay as the most prevalent childhood infectious disease, the omission of mandated dental coverage in CHIP has been a significant oversight.

Although all states provided some level of dental services in CHIP there were often service or dollar limitations. Now states must provide "coverage of dental services necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions." States have two options for providing this coverage:

• States can translate this requirement into a defined set of benefits that includes medically necessary services within specific categories. This may prove a bit tricky as the burden is on states to demonstrate that their package meets the intent of the statute.

• Alternatively, states can provide benefits equal to one of three benchmark plans: either the dental coverage in the most popular federal or state employee plan, or the state commercial plan with the highest non-Medicaid enrollment. Note that there is no option for proving actuarial equivalence (as there is for CHIP medical benefits).
  

Regardless of the option chosen, the cost-sharing requirements must meet CHIP rules. States cannot impose cost-sharing for preventive and diagnostic services and the cost-sharing for both medical and dental services can be no more than 5% of family income.  

States also now have the option to provide a stand-alone dental plan for children who are income-eligible for CHIP but who have private medical coverage that has limited or no dental benefits. States that elect to offer this coverage must offer the same (and not more favorable) dental benefit plan as is provided to CHIP enrollees. For children with some dental coverage, this plan can serve as a "wrap," filling in gaps as a secondary payer to their private coverage. In order to offer a stand-alone plan, states must not maintain a waiting list or set a numerical limitation on the number of children enrolled in CHIP. In addition, the 5% cost-sharing cap on total medical and dental services also applies, which may represent a challenge since the state may not have access to information about a family's cost-sharing in their private insurance. As such, this may present a sizeable administrative barrier.

Despite the recent guidance, some questions remain. For example, must cost-sharing above any aggregate or maximum cap on benefits (as are common in commercial plans) be counted toward the 5% maximum cost-sharing? While the provisions are effective October 1, 2009, are states with pre-existing managed care plans required to modify their current contracts to come into compliance immediately or at contract renewal? As is common with federal policy, we continue to peel back the multiple layers of intepretation in search of definitive answers states need to fulfill the promise of CHIPRA.

Yesterday, Secretary Sebelius awarded $40 million to 69 grantees in 41 states and the District of Columbia to find and enroll children who are uninsured but eligible for Medicaid or CHIP. This is the first round of outreach and enrollment grants funded through the Children's Health Insurance Reauthorization Act (CHIPRA), which was signed by President Obama in February 2009. CHIPRA provides $10 million each for a national enrollment campaign and outreach to American Natives. In addition to the $40 million in grants awarded yesterday, there is an additional $40 million that will be awarded in future grant rounds to states and other qualifying organizations.

Projects targeting outreach to children in families with limited English proficiency and other ethnic and cultural barriers were the big winners in this first round of CHIPRA grants, accounting for nearly one-third of the grants. Initiatives focused on school-based outreach, activities coordinated by community health centers and projects targeting rural children were also popular.

Notably, the majority of grantees are community-based organizations or coalitions, with only ten grants awarded to state agencies with primary responsibility for administering Medicaid and CHIP. Awards ranged from $69,102 to $988,177 for the two-year grant period with more than one third of the grantees receiving more than $900,000 each.

The projects promote strong community-based strategies targeting vulnerable populations. What is less clear is whether these efforts will result in the policy simplifications and systemic changes that are known to reduce paperwork and remove administrative barriers to enrollment and retention. Grantees are required to demonstrate with data the extent to which their strategies result in enrollment and retention. Best practices and lessons learned will be documented and shared with other states and organizations committed to ensuring that all children eligible for Medicaid and CHIP receive the health care they need.

Just two months after freezing enrollment in the Healthy Families Program and initiating a waitlist, enrollment has reopened in California Children's Health Insurance Program (CHIP). A budget shortfall of just under $200 million has been plugged by a generous contribution from the state's First Five Commission, increased family cost-sharing, and a new premium tax on Medi-Cal (Medicaid) managed care plans, which passed the legislature (AB 1422) and is awaiting the Governor's expected signature.

This turn of events illustrates how committed the public is to covering all children.

State child health advocates and other stakeholders, including the managed care plans in California and the Managed Risk Medical Insurance Board (which administers Healthy Families) worked with policymakers and the First Five Commission to find a solution. At one point the situation was so dire, it was likely that in addition to waitlisting new applicants, children who were due to renew their eligibility on their annual anniversary date would not be allowed to continue coverage. The loss of coverage at renewal due to a funding shortfall had never happened in the twelve-year history of CHIP.

Just this week, CCF released a report "Weathering the Storm" detailing action that 23 states have taken to improve children's health coverage. Only three states were noted as slipping in their efforts to cover more kids, California being one of them.  We are pleased to remove California from that list as Healthy Families works to clear the backlog of applications for nearly 90,000 children.

Health reform is capturing all the headlines these days. And much of the emphasis is on how to contain costs. Unfortunately, what Americans aren't hearing in the debate is a discussion about the proven ways to reduce costs while improving quality of care and health outcomes. The regrettable assumption is that containing costs means taking something away that I have or may need. This misconception is shaking the confidence of Americans who know that something has to be done to fix health care.

Instead of focusing on the politics, we should be promoting the models of health care delivery that are the "win-wins" we need for health care reform to work.

A few weeks ago, I blogged about the success of Medicaid and pointed to the Community Care of North Carolina, a primary care medical home model which has shown outstanding results in improving access while reducing costs.

There is plenty more proof out there that the medical home model works. Take for example a recent article in Pediatrics that reports on a study by the Center for Medical Home Improvement (CMHI) in my home state of New Hampshire. The study shows improved outcomes for children with special health care needs when care is coordinated through a pediatric medical home model.

Parents who were surveyed in the study reported fewer hospitalizations, fewer absent schools days, less worry about their child's health, and increased likelihood of having a written health care plan. Jeanne McAllister, Director of CMHI, points out that while a low percentage of children have complex needs that require extensive coordination among multiple agencies and providers, these children do account for about half of national expenses on pediatric healthcare.

The concept of "medical home" is a community-based primary care setting that provides and coordinates high quality, planned, family-centered health promotion, acute illness care and chronic condition management. Without a medical home as a centralized point of coordination, care can become fragmented, duplicative and overly specialized, particularly for those with chronic health conditions.

Instead of instilling fear in Americans that health reform will reduce their access to care, we need to highlight these very effective models that provide a much higher level of satisfaction with care, better health and enhanced quality of life. And, oh, by the way, they also save money. Money we can use to provide health coverage to everyone.

This past weekend some Governors attending their national association's meeting in Biloxi, Mississippi expressed concern over the future role of Medicaid in health reform. In particular, Tennessee Governor Bredesen, a former healthcare executive, stated that "it's not health care reform to dump more money into Medicaid." But indeed, investing more money in Medicaid by paying providers more appropriate rates in Medicaid could help reduce the cost-shifting that is driving up the cost of private insurance. It would also improve access to care.

Health reform shouldn't just "dump" more money into Medicaid. It should take what works and build upon it. In all of the political rhetoric, let's also not lose sight of the fact that Medicaid has proven itself to be the most efficient way to provide coverage to low-income Americans. It has lower administrative costs than private insurance and is better equipped to meet the unique needs of disabled Americans, seniors, and more than 20 million children.

Consider proven Medicaid care delivery models like Community Care of North Carolina (CCNC). CCNC is an enhanced medical home model that has greatly improved access and quality of care, while containing costs in Medicaid. A study by the Mercer consulting group estimated that the state's savings were between $150 and $170 million in FY 2006 alone. An evaluation conducted by the University of North Carolina demonstrated that asthma and diabetes patients had fewer hospitalizations and saw improvement in key health performance measures. Now that's the kind of health care reform we need.

And let's not forget that numerous studies have shown that families are grateful for the coverage they get for their kids through Medicaid. By covering kids from head-to-toe with child-appropriate benefits, by removing red-tape that keeps eligible children out and by improving provider payments, we can make great strides to improve the effectiveness and efficiency of Medicaid.  Hopefully other Governors will take a closer look at the successes of Medicaid and the willingness of the federal government to assume more financial responsibility for Medicaid before opposing a plan that would make a world of difference for those who cannot afford health coverage for themselves or their children.

Medicaid works, and it should be strengthened as part of health reform. By building on what works, we can capitalize on the infrastructure and experience states have developed in administering Medicaid over the past thirty-five years. In other words, let's not throw the baby out with the bath water; we should build on Medicaid's successes.

Yesterday HHS Secretary Kathleen Sebelius and Medicaid Director Cindy Mann announced the department's "Request for Proposals (RFP)" for a first round of outreach grants funded through CHIP reauthorization. Find more information here about this long awaited announcement.
 
It's encouraging that in the RFP the department has embraced a more appropriate definition of outreach which is "extending benefits or services" to a broader population.  Outreach may incorporate but is not synonymous with marketing and communications.  In this case, ensuring that eligible children get and stay enrolled as a result of outreach and enrollment efforts is a focal point of the grants.
 
It will come as no surprise if you've read my other blog entries that I'm thrilled to note that innovative applications of technology to facilitate enrollment and retention are encouraged in the RFP.  Web-based applications and telephone processes for enrollment and renewals, along with increasing ways for families to pay premiums, are examples of potential activities.  And to ensure that grants are successful in identifying best practices, grantees will be required to provide sound data demonstrating the connection between outreach efforts and enrollment and retention. To these ends, grant funds can be used to make data and systems improvements that are appropriate in the context of the proposed outreach strategies.
 
It seems that HHS is on the right track but this is a significant undertaking on an expedited timeline with proposals due in barely a month.  While a number of entities from government, community-based nonprofit and faith-based organizations to schools and safety net providers are eligible to apply, collaboration between the state and non-state applicants is strongly encouraged.  Stakeholders and advocates should weigh in with their state agencies to promote this spirit of collaboration.  After all, the best outreach efforts engage many partners in the process.
 
The outreach grants along with enhanced funding for translation and interpretation services, increased federal matching funds for certain systems changes, as well as performance bonuses for adopting streamlined enrollment and retention strategies and meeting Medicaid enrollment targets, provide new tools and resources to states and stakeholders to achieve our country's coverage goals.
 
Getting and keeping kids enrolled also helps prepare us for health care reform.  The lessons learned under an administration that wants to support and identify innovative practices in outreach and enrollment will add to our knowledge of how the system needs to be reformed. We can't afford to repeat the mistakes of a system that burdens families and state agencies with paperwork, creates administrative inefficiencies and serves as a deterrent to enrollment.

If technology were not so prolific, there would be no reason to write this blog.  My kids grew up using computers and cannot remember a time when technology was not a focal point of everyday life.  From researching homework (or health policy) to balancing your checkbook and paying bills, from shopping for hard-to-find sizes to socializing with friends, the internet is our connection to people and resources near and far. It's fast, friendly and convenient.

Unfortunately, applying for public health coverage programs online is not the norm.  Believe it or not, many states still do not have an online application for families to apply for coverage. Some of those that do merely provide an electronic version of a paper application that allows someone to type a response on a blank line.  And then, it's not uncommon that the applicant is required to print the application or a signature page, then sign the form and use snail mail to get it to an office where an eligibility worker has to input the data.  I know you must be shaking your head by now, but trust me, it's true!

One state in particular - Wisconsin - has made great gains in the use of technology for people to apply to a number of public programs, get information about their benefits and report changes.  Wisconsin's ACCESS program is a great example of how technology can be used to simplify the process of applying for children's health coverage.

I recently had a Q & A session with Angela Dombrowicki from the Wisconsin Division of Health Care Access and Accountability about ACCESS.  We were so excited we sent an e-postcard to all of our friends.  You can check it out here.  We'd love to hear about your state's innovations in technology.