Recently in Covering Kids & Families Category

By Gene Lewit and Liane Wong, The David and Lucile Packard Foundation

Those of you who are regular Say Ahhh! readers know that more children have health insurance coverage today than at any point in the nation's history. The steady growth in children's health coverage did not happen in a vacuum. State and federal leaders and program directors, policy and grassroots advocates, and concerned citizens - not to mention key pieces of federal legislation - all contributed to this success. In particular, state efforts, to grow and improve their children's coverage programs, supported and urged onward by policy and grassroots advocates, played a crucial role in the growth in children's coverage.

This week, the David and Lucile Packard Foundation and Mathematica Policy Research released new findings on the impact of children's health care coverage advocacy in the states. This brief, "Applying Advocacy Skills in Tumultuous Times: Adaptive Capacity of Insuring America's Children Grantees", is the latest from the  evaluation of the Packard Foundation's multi-year, multi-state, Insuring America's Children (IAC): States Leading the Way grantmaking strategy launched in 2007. One of IAC's goals was to broaden and strengthen the state-based children's health advocacy ecosystem to support the expansion of children's coverage at the state and federal levels en route to our goal of covering all of America's children. As the nation engages in the  implementation of health care reform and attempts to address a number of other pressing problems, we believe the findings in the just released brief hold lessons not only for children's coverage advocates and funders but for broader advocacy efforts as well.    

What ultimately transpired between 2007 and 2010 was a tumultuous period characterized by a severe economic downturn, an intense political battle around the reauthorization of the Children's Health Insurance Program, and widespread erosion of employer sponsored health insurance, capped by an intense debate on national health reform.

So, how did state-based advocacy groups navigate these rapidly shifting state and federal environments? By analyzing four years of comprehensive data, the evaluation team at Mathematica found that support of capacity and network building among states-based advocacy groups of different sizes strengthened their communications and policy capacity to make children's coverage a priority both within their own states, in other states, and at the national level.  The groups' work strengthened popular support for the broad goal of insuring all children and supported many targeted policy goals, such as expansion of CHIP eligibility, program improvements, and simplified, more efficient enrollment and retention practices..

Findings from the study highlight the key strategies that advocacy groups pursued aggressively to prepare for and respond effectively in a dynamic environment, including:

* Building and adapting strategic partnerships as the economic and political contexts in their states were shifting. Advocacy groups assumed new and expanded leadership roles within state-based coalitions;

* Serving as critical sources of information and analysis to state policymakers and other key stakeholders. Advocacy groups strengthened their reach and influence;

* Employing consistent and positive messaging. Advocacy groups successfully broke through the mire of a gloomy economic forecast and sometimes combative political atmosphere;

* Leveraging technical assistance and external support by the Packard Foundation, such as peer-to-peer learning. Advocacy groups were able to maximize their individual and collective efforts.

As the goal of ensuring that all children have health coverage becomes increasingly attainable, understanding how advocates have carried out this work in different and dynamic environments can provide lessons for future advocacy efforts on a variety of issues. The full details of these findings can be found on the Packard and Mathematica websites. To learn more about Insuring America's Children: States Leading the Way visit our website.    

By Adam Searing, North Carolina Justice Center

Recently my colleague Adam Linker and I had the opportunity from our friends here at the Georgetown Center for Children and Families and Atlantic Philanthropies to leave the North Carolina Justice Center and travel to other state capitols around the country.   Packing our bags and braving airport security lines, we visited several state collaborations of organizations working on improving the health and well-being of children. 

Our mission in going to Mississippi, Texas, New Mexico and Florida was threefold:  First, bring the excitement and experience we have creating and using short video clips to our fellow advocacy organizations.  Second, show how easy it is to use basic video and editing equipment.  Third, have a conversation in each state how this powerful tool can compliment all the other hard work child and family advocates do every day.  As we traveled however, our mission expanded.  We hadn't realized how much we would learn from our fellow advocates and how other organizations' work would be so relevant to our own efforts here in North Carolina.

This made our trips around the country an enormous privilege that extended well beyond the welcome break from our regular profession of health care advocacy that turning into self-appointed video experts for a few days provides.   Across the country at the New Mexico Center on Law and Poverty we learned how quick "person-on-the-street" interviews turned up large numbers of compelling stories of New Mexicans' reliance on Medicaid for family health coverage and what happens when that coverage goes away - a technique that went well beyond our own story collection efforts.   At Texans Care for Children we saw how different groups working together for children could more easily speak with one voice through using video to highlight their success. 

Over at the Mississippi Center for Justice advocates showed us how they were already using colorful animated charts to bring home the enormous effects extreme poverty combined with hurricane-driven devastation have had on the state.  And in Florida, an enormously challenging environment with substantial loss of health care dollars means an intense focus on really high-quality production of stories that illustrate the devastating effects of such huge budget cuts on children and families.

We brought these insights back to North Carolina along with another big return on our investment of time.  In every state, even advocates who had been using video in their work already were amazed at how our collection of relatively inexpensive camera equipment and basic knowledge of Apple's iMovie editing program could help make anyone a video expert.  In fact, in our own office some of the most successful community organizers and advocates at using video have never picked up a video camera or had much use at all for fancy computer programs.  Watching advocates in other states come to the same realization was probably one of the more rewarding results of our efforts.

The other overarching theme from our travels was the enormous work ethic, unrelenting optimism in the face of substantial challenges and the passion for improving the lives of children and families present in every state.  Pushing for change, especially for lower income families, is never an easy task.  With the recession this has become even harder.  But knowing other states are dealing with exactly the same problems we have here in North Carolina with grace and resolve gave us hope in our own work.  Clearly use of short video clips to tell personal stories, build collaborations, and compliment our other work is becoming an increasingly important technique.  But without the commitment of the people doing the work it simply becomes one more tool among many. 

To learn more about our video work you can download our Video Training Manual for Advocacy Organizations  and see our Behind the Scenes video where we show how easy it is to shoot and edit a simple personal story video.

Gene Lewit,  The David and Lucile Packard Foundation

Living in Silicon Valley, I am used to reading about new tech wonders every day. In fact, today, we use the internet to do many things we used to do in person, by snailmail or on the telephone. This trend is encouraged by new technology, but has gained popularity because it is often less expensive and more convenient than traditional methods. So, it's not surprising that states are increasingly using the internet to enroll, and sometimes re-enroll, children and families in their Medicaid and Children's Health Insurance Programs (CHIP).  A recent survey  by the Kaiser Family Foundation and Georgetown University's Center for Children and Families found that as of January 2012, 34 Medicaid programs and 30 separate CHIP programs allow for electronically- submitted applications for children and sometimes their parents as well.

California, the home of Silicon Valley, started providing a public access online application option, known as Healthy-e-Application Public Access (HeA PA), for its Medicaid (MediCal) and CHIP (Healthy Families) programs for children and pregnant women in December 2010. Previously, families could only apply for these programs using a paper application or with the help of application assistors and county employees who had exclusive access to HeA and/or One-e-App, an electronic application for a variety of public benefit programs. The positive change HeA PA has made in families' ability to enroll their eligible children in MediCal and Healthy Families is reported in Healthy-E-Application Public Access:  A New Online Path to Children's Health Care Coverage in California, An Overview of the First Year, released on March 5th by Mathematica Policy Research.  This report is the first in a series of reports that will examine the impact, functionality and user experience associated with the new online enrollment route.  The work is supported by the David and Lucile Packard Foundation and the California HealthCare Foundation in partnership with California's Managed Risk Medical Insurance Board.

The current report provides some encouraging information about the potential impact of HeA PA and other online application tools. One piece of good news is that the use of HeA PA was associated with a 14% increase in total applications submitted to the state processing center from 2010 to 2011.  About a quarter of HeA PA applications were submitted outside of regular business hours, which suggests convenience is important in the application process and the use of HeA PA. HeA PA applications were also more likely to be complete, including required documentation, than paper applications but less likely to be complete than assisted online applications.

But the report also raises a number of questions and caveats to be considered as we look for technological solutions to the challenges we face enrolling children and their families in these programs. For example, more than 4,000 HeA PA applications were submitted in the first full month it was available, but before there was an active outreach campaign. This is especially surprising since HeA PA was released at the end of 2010 during the holidays, with very little fanfare. However, the number of HeA PA applications remained at around the same level for the rest of the year, despite an outreach campaign launched in July. These findings suggest that while there may be a demand for online public access applications, that demand may be limited. 

Another interesting finding is the large variation in the use of HeA PA by county. The share of applications accounted for by HeA PA by county ranged from 0 to 48 percent and both heavily-populated urban and sparsely populated rural counties were present at both ends of the range. We need more research to better understand this variation and what it means for the impact HeA PA and other online application systems might have.

The Patient Protection and Affordable Care Act (ACA) calls for states to have enrollment portal systems that provide a high-quality customer experience, reach a high degree of online use, and maximize self service for people applying for health insurance coverage through Medicaid, CHIP or a health insurance exchange. We can learn a lot from the experience of the first year of HeA PA as California, along with other states, strive to implement the consumer-friendly online experience the ACA envisions.  The HeA PA data, and common sense, caution however that we will continue to need to accommodate people who prefer paper applications and/or personal assistance.

Undoubtedly you've heard about Super Bowl XLVI , but have you heard of CHIP III which is also taking the field this weekend?

CHIP is short for the Children's Health Insurance Program which was reauthorized three years ago this weekend. To mark the occasion, we're hosting a Super Blog-Off between Patriots fans and Giants fans.  But here's the kicker - they have to compete for kids. That's right, we've taken HHS Secretary Sebelius' "Connecting Kids to Coverage Challenge" quite literally and want the teams to compete based on how much they are doing to help uninsured children.

While we won't likely reach over 110 million people or be able to sell ads for $3.5 million per thirty seconds, our goal is to help reach the 4.3 million uninsured children who are eligible for CHIP or Medicaid coverage but not yet insured.

Last year, the Pittsburgh Steelers won.  That's right.  They might have lost the football game but they won our Super Blog-Off by going to great lengths to reach out to uninsured children.  Pittsburgh fans even swaddled newborn babies in "terrible towels" declaring that no baby should leave the hospital without an insurance card or a terrible towel.

This year, Dayanne Leal of Health Care for All Massachusetts is blogging on behalf of Patriot's fans and a team of health policy experts and advocates from New York are taking the field for Giant's fans. 

So whether you are a Pats' fan, a Giants' fan or wish there were a team from some place west of the Mississippi in the Super Bowl, you can bring home a victory for uninsured kids in your state by supporting efforts to enroll them in Medicaid or CHIP and keeping those programs strong. 

To vote for your favorite team, go to the Patriot's blog or the Giant's blog and post a comment.  Include the words "Go Patriots" or "Go Giants" in the text.

May the best (outreach) team win. 

By Dayanne Leal and the team at Health Care For All Massachusetts

On Sunday, the Patriots are going to win the Super Bowl. 

Really, I don't know why the Giants would even bother to show up. 

And since a 4th banner in Gillette Stadium is inevitable, it's worth asking to what can we credit this success? 

Some point to the offense, led by the great Tom Brady. Others look to the previously unheralded defense or maybe the play of the special teams. And there is a camp that says the culture of class and professionalism that Bob Kraft created should be credited. 

(Editor's note: That's Dayanne next to Tom Brady, his wife Gisele and son Benjamin)

At Health Care For All, we believe a big reason is the genius of Bill Belichick. And the genius of Mr. Belichick is not confined to the football field. To the contrary (and many don't know this), he has been a long-time and outspoken supporter of kid's health.     

For evidence of this, we have picked out eight (in recognition of this eighth trip to the Super Bowl by the Patriots) quotes from Coach Bill, cleverly disguised to make them appear to be pigskin-related and delivered at post-game press conferences.

But we know the truth: he was really talking about making sure that kids have health coverage. 

1. "I don't know what normal is. You can go back and look at the past few years. There are always going to be changes."

The normal in Massachusetts is that all kids through age 18 can qualify for health coverage regardless of family income or immigration status. We are proud that more than 99% of children are covered. 

2.  "This won't be good enough. It wasn't good enough today. It won't be good enough against anybody else, either."

The work goes on. 99% is good. Great even. But what about the few who aren't covered? We're working hard to make sure that they have access to care too. 

3. "The experience level they bring, there's no question there is a value to that... In the end, for me, it's more about having the best players that we can have on the roster. I think you have to look at it that way. You have to be cognizant of the overall makeup of your team, but you try and get the best players you can." 

No one organization can get to the remaining kids who aren't covered. Just like the Patriots, HCFA put together a strong squad as part of its "got coverage? Health Coverage for Kids and Teens campaign". We partnered with faith-based and community organizations, and collaborated with ethnic media to get the word out and reach across the state. 

4. "You can play hard. You can play aggressive. You can give 120%, but if one guy is out of position then someone's running through the line of scrimmage and he's going to gain a bunch of yards."

There are several important players in the game of making sure children access the health coverage they need. Community-based organizations like Health Care For All and many others have been the Most Valuable Players (MVP's) to the success of Massachusetts. Some 66 organizations from across Massachusetts stepped up and accepted the challenge of focusing their efforts on enrolling kids who weren't covered already. 

5. "On a football team, it's not the strength of the individual players, but it is the strength of the unit and how they all function".

The team of 66 was successful beyond our most optimistic goals. We had hoped to enroll 500 uninsured kids - instead, 1,479 children got coverage in only one month! HCFA and its partners carried the ball and pushed it over the goal line, nearly tripling the "score" they set out for.

"Pat" the Patriot loves kids and kids love the Patriots!

6.  "It's hard to win when you give the ball away."

All too often, newly insured individuals will go for a needed doctor visit or to pick up a prescription, only to find that their coverage has disappeared. Coverage is not a one-time thing. After you get it, you need to renew it every year. The work doesn't stop once you get children enrolled - as matter of fact, enrolling people is hard work, keeping them covered is even harder. That's HCFA's next frontier in kids' coverage work: making sure that the kids who have insurance keep their coverage from year to year. This time, the name of the game is coverage retention and we have innovative strategies to make this happen. Check out the got coverage? Campaign website for more details. 

7. "There are certainly areas that you can improve in and develop more consistency (in)."

Things aren't perfect and there are changes to be made that will make things better. We are lucky to have not only a strong advocacy community, but also a Legislature that has prioritized children's health.  Just like the Pats, we are working together to make sure that all kids have coverage and that all kids keep their coverage. 

8. "We'll worry about next week next week."

We're in it for the long haul. Next week, next month, next year - we'll be here working for the kids. HCFA isn't interested in just putting up good numbers for one year. Over 99% coverage of kids is only something to be proud of if we can keep it going. The Patriots have brought home three (about to be four) Lombardi trophies since 2002 - we're in the midst of our own dynasty of kid's coverage here too. 

Massachusetts has made the choice to defend children's health, has made a commitment to do the work and has embraced creativity to make it happen. We couldn't be more fired up if we had our own end zone militia to celebrate our success!

Go Patriots, it's your patriotic duty to jump, play and get covered.

Go Pats! Go kids!

(To vote for the Patriots and New England kids, post a comment on this blog with "Go Pats" in the text.  Tweet out the blog or like it on Facebook to get your friends to help put the Patriots over the top.)

By the Community Service Society of New York, Children's Defense Fund - New York, Schuyler Center for Analysis and Advocacy and Health Care for All New York

As the New York Giants head to the Super Bowl this year, another giant comes to mind, the title character from Roald Dahl's famous book, The Big Friendly Giant (BFG). Just as the BFG spreads good dreams to the children of the land, New York's BFG spreads health insurance to the children in the state.

New York's BFG comes in many forms and is incredibly benevolent. He has made sure all children in the state qualify for public health insurance, regardless of their immigration status and income. New York's CHIP, Child Health Plus, covers children up to 400% of the federal poverty level and a full premium buy-in option beyond that. To assist families with enrollment, the Facilitated Enrollment (FE) program in New York reaches families in their own communities. Community-based facilitated enrollers across the state represent the cultural and linguistic diversity of the communities they serve and are available at times and places convenient for working families. Building upon the FE program, Cycle 2 of the CHIPRA Outreach and Enrollment grants funds the REACH-Out project, with retention specialists working alongside facilitated enrollers to ensure children do not lose coverage. 

Beyond taking giant steps to connect kids to coverage, New York is also a behemoth when it comes to ensuring children have access to quality and affordable healthcare through school-based health centers (SBHC).  There are currently 217 SBHCs operating in New York State enrolling over 160,000 children.  These SBHCs help provide care to thousands of children who may have limited access due to geographical, financial or other barriers.  They make available services such as comprehensive physical health and mental health assessments, diagnosis and treatment of acute illnesses and chronic conditions, screenings, management of chronic diseases, health education, mental health counseling and referral and immunizations.  These services are offered to any student whose school has a SBHC and play a crucial role in the health of children who otherwise may not be able to see a doctor.   New York can and should do more to support SBHCs.

When the BFG in Dahl's book catches a nightmare, he destroys it. In New York, children's advocates work to identify and destroy barriers to enrollment. In 2010, the State eliminated the face-to-face interview and asset test for Medicaid. Online renewal for New York City residents makes it easier for families to renew coverage, and the Statewide Enrollment Center --which started rolling out in some New York counties in June 2011--is intended to facilitate renewal through phone and mail-in renewal. In November 2011, in anticipation of ACA requirements, the State eliminated Medicaid stair-step eligibility for children, bringing the eligibility level for children 6-18 up to 133% FPL from 100%FPL. (Children under the age of 1 are eligible at 200% FPL.)

As might be expected, the BFG is rather large. When he visits the Queen in Dahl's tale, they must make a table, chair, and cutlery big enough to accommodate him. With over 4.3 million children in New York State, and nearly half--2.1 million--of those enrolled in public health insurance, special structures must be in place to support such a large enrollment. The Affordable Care Act has provided the tools to support the building of structures, such as an online application and updating the state's eligibility systems.

We know there are many more big friendly giants across the country who, like New York's BFG, are working hard to spread insurance to the children of the land. (We hope there are no children-eating giants out there!) Just as we're rooting for the BFG to make sure every child has access to quality affordable healthcare, we'll be cheering on the New York Giants to win the Super Bowl! 

(To vote for the Giants and kids in the tri-state area, comment on this blog and use the words "Go Giants" in the text.)

By Gretchen Hammer, Colorado Coalition for the Medically Underserved

This month, All Kids Covered released Crossing the Finish Line: Achieving Meaningful Health Care Coverage and Access for All Children in Colorado.  The report provides an update on the current status of meaningful health care coverage and access for children in Colorado, and describes the significant progress we have made to make sure that all our children can get the health coverage and health care services they need. 

The good news is that roughly 90% of kids in Colorado have health insurance and between 2008 - 2010 over 40,000 children gained coverage.  In addition, the most recent Colorado Health Access survey reports that most of children in Colorado have a usual source of care - a place where they regularly go to get their health care.

Cue the Kool and the Gang music, start the disco ball and break out your best dance moves! Let's take a moment to celebrate these great accomplishments. 

As with any great success, many people have contributed to this progress.  Over the last five years, state policymakers, state and local agencies, community leaders, health care providers, advocates and private foundations have worked together with a common goal and concerted effort to achieve these milestones.

While recognizing and celebrating success is important, there is still more work to be done.  Much of that growth in coverage has come through higher enrollment in Medicaid and CHP+, resulting from policy changes to improve public programs and unfortunately, economic hardships facing many Colorado families which make them eligible for these programs.

Additionally, the most recent estimates suggest that between 112,200 (8.2%) and 124,128 (10.1%) children in Colorado still do not have health insurance.   And, access to care varies across the state.  While fewer than 5% of children in the metro area, the Eastern Plains and Northwest Colorado report they do not have a usual source of care, nearly 1 in 13 children (7.6%) in Southwest Colorado do not have a usual source of care.  And that's too many!

It is not too much to ask that all of Colorado's kids have access to they health care they need, when they need it.  To build on the strong momentum of the last few years we need to focus on five key strategies that we believe will continue the progress in Colorado and would likely be useful in other states, as well:

- Leadership and Accountability

- Coverage and Access for All Children

- Systems and Practices for Maximizing Enrollment and Retention

- Messaging and Communications

- Regional Adaptation

Check out the report for more details on these strategies and examples of how to implement them from Colorado and across the country.

Colorado is 90% of the way there to crossing the finish line and covering all kids.  It is going to take all of us working together to ensure that our children will have the health coverage and health care services they need to have healthy and fulfilling lives.   And, once we get there, we can really get the party started!

To access the full report, visit www.allkidscoveredcolorado.org/report.pdf

There are people in my family who think I am unduly obsessed with Tom Brady.  They might even accuse me of co-authoring a paper on states at the forefront of covering our nation's children that features Massachusetts just so I could say "Just as Tom Brady is in a league of his own when it comes to quarterbacking, the Commonwealth of Massachusetts is the clear national leader when it comes to covering children." But, the honest-to-goodness truth is that the new paper we issued yesterday with the Kaiser Commission on Medicaid and the Uninsured, "Secrets of Success: An Analysis of Four States at the Forefront of the Nation's Gains in Children's Health Coverage," grew out of a discussion that CCF and Kaiser Commission on Medicaid and the Uninsured staff had together last spring.  It took place long before Tom Brady beat Tim Tebow and the Denver Broncos (soundly, I must add) and resulted in a paper that examined Massachusetts, but also three other states -- Alabama, Iowa and Oregon -- that are at the forefront of covering children.

Here is how it started.  We were discussing the news that Massachusetts had achieved a 99.5 percent coverage rate among children in 2010 and commenting on the extraordinary nature of this achievement.  Tricia Brooks with CCF, Samantha Artiga with the Kaiser Commission on Medicaid and the Uninsured, and I decided to jump in and try to untangle how the state got there.  At the same time, we didn't want to leave it just at Massachusetts.  While it is in a league of its own, states around the country have made enormous strides in covering kids.  Indeed, as we've pointed out repeatedly at CCF, the nation now has the lowest uninsured rate of children on record despite sharp jumps in child poverty and lots of other dire economic news.  So, we selected a diverse group of four states - one state from each region of the country at the forefront of covering kids: Alabama, Iowa, Massachusetts and Oregon - to investigate the "secrets" to their success.

Even though these four states have dramatically different political and policy cultures, we heard a number of common themes when interviewing state officials and advocates from each of the four states: 

* At least one political leader in the state - and, in most instances, a number of political leaders over time - made coverage of children a top priority.

* Expansive eligibility levels for children and adoption of a broad range of simplification strategies have been key elements of achieving progress. All four states have expanded eligibility for children to 300% of the federal poverty level and have taken up many of the opportunities to streamline and simplify enrollment and renewal processes for families.

* Community partners and providers play a vital role in helping families to enroll in coverage. We heard this in each of the four states, but perhaps most strongly in Massachusetts.  Interestingly, Massachusetts lags somewhat in the extent to which it has simplified its application and enrollment process, but makes up for it in no small part by relying heavily on community partners to help people enroll in coverage.  (Hey, even Tom Brady has someone weakness - a poor running game - but he also makes up for it in other areas.)The state and advocates have a robust relationship in which they exchange information on emerging issues and ideas about how to improvement enrollment.  It also has the advantage of a strong culture of coverage, which can be directly linked to its passage of broad health reform in 2006. 

* Strong coordination between Medicaid and CHIP aid in outreach and enrollment efforts and smooth transitions between programs. Each of the four states has taken steps to promote close alignment between Medicaid and CHIP, with Massachusetts and Oregon fully unifying the two programs. 

We also talked to each of the states about where they see their remaining challenges, and what they are working on now.  In a sure sign of why they are at the forefront of covering kids, each of them had a long list of challenges they were actively working to tackle, such as the need to improve retention, to cope with ongoing growth in enrollment amidst diminishing administrative resources; updating decades-old eligibility systems; and improving communications with families and obtaining better enrollment data.  Just like Tom Brady and the New England Patriots, they do not rest on their laurels and, instead, start each week looking ahead and figuring out how to continue to get better and better.

By Beth Morrow, The Children's Partnership 

As all health advocates know, states face a daunting task in preparing to meet the demands of ACA implementation.  Building an eligibility, enrollment, and retention system is one of the first challenges involved in getting ready for state Exchanges' open enrollment period on Oct. 1, 2013.  Deploying such a system involves more than just building the technology.  The design and development of this technology will be driven by complex policy, process, and governance decisions that states are making now.  With aggressive implementation schedules, no state has the luxury of waiting before starting to design their system.

As California proceeds through this very consequential puzzle, The Children's Partnership has written a 40-page blueprint designed to assist in that process and make sure that consumers' interests are front and center as decisions are made.  Written by Dawn Horner and myself, Building A Consumer-Driven Eligibility, Enrollment, and Renewal System: Essential Design Features for Effective Health Reform in California lays out the essential design features that are required in any state for an effective enrollment system that meets federal expectations.  In California, this new system is being called CalHEERS (for California Healthcare Eligibility, Enrollment, and Retention System).

Broadly these essential design features are:

• Smart connections that allow consumers to apply for coverage through multiple doorways (whether online, by mail or phone, or in person) and receive consumer assistance -including live human assistance--as needed.
• Integrated eligibility criteria and processes that allow every consumer to apply using a single application for all programs, and to seamlessly move between programs as family circumstances change.
• Real-time, immediate, and ongoing enrollment that utilizes technology to obtain and verify data and eliminates unnecessary paper documentation.
• Easy navigation of coverage that allows consumers to pick their health plan, pay premiums, and update their account through a centralized system.

For each design feature, the report provides specific recommendations (some very detailed, some more general), summarized as a tear sheet in the Executive Summary.  A small sampling of the report's recommendations includes:

•  Establish accuracy and timeliness standards to guarantee quality of consumer assistance.

• Eliminate the three-month waiting period for children with employer coverage for Healthy Families (California's CHIP program).

•  Automatically transfer children from 101% to 138% FPL from Healthy Families to Medi-Cal (the state's Medicaid program) and provide support to maintain continuity of care.

• Integrate human service program enrollment into CalHEERS by the end of 2015, commencing with SNAP and TANF.

•  Establish a policy that finds "incompatibility" within an application only where the inconsistent data would have a "material" impact on eligibility - i.e., would change the outcome. 

• Design the premium payment function so that consumers receive one monthly bill for the whole family. 

Our new report provides a guide for action for California, to ensure that the state gets this right, right out of the gate.  And, while written to address California's specific concerns, this report can help any state move toward a first-class consumer experience that results in individuals getting the coverage and health care they need.