Say Ahhh!

Many thanks to the organizations that joined us in submitting a letter to federal officials in opposition of Wisconsin's request to waive maintenance of effort provisions.  These provisions are so valuable to families because they preserve stability in states' Medicaid and CHIP programs.  Groups such as the AARP, American Heart Association, Center on Budget and Policy Priorities, Families USA, First Focus, and the March of Dimes signed on to voice their concerns on this issue.

I won't go into too much detail about the waiver proposal because our friend, Jon Peacock, from the Wisconsin Council on Children and Families blogged about the specifics of the waiver proposal, while cleverly comparing it to a triple feature horror film.  Some of the proposals included:

* Increasing premiums to five percent of family income for families with incomes above 150% of the FPL;

* Excluding eligibility for adults ages 19 to 26 above 100% of FPL if they could be covered on a parent's employer sponsored plan; and

* Excluding adults from Medicaid with incomes above 100% of the FPL and children with family income above 133% of the FPL if they have access to employer coverage that costs less than 9.5% of their family income.

According to Wisconsin's Legislative Fiscal Bureau, just by raising these premiums, 19,000 individuals, including 12,000 children, would lose their Medicaid coverage.  The group letter stated that allowing these individuals to lose coverage would be an inappropriate use of the Section 1115 waiver authority and be unprecedented.  Section 1115 waivers should promote the objectives of Medicaid and test innovative approaches to provide health care to families in Medicaid.  Waiving the maintenance of effort protections would have the opposite effect. 

Just from reading some of what's been proposed, you can see that Jon's analogy of a horror film is pretty accurate.  If these provisions were waived, this would be frightening to families, to say the least. 

We hope that HHS holds their ground on the maintenance of effort waiver in Wisconsin.

It's a really big weekend: the third anniversary of CHIPRA and the Super Bowl rematch between the New England Patriots and New York Giants. What more could a child health policy wonk and Patriots fan, want? There is a connection between these seemingly disparate events. Thousands of kids watching the action will be dreaming of becoming the next Tom Brady or Eli Manning or the first female NFL Commissioner!

But too frequently, you can't get in the game if you aren't covered! How often have we heard parents of uninsured children say their kids aren't allowed to play sports because of a lack of insurance or for fear of an injury they can't afford?

So one thing we can all cheer is the fact that 1 million more children have insurance today than in 2008 when the Patriots and Giants met in the epic Super Bowl that brought an end to the Pats' perfect season in an upset victory.

No doubt that CHIPRA has much to do with this winning story - no, no, not the Pats' loss in 2008 - the fact that 1 million more kids are covered today. Covered despite the fact that the economy and erosion of employer-based insurance keep moving the goalposts.

For a play-by-play description of the impact CHIPRA has had on children's coverage over the past three years, my colleague, Jocelyn Guyer, and I put together this brief that celebrates the victories, both small and large. From eligibility expansions to outreach grants to removing red tape and paperwork barriers, CHIPRA has been gaining yardage and scoring points across the country. In fact, each and every state has gotten in on the action, some more than others benefitting from the options and opportunities provided by CHIPRA.

Whether it's the Patriots or the Giants that take home the Vince Lombardi trophy on Sunday, every state can be a winner when it comes to covering kids. The game plan is easy to follow. Scout out the uninsured, practice streamlining how families apply for and renew coverage and earn performance bonuses when your efforts get you to the playoffs.

And just think about the team we're building for the future. Healthy kids today means lower health care costs tomorrow. With kids, we can spot problems early and block them from interfering with a child's development. We don't have to fumble our children's future health. CHIPRA gave us more tools and resources, but the ball doesn't run itself down the field. Strategic plays and strong fans (including policymakers, state officials and advocates alike) are the winning combination needed to score extra points and get to the end zone!

On Super Bowl Sunday 2012, I'll be rooting for the Patriots. But on Monday, I'll be back cheering on states and advocates to use more of CHIPRA's resources to make sure all of our kids can get in the game and be winners in life.

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.)