On the Road to Universal Children's Health Coverage: An Update on the KidsWell Campaign

The Patient Protection and Affordable Care Act (ACA), enacted in 2010, held great promise for expanding insurance coverage to millions of uninsured Americans. Starting in 2014, it expanded Medicaid eligibility to low-income adults with family income below 138 percent of the federal poverty level. It also offered premium subsidies to people with income up to four times the poverty level so they could purchase private insurance through federal or state health insurance exchanges. While most of those expected to gain insurance coverage for the first time are adults, children stand to gain as well, since children are more likely to have health care coverage when their parents do too (DeVoe et al. 2015). In 2014, about 3.9 million children were estimated to be eligible but not enrolled in Medicaid or the Children's Health Insurance Program (CHIP), representing roughly two-thirds of all uninsured children (Kaiser Family Foundation 2015). This brief looks at the KidsWell Campaign, a multilevel effort designed to ensure access to health insurance for all children. It summarizes evaluation findings on two research questions: (1) to what extent has state grantees' participation in KidsWell strengthened advocacy networks and capacities so far? and (2) which advocacy activities do grantees believe to be most effective in securing policy advances for children's health care coverage

Leading the Way?: Maine's Initial Experience in Expanding Coverage Through Dirigo Health Reforms

Examines interim indicators -- enrollment of the previously uninsured, responses from small firms and the working poor, and the impact on costs -- of Maine's progress in providing affordable health insurance through the Dirigo Health program

KidsWell: Securing Coverage for Children by Advocating for the ACA

The expansion of Medicaid eligibility to low income adults and subsidies to purchase private insurance are arguably the most significant provisions of the Affordable Care Act (ACA). To the extent these measures reduce rates of uninsured parents, they could also help to close the gap in children's coverage, 7.2 million of whom were uninsured in 2012 (Finegold 2013). States are on the front-line of ACA implementation: their success in enrolling uninsured parents and their children depends on the effectiveness of state policies and systems for operating one-stop shopping portals, conducting outreach to low income families, helping them apply for insurance, and creating consumer-friendly communication about families' coverage options and their costs. This brief examines how children's advocates in New Mexico and New York have tried to shape state decisions on ACA implementation policies and their achievements to date

Lessons About Evaluating Health-Coverage Advocacy Across Multiple Campaigns and Foundations

This article draws on a dozen years’ experience in evaluating major consumerhealth advocacy initiatives to build the knowledge base about advocacy evaluation. The authors explain how their evaluations were strengthened by articulating a detailed theory of change and emphasizing assessment of interim outcomes from many perspectives and methods. Even with comprehensive data and integrated analysis, however, some ambiguity in the results is inevitable; there is no completely objective way to determine the effectiveness of an advocacy initiative. Moreover, sometimes solid or even exceptional advocacy efforts do not lead to desired policy outcomes. Advocacy initiatives that fail initially may be groundwork for future opportunities. Evaluators must tell a compelling story about what advocates hope to achieve, how they tried to achieve it, and the extent to which external factors helped or hindered progress. The narrative about why advocates did what they did must describe context and its influence on all aspects of advocacy campaigns, from goal setting to strategy development to implementation

Aiming High: Foundation Support for State Advocates Brings Universal Children’s Health Coverage Within Reach

To help close the children’s health insurance coverage gap in the United States, in 2011 the Atlantic Philanthropies created the Kids- Well Campaign. KidsWell’s theory of change posits that if advocates could leverage new funding and coverage opportunities created by the Patient Protection and Affordable Care Act, they could expand the number of children with health insurance coverage. This article presents the major results of the KidsWell evaluation, which found substantial progress in achieving KidsWell interim policy changes and coverage outcomes. But advocates still have a full agenda, which means grantees and funders need to redouble efforts to educate the larger field about the type of advocacy that can legally be supported by funders, the gains in children’s coverage achieved in part with such support, and what remains at stake for children’s coverage. While other funders may not be able to make investments comparable to Atlantic’s, advocacy networks and capacities have already been built and valuable knowledge has been gained through the KidsWell effort. Funders could target future investment to states and activities needing a short-term boost to exploit windows of political opportunity or to fight threats to children’s coverage. Such support is still needed to continue momentum toward universal health insurance coverage for all children

Translating Research Into Practice: Speeding the Adoption of Innovative Health Care Programs

Looks at case studies of four innovative clinical programs to determine key factors influencing the diffusion and adoption of innovations in health care

Medicaids Role in Improving the Social Determinants of Health: Opportunities for States

In an environment of uncertainty surrounding the future of Medicaid policy and funding, addressing the social determinants of health to improve the health status of Medicaid beneficiaries could be dismissed as an unaffordable luxury. But there is a strong business case for state Medicaid programs to address the social determinants of health as a key strategy for providing cost-effective, efficient care. By partnering with state and local agencies to address the social determinants of health, state Medicaid leaders may enhance their ability to control costs and strengthen the program's financial sustainability over the long term.This policy brief explains how state Medicaid agencies and managed care organizations can address the social determinants of health (SDH). It reviews the evidence demonstrating a link between health status and SDH, summarizes the business case for Medicaid to support interventions aimed at addressing SDH, describes current opportunities—and limitations—for using Medicaid as a lever to address SDH, and discusses new prospects for state policymakers to tackle SDH in the current environment