SCHIP in the Formative Years: An Update

This issue brief examines the status of the State Children\u27s Health Insurance Program (SCHIP) three years after authorizing legislation was enacted. Topics addressed include enrollment and retention of children in new programs, funding allotments and expenditures, evaluation activities planned and underway, the interaction of Medicaid and SCHIP, and problems common across many states

A Report from the Forum Session Implementing the New Medicare Drug Benefit: Challenges and Opportunities for States

The National Health Policy Forum convened a meeting on July 22, 2004 to discuss state-based challenges associated with implementing the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). The meeting brought together an extremely insightful and experienced group of current and former state officials and other experts to discuss key issues. In keeping with its tradition of promoting a frank, off-the-record exchange on health policy issues, NHPF does not normally prepare written summaries or reports of meetings. However, because this meeting provided vivid illustrations of the importance of state-federal collaboration for the successful implementation of the new Medicare drug benefit, participants agreed that the information should be shared more widely. Thus, this report is intended to provide a candid montage of the July 22 meeting and supply additional information and insights into state issues surrounding MMA implementation. Though the MMA offers a huge number and range of potential subjects, the discussion was focused around four primary areas affecting states: eligibility, enrollment, and outreach; the transition for dual eligibles; financing challenges; and administrative and systems issues

Welfare Reform and Its Impact on Medicaid: An Update

Welfare reform, enacted in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), had a profound impact on the Medicaid program, delinking Medicaid from the new TANF program and for the first time allowing Medicaid eligibility to be divorced from welfare status. This paper reviews the national impact of this decoupling, describing research, implementation activities, and the impact of new state welfare programs on health programs in general

CHIP and Medicaid Outreach and Enrollment: A Hands-on Look at Marketing and Applications

The State Children\u27s Health Insurance Program (SCHIP or CHIP), enacted as part of the Balanced Budget Act (BBA) in 1997, has enrolled eligible low-income children in innovative ways and tackled a variety of challenges to make sure that families know about the new program. This issue brief describes the outreach, application, and enrollment process for both SCHIP and Medicaid, analyzing the difficulty in simplifying applications, and noting problems that states must solve around systems design, immigration issues, and the stigma sometimes associated with government programs

Quality Improvement in Maryland: Partnerships and Progress

This one-and-a-half-day site visit to Easton, Maryland, explored the activities of the Delmarva Foundation, the Quality Improvement Organization (QIO) for Maryland and the District of Columbia. The program reviewed Delmarva’s responsibilities under their Medicare contract and the initiatives they have undertaken with hospitals and other providers to improve health care outcomes and to define, collect, and report quality data. Local hospital officials added their perspective on quality programs and working with Delmarva. Topics of particular interest were health information technology, patient safety, and quality reporting both to government agencies and to consumers

Insuring Virginia\u27s Children: Local Outreach and Enrollment (Northern Virginia)

This one-day visit to a nearby jurisdiction was designed to allow participation by federal staff who have been unable to commit the three days required by a typical Forum site visit. Site visitors were given an overview of health care in Virginia and an introduction to the Children\u27s Medical Income Security Program (CMSIP) as well as its proposed replacement, the Family Access to Medical Insurance Security program (FAMIS). A panel representing community organizations and providers shared their experience, touching on provider concerns, coordination of outreach efforts across counties, and assistance for clients after they are enrolled. The group visited the Arlington County Department of Human Services and the Inova-sponsored Partnership for Healthier Kids in Fairfax County

Welfare Reform in Maryland: Flexibility in Action

This site visit took federal participants on a tour around Maryland, providing a three-way comparison of suburban, urban, and rural service delivery in a diverse state. The site visit focused on the Family Investment Program, a statewide effort to reduce the state\u27s welfare caseload through temporary cash assistance (TCA) and other needed supports to help customers become self-sufficient. In particular, site visitors examined rural perspectives on reform, substance abuse assessment and treatment innovations, and fatherhood and family support initiatives. The group heard from state officials, researchers, advocates, and a variety of direct service providers about the successes and challenges of the Family Investment Program and the effects of program implementation on low-income families. Site visitors had several opportunities to meet and interact with TCA customers to gain a clearer perspective of the issues faced each day

Reinventing Medicaid: Hoosier Healthwise and Children\u27s Health Insurance in Indiana

This site visit explored the factors that have made Indiana so successful in enrolling children in its Medicaid and SCHIP plans under the brand name Hoosier Healthwise. Site visitors met with legislators and state officials to gain understanding of the genesis and development of Hoosier Healthwise and its aggressive outreach component. A panel of representatives from partner organizations engaged in enrolling children provided further insight into this process. The site visit participants traveled to observe enrollment and operations in both urban (Marion) and rural (Clay) county offices. They also met with health care executives at hospitals, clinics, and neighborhood health centers delivering care to Hoosier Healthwise beneficiaries

Tending to Richmond\u27s Children: Community Strategies to Bridge Service Gaps

The National Health Policy Forum sponsored a site visit to Richmond, Virginia, in October 2008 to explore social and environmental determinants of children’s health, including the impacts that poverty and exposure to lead-based paint have on birth outcomes, child development, and school readiness; and the community\u27s efforts to address them. Though not large in population terms, Richmond faces many of the social and economic problems often common in larger urban areas—concentrated poverty, migration of wealth and services to the surrounding counties, a high infant mortality rate, and troubled schools. The site visit explored community strategies to improve birth outcomes and early childhood development, such as home visiting programs. Efforts to serve children with special behavioral and physical health care needs were discussed as were community-level efforts to bridge service fragmentation and gaps. Site visitors learned about issues faced by community-based organizations serving children and families, including problems with federal funding streams, state and local politics and bureaucracies, and perennial budget challenges

Coordinating Care for People with Multiple Chronic Conditions: The Guided Care Model and Other Innovative Approaches

The Forum sponsored two site visits to explore the Johns Hopkins University\u27s research and demonstration program on Guided Care, in April and August 2009. Guided Care is a patient-centered medical home model that uses an interdisciplinary approach to coordinating health care for older people with multiple chronic conditions. Guided Care nurses located in primary care practices work with Medicare patients on a long-term basis, coordinate their care among various providers, provide transitional care, and assist patients with self-management skills. Site visit participants learned about the complexities of caring for frail Medicare patients, some of whom see multiple physicians and other health care providers on a continuous basis. Guided Care nurses, physicians, and patients discussed with the site visit participants the impact of the program on medical practice and individual patients and the research results of the Guided Care approach on cost and quality outcomes