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Presumptive Eligibility for Pregnant Women

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Early prenatal care plays a critical role in the health of pregnant women and their babies. Access to early prenatal care can lead to better birth outcomes, healthier babies, and reduced health care costs. Presumptive eligibility in Medicaid has become an important strategy for improving access to prenatal care for low-income pregnant women. Presumptive eligibility is an option that states can use to allow authorized providers to begin treating pregnant women when they first seek prenatal care rather than several weeks later after a final determination has been made regarding their Medicaid eligibility.
This state health policy monitor discusses the role that presumptive eligibility programs have played in state efforts to streamline and simplify their enrollment and eligibility processes for pregnant women in both Medicaid and SCHIP. Currently, twenty-nine states and the District of Columbia have adopted presumptive eligibility to grant Medicaid coverage to pregnant women. Seven states currently have other expedited processes for enrolling pregnant women into coverage, while some states have no such programs.
Although certain aspects of presumptive eligibility policies differ from state to state, these programs have proved to be an effective tool for enrolling pregnant women into early prenatal care.

Presumptive Eligibility 413.1 KB

 

Maximizing Kids’ Enrollment in Medicaid and SCHIP: What Works in Reaching, Enrolling and Retaining Eligible Children

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Nearly two thirds of the nation’s 8.9 million uninsured children are eligible but not enrolled in Medicaid and SCHIP. This new report from the National Academy for State Health Policy, the National Program Office for the Maximizing Enrollment for Kids program of the Robert Wood Johnson Foundation, examines strategies states can use to increase enrollment in these two programs.
Building on a 2006 NASHP report, the new paper reviews literature and expert opinions to elaborate on seven strategies states can implement to maximize enrollment for uninsured children eligible for public coverage. From simplifying the enrollment process to implementing the latest technology and urging political leaders to make enrollment a priority, the report lays out key steps that states may consider when tackling the difficult issues of making sure the pathways for enrollment and renewal for all eligible children are as efficient as possible.
The seven strategies states can pursue are:
• Keeping enrollment and renewal procedures simple
• Reaching out through community-based organizations and institutions
• Using technology to coordinate programs and reduce administrative burdens
• Changing agency culture to promote enrollment
• Engaging leaders to champion the goal of enrolling children
• Engaging partners to help reach enrollment goals
• Using marketing to promote enrollment in public programs
The report contains important information for states on each of these strategies and can be an invaluable tool for policy makers, program administrators, children’s health care advocates and others concerned with children’s health.

Maximizing Enrollment Report 823.7 KB

 

Delivery System Reforms for Chronic and Long Term Care

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States that have been the most successful in transforming their systems of long term services and supports to be primarily provided in the community have tackled reforms on multiple forms. They have streamlined entry in to community services programs to make them as accessible as institutional care; made effective use of technology to help individuals access and coordinate needed supports; controlled the growth of both community and institutional spending; and have begun to better integrate the delivery of long term and chronic care.  Other states across the country are looking to the leader states for strategies they can apply to reforming their systems.
NASHP’s work in long term and chronic care delivery systems analyzes state initiatives in order to advance promising practices that could be adopted more broadly by states. We have also conducted assessments of the factors that are limiting further progress on delivery systems reforms and have recommended changes in federal financing of long term services and supports and ways to better coordinate the Medicare and Medicaid programs of behalf of dual eligibles.

Population & Public Health

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States have a critical role to play in developing public health systems that protect and improve health at the community and population levels by preventing disease and promoting healthy behaviors.  States can develop policies and initiatives to educate the public, support community programs, prepare for and prevent infectious disease outbreaks, prevent injuries, and ensure safe environments.
NASHP creates opportunities to engage groups of influential state officials, including Governor’s policy advisors, public health directors and staff, and Medicaid and CHIP leadership more fully in chronic disease prevention and health promotion. NASHP has analyzed state efforts focused on specific chronic diseases, such as obesity, and also worked with states focused on broad health reform initiatives to examine how they have addressed chronic disease prevention to improve health outcomes and contain costs in the long term.
 

Community Health Centers

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While federally funded community health centers (CHCs) operate with strong federal direction, state health policy has substantial implications for CHCs, and state health policymakers have a variety of tools and levers with which to influence the role of health centers in state health systems. State policymakers and health centers need to understand the issues and have opportunities to exchange ideas about state health policy making as it affects health centers.
Since 2006, NASHP has been working with the federal Health Resources and Services Administration’s (HRSA) Bureau of Primary Health Care (BPHC) through a National Cooperative Agreement (NCA). The goal of the agreement is to better equip state policymakers with tools for informed decision-making about CHCs and access to primary health care.
Through the work under the NCA, NASHP is informing state policymakers about primary health care policy issues; highlighting states with strong relationships and policy supports for health centers; developing and disseminating analyses of key state and federal health policy issues affecting federal health centers; and creating forums for dialogue between state policymakers and health center representatives.
NASHP’s Cooperative Agreement work is guided and implemented by our State Primary Care and Health Policy Teams, along with advisors from among the members of the National Academy. The link to the map on this page provides more information about the state teams.

RETURN TO THE ACCESS AND THE SAFETY NET OVERVIEW

 
 

Coordination of Care

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Care coordination is a critical element of both long term care and chronic care delivery systems. Persons with long term care needs often require services and supports financed by differing programs and provided by multiple entities.  To overcome this fragmentation, states have established single entry points for accessing services, creating an umbrella under which multiple long term services and supports can be coordinated. These case management programs have streamlined access to Medicaid long term care services. However, they typically do not have authority to coordinate the primary and chronic health services needed by persons who have limitations in conducting activities of daily living. For dual eligibles these services are financed by the Medicare programs.
Likewise, persons with multiple chronic illnesses often need help coordinating their health care services, which are frequently provided by multiple specialists who separately treat each chronic condition.  People having both complex health needs and limitations in daily living activities have even more challenges in coordinating needed services across chronic and long term care systems.
NASHP’s work in this area has supported states in defining the need for better care coordination, identifying strategies for improving care, and making the case for policy changes that would enable states to better integrate the delivery of primary, chronic and long term care.

Access for the Uninsured

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Nearly 50 million Americans lack any form of health insurance, impairing their ability to access the care they need. For more than 25 years state governments have experimented with a wide variety of initiatives to expand access to health care for the uninsured, while continually battling the rise of health care costs.  State reforms have helped hold the line on even greater growth in the numbers of the uninsured and have laid the groundwork for further improvements in the system. But the challenge of improving access to coverage while keeping costs affordable remains.
In their roles as regulators, purchasers, and providers, states have:
•  created state-funded programs;
•  expanded and restructured Medicaid;
•  reformed the individual and small group insurance markets;
•  established purchasing alliances, high-risk pools, and indigent care programs; and
•  designed children’s health coverage programs.
NASHP’s work in this area aims to help states work together to learn strategies for covering the uninsured; and also aims to educate federal officials about what states can do alone and where they need more federal help.  NASHP has released numerous reports on this issue, in addition to holding webcasts and many sessions at our annual conference.
 

ERISA

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Congress enacted the Employee Retirement Income Security Act (ERISA) in 1974 primarily to address the management of employer pension plans, but it also applies to employer benefits like health insurance.  ERISA’s provisions sometimes preempt state laws and complicate state efforts to make health care coverage more broadly available. For example, under ERISA, states are prohibited from directly requiring employers to provide health insurance coverage for their workers.
NASHP’s ERISA work hopes to shed light on the possibilities and limitations of state health reform as ERISA legal doctrine evolves. It includes a number of issue briefs and papers, as well as webinars.

Children’s Health Insurance

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Federal-state partnerships to provide health insurance coverage for children and youth date back to creation of Medicaid in 1965. The 1997 bipartisan enactment of the Children’s Health Insurance Program (CHIP) provided significant new state options to expand coverage through Medicaid or separate programs meeting federal requirements. The 2009 Children’s Health Insurance Reauthorization Act (CHIPRA) provides new tools to improve children’s coverage. Over time, states and the nation have made substantial progress in covering children and improving their access to quality health care supporting healthy growth and development.
With ongoing support from the David and Lucile Packard Foundation, NASHP has supported, analyzed and reported on state efforts to extend children’s coverage since the CHIP program’s inception, building on our longstanding work on Medicaid. Other funders contributing to this work have included the W.K.Kellogg Foundation and the Atlantic Philanthropies. NASHP also is the National Program Office for the Robert Wood Johnson Foundation’s Maximizing Enrollment initiative, which aims to increase enrollment of eligible but uninsured children by helping states improve enrollment and retention systems.
 
NASHP supports active state to state exchange and collaborative learning by regularly convening state officials working to cover children via web, audio and in-person meetings and through mechanisms such as workgroups and electronic discussion forums. We facilitate dialogue between, and serve as an information resource for, state and federal program administrators and policymakers, as well as advocates, researchers and other stakeholders. Through surveys, case studies and other methods, we collect, analyze and report information on the characteristics, challenges and best practices of state children’s coverage programs and initiatives in achieving state and federal goals for improving children’s coverage.
 
 

Comprehensive State Reforms

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A handful of states have enacted and implemented comprehensive reforms that provide access to health coverage, improve the quality of care, and decrease costs. These reforms required tremendous leadership and hold great promise.
NASHP has monitored and analyzed these comprehensive state reforms in order to inform conversations about health reform at both the state and federal level. Our work includes convening states to share lessons learned among each other and providing forums where federal officials can learn from states. Key topics NASHP has worked on include: financing coverage expansions in Medicaid and SCHIP, the role of employers in health reform, private market reform, cost containment, and quality improvement.
The Robert Wood Johnson Foundation, and the Maine Health Care Foundation, have generously supported NASHP’s work in this area.

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