HRSA State Planning Grants

1. HRSA State Planning Grants Readiness To Act Rachel L. Police AcademyHealth

2. Program Goals & Timeline • Announced in 2000, SPG program designed to help states create plans to provide access to health coverage for all citizens. • SPG program goals included: • Assist states in collection and analysis of data on uninsured • Develop sustainable health coverage policy options • Work with key constituency groups and public to reach consensus on viable insurance expansion options • SPG program could benefit both grantee/non grantee states as well as Department of Health & Human Services.

3. Program Goals & Timeline • First round of HRSA state planning grants awarded in 2000 to 11 states. • SPG awarded over five years (2000-2005) of program to 47states and 4 territories, the latest grant going to Alaska in 2005. • HRSA initiated Pilot Planning Grant program in 2004. These grants provided funds to states that had already developed policy options through SPG funds. • HRSA Pilot Grants were awarded to 17states and 2territories.

4. State Activities • Conducted household and employer surveys • Held individual and employer focus groups • Collected both quantitative and qualitative research findings on: • Uninsured population: barriers to care, failure to enroll, where uninsured currently access care etc. • Healthcare environment: employer-based coverage, safety net access, crowd-out, current market trends etc. • Wrote nearly 300 reports on their uninsured populations and ways to solve coverage gaps • List of reports in notebook. Can also access online at www.statecoverage.net • Reports still trickling in from states who received grants in 2004 & 2005.

5. Community Building • States used several strategies to gain stakeholder and community consensus-key to policy development & implementation. • SPG Lead Agencies: Medicaid agencies, research centers, health departments, insurance divisions. Agency selected reflective of political environment. • Key Stakeholders: Both public & private sector involvement including dept of health & insurance, hospitals, advocates, labor unions, universities etc. • Analysis & Selection of Policy Recommendations: Most states established steering or oversight panels made up of demographically diverse members to review and recommend coverage options.

6. Policy Options Considered • Medicaid/SCHIP Expansions: 41 states • Group Purchasing arrangements: 24 states • Limited Benefit/bare bones: 21states • Premium Assistance: 19 states • Safety Net Strategies: 16 states • High Risk Pools:15 states • Outreach to eligible but not enrolled: 11states • Tax Credits for individuals/employers: 10 states • Employer mandates/“Fair Share”: 9states • Individual mandates: 7 states

7. Policy Options Implemented • Medicaid/SCHIP Expansions: 29 states • Group Purchasing arrangements: 9states • Limited Benefit/bare bones: 12states • Premium Assistance: 10 states • High Risk Pools: 10 states • Outreach to eligible but not enrolled: 4states • Safety Net Strategies: 4 states • Tax Credits for individuals/employers: 3 state • Employer mandates/”Fair Share”: 4states • Individual mandates: 1state

8. HRSA Notables • SPG grants served as one of the catalysts for innovative state health coverage reform including: • Maine Dirigo Health Reform • Vermont Catamount Health • Utah Primary Care Network

9. Lessons from the States • Changes in coverage strategy needed to be incremental • Needed to involve a diverse community of stakeholders, both public & private and foster competition • State agencies needed to communicate and cooperate with each other • Coverage was a shared responsibility (individuals, employers, providers and government) • Tying access expansions to cost containment measures and quality enhancements was critical to the political acceptability of reform proposal AND critical to a sustainable system • The general public must be included in the reform debate in a meaningful way; it can’t just be an “insiders game” where public officials and stakeholders argue about options. • Given that the policy process is so dynamic, it is important that coverage models are fluid and alternatives can be quickly generated. • Needed to educate and include any and all state agencies which may be “touched” by problems related to the uninsured or proposed solutions.

10. HRSA: The Technical Roadmap • There are 4 components necessary to affect change in the health policy arena: • Leadership • Political Will • Financing • Technical & Organizational Structures • SPG program served as technical and organizational backbone of support for other 3 areas. • Provided solid analytical structure/methodology and support. • Provided a “roadmap” to state health policy process.

11. HRSA: Readiness to Act • HRSA program contributed to creation of an environment of understanding • Began and encouraged open dialogue between states; a sharing of ideas on what “works” • HRSA served as organizational/technical catalyst to initiate policy process. • Was the HRSA State Planning Program a success? • How should program success be defined and measured? • SPG program had lasting “intangible” effect on state community building and policy development.

12. Modest Funding, Ambitious Goals • Total HRSA SPG spending 2000-2005: $76 million • Total CAP grant spending 2000-2005: $525 million • The Office of Management and Budget wrote a report in which they claim the SPG program • No benchmark for data collection & analysis • Program has not made progress on long term goals of increasing health coverage • No clear need for SPG program