Laura-Welcome and thank you for joining us today. My name is Laura Goodhue and I’m the Executive Director of Florida CHAIN, a statewide healthcare advocacy organization. I will be hosting today’s webinar- KidsWell Florida- practical solutions to cover all kids. The webinar will run for approximately 1 hour and we plan to have time for questions. The presentation will be recorded and slides made available. If we don’t have time to answer all questions we will follow up with responses. A few housekeeping comments before we begin:1. During the Q&A period, if you have a question for the panelists, please type a message in the chat box in the bottom left corner of the screen.2. To place your screen into a "Full Screen" mode, click the "Full Screen" button in the top right corner.3. We recommend using the audio from your phone and not the computer. Now I’d like to introduce our presenters and panelists: We are so fortunate to have Dr. Louis St. Petery as our main presenter. Dr. Petery graduated from the University of Florida College of Medicine, and has practiced pediatric cardiology in Tallahassee for 37 years. He serves as Executive Vice President for the Florida Pediatric Society (FPS) and has led the fight for two notable recent FPS initiatives, the Medicaid Access Lawsuit and the Gun Bill Lawsuit. He has been one of the most recognizable and passionate advocates for access to children’s health care in Florida.Also with us today is Nick Duran, the Grassroots Organizer for KidsWell Florida. Nick also serves as Health Care Coordinator for the Children’s Movement of Florida. He joined The Movement in June 2010 as a state coordinator assembling and directing a team to execute its 17 "Milk Party" rallies throughout the state in September 2010. Prior to joining the Movement, Nick worked in civil litigation as an associate with the Lydecker Diaz law firm and he is a proud graduate of the University of Florida.After completing his undergraduate studies, he moved to New York and earned a Juris Doctorate degree from New York Law School. Nick was born and raised in South Florida and lives in Miami Shores with his wife Danielle and son Mason. Also joining us today to answer questions is Karen Woodall, the Executive Director of the Florida Center for Fiscal and Economic Policy. Karen has over 30 years’ experience in supporting, developing and advocating for programs to improve the conditions of working families, children, seniors, people with disabilities, rural families, migrant and seasonal farm workers, immigrants and other vulnerable populations. She is a recognized expert in the area of health care, especially for children. She has been a member of the Kidcare Coordinating Council since its inception. She has worked with the Children's Defense Fund for years and was the recipient of the Lawton Chiles Award for child advocacy in 2007. By the end of this webinar you will:Understand the KidsWell FL initiative and how it can move policy solutions to increase access to health coverage for childrenHave an understanding of the many issues contributing to a lack of coverage and possible solutions and finallyUnderstand how YOU can play a part in this campaign
So what is KidsWell FL?It is a collaborative grassroots movement that will BUILD UPON and EXPAND existing efforts to get kids health coverage in Florida. Many of you on the call have worked tireless for years engaging in outreach, navigating the system for families and working on administrative, state and federal policy. KidsWell Florida will not replace these efforts.Rather it brings resources and leadership to connect community organizations, providers, families, businesses, and the public to connect ongoing work to raise our collective voices for practical policy solutions.
KidsWellFloria is:A staffed, long term investment to help you make a difference for kids and families in our State.Right now the collaborative has on staff 3 organizers:Joining our full time KidsWell Organizer Nick Duran is Florida CHAIN’s Organizer Ryan Morris, formerly of Covering Kids and Families. Ryan will primarily work to identify parents and families to engage them in advocacy.Our third organizer is super advocate Linda Merrell who will work with “grasstops” providers, organizations and businesses helping to coordinate advocacy efforts around the state.The collaborative will draw upon expert research and policy analysis from the Florida Center for Fiscal and Economic Policy and help from national groups like Georgetown Health Policy Institute.Strategic Communications and Advocacy will be supported by the Children’s Trust of Miami-Dade, Florida CHAIN, the Children’s Movement and the Florida Child Health CoalitionThis is a group effort, resourced to help you get the job done and depends upon your participation
You have heard the stories before of families navigating a complex public health system only to fall through the cracks. I want to share a few of those stories before we begin with the policy section of this webinar. Trilce is a nursing student who knows how important health coverage is for her two small children. She’s thankful that Medicaid was there for her 3 yr. old son Luc when he fractured his leg on a playground far away from home. Luckily she was able to seek follow up care from an orthopedist outside of her county. She is concerned about moving into a managed care network that might not have the doctors and specialists she needs. After her husband got a new job she enrolled her son in KidCare paying the full premium but was shocked to learn that 5 month old Kaci was ineligible for the sliding scale fee or the full pay. On Mother’s Day this year, Trilce found out she has a rare eye disease that is causing her to slowly lose vision. She is seeking treatment but is unable to drive to work. She is concerned about finding coverage for her kids on top of trying to stay calm and seek care for herself.
Dawn’s son Wesley has an eye condition called strabismus, and had been worried because one insurer dropped then and another excluded Wesley’s condition from coverage. Then, as the new patient protections under health reform began to take effect, they finally had the option of buying affordable health insurance without any exclusions for pre-existing conditions for Wesley.We’ve also heard the frustrations of parents struggling to navigate the system. Here is a video of mother Kendra Garcia expressing frustration in obtaining care for her three kids.
Laura- We need to tell the stories of Trilce, Dawn and Kendra and we need them to speak out as well. KidsWell will give them a voice to make change.I’d now like to hand over the presentation to Dr. St. Petery who will give us an overview of children’s health access in Florida.
Dr. St. Petery-Let’s start by looking at howFlorida is doing in covering kids:In 2010, the most recent estimate available, only Arizona, Nevada and Texas had more uninsured children than Florida. About 1 out of every 8 Florida kids has no health coverage at all. By contrast, in numerous states, fewer than 1 out of every 20 kids are uninsured.32% don’t have a regular place to access care. Like adults, easily preventable illnesses go undetected and are treated less efficiently and more cost in emergency rooms. Florida ranks 47th in the percentage of pregnant women seeking care in the first trimester
Surprisingly, data released from the Georgetown Center for Children and Families found that Florida had the steepest decline in the rate of uninsured children over a recent 2 year periodThis could account for several unresearched reasons including a steep increase in poverty over the same time period. Medicaid enrollment jumped from 2 million to 3 million from 2006 to 2010
However, far too many Florida kids remain without coverage. Even though 160,000 fewer were uninsured in 2010 than 2008, more than a ½ million are out there. Florida remains a key obstacle blocking the path to covering all children. In fact, although only about 1 out of every 19 children in the U.S. are Floridians, 1 out of every 12 UNINSURED children is a Floridian. We clearly have a long way to go.
As you may already know, the majority of these children are eligible for subsidized coverage through the Florida KidCare program. That is why many of you on the call with us today already do work in the areas of public education, outreach, and enrollment for or with KidCare.But as the chart above shows, at least in 2008, only about 70% of the Florida kids potentially eligible for Medicaid and CHIP were enrolled. That rate is lower even than for other southern states, and much lower than the national rate of 82%.
Complex Eligibility SystemYou also know that we invest so much of our scarce time and resources in outreach, enrollment and navigation because the system is not automatic and eligibility and enrollment hurdles block many from obtaining coverage. With a fragmented system that treats kids in the same family differently according to age and sometimes health status, it’s no wonder we need a village just to get and keep children enrolled.
Complex Administrative SystemAdvocates have tried for years to make sense of, streamline and simplify the four different agencies that manage Florida KidCare. Parents and the community workers that help them are struggling to navigate the system.
A particular concern given the number of uninsured kids we have is the fact that we have not been able to use all of the federal funding available to cover kids, and that money instead is going to other states. This is particularly true in the CHIP portion of KidCare. Unlike Medicaid, Congress provides a fixed amount of funding for CHIP each year, and that money is divided among the states to enroll eligible kids. Funding that Florida left unused, first after 3 years and more recently after 2 years, has been redistributed to other states. Most recently, the federal funding formula has been changed to base funding for one year on spending in previous years, meaning Florida lost money that it never even received. Finally, Florida has continued to miss out on performance bonuses each year that it would have earned for removing barriers to enrollment. That’s a double whammy – losing money for doing things that would have helped Florida keep other funding it lost.
[briefly discuss state of lawsuit]Ex. of lack of doctors- Monroe County children must travel to Miami to see a pediatrician due to a lack of providers and many rural counties face transportation and other barriersFlorida’s version of Medicaid managed care has been problematic: for-profit managed care plans, particularly HMOs, have a financial incentive to put in place utilization management practices intended to block access and sidestep accountability measures. Now the Florida Legislature is trying to require that almost all Medicaid recipients statewide enroll in managed care plans.
The Medicaid ReformPilot and now the proposed Statewide Medicaid Managed Care initiative create numerous access-related concerns for children.Although the federal government, through the Centers for Medicare and Medicaid Services, has allowed the Reform Pilot to continue, a final decision on whether or not to approve expansion statewide.
With the efforts of dedicated policymakers and advocates like you, Florida has addressed many of the longstanding barriers to getting and keeping health coverage for children, particularly coverage through Medicaid and the Children’s Health Insurance Program.Here is a brief list of recent wins…
2010 – Federal ACA ends exclusion of coverage for pre-existing conditions for children in private health plans2010 – Federal prohibition on tightening eligibility in Medicaid and CHIP until 2019e.g., Rejection of State’s proposed $10 premium requirement
This session, the Legislature agreed to begin the work needed to create a seamless, “no wrong door” system for eligibility determination and enrollment in Medicaid, Healthy Kids, and the new health insurance exchange created by the Affordable Care Act. The State will first work to upgrade the technology needed for this system.
In order to reach full enrollment, other improvements need to be made. You are no doubt familiar with some of these solutions. I will briefly touch on some of them. The goal of KidsWell is to build capacity to connect these policy solutions, strategically take on campaigns where opportunity arises and follow through to move towards solutions with grassroots organizing. Although much of what needs to be done requires changes in the law or budget increases, there are things we can do even without action by the Florida Legislature.[brief overview of administrative changes]
A bill allowing immigrant children who are lawfully present in the U.S. to be qualify for KidCare without the current five-year waiting period passed a key legislative committee last session, but did not make it all the way through the process.Express Lane eligibility: using information available from other assistance programs, to determine KidCare eligibility…this is information the State already has available.Presumptive eligibility: making the assumption that kids are eligible at the time of application in order to get them directly plugged into care.Continuous eligibility: reducing the burden created by the requirement to frequently prove eligibility in one program component - Medicaid for school age children…many recipients unnecessarily lose coverage as a result
Full utilization of CHIP fundingFor those over income, there are “full pay” options – families pay the unsubsidized cost of coverage…but this coverage is available for young and school-age children but not for infants.Restore outreach funding not available since 2004
The Affordable Care Act will make 2½ million currently uninsured Floridians eligible for meaningful, affordable coverage. A million of these will become newly eligible for Medicaid – the income eligibility limit for most will now be increased to 133% of the poverty level.For the first time ever childless adults will be eligibleAs parents obtain coverage, research has shown that children also gain coverageChildren from 200% to 400% of the federal poverty level will be eligible for tax subsidies to purchase private coverage with guaranteed benefit levels through a transparent marketplace called the ExchangeThere are many Exchange implementation issues to address
In addition to Medicaid expansion, Floridians with incomes between 133% and 400% of poverty level will be eligible to purchase private health coverage through the Health Insurance Exchange. To ensure that this coverage is affordable, advance tax credits will be provided on a sliding scale based on income. Uninsured kids who are not Medicaid-eligible might get coverage through the Exchange.
Health Care Reform: Increases coverage opportunities for families through Medicaid and affordability credits through the ExchangeEnds complex, “stair-step” eligibility in KidCareRemoves premium payment requirement for some school-age kidsRemoves asset test for parentsStreamlines and simplifies eligibility and enrollmentExpedites or automates renewals
We expect to have a ruling from the Supreme Court on June 26th on the 26-state legal challenge to the Affordable Care ActVarious outcomes are possible including:Decision upholding the entire lawDecision that the “individual mandate” – requirement that most Americans obtain health insurance coverage – and possibly some related provisions - unconstitutional. Decision that the law is not what is called “severable” and therefore the entire ACA is unconstitutionalAlthough seen as a very unlikely scenario, decision that Medicaid expansion is an unconstitutional burden on statesOnly if the entire law is thrown out would we not have an urgent need to proceed with effort to implement the ACA.
Laura and Leah- no more than 5 min. if time allows
Laura-Through KidsWell Florida we will organize on many levels. We will raise the voices of parents, business leaders, providers and advocates. We will use sound research and policy analysis to propose solutions. We will speak with shared messages and many voices using effective messagingWe will campaign strategically
Laura-We will bring the goals of KidsWell Florida to the public and lay the groundwork for a public launch throughout the summer. In June, July and August we’ll hold regional meetings focusing on identifying consumers, building grassroots support and identifying potential campaigns- Nick will discuss more in detail
Laura-By September we will be ready for a full public launch of the collaborative. We will have families recruited, trained and prepped in all of the media markets throughout the state. We will collectively pitch local stories and data to media outlets. A statewide research report will be released with the media campaign and earned media will be coordinated among partners.A full website and interactive social media including online videos will also be made available. Hand over to Nick Duran, KidsWell Organizer
Nick-Times and locations TBD in coming days
Laura-Follow up webinar with surveyWebinar availableFull website upcomingContact Nick for regional meetings this summerPublic launch in September
Laura-Thank you so much for joining us today
Kidswell webinar presentation
KidsWell Florida:Practical solutions to cover all kids Wednesday, May 30th Noon to 1 pm Audio: 866.740.1260 Access Code: 9565473
PROGRAM• Welcome• What is Florida KidsWell?• Uninsured Florida kids: It doesn’t have to be this way- Dr. Louis St. Petery• Discussion/ Q&A• KidsWell Florida- bringing it all together• KidsWell Florida next steps• Q&A• Adjourn
WHAT IS KIDSWELL FLORIDA?• Collaborative grassroots movement to BUILD UPON and EXPAND existing efforts to get kids health coverage• Connects community organizations, providers, families, businesse s, and the public to build support for and achieve policy solutions
WHAT IS KIDSWELL FLORIDA?• Staffed, long term investment to help you• Research, organizing, communic ations and advocacy resources to get the job done• Nationally supported and successful campaigns: TX, NM, CA, NY, PA, MD & now Florida• We need EVERYONE!
WE CAN DO BETTER FOR FL KIDS The Henderson Family West Palm Beach
FLORIDA LED NATION IN DECLINE RATE OF UNINSURED CHILDREN IN 2008-201018.0% 16.7%16.0%14.0% 12.7%12.0%10.0% 9.0% 8.0% National8.0% Florida6.0%4.0%2.0%0.0% 2008 Uninsured Rate 2010 Uninsured Rate Source: Georgetown University Center for Children and Families, “Despite Economic Challenges, Progress Continues:Childrens Health Insurance Coverage in the United states fro m2008- 2010”
FLORIDA STILL HAS MANY UNINSURED CHILDREN - IN BOTH RELATIVE & ABSOLUTE TERMS Percent of U.S. Total in Florida (2010)10% 8.6% 9% 8% 7% 507,000 6% 5.4% out of 5% 5.9 million 4% uninsured 3% U.S. kids 2% were 1% Floridians 0% All Kids Uninsured Kids
CHILDREN’S MEDICAID/CHIPPARTICIPATION RATES BY STATE (2008) US 82% New York 89% California Texas 75% Tennessee 87% VirginiaNorth Carolina 85%South Carolina Mississippi 81% Alabama 85% Georgia Florida 70% 0% 20% 40% 60% 80% 100%Source: Who And Where Are The Children Yet To Enroll In Medicaid And The Childrens Health Insurance Program?, Health Affairs, October 2010, http://content.healthaffairs.org/cgi/content/abstract/hlthaff.2010.0747.
FLORIDA - THE DONOR STATE• Millions of federal dollars lost over the last two decades due to low enrollment• CHIP awards funding not used to other states and Florida repeatedly missing out on much needed dollars• Title XXI higher match rate than Medicaid in KidCare at 70/30• Even more money was lost from CHIPRA bonuses
COVERAGE MAY NOT MEAN ACCESS • Strained providers/Low provider participation - Legal challenge over inadequate provider reimbursement rates • Barriers to access (e.g., rural areas) • Delays in care due to gaps when transitioning between KidCare components • Obstacles raised by for-profit managed care plans
WHAT DOES FL’S PUSH FOR STATEWIDEMEDICAID MANAGED CARE MEAN FOR KIDS?• Florida Medicaid 1115 waiver operating in 5 counties requires all children to enroll in managed care or PSN since 2006• 76% of participants in “Medicaid Reform Pilot” are children and parents• Approval of expansion STILL PENDING and many health advocates urging CMS to deny waiver amendment
FLORIDA CHILD HEALTH WINS• 2008 – State bureaucratic barriers removed: • Added exemptions to waiting period for kids who leave private coverage to qualify • Reduced waiting period for those not exempt• 2009 – Federal reauthorization of CHIP until 2019
FLORIDA CHILD HEALTH WINS• 2010 – Federal ACA ends exclusion of coverage for pre-existing conditions for children in private health plans• 2010 – Federal prohibition on tightening eligibility in Medicaid and CHIP until 2019 • e.g., Rejection of State’s proposed $10 premium requirement
FLORIDA CHILD HEALTH WINS• 2012 – State legislation extending KidCare eligibility to children of State employees• 2012 - State legislation setting in motion plan for “no wrong door” coordinated enrollment and eligibility system (ACA implementation)• 2013 – Federal increase in Medicaid reimbursement rates for primary care to Medicare levels (though State has not yet approved)
OPPORTUNITIES• #1) Administrative (KidCare-related) • Identify eligible children through free and reduced lunch data • Eliminate unnecessary administrative requirements (Demanding that families produce paperwork for SSA match) • Implement seamless, real-time eligibility determination • Reduced “churning”
OPPORTUNITIES• #2) State Legislation (Kid-Care related) • Expand coverage to lawfully residing immigrant children • Implement “Express Lane” eligibility • Implement presumptive eligibility • Implement 12-month continuous eligibility in all KidCare components
OPPORTUNITIES• #2) State Legislation (Kid-Care related) • Full utilization of CHIP funding • “Full-pay” coverage option for infants • Restore outreach funding
FEDERAL HEATH CARE REFORM IMPACT ON MEDICAID COVERAGE 200% Health Reform 200% 185% Current Law% of Federal Poverty Level 150% 133% 133% 100% 100% 50% 74% 20% 0% 0% Infants Pregnant Young School-Age Adults with Parents Childless Women Children Children Disabilities Adults
FEDERAL HEATH CARE REFORM IMPACT ON COVERAGE No subsidy400% ofpovertylevel 300 Health % Insurance Subsidized 200% Exchange(s)200 185% % 133% 2014 Medicaid Expansion100% 74% 20% Not eligible now Children Pregnant Parents Seniors/ Adults w/o Undocumented People with Children Immigrants Women Disabilities ■ Current Medicaid and CHIP (Florida 2011 eligibility levels) ■ Uninsured or insured via other source of coverage
FEDERAL HEATH REFORM OPPORTUNITIES• Increases coverage opportunities for families through Medicaid and affordability credits through the Exchange• Ends complex, “stair-step” eligibility in KidCare• Removes premium payment requirement for some school-age kids• Removes asset test for parents• Streamlines and simplifies eligibility and enrollment• Expedites or automates renewals
HOW DO WE GET THERE?• Strengthen collective action• Raise consumer voices• Research- feedback from the field, policy analysis and research• Speak with shared messages and many voices- develop effective messaging• Campaign strategically
KIDSWELL PUBLIC LAUNCH SEQUENCE• June - July - August • Regional meetings focusing on identifying consumers, building grassroots support and identifying strategic campaigns
KIDSWELL PUBLIC LAUNCH SEQUENCE• September - Public Launch • Media event announcing KidsWell formation • Release of report • Full website • Op-eds, LTEs and other earned media• Post September • Advocacy agenda formed • Advocacy campaigns launched
KidsWell Florida Organizational Chart Lead Collaborators provide support to the Executive Committee and Regional Lead Collaborators Committees by staffing meetings and events, building and maintaining the Florida CHAIN, Children’s coalition infrastructure, and providing Movement, FCFEP, FCHC, Children’s educational materials, advocacy Trust opportunities, and technical expertise. The Executive Committee provides feedback and directional support to the Leadership team and is supported by the Regional Committees. Executive Committee The Regional Committees plan and execute advocacy campaigns, deliver 1 to 2 Representatives from each educational presentations, and provide KidsWell Regional Committee “on the ground” information about policy priorities. Region 1 Region 2 Region 3 Region 4 Region 5 Miami-Dade Broward Hillsborough Orange Alachua Monroe Palm Beach Pinellas Seminole Duval VolusiaRegion 6 Region 7 Region 8 Region 9 Region 10 Region 11Manatee Pasco Treasure Escambia Leon LeeSarasota Polk Coast Bay Collier Counties
UPCOMING REGIONAL MEETINGSJune• 6-19: Region 1 (Miami-Dade, Monroe)• 6-20: Region 2 (Broward, Palm Beach)• 6-26: Region 3 (Hillsborough, Pinellas)• 6-27: Region 4 (Orange, Seminole, Volusia)• 6-28: Region 5 (Alachua, Duval) July• 7-10: Region 6 (Manatee, Sarasota)• 7-11: Region 7 (Pasco, Polk)• 7-12: Region 8 (Treasure Coast counties)• 7-24: Region 9 (Escambia – Bay)• 7-25: Region 10 (Leon)• 7-26: Region 11 (Lee/Collier)
REGIONAL MEETINGS• Discuss and deliberate potential policy issues and areas of focus• Gather everyone’s input and thoughts related to potential policy/issues with hopes of reaching consensus• Identify potential executive committee members for respective region• Discuss building regional capacity for advocacy activity on both regional and statewide levels