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Building Blocks to Health Care Reform

Sue Williamson

July 29, 2009

Colorado Health Care Snapshot

8.8%1.1%

Medicare404

Medicare &Medicaid

49

MedicaidOnly346

Non-Group157

EmployerRetiree

54

EmployerWorkers &

Dependents2,605

TRICARE/Other111

Uninsured785

7.6%

57.1%

1.2%3.5%

2.4%

17.2%

Total Population = 4,564

SCHIP531.1%

8.8%1.1%

Medicare404

Medicare &Medicaid

49

MedicaidOnly346

Non-Group157

EmployerRetiree

54

EmployerWorkers &

Dependents2,605

TRICARE/Other111

Uninsured785

7.6%

57.1%

1.2%3.5%

2.4%

17.2%

Total Population = 4,564

SCHIP531.1%

Source of InsuranceNumbers in Thousands – Source: June 2007 Lewin Report

TEXT TEXT TEXT TEXT

Colorado Health Care Snapshot

Characteristics of the Uninsured

70% of the uninsured are in the workforce or are the dependent of a worker

32% of the uninsured have family incomes of $20,000 or less; 13% have family incomes of $75,000 or more.

40% of the uninsured are between the ages of 19 and 34; Almost 20% are children

57% of the uninsured are white

About $1.25 billion will be spent on Colorado’s uninsured in 2007 – 2008. The uninsured pay for about ½ of their care out of pocket.

Source: 208 Commission Report – January 2008

The Colorado Promise

Basic health care should be available and accessible to all Coloradans.

High quality health care should be available and accessible regardless of geography.

Health care for the 180,000 uninsured children should be an immediate priority.

Health care should be affordable and financed in a cost-effective manner.

Medicaid must become more efficient and effective.

We should foster competition as a means to drive quality up and costs down.

We all must take personal responsibility for our own health.

Health care reform must be developed collaboratively.

Health Reform Research

208 Commission

2006 Bi-partisan Commission created

27 very diverse members

15 months, 31 proposals, 24 community meetings

Delivered recommendations to Legislature Jan. 31

Historic, important

Community Forums

Fall of 2007 & 2008

Statewide outreach

2007: Focused on the vision for a stronger health care system and the values guiding that vision

2008: Update on progress, discussion of specific strategies

Delivering on the Promise

2007 Established Preferred Drug

List for Medicaid Launched Medical Home pilot

program Expanded mental health

benefits in the small group private market

Invested in immunizations Launched anti-obesity & rural

health initiatives with private sector partners

Piloted important disease management programs

2008 Expanded CHP+ eligibility* Provided Medical Homes for

all Medicaid & CHP+ children Began Eligibility Modernization Increased Medicaid

reimbursement rates* Established CIVHC Made Health IT investment

through CORHIO Required standard health plan

ID cards Established consumer

resource website

2007 / 2008 Results

$4 million realized savings to Medicaid from the Preferred Drug List in the first year

149,000 Medicaid and CHP+ children enrolled in Medical Homes

Increases in all categories of primary care providers accepting Medicaid clients

Launched DOI consumer Web site Promulgated regulations for standard ID cards Hired Dori Biester as Interim Director of CIVHC

and appointed board of high profile community leaders

Delivering on the Promise

2009: CO Healthcare Affordability Act Historic legislation – largest health coverage

expansion in 40 years Cover more than 100,000 uninsured through Medicaid

and CHP+ expansions CHP+ to 250% for kids and pregnant women Medicaid to 100% for parents and childless adults Medicaid buy-in for working disabled

Reduce uncompensated care and cost shifting by increasing Medicaid reimbursement to hospitals

Financed through hospital provider fee – commonly used financing tool; 23 states using hospital fees

Delivering on the Promise

Strengthen and streamline loan forgiveness programs & establish Primary Care Office to help rural & underserved communities (HB 1111)

Ensure faster, easier transitions to long term care for Medicaid clients through presumptive eligibility (HB 1103)

Allow incentives in insurance for voluntary wellness programs (HB 1012)

Make it easier for families to navigate Medicaid and CHP+, by establishing electronic systems for re-enrollment (HB 1020)

Eliminate the arbitrary waiting period for legally present pregnant women and children to enroll in Medicaid and CHP+ (HB 1353)

Requires insurance coverage for the treatment of Autism (SB 244)

Outreach and Enrollment

Since January 2007 67,000 more children (27% increase) and

23,000 more adults enrolled in Medicaid and CHP+

Robust outreach activities Advertising Community outreach and training Media relations Marketing materials development and

dissemination

Outreach and Enrollment

Novela (Spanish soap opera) Targeted our Latino families (70% eligible, but

not enrolled in our programs) Twelve 30 minute episodes that emphasize

family values and weaves primary health care converns into plot of the stories

Enrollment Fair Mini-Grant Program $115,000 ($5,000 grants each) to 23 local

CBOs yielded 700 new enrollments

Regional conferences and trainings

Pre-Implementation Funding and Technical Assistance Opportunities

Colorado has experienced strong local health foundation support

Funding from Colorado Trust allowed us to begin planning for implementation even before we knew what the policy solutions were going to be

SCI opportunity allowed us to meet with national experts and share information with other states as we began health care reform discussions