In March 2007, the Packard Foundation Board of Trustees approved a significant new, multi-year investment toward the goal of ensuring that all of America’s children have health insurance that provides them with the care they need. This grantmaking strategy builds upon the remarkable activity unfolding across the country to cover children, including some state initiatives to cover all children. It focuses at the state level where the policy momentum is building and where workable solutions are most likely to be tested and implemented. Supporting states’ pioneering efforts also informs and advances the long-term goal of federal and state policies which cover all children.
Since the launch of Insuring America’s Children (IAC) in 2007, more than 1.3 million children have enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) programs in states where IAC grantees are working. Just as the work on children’s coverage in recent years helped lay the groundwork for further federal and state reforms, the lessons learned from Insuring America’s Children will inform implementation of the Patient Protection and Affordable Care Act and other ongoing healthcare reform efforts.
Insuring America’s Children: Getting to the Finish Line has three key components:
I. The Getting to the Finish Line Project
In support of state-based advocacy organizations, the Foundation launched the Narrative Communications Project in 2006–2007. The Narrative Communications Project provided grant support as well as peer-to-peer learning, training, and tailored technical assistance to strengthen the communications efforts of state-based policy advocacy groups working on advancing children’s coverage in their states.
Building on the momentum fostered by the Narrative Project, in 2007, the Foundation launched the Finish Line Project, a new multi-year, multi-state grant project to provide financial and technical support to policy advocacy organizations in states positioned to make significant advances in children’s coverage. Through a competitive process, eight organizations in states across the country were selected to receive multi-year grant support under the project. By 2010, half of the states with Finish Line grantees had child uninsured rates at or below 5 percent of their total child populations.
The Foundation consolidated the two projects under the Getting to the Finish Line Project in early 2011 and grants were awarded to advocacy organizations in 12 states that are well positioned to insure more children and families. The Georgetown Center for Children and Families, a national health policy center, in partnership with Spitfire Strategies, a strategic communications firm, provides policy and communication support and strategic counsel to each of the state grantees. Participants in Insuring America’s Children also work to inform, seed, and support improvements in children and family coverage in other states and at the federal level.
II. Supporting State Officials in Moving Forward
The role of state administrators and policy makers in continuing to grow children’s coverage is critical. Accordingly, the IAC strategy provides policy and peer-to-peer technical assistance to state child health program administrators and policymakers in states that are working to improve existing programs or implement new coverage initiatives for children. The state collaborative, supported by the National Academy for State Health Policy, facilitates cross-state learning, and informs national policy makers and other interested parties of these state-based developments.
III. Evaluating New Coverage Initiatives
The third major component of Insuring America’s Children is a multi-state evaluation project, conducted by Mathematica Policy Research in conjunction with the Urban Institute and the Center for Studying Health Systems Change. The evaluation aims to measure the progress of the grantmaking strategy, identify effective advocacy activities, and inform decision makers in states and at the national level about promising coverage strategies and programs. During the first year of the evaluation, the project team conducted in-depth site visits to six of the Finish Line grantee states to gather insights and perspectives on the issue of children’s health coverage and the environment for expanding coverage in each state. Findings from the site visits are published in two briefs, “State-based Advocacy as a Tool for Expanding Children’s Coverage: Lessons from Site Visits to Six IAC Grantee States” and “Strategic Engagement of Policymakers Is Key to Advancing a Children’s Health Care Coverage Policy Agenda”. The briefs are available at http://www.mathematica-mpr.com/health/iac.asp.