The Connecticut Experience-Medicaid

1
The Connecticut Experience-Medicaid

• Patricia Baker
• Connecticut Health Foundation May 13, 2004

2
Preservation of Medicaid as we know it

• Medicaid in the form of a block grant supported
  by Bush Administration hopes to control costs and
  undermine entitlements
• Bush block grant proposal strongly and visibly
  supported by our Governor
• CT Health Foundation and Anthem Foundation
  Commissioned report by the Health Policy
  Institute of Georgetown and Child Health Council
  now CT Voices for Children to examine impact of
  changes on CT
• Providers and others were in state of denial-
  Report presented in June 2003

3
Preservation of Medicaid

• Block grant comes to CT
• Late night negotiations on budget implementer
  bill yields agreement by a select few in
  leadership to pursue waiver that includes
  premiums on Medicaid children,parents, elderly
  and medially needy at the 50 poverty rate and
  above, co pays, and the elimination of EPSDT-
  August 30, 2003

4
Preservation of Medicaid

• CT Health Foundation convened original work group
  to determine what the foundation and original
  policy experts should do in light of passage of
  budget implementer.
• Legislative monitor explaining we must act to
  inform policymakers regarding impact in a user
  friendly way
• Board memos updating them of actions and why it
  is important to act

5
Preservation of Medicaid

• Goal Waiver provisions would be repealed
• Our role
• Analyze the impact of proposed changes producing
  hard numbers
• Consider target audience regarding format and
  distribution of public information if we are to
  be effective
• Dissemination is equally important to content in
  order to accomplish goal
• Activist role in connecting dots

6
Preservation of Medicaid

• Format-Policy Briefs
• 5 Briefs breaking down each issue including
  economic impact of changes on the whole state-
  5th added when pursuit of a global cap came to
  light. All are posted on websites
• Timing of release scheduled to build momentum
  going into the session and throughout the session

7
Preservation of Medicaid

• Making the dots connect
• Medicaid defense coalition
• Ct Academy of Pediatrics
• Outreach to unlikely suspects
• Media
• Educate both sides of the aisle

8
Preservation of Medicaid

• We Won!!!
• Going into the session, there were enough
  cosponsors on the repeal bill to pass the
  legislation, but mostly one party support.
• Education of legislators both policy implications
  and context of real peoples lives is
  necessary-some legislators saw us at the line if
  not over so there is risk with activist role
• 2005budget sees allocation to reverse cuts
• Budget Implementer has specific language against
  the pursuit of a global cap

9
Lessons Learned/Issues to Consider

• GIH policy calls help-I was inspired by our first
  call when MA spoke of their experience defending
  the Medicaid budget
• Financing drives program priorities, but there is
  not an automatic connection for all board and
  staff
• To be successful think of it in terms of an
  initiative fight with concrete outcomes so
  strategy and tactics follow vs. shed some light
  onto the problem

10
Lessons Learned/Issues to be Considered

• Imperative to connect the dots from research and
  analysis to convening, to legislative monitoring,
  to media to public education to advocacy- Work
  group spoke every 2-3 weeks from September to
  May.
• Must marry thoroughness and impeccable data with
  quick turnaround and nimbleness- One more Woe is
  me story will not carry the day
• Waiver process is a very secretive - executive
  branch to executive branch discussion, need to
  monitor and bring out into light of day

11
Lessons Learned/Issues to be Considered

• Leadership is key, need legislative champions
  including unlikely suspects
• Timing, dissemination, and promotion are key to
  success
• Use every strategy available to the foundation,
  research, publications, communication,
  grantmaking, convening, etc.

12
Lessons Learned/Issues to be considered

• Grassroots are essential and weak, need to think
  long-term about what we can do. People want top
  down strategy to take care of the basics.
• Medicaid is very complicated and make no
  assumptions that folks understand it including
  the committees of cognizance
• Medicaid does need reform, and we must ask
  ourselves what can we do to promote a positive
  reform in our state.

13
Lessons Learned/Issues to be considered

• Must pay attention to the internal side of the
  shop as well as external
• Is the Board behind the campaign do they
  understand the implications
• Effort very time intensive, what capacity do you
  have internally, what do you have externally, can
  you act quickly, must make it a top priority to
  win
• Are people prepared to see foundation in the
  center of controversy
• Name will be in papers, must ensure credibility
  by having the best analysis possible