Coverage Institute Offers In-Depth Technical Assistance to States

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The Coverage Institute (CI), a targeted SCI technical assistance program, was unveiled in 2007 and has helped states address substantial and comprehensive care health reform throughout 2008. The CI was instrumental in helping a group of state leaders from the public and private sectors deepen their understanding of the implications of various programmatic options for expanding health coverage in their respective states.

The CI began with a kick-off meeting that brought together representatives of 14 states (Arkansas, Colorado, Indiana, Kansas, Maryland, Minnesota, New Hampshire, New Jersey, New Mexico, Ohio, Oklahoma, Oregon, Texas, and Wisconsin). Each state selected a team to participate in the highly interactive process for developing policy and program recommendations. While the mix of participants varied by state, the teams included senior executive branch officials, legislators, and decision makers from private purchasers, the advocacy community, and practitioners. Fifteen distinguished faculty members shared their expertise on various issues, including insurance market reforms, reinsurance, other methods to subsidize coverage, connectors/exchanges, Medicaid waivers and the Deficit Reduction Act, health systems improvement, and strategies for building stakeholder and policymaker support.
Following the initial meeting, participating states were then eligible to compete for additional funding for development/microsimulation modeling or other reform development activities. In February, the Robert Wood Johnson Foundation, through SCI, awarded development grants to Arkansas, Kansas, Maryland, Minnesota, New Mexico, Oklahoma, Oregon, Texas, and Wisconsin. For the most part, the states are using the funds to continue their involvement in a stakeholder consensus-building process, to fund experts to help them develop policy proposals, and to fund the actuarial modeling of various policy options. In addition, Colorado and New Jersey were awarded microsimulation modeling grants. Both states are working with a team from the Urban Institute to develop and delineate a finite number of policy options for use in a microsimulation model, and to understand important design and implementation issues.
Despite the severe budget setbacks experienced by many of the participating states, many have made extraordinary progress. Throughout, this report highlights the successes of participating states, but a few examples of CI team achievements include the following:
  • The Ohio CI Team developed a comprehensive plan to reduce the number of uninsured Ohioans by half; the team presented the plan to the governor in July 2008.[i]
  • The Maryland team developed a proposal, subsequently enacted, that included a Medicaid expansion for parents/caretaker relatives with a phased-in expansion for childless adults, along with as a small business subsidy program that started offering assistance to small businesses in October 2008.[ii] 
  • For the New Jersey team, the kick-off meeting brought together key legislative and executive branch leaders for a constructive conversation on health coverage, leading to the development of a sequential coverage expansion proposal. Governor Corzine signed into law the first phase of the reforms, sponsored by Senator Joe Vitale, in July 2008.[iii]
Perhaps one of the most important aspects of the Institute is collaboration—the result of requiring teams to represent various components of government and the private sector. Such collaboration encouraged states to move beyond political turf, to dampen political rhetoric, and to bring disparate parties together in a neutral environment. As one state official commented, “You can’t put a dollar figure on the importance of having SCI as a neutral third party spearheading the efforts.” 

The Coverage Institute has fostered a sense of community among all participating states. Participants stay in contact with one another and are aware of each other’s progress through bimonthly conference calls. The states also have participated in technical assistance meetings that allow them to advise and learn from one another.


[i] “Covering Ohio’s Uninsured: The SCI Team’s Final Report to Governor Ted Strickland,” State Coverage Initiatives.
[ii] Maryland Health Insurance Partnership.
[iii] New Jersey Senate No. 1557, available at