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Step by Step: Local Coverage Expansion Initiative

Project Overview

Over five years, this CHCF initiative invested $5 million to support local efforts in creating health insurance programs for Californians who were ineligible for existing public programs such as Medi-Cal and Healthy Families.

Between 2003 and 2007, the California HealthCare Foundation (CHCF) invested approximately $5 million in its Step by Step: Local Coverage Expansion Initiative. The initiative supported local efforts to develop health insurance programs for those Californians who were uninsured and ineligible for existing public programs such as Medi-Cal and Healthy Families. During its five years, the initiative supported development of diverse approaches aimed at expanding health coverage at the local level.

The initiative funded three types of grants: planning grants to support activities from initial design through development of a detailed implementation plan, implementation grants to help local efforts meet specific needs associated with launching a local coverage program, and One-e-App grants to assess local requirements to implement this online application that can automate enrollment in public benefit programs.

The topline results of the initiative included:

  • Programs that received support under Step by Step from 2004 to 2007 will extend coverage to an estimated 91,000 children and 5,152 adults through 2008. In addition to developing new coverage products, most of the children's programs incorporated outreach and enrollment efforts that resulted in greater coverage through Medi-Cal and Healthy Families, which newly enrolled an estimated 62,000 children and re-enrolled 47,000 children through 2008.
  • Most grantees created coalitions to work together on complex issues and to achieve lasting changes in their communities.
  • Adult programs have provided new insights into coverage models for diverse populations.

Project Evaluation 

An evaluation based on updated information on funding prospects, a scan of the policy environment, and stakeholder input led CHCF to conclude that few opportunities remained to leverage public and private funding for new local health insurance programs. The evaluation results led the foundation to determine that 2007 would be the final year to fund projects under the Step by Step Initiative. CHCF, through its Health Reform and Public Programs Initiative, continues to support the evolution of state and local coverage programs within the context of the Affordable Care Act.

A concluding summary of the Step by Step: Local Coverage Expansion Initiative and a list of grants awarded during each funding cycle are available under Document Downloads. Evaluation summaries describing the outcomes of projects funded in 2004 and 2005 are also available as separate files.

A summary of the initiative appeared in the September/October 2008 issue of Health Affairs, available through the External Link below.

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