CHIPRA Cycle III Connecting
Kids to Coverage Grant |
Reporting Period: Report Due Date: Grant Award Number: State: Name of Grantee: Focus
Area Listed In Grant Application (number and name): Name
and Title of Person Completing Report: |
Authentication |
I Certify the Accuracy of All Report Contents:
Authorized Certifying Official (Typed name in Lieu of Signature)
CMS Project Officer Approval |
I have approved the contents of this report:
CMS Project Officer (Typed Name in Lieu of Signature, and Date)
To meet Congressional requirements—as expressed in the terms and conditions of your grant—you are required to report on your grant’s strategies and outcomes—specifically, the number of enrollments and renewals in Medicaid and CHIP that resulted from your grant. The Centers for Medicare & Medicaid Services (CMS) will use Grantees’ reports to prepare a Report to the United States Congress.
This Report to Congress will describe Grantees’ progress towards their CMS approved goals—as a group and individually—and will highlight successful outreach and enrollment strategies, discuss common enrollment and renewal challenges and barriers, and present the lessons learned about strategies to increase Medicaid and CHIP coverage of uninsured eligible children.
This semi-annual report template provides a framework for describing and summarizing the outcomes for each of the reporting periods of the two-year CHIPRA Cycle III Outreach and Enrollment Grants. The reporting period for this semi-annual report is XXXX to XXXX.
This template is formatted for Microsoft Word software (doc format) and the template must be returned as a Word document. Do not send a PDF file.
Some questions provide tables for entering numbers, as well as sections for providing brief narrative answers. These questions include specific instructions for entering the data.
Narrative should be entered in the template under each question, in single-spaced, 12 point, Times New Roman font.
Word limitations are indicated for each question; 600 words equal approximately one page of single-spaced, Times New Roman font in 12 point type. The word limitations are intended as a guide. If you need to use more words to adequately describe your activities, you may do so. However, aim for both clarity and brevity when writing your narrative responses.
You may attach no more than two pages of tables, graphs or other documents that contain grant information that is not covered by the questions in the template. For example, if your grant includes more than one state, you may use the additional tables to report information on applications and enrollments for each state separately. This additional information may not substitute for the information requested n the semi-annual report template.
Focus Area 5 Grantees Only: All template questions may not apply to your project; please answer every question that applies, with particular attention to thoroughly answer Question 1. You must also answer Questions 15-21.
Send the completed report to your CMS Project Officer by XXXX.
1. What activities did you undertake during this reporting period?
Describe the progress you have made toward the milestones for this reporting period. Please take these milestones directly from the work plan in your grant application. Please note that the chart is expandable, so that you can add additional milestones, if needed.
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Status or Date Achieved (mo/day/yr) |
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Indicate any changes from the proposed schedule/timeline described in your grant application, showing the original schedule/timeline date, the revised date and provide a brief explanation of the reason for the modification. You may add additional milestones as needed.
Milestone |
Original date
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Current date
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Explanation |
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2. Grant evaluation activities
Describe any activities you have undertaken during the reporting period related to your grant evaluation. (300 words)
3. Data for identifying children eligible for CHIP/Medicaid
If you are obtaining data that you are using to identify potentially eligible uninsured children and/or children coming up for program renewal, (1) what type of data are you using, (2) how and from where are you obtaining these data, and (3) how often do you receive the data? (200 words)
Did you face any challenges obtaining these data or challenges using the data, e.g. did it include outdated information? If so, describe the challenge, the actions you took to address it and their effectiveness. (200 words)
All Focus Area 1-5 Grantees providing application assistance, please answer Questions 4 through 14. If you are a Focus Area 5 Grantee, and your organization is not providing application assistance, please indicate here with an X and skip to Question 15: .
4. How many children applied for CHIP/Medicaid as a result of your grant activities, during the reporting period?
In the table below, enter the number of children for whom an application was submitted. Report separately the number of children newly applying and those renewing. If you do not have separate data for newly applying and renewing children, then enter the combined number in the Total row.
If you are only able to report the number of applications—which can include more than one child—please indicate that with an X here: .
If reporting the numbers of applications, enter the data in the table below and explain why you are unable to provide data on the number of children. (200 words)
NUMBER OF CHILDREN FOR
WHOM |
Number |
1. Number of children for
whom a NEW CHIP/Medicaid application |
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2. Number of children for whom a RENEWAL CHIP/Medicaid application was submitted |
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3. TOTAL number of children for whom CHIP/Medicaid applications were submitted (Children with new + renewal applications) |
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Of the total number: |
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Number of children whose applications were DENIED |
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Number of children whose
applications are PENDING |
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5. Of the total number of children for whom a renewal application was submitted this reporting period:
How many children did you contact prior to their renewal date?
Of the children you contacted, how many did you personally assist with their renewal applications? Do not count children as personally assisted if you sent only a robocall, email, letter, postcard, or text message without any additional one-on-one assistance.
6. How many children were enrolled or renewed in CHIP/Medicaid as a result of your grant activities, during the reporting period?
Please enter the number of children newly enrolled and renewed during the reporting period.
If you cannot distinguish between new enrollments and renewals, enter the combined number in column C.
If you cannot distinguish between CHIP and Medicaid, enter the combined number of CHIP/Medicaid new enrollments and renewals in the TOTAL row.
If your enrollment numbers include children whose applications were pending in an earlier reporting period and who became enrolled in this reporting period, please indicate here with an X: and report the number of children:
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(Column B) |
(Column C) |
CHIP |
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Medicaid |
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TOTAL |
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7. Explanation of enrollment data
Please provide additional information, if needed, to explain your results. For example, if the number of new enrollments and renewals is much higher or lower than your expected progress toward your CMS approved goal, explain why you think this happened. (200 words)
Please describe your system for tracking applications—from the time they are submitted, through the review process, to approval or denial. Also describe how you determine the number enrolled; e.g., data obtained from the state or county, calls to the State eligibility determination office, etc. (300 words)
Please provide additional information, if needed that will help to explain the enrollment numbers for groups specifically targeted by your grant. For example, if the numbers are much higher or lower than expected, explain why you think this happened. (200 words)
8. Other outcomes
In addition to enrolling and retaining children in CHIP/Medicaid, your grant activities over the reporting period, may have resulted in other positive outcomes, such as those listed below. If so, please describe these results in the relevant section below. (400 words)
Enrollment of other populations in CHIP or Medicaid, such as pregnant women, parents, or other adults.
Enrollment of children, families, or other adults in public programs other than CHIP/ Medicaid, such as SNAP and WIC.
New outreach and enrollment policies and procedures that will be sustained after the grant ends.
Enrollment of families in the state/federal insurance exchanges through the Affordable Care Act (ACA)?
Establishment of new physical sites where families can apply for CHIP/Medicaid as a result of support through your grant. (List the number and types of sites and how often you are providing assistance at each new site).
Any other positive unplanned/ unanticipated grant outcomes?
9. Most effective strategies in the reporting period
Your most effective strategies are those that resulted in a greater number of enrollments/renewals from grant activities in your focus area. While we realize educating families with uninsured children potentially eligible for CHIP or Medicaid and raising community awareness about CHIP and Medicaid is an important strategy for Grantees, please only report those strategies that resulted in enrollments or renewals that you could verify.
Not every strategy employed has to be considered as most effective; report only on those strategies deemed most effective relative to the other strategies you used.
Answer the following questions for up to 3 strategies. Please write your answers under each question. (600 words total for each strategy.)
Describe the strategy and specify whether it was focused on new enrollments, renewals, or both.
How did you determine that this strategy was effective at enrolling and/or renewing children in CHIP/Medicaid (e.g., through a data tracking mechanism that allowed you track enrollments to the strategy)? If available, please report the percentage of new enrollments or renewals attributable to this strategy.
Was this strategy effective for the specific group(s) of children you were targeting through your focus area. For example, was it more effective with school-age children, teens, children participating in other public programs, members of specific racial or ethnic groups, or those in certain geographic areas? Please explain.
Was this strategy effective for the specific group(s) of children you were not targeting? Please explain.
What lessons did you learn about this strategy? What components of this strategy do you feel are critical to its effectiveness?
Did you modify the strategy during the reporting period to improve its effectiveness at enrolling and/or renewing children in CHIP/Medicaid ? If yes, please describe.
Can this strategy be replicated by organizations similar to yours? Please explain why or why not?
Describe the strategy and specify whether it was focused on new enrollments, renewals, or both.
How did you determine that this strategy was effective at enrolling and/or renewing children in CHIP/Medicaid (e.g., through a data tracking mechanism that allowed you track enrollments to the strategy)? If available, please report the percentage of new enrollments or renewals attributable to this strategy.
Was this strategy effective for the specific group(s) of children you were targeting through your focus area. For example, was it more effective with school-age children, teens, children participating in other public programs, members of specific racial or ethnic groups, or those in certain geographic areas? Please explain.
Was this strategy effective for the specific group(s) of children you were not targeting? Please explain.
What lessons did you learn about this strategy? What components of this strategy do you feel are critical to its effectiveness?
Did you modify the strategy during the reporting period to improve its effectiveness at enrolling and/or renewing children in CHIP/Medicaid ? If yes, please describe.
Can this strategy be replicated by organizations similar to yours? Please explain why or why not?
Describe the strategy and specify whether it was focused on new enrollments, renewals, or both.
How did you determine that this strategy was effective at enrolling and/or renewing children in CHIP/Medicaid (e.g., through a data tracking mechanism that allowed you track enrollments to the strategy)? If available, please report the percentage of new enrollments or renewals attributable to this strategy.
Was this strategy effective for the specific group(s) of children you were targeting through your focus area. For example, was it more effective with school-age children, teens, children participating in other public programs, members of specific racial or ethnic groups, or those in certain geographic areas? Please explain.
Was this strategy effective for the specific group(s) of children you were not targeting? Please explain.
What lessons did you learn about this strategy? What components of this strategy do you feel are critical to its effectiveness?
Did you modify the strategy during the reporting period to improve its effectiveness at enrolling and/or renewing children in CHIP/Medicaid ? If yes, please describe.
Can this strategy be replicated by organizations similar to yours? Please explain why or why not?
10. Least effective strategies in the reporting period
Your least effective strategies are those that resulted in a lower number of enrollments/renewals of potentially eligible children in CHIP/Medicaid from your grant activities. Not every strategy employed has to be considered as least effective; report only on those strategies deemed least effective relative to the other strategies you used. Please only report those strategies that resulted in enrollments or renewals that you could verify.
Answer the following questions for up to 3 strategies. Please write your answers under each question. (600 words total for each strategy.)
Describe the strategy and specify whether it was focused on new enrollments, renewals, or both.
Explain why this strategy was less effective than others; include any challenges or barriers to its effectiveness.
Was this strategy least effective for the specific group(s) of children you were targeting through your focus area. For example, was it less effective with school-age children, teens, children participating in other public programs, members of specific racial or ethnic groups, or those in certain geographic areas? Please explain.
Describe any modifications you made to improve this strategy’s effectiveness and whether they made a difference. If you have made no modifications and you plan to continue using this strategy in the future, what do you plan to do to improve its effectiveness?
What lessons did you learn from this strategy?
Describe the strategy and specify whether it was focused on new enrollments, renewals, or both.
Explain why this strategy was less effective than others; include any challenges or barriers to its effectiveness.
Was this strategy least effective for the specific group(s) of children you were targeting through your focus area. For example, was it less effective with school-age children, teens, children participating in other public programs, members of specific racial or ethnic groups, or those in certain geographic areas? Please explain.
Describe any modifications you made to improve this strategy’s effectiveness and whether they made a difference. If you have made no modifications and you plan to continue using this strategy in the future, what do you plan to do to improve its effectiveness?
What lessons did you learn from this strategy?
Describe the strategy and specify whether it was focused on new enrollments, renewals, or both.
Explain why this strategy was less effective than others; include any challenges or barriers to its effectiveness.
Was this strategy least effective for the specific group(s) of children you were targeting through your focus area. For example, was it less effective with school-age children, teens, children participating in other public programs, members of specific racial or ethnic groups, or those in certain geographic areas? Please explain.
Describe any modifications you made to improve this strategy’s effectiveness and whether they made a difference. If you have made no modifications and you plan to continue using this strategy in the future, what do you plan to do to improve its effectiveness?
What lessons did you learn from this strategy?
11. Based upon your experience in implementing grant activities, have you 1) discontinued a strategy, 2) implemented minor changes to improve the effectiveness of a current strategy, and/or 3) sought CMS Project Officer approval to implement a new strategy in this reporting period? If so, please explain. (200 words)
12. Describe the strategy you considered most effective at increasing awareness of CHIP/ Medicaid in your target population and describe the components of the strategy you feel are critical to its effectiveness (200 words).
13. What challenges did you face in the reporting period?
Administrative and Management Challenges
Discuss any administrative or management challenges you faced when implementing your grant—such as staff turnover—and how you dealt with them. Do not include detailed information about challenges you encountered when implementing your outreach and application assistance strategies—such as difficulty obtaining information needed to target outreach activities. This information is to be reported in the next question. (200 words)
Enrollment and Renewal Challenges in Your Focus Area
Discuss enrollment and renewal challenges you faced when implementing your grant. Enrollment and renewal challenges are those that make it difficult to reach and engage families in the application process: e.g., beliefs or attitudes people have that make them reluctant to enroll, such as stigma associated with public benefits; lack of transportation to application assistance sites; lack of awareness about CHIP/Medicaid; and complex eligibility rules and requirements that are difficult for families to understand and comply with.
Please describe no more than four enrollment and renewal challenges that you may have encountered. Consider challenges as they relate to the populations you targeted and your grant’s focus area. Describe the challenge in detail and how you addressed it. State whether you successfully dealt with the challenge and if not, describe your next steps to address the challenge.
(300 words total for each challenge)
Describe the challenge and how it creates a barrier to enrollment and/or renewal.
Describe the actions you took to address the challenge, and state whether they were effective.
Did this challenge also apply when trying to reach and engage families not targeted specifically by your grant’s focus area? Please explain.
Describe the challenge and how it creates a barrier to enrollment and/or renewal.
Describe the actions you took to address the challenge, and state whether they were effective.
Did this challenge also apply when trying to reach and engage families not targeted specifically by your grant’s focus area? Please explain.
Describe the challenge and how it creates a barrier to enrollment and/or renewal.
Describe the actions you took to address the challenge, and state whether they were effective.
Did this challenge also apply when trying to reach and engage families not targeted specifically by your grant’s focus area? Please explain.
14. Outreach and enrollment lessons learned
What are the most important lessons you have learned about how to increase new enrollments and/or renewals in CHIP/Medicaid? Do not include lessons learned about administering a grant program; please focus only on overarching lessons learned about outreach and enrollment. Do not repeat the lessons learned reported in the strategy section above. (400 words)
Lessons Learned:
Lessons Learned Specific to Your Focus Area:
If your grant is a Focus Area 1, 2, 3, or 4 grant, STOP HERE.
If
your grant is a Focus Area 5 grant,
answer the following
questions
15. Please provide an overview of the topics covered in the training curriculum.
a. Are there different versions of the training and if so, who are the intended audience(s)?
b. Please provide bullet points on:
1) the key content areas for each audience group
2) how long the training lasts
3) whether you provide follow-up or customer service to trainees and the nature of that follow-up
c. How do you provide ongoing assistance to trainees to update them on CHIP or Medicaid programmatic changes and to answer questions from trainees?
16. Data on trainings conducted this reporting period
In the table below, enter the number of trainings conducted, the number of individuals trained, and the number and type of organizations represented by the trainees. You may add more rows to the table as needed to describe the types of organizations.
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Number |
Number of Training Sessions Conducted |
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Number of Individuals Trained |
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Number of Organizations Represented by the Trainees |
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List the types of organizations represented and the corresponding number (e.g., primary care clinic – 15) |
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Type: |
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Type: |
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Type: |
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17. What challenges have you experienced recruiting trainees? You can list up to 3 challenges. Describe the challenge, the actions you took to address the challenge, and state whether the actions were effective.
Challenge 1:
Challenge 2:
Challenge 3:
18. What challenges have you experienced implementing the training curriculum? You can list up to 3 challenges. Describe the challenge, the actions you took to address the challenge, and state whether the actions were effective.
Challenge 1:
Challenge 2:
Challenge 3:
19. What are the most important lessons you have learned about recruiting trainees and implementing the training curriculum? You can list up to 3 lessons learned.
Lesson Learned 1:
Lesson Learned 2:
Lesson Learned 3:
20. Have you evaluated the effectiveness of the training curriculum this reporting period? If so, how did you evaluate it (e.g., focus groups with trainees, pre/post surveys, etc.)? What were the results of the performance measures of your evaluation (e.g., increase in trainee’s knowledge of CHIP/Medicaid procedures)?
21. Given your experience implementing the training curriculum, what changes, if any, have you made in this reporting period to your trainee recruitment strategies and/or to your training curriculum? For example, have you discontinued a certain recruitment strategy or have you changed the content of the curriculum?
PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1148. The time required to complete this information collection is estimated to average 20 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
| File Type | application/msword |
| Author | kfarrell |
| Last Modified By | FALECIA SMITH |
| File Modified | 2014-03-07 |
| File Created | 2014-03-07 |