Form CMS-10398 #7 CMS-10398 #7 HEALTHY KIDS Cycle Va: Semi-Annual Report Template (qual

OMB Control Number CMS-XXXX, OMB XXXX-XXXX

Connecting Kids to Coverage
Outreach and Enrollment
Semi-Annual Report Template

Project Title:

Funding Opportunity:

Reporting Period:

Report Due Date:

Cooperative Agreement Number: Start typing here.

State: Start typing here.

Name of Awardee: Start typing here.

Name and Title of Person Completing Report: Start typing here.

Authentication

I certify the accuracy of all report content:

Type name in lieu of signature Enter date

Authorized Certifying Official (typed name in lieu of signature; add date)

CMS Project Officer Acknowledgement & Acceptance

I acknowledge and accept the content of this report:

Type name in lieu of signature Enter date

CMS Project Officer (type name in lieu of signature; add date)

Reporting Requirements

Use this semi-annual report template to describe the progress of your Connecting Kids to Coverage Healthy Kids Outreach and Enrollment grant.

The reporting period for this semi-annual report is ___________. All information reported must be the result of project activities during this reporting period.

This semi-annual report must be submitted to CMS through Grantsolutions.gov, as described in the special terms and conditions of your cooperative agreement.

This template is formatted for Microsoft Word software (.docx format), and the template must be returned as a Word document. Please do not submit a PDF file.

• Narrative should be entered in the template under each question, in single-spaced, 12-point, Times New Roman font. Length guidelines are indicated for each question; 600 words are equal to approximately one page of single-spaced, Times New Roman 12-point type. Please aim for clarity when writing your narrative responses.

• You may attach up to two pages of additional narrative, tables, graphs, or other documents that contain project information that is not covered by the questions in the template.

Upload the completed report into Grantsolutions.gov for review by your CMS Project Officer by ___________.

PRA Disclosure Statement This information is being collected to assist the Centers for Medicare & Medicaid Services (CMS) with the data needed to reflect the aggregate goals and accomplishments for this cooperative agreement program. This mandatory information collection (42 U.S.C. 1396a) will be used to demonstrate the outcomes that result directly from this funding opportunity, and will also be used to help evaluate the success of outreach and enrollment strategies and identify areas that need improvement or mid-course corrections. This request does not collect personally identifiable information. Consequently, the Privacy Act of 1974 does not apply. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid Office of Management and Budget (OMB) control number. The valid OMB control number for this information collection is 0938-1148 (CMS-10398 #7). Public burden for all of the collection of information requirements under this control number is estimated to range from 16 to 20 hours per response, including the time reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to CMS, 7500 Security Boulevard, Attn: Paperwork Reduction Act Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

1. What activities were performed with CKC funding during this reporting period?

1a. Please list the milestones from the work plan in your project application. Describe activities that demonstrate progress towards each milestone as long as they were covered by CKC funding. For example, you might describe any activities, trainings, or new community partnerships under this award that contribute to the goals of reaching your target population of uninsured, but eligible children (and parents, if relevant). (400 words)

Milestone	Activities Demonstrating Progress	Date Milestone Was Achieved (or status update, if milestone not yet achieved)
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1b. Which of these activities were undertaken in collaboration with the National Connecting Kids to Coverage Campaign, including the Back to School or Post-Open Enrollment initiatives? Please explain what your collaboration with the National Campaign involved. (200 words)

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1c. Indicate any changes from the proposed schedule or timeline described in your project application, showing the original schedule or timeline date and the revised date; briefly explain the reason for the modification. You may add milestones as needed.

Milestone	Original Date	Expected Date	Explanation
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2. Identifying children who are potentially eligible for CHIP and Medicaid

2a. How did your organization go about identifying potentially eligible children to help with enrollment or renewal? If you continued strategies that you have described in previous reports without change, please indicate that in the space below.

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2b. If you used any data-driven strategies to find potentially eligible children, please list the data sources you used and explain how you used these sources. Please indicate any challenges you encountered, if any, in obtaining or using the data. If you have already described strategies in your previous reports, please only describe any changes you have made in the way you identify potentially eligible children. (Total of 300 words per source)

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ENROLLMENT AND RENEWAL DATA EXPLANATIONS AND OTHER OUTCOMES

3. Explanation of enrollment and renewal data

3a. 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 verify the number of children and parents (as applicable) enrolled and renewed as a direct result of CKC funding (e.g., data obtained from the state or county, calls to the state eligibility determination office). (300 words)

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3b. Please provide any additional information to explain the results in the monthly reports you submit. 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)

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3c. If the number of new applications, enrollments, and/or renewals reported in your monthly reports is lower than expected (either overall or within your target population), how do you plan to overcome the challenges you identified? (300 words)

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4. Outcomes other than enrollments and renewals in Medicaid, CHIP, and insurance affordability programs

Your CKC project activities over the reporting period may have resulted in other positive outcomes besides enrolling and retaining children in CHIP and Medicaid, and enrolling and retaining parents in insurance affordability programs. If so, please describe these results in the relevant section below. (400 words total)

4a. Enrollment of children, their families, or other adults in human services public programs such as the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

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4b. New outreach and enrollment policies and procedures that may be sustained after the CKC project ends.

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4c. Enrollment of children in Qualified Health Plans offered through the state/federal Marketplaces.

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4d. Establishment of new physical sites where families can apply for CHIP, Medicaid, or other insurance affordability programs as a result of support through your project. (List the number and types of sites and how often you are providing assistance at each new site.)

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4e. Any other positive unplanned or unanticipated outcomes as a direct result of your CKC funding.

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STRATEGIES

5. Strategies to educate families and increase awareness

Describe the strategy you considered most effective in increasing awareness of CHIP and Medicaid in your target population. What were the critical components of the strategy? What evidence supports your conclusion that the strategy works? Please be specific. (200 words)

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6. Most effective enrollment and renewal strategies

Your most effective strategies are those that, relative to others, resulted in more enrollments and renewals from the CKC project activities among your target population in the reporting period.

Answer the following questions for up to two of your most effective strategies. Please write your answers under each question. (600 words total for each strategy)

Strategy 1

1. Describe the your most effective strategy and specify whether it focused on new enrollments, renewals, or both.

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1. What evidence supports your conclusion that this strategy was effective in enrolling and/or renewing children in CHIP and Medicaid (e.g., through a data-tracking mechanism that allowed you to track enrollments to the strategy)? If available, please report the percentage of your numbers of new enrollments and renewals in this reporting period attributable to this strategy.

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3. Was this strategy effective for the specific group(s) of children you were targeting? For example, was it more effective with school-aged children or with teens? Please explain.

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4. What components of this strategy do you feel are critical to its effectiveness? Why is this particular strategy effective?

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5. Did you change the strategy during the reporting period to improve its effectiveness in enrolling and/or renewing children in CHIP and Medicaid? If yes, please describe the changes.

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6. Can this strategy be replicated by organizations similar to yours? Please explain why or why not and note any special circumstances needed for replication.

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Strategy 2

1. Describe your second most effective strategy and specify whether it focused on new enrollments, renewals, or both.

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2. What evidence supports your conclusion that this strategy was effective in enrolling and/or renewing children in CHIP and Medicaid (e.g., through a data-tracking mechanism that allowed you to track enrollments to the strategy)? If available, please report the percentage of your numbers of new enrollments and renewals in this reporting period attributable to this strategy.

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3. Was this strategy effective for the specific group(s) of children you were targeting? For example, was it more effective with school-aged children or with teens? Please explain.

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4. What components of this strategy do you feel are critical to its effectiveness? Why is this particular strategy effective?

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5. Did you change the strategy during the reporting period to improve its effectiveness in enrolling and/or renewing children in CHIP and Medicaid? If yes, please describe the changes.

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6. Can this strategy be replicated by organizations similar to yours? Please explain why or why not and note any special circumstances needed for replication.

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7. Least effective enrollment and renewal strategies

Your least effective strategies are those that resulted in fewer enrollments and renewals of potentially eligible children relative to other strategies you used in the reporting period.

Answer the following questions for up to two of your least effective strategies. Please write your answers under each question. (600 words total for each strategy)

Strategy 1

1. Describe your least effective strategy and specify whether it focused on new enrollments, renewals, or both.

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2. Explain why this strategy was less effective than others, including evidence that supports your conclusion.

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3. Was this strategy least effective for the specific group(s) of children you were targeting? For example, was it less effective with teens or with younger children? Please explain.

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4. Describe any changes you made to improve this strategy’s effectiveness and whether they made a difference. If you have made no changes and you plan to continue using this strategy in the future, what do you plan to do to improve its effectiveness?

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5. What lessons did you learn from this strategy?

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Strategy 2

1. Describe your second least effective strategy and specify whether it focused on new enrollments, renewals, or both.

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2. Explain why this strategy was less effective than others; including evidence that supports your conclusion.

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3. Was this strategy least effective for the specific group(s) of children you were targeting? For example, was it less effective with school-aged children or with teens? Please explain.

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4. Describe any changes you made to improve this strategy’s effectiveness and whether they made a difference. If you have made no changes and you plan to continue using this strategy in the future, what do you plan to do to improve its effectiveness?

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5. What lessons did you learn from this strategy?

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8. DISCONTINUED AND NEW STRATEGIES

8a. Have you discontinued a strategy in this reporting period? If so, please explain. (150 words)

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8b. Have you sought approval from the CMS Project Officer to implement a new strategy in this reporting period? If so, please explain. (150 words)

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CHALLENGES AND LESSONS

9. What challenges did you face in the reporting period?

9a. Administrative and management challenges

Discuss any administrative or management challenges you faced when implementing your CKC project and how you dealt with them. These may include, for example, staff turnover, insufficient staff or lack of staff with the right skills, competing demands on project leadership, and so forth. (200 words)

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9b. Enrollment and renewal challenges

Discuss the two most difficult enrollment and renewal challenges you faced when implementing your CKC project. These may include, for example, beliefs or attitudes that make people reluctant to enroll, such as stigma associated with public benefits; lack of transportation to application assistance sites; lack of awareness about CHIP and Medicaid; or complex eligibility rules and requirements that are difficult for families to understand and comply with. Consider challenges as they relate to the populations you targeted for enrollment.

Answer the following questions for up to two of your most difficult challenges in increasing the percentage of eligible children enrolled in CHIP and Medicaid. Please write your answers under each question. (300 words total for each challenge)

Challenge 1

1. Describe your biggest challenge in increasing the percentage of eligible children enrolled in CHIP and Medicaid in your state. How did this create a barrier to enrollment and/or renewal?

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2. Describe the actions you took to address the challenge, and explain whether they were effective.

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3. Have you overcome the challenge? If not, what are your next steps to do so?

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Challenge 2

1. Describe your second biggest challenge in increasing the percentage of eligible children enrolled in CHIP and Medicaid in your state. How did this create a barrier to enrollment and/or renewal?

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2. Describe the actions you took to address the challenge, and explain whether they were effective.

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3. Have you overcome the challenge? If not, what are your next steps to do so?

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10. Outreach and enrollment lessons

What are the most important lessons you would share with peers about how to increase new enrollments and/or renewals in CHIP and Medicaid? (400 words)

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Technical Assistance

11. Technical assistance needs and preferences

11a. What technical assistance topics would be most useful to your project in the next six months? Check all that apply.

Using data to identify potentially eligible children and parents

Using eligibility and enrollment data to track progress

Establishing memoranda of understanding (MOUs) with states

School-based strategies

Communications strategies

Effective messaging

Including culture in our messaging

Selecting the best media to disseminate our messages

Using social media effectively

Engaging hard-to-reach populations

Teens

Latino/Hispanic families

American Indian/Alaska Native families

Families in rural areas

Immigrant families

Medicaid and CHIP eligibility, enrollment, and renewal policies

Other topics—please specify:

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11b. What forms of technical assistance would be most useful to your project in the next six months? Check all that apply.

Receiving issue briefs or tool kits, and other resources in the interest areas I checked above.

Access to a bibliography with hyperlinks so I can find resources that interest me.

Webinar presentations

Presentations by peers

Facilitated discussions with small groups of peers

Newsletter-style updates on the successes and challenges of peers

Help desk to answer specific questions

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