HK2022NOFO_Final_012622_v2_020922.pdf

Applicable Dates:

U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services

Center for Medicaid and CHIP Services

Connecting Kids to Coverage HEALTHY KIDS 2022 Outreach and Enrollment Cooperative Agreements

Notice of Funding Opportunity Type: New

Funding Opportunity Award Type: Cooperative Agreement

Notice of Funding Opportunity Number: CMS-2Y2-22-001

Federal Assistance Listings Number (CFDA): 93.767

Notice of Funding Opportunity Posting Date: January 27, 2022

Letter of Intent to Apply Due Date: N/A

Electronic Application Due Date: March 28, 2022, 3:00 pm Eastern Standard Time

Anticipated Issuance Notice(s) of Award: July 1, 2022

Anticipated Period of Performance: July 1, 2022 – June 30, 2025

Table of Contents Executive Summary

A. Program Description

A1. Purpose

A2. Authority

A3. Background

A4. Program Requirements

B. Federal Award Information

B1. Total Funding

B2. Award Amount

B3. Anticipated Award Dates

B4. Period of Performance

B5. Number of Awards

B6. Type of Award

B7. Type of Competition

C. Eligibility Information

C1. Eligible Applicants

C2. Cost Sharing or Matching

C3. Letter of Intent

C4. Ineligibility Criteria

C5. Single Application Requirement

C6. Continued Eligibility

C7. EIN, DUNS, and SAM Regulations

C8. Faith-Based Organizations

C9. Other Eligibility Requirements

D. Application and Submission Information

D1. Address to Request Application Package

D2. Content and Form of Application Submission

a. Application format

b. Standard forms

c. Application cover letter or cover page (optional)

d. Project Narrative

e. Data Collection and Reporting Plan

f. Work Plan and Timeline

g. Budget Narrative

h. Evaluation Plan

i. Staffing Plan

j. Business assessment of applicant organization (maximum 12 pages)

D3. Unique Entity Identifier and System for Award Management (SAM)

D4. Submission Dates and Times

D5. Intergovernmental Review

D6. Cost Restrictions

D7. Mandatory Disclosure

E. Application Review Information

E1. Criteria

E2. Review and Selection Process

E3. Federal Awardee Performance Integrity Information System (FAPIIS)

F. Federal Award Administration Information

F1. Federal Award Notices

F2. Administrative and National Policy Requirements

F3. Terms and Conditions

F4. Cooperative Agreement Terms and Conditions of Award

F5. Reporting

G. CMS Contacts

G1. Programmatic Questions

G2. Administrative/Budget Questions

H. Other Information

Appendix I. Guidance for Preparing a Budget Request and Narrative

Appendix II. Application and Submission Information

Appendix III. Business Assessment of Applicant Organization

Appendix IV: Accessibility Requirements

Appendix V. Review and Selection Process

Appendix VI. Application Check-Off List

Appendix VII. Outreach Activities to Consider

Appendix VIII. Using Parents of Medicaid or CHIP enrolled Children as Mentors to Parents of Uninsured Children

Appendix IX. Definitions of Frequently Used Terms

Executive Summary

The Connecting Kids to Coverage HEALTHY KIDS 2022 Outreach and Enrollment Cooperative Agreements program provides funding opportunities to reduce the number of children who are eligible for, but not enrolled in, Medicaid and the Children’s Health Insurance Program (CHIP), and to improve retention of eligible children who are enrolled in the programs. This program is authorized under Section 2113 of the Social Security Act, as amended by Section 3004(a) of the Helping Ensure Access for Little Ones, Toddlers and Hopeful Youth by Keeping Insurance Delivery Stable Act (referred to as the HEALTHY KIDS Act and included in Pub. L. 115-120).

Section 50103 of the Advancing Chronic Care, Extenders, and Social Services Act (referred to as the ACCESS Act and included in Pub. L. 115-123) further extended the program, providing funding for future cooperative agreement awards.

Item Description

HHS Awarding Agency Centers for Medicare & Medicaid Services (CMS)

CMS Awarding Center Center for Medicaid & CHIP Services (CMCS)

Notice of Funding Opportunity Title

Connecting Kids to Coverage HEALTHY KIDS 2022 Outreach and Enrollment Cooperative Agreements

Authorization Section 3004(a) of the Helping Ensure Access for Little Ones, Toddlers and Hopeful Youth by Keeping Insurance Delivery Stable Act (referred to as the HEALTHY KIDS Act and included in Pub. L. 115-120)

Federal Assistance Listings Number

93.767

Funding Opportunity Type

Cooperative Agreement

Funding Opportunity Number

CMS-2Y2-22-001

Type of Award New

Type of Competition Competitive - Open to All Eligible Applicants as described in Section 2113(f)(1) of the Social Security Act

Letter of Intent N/A

Application Due Date and Time

March 28, 2022 by 3:00 pm EST (Baltimore, MD)

Anticipated Issuance Notice(s) of Award

July 1, 2022

Period of Performance Start Date

July 1, 2022

Period of Performance End Date

June 30, 2025

Anticipated Total Available Funding

$49,400,000 (pending availability of funds)

Estimated Maximum Award Amount

$1,500,000

Estimated Maximum Number of Awardees

A. Program Description

This Notice of Funding Opportunity (NOFO) seeks applications for the Connecting Kids to Coverage HEALTHY KIDS 2022 Outreach and Enrollment Cooperative Agreement grant funding (HEALTHY KIDS 2022 Cooperative Agreements). These HEALTHY KIDS 2022 Cooperative Agreements will support outreach strategies similar to those conducted in previous Connecting Kids to Coverage (CKC) grant cycles, and will require participation in key outreach initiatives coordinated by the CKC National Campaign (the National Campaign).

The National Campaign, led by CMS, provides outreach training and support for grantees and other partners who are working to help enroll eligible children in Medicaid and CHIP.

A1. Purpose

The HEALTHY KIDS Act provides $120 million for activities aimed at reducing the number of children who are eligible for, but not enrolled in, Medicaid and CHIP, and improving retention of enrolled children. Of the total $120 million in funding, 10 percent is allocated for outreach to American Indian/Alaska Native (AI/AN) children, 10 percent is allocated for the National Campaign, and the remainder is allocated for outreach and enrollment of uninsured children and their parents. We have awarded $54 million in HEALTHY KIDS Act funding through two rounds of funding to eligible organizations: $48 million in 2019 for outreach and enrollment grants targeting all uninsured children and their parents; and $6 million in 2020 for outreach and enrollment grants targeting AI/AN children and their parents.1

This specific NOFO makes available up to an additional $49.4 million (pending availability of funds) in HEALTHY KIDS Act funding to states, local governments, Indian tribes, tribal consortium, urban Indian organizations receiving funds under Title V of the Indian Health Care Improvement Act, federal health safety net organizations, community-based organizations, faith-based organizations, and schools. The list of eligible entities is located in section C1. Eligible Applicants, of this NOFO.

The HEALTHY KIDS Act funding for outreach and enrollment grants will build upon successful strategies facilitated by previous CKC grant funding initiatives under the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 (Pub. L. 111-3), the Patient Protection and Affordable Care Act (ACA) of 2010 (Pub. L. 111-148), and the Medicare Access and CHIP Reauthorization Act (MACRA) (Pub. L. 114-10). To date, CHIPRA, the ACA, MACRA, and the HEALTHY KIDS Act provided the Centers for Medicare and Medicaid Services (CMS) with funding to award $216 million to eligible entities to support the enrollment and retention of eligible children in Medicaid and CHIP. This funding has been disbursed through five cycles of grants that were broadly targeted to eligible but unenrolled children, and four rounds of grants that were specifically targeted to AI/AN children.

Since 2009, enrollment grants have been awarded to over 294 community-based organizations, states, and local governments. Community-based organization awardees have included health care providers, schools, tribal organizations, faith-based organizations, and other types of nonprofits. Community-based organizations typically have access to and credibility with low-income families in their communities, making them indispensable partners for carrying out specialized strategies to target the hard-to-reach children who remain uninsured. State and local government agencies also play a critical role in helping to identify and enroll children.

They are in a strong position to partner with other local and state-run health and human services programs and agencies such as Supplemental Nutrition Assistance Program (SNAP), child care agencies, and Women, Infants, and Children (WIC) to identify uninsured children and enroll them in coverage.

Past recipients have implemented a variety of outreach and enrollment strategies aimed at educating families about the availability of Medicaid and CHIP, identifying children likely to be eligible for these programs, and directly assisting families with the application and renewal process. For example, during the COVID-19 public health emergency (PHE), recipients used virtual outreach and enrollment strategies to provide one-on-one direct assistance to families, and worked closely with partners, often leveraging partners’ services and social media platforms and websites, community relationships, and other resources to reach more children and families.

Recipients also participated in key initiatives coordinated by the National Campaign, such as back-to-school outreach efforts, annual Marketplace open enrollment, and PHE special initiatives focusing on highlighting Medicaid and CHIP’s coverage of mental and behavioral health services and encouraging families to catch up on missed care and vaccinations.2

1 https://www.insurekidsnow.gov/campaign-information/outreach-enrollment-grants/index.html 2 https://www.insurekidsnow.gov/initiatives/index.html https://www.insurekidsnow.gov/campaign-information/outreach-enrollment-grants/index.html https://www.insurekidsnow.gov/initiatives/index.html

A2. Authority

The HEALTHY KIDS Act provides funding for grants through federal fiscal year (FFY) 2023 per Section 3004(a) of the Helping Ensure Access for Little Ones, Toddlers and Hopeful Youth by Keeping Insurance Delivery Stable Act (referred to as the HEALTHY KIDS Act and included in Pub. L. 115-120). The ACCESS Act subsequently extended funding for an additional four years through FFY 2027 in Section 50103 of the Advancing C hronic Care, Extenders, and Social Services Act (referred to as the ACCESS Act and included in Pub. L.

115-123).

A3. Background

Since 2009, the nation has made substantial progress on reducing the number of uninsured children and enrolling eligible children in Medicaid and CHIP largely as a result of CHIPRA and the ACA. Eligibility expansions, and streamlining verification, enrollment and renewal policies and procedures have helped to promote the coverage and retention of eligible individuals in Medicaid and CHIP. In 2016, 93.7 percent of eligible children were enrolled in Medicaid or CHIP nationwide, the highest rate observed since researchers began tracking participation in 2008.4

However, a recent analysis of Medicaid and CHIP enrollment data found that while the rate of uninsured children fell to an all-time low of 4.3 percent in 2016, the uninsured rate increased to

5.2 percent in 20195. This is an increase from 3.4 million uninsured children in 2016 to 4.0 million uninsured children in 2019.

Since 2016, applicants have been encouraged to include parents in outreach and enrollment efforts because a large body of research suggests this is effective in increasing children’s enrollment and access to care.

In this NOFO, we add pregnant individuals as an optional target population. Expanding to include this population will directly lead to increasing the enrollment of eligible children in Medicaid and CHIP because generally the infants born to individuals who are enrolled in these programs at the time of the birth are automatically deemed eligible for Medicaid or CHIP for one year, without an application or further determination of eligibility. In addition, increasing enrollment of eligible pregnant individuals in Medicaid and CHIP promotes improved maternal and infant health outcomes.3

3 https://www.medicaid.gov/medicaid/quality-of-care/downloads/mih-expert-workgroup-recommendations.pdf 4 Haley, Jennifer, Genevieve M. Kenney, Robin Wang, Clare Pan, Victoria Lynch, and Matthew Buettgens. “Uninsurance and Medicaid/CHIP Participation Among Children and Parents: Variation in 2016 and Recent Trends.” Washington, DC: Urban Institute, September 2018. Available https://www.urban.org/sites/default/files/publication/99058/uninsurance_and_medicaidchip_participation_among_children_and_parents_updated _1.pdf. Accessed May 18, 2021.

5 https://www.urban.org/research/publication/uninsurance-rose-among-children-and-parents-2019/view/full_report.

https://www.medicaid.gov/medicaid/quality-of-care/downloads/mih-expert-workgroup-recommendations.pdf https://www.urban.org/sites/default/files/publication/99058/uninsurance_and_medicaidchip_participation_among_children_and_parents_updated_1.pdf https://www.urban.org/sites/default/files/publication/99058/uninsurance_and_medicaidchip_participation_among_children_and_parents_updated_1.pdf https://www.urban.org/research/publication/uninsurance-rose-among-children-and-parents-2019/view/full_report

In addition to the increase in the percentage of uninsured children, Medicaid and CHIP participation rates have declined, indicating that a greater proportion of eligible children are not accessing the health benefits that Medicaid and CHIP provide. The Urban Institute, which tracks Medicaid and CHIP participation rates, found that participation in Medicaid and CHIP decreased from 2016 to 2019, after a long trend of participation rate increases. This means that a smaller percentage of eligible children were enrolled in Medicaid and CHIP in 2019 compared to 2016. In 2019, 91.9 percent of eligible children were enrolled in Medicaid and CHIP, compared to 93.4 percent in 2016. The researchers noted that in particular, the drop in participation from 2018 to 2019 was the largest annual drop in Medicaid and CHIP participation since the American Community Survey started collecting health care coverage data.

The Urban Institute analysis shows that there are approximately 4.0 million children that remain uninsured, with significant coverage disparities across demographic and socioeconomic groups.

For example, among those uninsured, an estimated 2.3 million children are eligible for Medicaid and CHIP. AI/AN children continue to experience the highest uninsured rate at 11.8 percent, followed by Hispanic children with a rate of 11.4 percent uninsured and Black/non-Hispanic children with a rate of 5.9 percent uninsured. The Urban Institute analysis shows that more than a third of Medicaid and CHIP-eligible uninsured children in 2019 lived in just three large states:

Texas, California and Florida. Half of eligible but unenrolled children lived in just seven states, with Georgia, Illinois, Indiana, and Arizona rounding out the list of states with a high number of

6such children. These data demonstrate there is more that needs to be done to ensure that children have the health coverage they need and to remain covered, and that disparities in uninsurance are addressed.

As a result of the COVID-19 PHE, Medicaid and CHIP enrollment steadily increased during the latter half of 2020 to record highs in 2021. In June 2021, Medicaid and CHIP enrollment totaled

83.2 million individuals, including over 39 million children.7 That is more than 1 in every 2 children in America and represents approximately 48.3 percent of total Medicaid and CHIP enrollment. These enrollment statistics highlight the essential role that Medicaid and CHIP programs play in providing quality and needed coverage for millions of vulnerable children.

The increase in enrollment is largely attributed to the COVID-19 economic crisis and the enactment of section 6008 of the Families First Coronavirus Response Act (FFCRA), which makes available to states a temporary 6.2 percentage point Federal Medical Assistance Percentage (FMAP) bump that includes a requirement to maintain Medicaid enrollment. In order to receive the temporary FMAP increase, states must generally provide continuous enrollment, through the end of the month in which the public health emergency period ends, to all Medicaid beneficiaries who were validly enrolled in Medicaid on or after March 18, 2020, regardless of any changes in circumstances or redeterminations at scheduled renewals that otherwise would result in termination. Further, to assist states and territories in their response to COVID-19, CMS

6 https://www.urban.org/research/publication/uninsurance-rose-among-children-and-parents-2019/view/full_report.

7 https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html https://www.urban.org/research/publication/uninsurance-rose-among-children-and-parents-2019/view/full_report https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html developed numerous strategies to support Medicaid and CHIP operations and enrollees in times of crisis, including granting states more flexibility in their Medicaid and CHIP operations. Given the importance of Medicaid and CHIP coverage during a PHE, many of these flexibilities and policy options expedite enrollment and further retention (i.e., presumptive eligibility, continuous eligibility, waiving premiums and cost sharing, using regulatory authority to apply exceptions to the timeliness standards for application and renewal processing, etc.).8

As states start to prepare and eventually transition back to normal operations when the PHE ends, ensuring that eligible children retain Medicaid and CHIP coverage is critical. Due to disruptions to state operations during the COVID-19 PHE and the continuous enrollment requirement under section 6008 of the FFCRA, states will be faced with a large number of eligibility and enrollment actions (including renewals, redeterminations, and post-enrollment verifications), which they will need to complete after the PHE ends. CMS has issued guidance to states regarding how to address the large volume of pending eligibility and enrollment actions they will need to take after the PHE ends and how to minimize beneficiary burden.9

States are reminded about federal requirements and expectations codified in existing regulations at 42 C.F.R. §435.916 and §457.343 for completing Medicaid and CHIP redeterminations that are intended to ease administrative burden by using a data-driven redetermination process to limit requests for information needed to determine eligibility, ensure beneficiary eligibility is assessed on all bases before determining an individual is ineligible, promote seamless transitions of coverage, and minimize the churn of beneficiaries on and off Medicaid and CHIP coverage for procedural reasons.10 Nevertheless, resuming to normal operations when the PHE ends is likely to be labor-intensive and it will be essential for states and other stakeholders to work in partnership to conduct outreach and provide assistance to beneficiaries needing to renew coverage and to applicants that may have been inappropriately terminated and need help to re-apply.

Since 2009, CKC recipients have played an essential role in providing enrollment and renewal assistance to applicants and beneficiaries. This is because families and individuals seek such help from organizations (i.e., health care providers, their child’s school, familiar community-based organizations, and faith-based groups) they know and trust to navigate these processes. In addition, state and local government agencies, also eligible entities under this funding opportunity, play a critical role in helping to identify, enroll, and retain eligible children.

Government agencies are in a strong position to partner with other local and state-run health and human service programs and agencies such as SNAP, child care, and WIC to identify uninsured children and enroll them in coverage. Government agencies also have relationships with local communities that can be leveraged to support outreach and enrollment efforts.

8 A full list of the flexibilities CMS made available to help states and territories in their response to the COVID-19 PHE is available at:

https://www.medicaid.gov/state-resource-center/downloads/strategies-for-covrg-of-indiv.pdf 9 See SHO # 21-002. Updated Guidance Related to Planning for Resumption of Normal State Medicaid, Children’s Health Insurance Program (CHIP), and Basic Health Program (BHP) Operations Upon Conclusion of the COVID-19 Public Health Emergency. Available at:

https://www.medicaid.gov/sites/default/files/2021-08/sho-21-002.pdf.

See SHO # 20-004. Planning for the Resumption of Normal State Medicaid, Children’s Health Insurance Program (CHIP), and Basic Health Program (BHP) Operations Upon Conclusion of the COVID-19 Public Health Emergency. Section III. P. 9; Section IV., pp 14 -15; Appendix B: Table B-1, p. 40. Available at: https://www.medicaid.gov/sites/default/files/2020-12/sho20004.pdf 10 https://www.medicaid.gov/federal-policy-guidance/downloads/sho-21-002.pdf https://www.medicaid.gov/state-resource-center/downloads/strategies-for-covrg-of-indiv.pdf https://www.medicaid.gov/sites/default/files/2021-08/sho-21-002.pdf https://www.medicaid.gov/sites/default/files/2020-12/sho20004.pdf https://www.medicaid.gov/federal-policy-guidance/downloads/sho-21-002.pdf

Thus, the services of CKC recipients remain fundamental to enrolling and retaining eligible children in Medicaid and CHIP, and targeting the hardest to reach uninsured children to reduce coverage disparities. Given the increased need for consumer assistance with applying and especially renewing coverage post-PHE, CKC recipients will play a critical role in minimizing coverage gaps, and consistent with a 2021 Executive Order on Strengthening Medicaid and the Affordable Care Act, supporting the overarching goal to make healthcare accessible and affordable for every American.11

A4. Program Requirements

Planning Period All awardees will be given a 90-day planning period to ensure that needed project leadership is engaged and the identified employees are fully trained and available to work on the cooperative agreement. CMS will allow recipients to use grant funds to employ individuals and begin operations during this time.

CMS may waive or reduce the 90-day planning period if the awardee’s outreach and enrollment efforts, as specified in this funding opportunity, and as detailed in the recipient’s approved application, are well established with all project leadership, staffing, and support already in place.

Special Considerations for Applicants that Represent Collaborative Efforts Applicants that are collaboratives, and will use the strengths of each participating group, should identify all member organizations and the roles and responsibilities of each under the cooperative agreement. Proposals must designate a lead agency or organization that will serve as the recipient organization. Proposals from collaboratives will be considered on their strengths and merits in the same manner as proposals from individual states or other entities. Proposals must include a Letter of Commitment from the director (or other responsible person) of each organization participating in the collaborative as a subrecipient. The letter must confirm the organization’s participation in the collaborative and the role it will play. Alternatively, applicants may include one Statement of Collaborative Effort (SCE) which lists each partner organization, the role each will play and the signature of the director of each organization (or other responsible person). Where applicable, Letters of Commitment or the SCE must provide information about past joint endeavors.

Please see Appendix IX. Definitions of Frequently Used Terms for definitions on recipient, subrecipient, and subaward. Recipient should also review 45 CFR 75.351 Subrecipient and Contractor determinations (https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part- 75#75.351) to ensure recipient accurately classifies the type of relationship between the recipient and each organization participating in the collaborative as well as

11 https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/28/executive-order-on-strengthening-medicaid-and-the-affordable-care-act/?_hsmi=117826243&_hsenc=p2ANqtz-nIzZgS3k9TdAOcodfoMwCEvTjOAouqqYahqRn0R1VSiS3DHFwkf4jMo5I63ypj6u35JfQjj98yGtXYvlLw0mIEzDa8w https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75#75.351 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75#75.351 https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/28/executive-order-on-strengthening-medicaid-and-the-affordable-care-act/?_hsmi=117826243&_hsenc=p2ANqtz-nIzZgS3k9TdAOcodfoMwCEvTjOAouqqYahqRn0R1VSiS3DHFwkf4jMo5I63ypj6u35JfQjj98yGtXYvlLw0mIEzDa8w https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/28/executive-order-on-strengthening-medicaid-and-the-affordable-care-act/?_hsmi=117826243&_hsenc=p2ANqtz-nIzZgS3k9TdAOcodfoMwCEvTjOAouqqYahqRn0R1VSiS3DHFwkf4jMo5I63ypj6u35JfQjj98yGtXYvlLw0mIEzDa8w https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/28/executive-order-on-strengthening-medicaid-and-the-affordable-care-act/?_hsmi=117826243&_hsenc=p2ANqtz-nIzZgS3k9TdAOcodfoMwCEvTjOAouqqYahqRn0R1VSiS3DHFwkf4jMo5I63ypj6u35JfQjj98yGtXYvlLw0mIEzDa8w

45 CFR 75.352 Requirements for pass-through entities (https://www.ecfr.gov/current/title- 45/subtitle-A/subchapter-A/part-75#75.352) for requirements in issuing subawards to these organizations.

Project Activities Cooperative Agreements will fund activities/strategies aimed at educating families about the availability of free or low-cost health coverage under Medicaid and CHIP, identifying children likely to be eligible for these programs, and assisting families, including parents and pregnant individuals, to apply for coverage. Funds will also support efforts to assist families with the annual renewal process.

Applicants are encouraged to consider any of the following outreach strategies (See Appendix VII for more information):

• Engaging schools and other programs serving young people in outreach, enrollment and retention activities;

• Bridging racial and demographic health coverage disparities by targeting subgroups of children with lower than average health coverage rates (e.g. adolescents, Latino, AI/AN or children in rural areas);

• Establishing and developing application assistance resources to provide high quality, reliable Medicaid/CHIP enrollment and renewal services in local communities;

• Using social media to conduct virtual outreach and enrollment assistance; and

• Using parent mentors and community health workers to assist families with enrolling in Medicaid and CHIP, retaining coverage and finding resources for addressing social determinants of health.

Recipients will be required to participate in National Campaign activities and adopt strategies promoted by the National Campaign. The National Campaign provides a full range of outreach and enrollment materials including customizable posters and flyers, social media messaging, as well as radio and TV public service announcements, videos featuring successful outreach strategies, and outreach strategy and social media guides for award recipients, states, and stakeholders that suggest effective ways to use the materials. Most materials are available in English and Spanish, and some are available in other languages as well. The National Campaign regularly conducts training webinars on key outreach and enrollment topics and also augments media outreach in selected target markets. We especially encourage applicants to reference “Outreach and Enrollment Fundamentals: How Can My Organization Connect Children to Coverage? A Guide to Fundamentals and Promising Practices.” All materials produced by the National Campaign, including recordings of all past webinars along with information about previous recipients, are available at https://www.insurekidsnow.gov/.

At a minimum, recipients are expected to work with the National Campaign on the Back-to- School Initiative,12 the Year-Round Enrollment Initiative,13and any new initiatives focused

12 https://www.insurekidsnow.gov/initiatives/back-school-school-based-outreach/index.html 13 https://www.insurekidsnow.gov/initiatives/year-round-enrollment/index.html https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75#75.352 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75#75.352 https://www.insurekidsnow.gov/downloads/library/misc/outreach-and-enrollment-fundamentals.pdf https://www.insurekidsnow.gov/downloads/library/misc/outreach-and-enrollment-fundamentals.pdf https://www.insurekidsnow.gov/downloads/library/misc/outreach-and-enrollment-fundamentals.pdf https://www.insurekidsnow.gov/ https://www.insurekidsnow.gov/initiatives/back-school-school-based-outreach/index.html https://www.insurekidsnow.gov/initiatives/year-round-enrollment/index.html on retaining eligible individuals in Medicaid and CHIP as states resume conducting renewals after the end of the PHE. These initiatives are designed to capitalize on key opportunities for outreach that are expected to be particularly productive to promoting enrollment and retention in Medicaid and CHIP. The Back-to-School Initiative is critical for promoting enrollment and retention in Medicaid and CHIP because health coverage is top of mind for families as students are typically required to have check-ups and immunizations to enroll, go back to school, and participate in after school activities and sports. The Year-Round Initiative will take place after the annual Marketplace open enrollment period ends and will feature the Medicaid/CHIP year-round application and enrollment messaging. This is critical as people can enroll in Medicaid and CHIP at any time and are not limited to an open enrollment period. Activities funded under this cooperative agreement must include messaging to remind families that they can apply for Medicaid and CHIP year-round. In addition, recipients are required to participate in National Campaign activities related to retaining eligible individuals in Medicaid and CHIP. As states resume conducting renewals after the end of the PHE, there will be a greater need for consumer assistance to help ensure continuity of coverage and prevent inappropriate terminations of coverage. Recipients will play a vital role communicating to beneficiaries, encouraging them to update their contact information with the state to ensure receipt of renewal notices, and providing renewal assistance.

The National Campaign will make outreach materials available to recipients that can be customized for local use. It will also host training webinars to help guide recipients and others who will be conducting activities locally. Recipients will have the flexibility to tailor activities to the needs of their communities and to build on what they have been doing throughout the cooperative agreement period. The goal is to coordinate an intensive set of activities and a cohesive National Campaign during these critical initiatives.

All applicants should take these additional factors into consideration when designing proposals:

• The most effective outreach efforts link families to direct (one-on-one) enrollment and renewal support.

• Providing assistance with online applications and providing renewal support in-person or virtually can make enrollment and retention more efficient, effective, and consumer-friendly.

• The use of social media to conduct outreach and enroll eligible children and families in Medicaid and CHIP.

• While the emphasis of the HEALTHY KIDS 2022 Outreach and Enrollment Cooperative Agreements remains enrolling eligible children in Medicaid and CHIP, a large body of research finds that when eligible parents get enrolled in health insurance, their children are more likely to get enrolled and receive necessary preventive care.14 Appropriate messaging and strategies that help enroll eligible parents can also facilitate the enrollment of eligible children. Thirty-nine states and the District of Columbia have expanded their Medicaid programs to

14 Hudson, Julie, Asako Moriya, “Medicaid Expansion for Adults Had Measureable ‘Welcome Mat’ Effects on Their Children,” Health Affairs, 36 no. 9 (September 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0347 https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0347 cover more low-income adults.15 This provides an important opportunity to take a two-generation approach, helping parents apply for coverage as a means to getting more eligible children enrolled and improving the health and financial security of the family.

• With this NOFO, we are encouraging applicants to include pregnant individuals as a target population. Infants born to pregnant individuals in Medicaid and CHIP are required to be automatically deemed eligible for Medicaid or CHIP, without an application or further determination of eligibility. Therefore, enrolling pregnant individuals facilitates enrollment of newborn children.

• In past cycles, a number of CKC recipients have also been Navigators, or coordinated closely with Navigators to ensure that a holistic approach is taken to provide coverage to all eligible members in a family.16 We continue to welcome applicants that are Navigators or coordinate closely with Navigators.

• Families often seek health insurance for their children at times when they are most attuned to needing health services, such as when the children are sick or injured, need physical exams to enroll in school or summer programs, or need routine preventive care, including immunizations, dental, vision and hearing tests, asthma and allergy screenings, or are in search of essential mental and behavioral health services. Organizations and institutions that provide such services – such as hospitals, health clinics, departments of health, and schools – are in a good position to conduct outreach and help families get their eligible children enrolled.

They may also be more likely to have the infrastructure to sustain and track progress of outreach and enrollment efforts.

• States and local government agencies play key roles in helping to identify and enroll children. They can partner with other local and state health and human service programs and agencies such as SNAP, child care agencies, Head Start, and WIC to identify uninsured children and enroll them in coverage because of their relationships with local communities that can be leveraged to support outreach and enrollment efforts.

• Applicants that are not health care providers or state and local governments may wish to consider partnering with one or more of these entities.

• Parents who have at least one Medicaid or CHIP-enrolled child can serve as mentors to parents of uninsured children during the application and renewal process. Parent mentors educate families with uninsured children about health insurance coverage, and assist with completing and submitting applications for health insurance coverage. They can also provide guidance on identifying medical and dental homes and community pharmacies for children, provide assistance and referrals to successfully address social determinants of children’s health, and act as a liaison between the families and the state. One study showed that the use of parent mentors was more effective than traditional methods in insuring children, 15 For information on adult expansion states: https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/; Information on state eligibility levels can also be found at: https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-eligibility-levels/index.html 16 A Navigator is an individual or organization that's trained and able to help consumers, small businesses, and their employees as they look for health coverage options through the Exchange, including completing eligibility and enrollment forms. These individuals and organizations are required to be unbiased and their services are free to consumers.

https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/ https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/ https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-eligibility-levels/index.html https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-eligibility-levels/index.html achieving faster coverage, and renewing coverage.17 Applicant organizations may wish to work with parent mentors as a strategy to increase the participation of eligible, particularly hard-to-reach, children in Medicaid and CHIP (Please see Appendix VIII for more information).

Data and Reporting Requirements Recipients will be required to collect and report to CMS, data related to their goals and accomplishments for this funding opportunity. Such data will 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. All recipients will be responsible for collecting and reporting particular data elements (presented below). In addition, applicants may identify additional metrics that could be used to evaluate the efforts of the recipient’s work. All required data must be reported to CMS by adhering to a detailed data dictionary and uploading the required data to a web-based portal provided by CMS. Recipients will be provided with reporting tools for the submission of all required data and reporting elements. Recipients may also report additional data that illustrates their progress in increasing the participation of eligible children in Medicaid and

CHIP.

The required data that all recipients must report on a monthly basis include:

• Number of children for whom an application for health coverage has been submitted

• Number of children verified to be newly enrolled in Medicaid or CHIP

• Number of children denied new enrollment in Medicaid or CHIP

• Number of children for whom the recipient submitted a renewal form for Medicaid or CHIP coverage

• Number of children verified to be renewed in Medicaid or CHIP Number of children denied renewal coverage in Medicaid or CHIP

• The outreach and enrollment activities completed during the month

The following data must be reported on a monthly basis only if the applicant proposes to target parents with CKC funds:

• Number of parents for whom an application for health coverage has been submitted

• Number of parents verified to be newly enrolled in Medicaid

• Number of parents denied new enrollment in Medicaid

• Number of parents for whom the recipient submitted a renewal form for Medicaid coverage

• Number of parents verified to be renewed in Medicaid

• Number of parents denied renewal coverage in Medicaid

The following data must be reported on a monthly basis only if the applicant proposes to target pregnant individuals with CKC funds:

• Number of pregnant individuals for whom an application for health coverage has

17 Flores G., Lin H., Walker C, et al. Parent Mentors and Insuring Uninsured Children: A Randomized Controlled Trial. Pediatrics. 2016; 137(4):

e 0153519; Flores G., Lin H., Walker C, et al. Parent Mentoring Program Increases Coverage Rates for Uninsured Latino Children. Health Affairs. 2018; 37(3); 403–412.

been submitted

• Number of pregnant individuals verified to be newly enrolled in Medicaid or CHIP

• Number of pregnant individuals denied new enrollment in Medicaid or CHIP

• Number of pregnant individuals for whom the recipient submitted a renewal form for Medicaid or CHIP coverage

• Number of pregnant individuals verified to be renewed in Medicaid or CHIP

• Number of pregnant individuals denied renewal coverage in Medicaid or CHIP

CMS may require the reporting of additional data elements over the course of the cooperative agreement in order to fully assess recipient performance.

Recipients will be required to verify which children and proposed targeted populations are enrolled, renewed, and denied coverage as a result of CKC funding. To the extent possible, the best way to verify new enrollments, successful renewals and denials is with the state or county Medicaid and/or CHIP agencies. This would typically require the establishment of a detailed Memorandum of Understanding (MOU) or other data-sharing agreement between the recipient and the relevant state or county Medicaid/CHIP agencies that allows recipients to submit detailed identifying information about the people they have assisted and receive verifications in response. Non-state applicants must describe their plans to secure an MOU or other data-sharing agreement with the state or county Medicaid/CHIP agencies within 90-days after the cooperative agreement is awarded.

CMS recognizes that it may not always be possible to obtain data from state or county sources.

Therefore, all non-state applicants must also describe alternative methods for verifying new enrollments and renewals that do not depend on cooperation by state or county agencies and that can be implemented with the requested funding. If the recipient does not obtain an MOU, or create and implement a well-designed and effective alternative data methodology within 120 days from the date of the award, CMS may terminate the award for failing to have a process in place to collect and report the required data elements.

Please note, all applications, enrollments, renewals and denials reported should be directly attributable to this cooperative agreement. For example, if a HEALTHY KIDS 2022 recipient is also a Navigator grant recipient under the Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges, only enrollment and renewal data directly attributed to CKC HEALTHY KIDS 2022 funding should be reported.

A5. Technical Assistance and Information for Prospective Applicants

Prior to the application deadline, CMS will host two webinars to provide details about the HEALTHY KIDS 2022 program to answer questions from potential applicants regarding this funding opportunity. Information about the webinars will be posted on the InsureKidsNow website at https://www.insurekidsnow.gov/.

B. Federal Award Information https://www.insurekidsnow.gov/

Note: If the estimated number of eligible applicants (36) receive a cooperative agreement award and request the anticipated maximum award amount of $1,500,000, CMS may reduce the award amount in accordance with the estimated maximum funding amount available for all applicants.

B3. Anticipated Award Dates

The anticipated award issuance date for these awards is July 1, 2022.

B1. Total Funding

The total funding a mount of federal funds available is anticipated to be $49,400,000 pending availability of funds. Cooperative agreements will be awarded with consideration to the overall quality of the proposal and the ability to meet project goals. The amount of funding for each cooperative agreement award will depend on the individual recipient’s need as demonstrated in its application submitted in response to this NOFO.

B2. Award Amount

The amount of each cooperative agreement award made to eligible applicants may range from $500,000 up to an anticipated $1,500,000 (pending availability of funds) over a three-year period with the award amount commensurate with enrollment and renewal targets. Individual awards will not exceed $1,500,000. Recipients will participate in HK 2022 for 3 years and will consist of three 12-month budgets. Estimated budgets for all three budget years must be provided as instructed in Appendix I. Guidance for Preparing a Budget Request and Narrative.

B4. Period of Performance

The Period of Performance f or each cooperative agreement awarded will be three years from the date of award. The estimated project period is July 1, 2022 – June 30, 2025. The grant period will consist of three 12-month budget periods.

• First 12-month budget period: July 1, 2022 to June 30, 2023

• Second 12-month budget period: July 1, 2023 to June 30, 2024

• Third 12-month budget period: July 1, 2024 to June 30, 2025

B5. Number of Awards

The maximum number of awards is anticipated to be 36. The actual number of awards will depend upon the number and quality of applications.

B6. Type of Award

The type of award issued under this NOFO is a cooperative agreement. The difference between grants and cooperative agreements is the degree of federal programmatic involvement rather than the type of administrative requirements imposed. A cooperative agreement differs from a grant in that it provides for substantial involvement between the federal awarding agency and the non-federal entity in carrying out the activity contemplated by the federal award. Therefore, statutes, regulations, policies, that are applicable to grants also apply to cooperative agreements, unless the award itself provides otherwise. References throughout this NOFO to grants also apply to cooperative agreements unless this NOFO states otherwise. Please refer to section F4.

Cooperative Agreement Terms and Conditions of Award for more information about cooperative agreements.

B7. Type of Competition

This will be a competitive Funding Opportunity and is open to all eligible applicants in Section C1. Eligible Applicants.

C. Eligibility Information

C1. Eligible Applicants Government Organizations

State governments County governments City of Township governments Special District governments Native American tribal governments (Federally recognized) Native American tribal organizations (other than federally recognized tribal governments)

Education Organizations Independent School Districts Public and State Controlled Institutions of Higher Education

Private institutions of higher education Public Housing Organizations

Public housing authorities Indian housing authorities

Nonprofit Organizations Nonprofits having a 501(c)(3) status with the IRS, other than institutions of higher education Nonprofits that do not have a 501(c)(3) status with the IRS, other than institutions of higher education

For-profit Businesses (organizations other than small businesses) Small Businesses Individuals Others Unrestricted

This cooperative agreement opportunity is open to the following eligible entities, or collaboratives of eligible entities:

a. A state with an approved child health plan under Title XXI.

a. A local government;

b. An Indian tribe or tribal consortium, a tribal organization, an urban Indian organization receiving funds under Title V of the Indian Health Care Improvement Act (25 U.S.C. § 1651 et seq.), or an Indian Health Service provider;

c. A federal health safety net organization;

d. A national, state, local, or community-based public or nonprofit private organization, including organizations that use community health workers, community-based doula programs, or parent mentors;18

e. A faith-based organization or consortia, to the extent that a cooperative agreement awarded to such an entity is consistent with the requirements of Section 1955 of the Public Health Service Act (42 U.S.C. 300x-65) relating to a grant award to nongovernmental entities; and/or

f. An elementary or secondary school.

Applicants that had Cycle I, II, III, IV, HEALTHY KIDS or AI/AN grants may apply for a Connecting Kids to Coverage HEALTHY KIDS 2022 cooperative agreement if their proposal meets one of the following:

o New and distinct activities: A Cycle I, Cycle II, Cycle III, Cycle IV, HEALTHY KIDS or AI/AN recipient may submit a proposal for activities that are new and distinct from those previously funded under the Cycle I, Cycle II, Cycle III, Cycle IV, HEALTHY KIDS or AI/AN grant, OR o Continuation of successful activities: A Cycle I, Cycle II, Cycle III, Cycle IV, HEALTHY KIDS or AI/AN recipient that wishes to continue activities it is currently or previously conducted, may submit a proposal for a HEALTHY KIDS 2022 grant, but must present data demonstrating that the activities it wishes to continue have proved successful in enrolling and/or retaining eligible children in Medicaid and CHIP and warrants further funding.

Former and current CKC recipients (from Cycles I, II, III, or IV, HEALTHY KIDS 2019) or AI/AN recipients (from Rounds I, II, or III, HEALTHY KIDS AI/AN 2020) submitting proposals under this NOFO must be or have been recipients in good standing, meaning they

18 Please see Appendix IX for more information.

must be meeting or have met all reporting requirements and other contractual obligations under their grants.

Threshold Criteria

• Application deadline: Applications not received electronically through www.grants.gov by the application deadline will not be reviewed.

• Applications will be considered for funding only if the application meets the requirements as outlined in IV. Eligibility Information, and V. Application Information.

• Applicants are strongly encouraged to use the review criteria information provided in Section VI. Application Review Information, Section V. Application Information, and Appendix D, Application and Submission Information, to ensure that the application proposal adequately addresses all the criteria.

C2. Cost Sharing or Matching

Cost sharing or matching is not required.

However, applicants must provide a clear explanation of non-federal resources to be utilized to support and manage activities in support of this Notice of Funding Opportunity. Non-federal share must be included in the Budget Narrative. Cost sharing is the portion of project costs not paid by federal funds.