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Many States Moving Forward on Child-Health Effort

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With billions in federal money waiting for them beginning this month, states are scrambling to complete plans that could provide up to 5 million uninsured children with health-care coverage.

The federal government's $24 billion effort to improve children's health, the largest expansion of government-paid health insurance in more than 30 years, was included in the five-year balanced-budget and tax-cut agreement forged by the White House and Congress in August.

Starting Oct. 1, an initial $4.3 billion becomes available for the effort. The rest of the money will be spent in the following four years. For most states, the additional funding represents a 30 percent increase in federal money paid for Medicaid, the joint federal-state program that provides most of the country's health coverage for poor people.

The Congressional Budget Office estimates that as many as 2.2 million children could be served through the initiative, while the Children's Defense Fund, a Washington advocacy group, predicts that the number could climb as high as 5 million.

Observers say it's too early to even guess whether all states will take advantage of the voluntary program, which, like Medicaid, requires states to kick in their own money to get federal funds. But at least 18 states have announced plans to go forward, and a few have already passed legislation outlining how the money will be spent, according to the Health Policy Tracking Service of the National Conference of State Legislatures in Washington and other sources.

"I think people are pretty excited by the opportunity to do something like this," said Anne Rossier Markus, a research associate with George Washington University's Center for Health Policy Research in Washington.

Schools also are likely to play a part in some state plans, particularly in helping states locate eligible children. "Educators play a key role" in many outreach efforts, said Donna Langill, the director of the Child Health Advocacy Program of the Washington-based National Association of Child Advocates. "Eventually every child ends up at the schoolhouse door."

Funding Details

The August budget measure specified that states must use the new money to cover children under age 19 in families with incomes up to twice the federal poverty line of $16,000 for a family of four. But it gave them considerable freedom in deciding how to offer that insurance.

Federal officials have said that money allocated for this fiscal year can also be spent in the following two years, and that plans submitted by next July will be approved by October 1998.

Many states have signed on in spirit for the effort. "Who's going to stand up and say we're not going to take care of kids?" said John Garlinger, the spokesman for the Kansas Department of Social and Rehabilitative Services. Conservative Kansas has not been a leader in expanding health-care coverage to poor children, but Mr. Garlinger said he was confident the state would raise the $12 million needed to participate in the first year of the initiative. In exchange, Kansas will get an additional $31 million from the federal government. A legislative work group will come up with a plan by the time state lawmakers begin their next session in January, he said.

Exercising Options

The federal budget legislation gives state officials the option of expanding coverage in two principal ways: putting more children under the Medicaid umbrella by loosening eligibility requirements, or coming up with a state-sponsored program that subsidizes private insurance, mainly for children of the working poor. Three states with extensive programs for children's health coverage--Florida, New York, and Pennsylvania--may funnel money into their existing efforts without the federal approval other states will need.

Bobby Jindal, the secretary of health for Louisiana, said his state is likely to combine approaches. And, he added, a task force charged with putting together Louisiana's plan would give serious attention to making private, state-subsidized insurance available for children through their schools. "We'd provide information through the schools and use the same income screening" that determines which children are eligible for free or reduced-price lunches, as Florida does now, he said.

Massachusetts is one state likely to go the Medicaid-expansion route, which experts say allows states to move more quickly. Under pending legislation, the state would raise its cut-off point for Medicaid eligibility for children to extend coverage to an additional 35,000 children. California, on the other hand, has opted to launch a state-sponsored insurance pool, as well as modestly expand Medicaid coverage.

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