States Move Swiftly on Child-Insurance Front

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When lawmakers in Illinois emerge from this year's legislative session shortly, they may be heard singing the praises of their newly adopted comprehensive child-health-care program.

Joining in on that chorus will be state leaders across the country, who are racing to take advantage of a $24 billion federal windfall to extend health coverage to millions of uninsured children. Many states have spent the past several months brokering health plans of their own.

The initiatives, intended for youngsters in lower-income families, are offshoots of the State Children's Health Insurance Program, or SCHIP, a five-year federal program created in the federal Balanced Budget Act of 1997.

As of the middle of last week, 29 states, as well as the District of Columbia and Puerto Rico, had submitted SCHIP plans to the federal government for approval, and several other states are planning to submit plans in the near future, according to the National Governors' Association.

The hope is that if government agencies, schools, and private advocacy groups work together to identify qualified children, the programs will provide coverage to as many as half the estimated 10 million children who now lack health insurance. More than 90 percent of those children, according to the U.S. Bureau of the Census, have one or more parents who work.

"Governors see this as an incredible opportunity to help working families," said Joan Henneberry, a program director at the governors' association, which is based in Washington. "It's the single largest appropriation of money for health care for children since Medicaid. There's never been a block grant like this provided to states."

The state activity comes as a new federal report indicates that millions of children who are already eligible for Medicaid--which offers free coverage to poor families--aren't signing up. In a study released this month, a division of the U.S. Public Health Service found that about 22 percent--or 4.7 million--of the 21 million children age 18 or under who qualify for Medicaid aren't enrolled. That's out of a total 18-and-under population of 76 million young people.

The White House had previously estimated that 3 million Medicaid-eligible children had not subscribed, and in January it asked the U.S. Department of Health and Human Services to help enroll more children. The report's authors found that families who were enrolled under the old federal welfare program were routinely registered for Medicaid, but that recipients who are now eligible for Medicaid under recent expansions of the program are less likely to be automatically registered for the coverage.

Outreach and Schools

In February, President Clinton sent a memorandum to several federal agencies, including the U.S. Department of Education, establishing a multipronged effort to reach uninsured children by distributing program information, coordinating toll-free numbers for information and referrals, and simplifying and combining application forms for government services.

To qualify for the SCHIP program, which is voluntary, states must submit their children's insurance plans--including designs for how they will inform and enroll eligible children--for federal approval and must agree to pitch in matching funds.

Most of the new child-health dollars are being targeted to families in which parents earn too much to qualify for Medicaid but too little to pay for private insurance coverage.

In Illinois, for example, leaders have expanded the state's Medicaid program to cover more than 40,000 uninsured families with incomes between 100 percent and 133 percent of the federally established poverty level, which is about $36,000 a year for a family of four.

And KidCare, an existing state health-insurance program, is being broadened to cover an additional 200,000 uninsured children from families with incomes from 133 percent to 185 percent of the poverty level.

Valerie Brooks, a senior adviser to Illinois Gov. Jim Edgar, a Republican, said that passing the state's $122 million health-care initiative--which received federal approval in May--was only part of the battle. A huge challenge, she and other state leaders say, will be identifying and enrolling eligible children. Schools will play a pivotal outreach role in the effort.

"We've really focused on schools as a key place to get information out to parents," Ms. Brooks said, adding that other government agencies and day-care centers will also be bases for information.

"Schools are where kids are," said Jim Parks, a division administrator at the Illinois education department who has been working with the governor's office to coordinate the outreach efforts.

Because the state's eligibility cutoff for reduced-priced lunches is the same as for its new children's-health program--185 percent of the poverty level--combining sign-up efforts for the programs is one of many things schools can do to help boost enrollment, he said.

Schools will also be involved in New York, where lawmakers approved a program earlier this spring that will extend the reach of a state health-care plan that currently insures 175,000 children to more than 400,000. Under the new insurance plan, known as Child Health Plus, children from families taking home less than 222 percent of the federal poverty level will qualify for state health coverage.

"Schools are not only the most logical places to reach parents, they work the best, because they're in a position of credibility," said Sheila Humiston, the director of public policy for the Albany-based HMO Council of New York, a private group representing health-maintenance organizations that is charged with heading the state's outreach efforts. "We've been working with administrators, school nurses, and counselors to get information to parents," she said.

In getting educators on board, Ms. Humiston said she emphasizes what's in it for schools.

"Kids that are getting regular, quality health care will perform better," she said. "Schools appreciate that."

While acknowledging the merits of the SCHIPs, some in the education community fear that major outreach tasks will get tacked on to schools' ever-increasing list of responsibilities.

"I think these health programs are wonderful, and I think that to some extent schools can take a role in the effort to get kids signed up as long as it's a relatively painless one, like passing out brochures and forms," said Bruce Hunter, a senior associate executive director of the Arlington, Va.,-based American Association of School Administrators.

New Concerns

"But schools are not being judged on how many children they enroll in these programs--they're being judged on test scores," he added. "And any time staff spends linking kids up to health coverage takes away from" efforts to raise academic achievement, he argued.

Mr. Parks of the Illinois education department echoed that sentiment, saying there is already concern among officials in his agency about what will be required from the state's schools.

"We need to take into account what's already expected from school administrators," he said.

But Lamar Haynes, the director of the National Education Association's Emergency Commission on Urban Children, said school administrators can relax.

Enrolling eligible children in new health-insurance programs will be "a collaborative effort," he said.

"Federal agencies, local leaders, and private organizations are sharing in it," Mr. Haynes said. "Schools, like all of these groups, might have a slight additional burden, but the payoff will be healthier kids."

Staff Writer Jessica Portner contributed to this report.

Vol. 17, Issue 37, Pages 13-14

Published in Print: May 27, 1998, as States Move Swiftly on Child-Insurance Front
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