Health
Child Health Coverage
In a land of plenty, many low-income working families are struggling
to pay for housing, utilities, food, clothing,
transportation, child care and other needs. Unfortunately, health
care often falls to the bottom of the list— unless there is a medical
crisis.
Research has shown that health insurance makes
a difference when it comes to children having
access to needed health care. Children without
public or private health coverage are less
likely to have access to a regular source of
medical care or to seek care for injuries,
and are more likely to receive care in a clinic
or emergency room and less likely to be appropriately
immunized.1 Thirty-seven
percent (37%) of long-term uninsured children
have no doctor visits throughout the year.2
The majority of uninsured children live in
families where at least one parent is employed
full time at low wages.3 Hundreds
of thousands of low-income families who cannot
afford to purchase child health coverage do
not know that help is available. In fact, it
is estimated that more than 7 million of our
nations uninsured children are eligible
for Medicaid and other health coverage programs
but are not enrolled. One major reason is the
lack of information and outreach. Many families
are not aware of public and private sector
health coverage programs available for children
in working families. Other reasons include
the complexity of the application process,
the stigma attached to public coverage, disruption
of continuous coverage due to categorical changes
in eligibility and the lack of coordination
across the various public and private sector
programs that provide coverage.
Eligibility Simplification
Simplification of the application process is a critical component
of serious efforts to help children gain access to Medicaid or other
health coverage programs. To decrease the eligibility barriers and
increase the likelihood that eligible children can become enrolled
will require a comprehensive review of current application policies
and procedures with the clear intent of making coverage more accessible.
Many families have been discouraged by application processes they
consider demeaning. One of the major reasons for this negative perception
is the practice by many eligibility agencies of requiring families
to produce numerous documents to verify statements made on the application,
even though applicants are warned in writing of fraud penalties and
are required to sign a statement testifying to the truthfulness of
their statements.
Extensive verification requirements are time-consuming and expensive,
especially for working families who may lose wages while seeking to
comply with documentation requirements. Other barriers include lengthy
and complicated applications, intake protocols that fail to initiate
a child health coverage application while considering the family for
other benefits, hours of operation that are problematic for working
parents, agency resistance to applications by mail and lack of access
to on-line state data, such as birth certificates.
Reports prepared by the Southern Institute discuss simplification
issues and offer strategies to reduce eligibility barriers.
For other reports on the topic of simplification,
visit the Southern Institute's Publications page
on this site and the Resource
Center on the Covering Kids & Families website.
Information Outreach
With support from the states of Georgia and North
Carolina, the Southern Institute developed
for various audiences three outreach brochures
that effectively communicate the availability
of benefits. With support from The
Robert Wood Johnson Foundation, the brochures
have been replicated and localized in 16
southern states, and Spanish-language versions
are in production and will be available in
mid-1999. In addition, The Robert Wood Johnson
Foundation provided further support to develop
six information outreach videos in English
and Spanish for use with the brochures, including
a training video on how to most effectively
use the brochures.
Outreach brochures developed by the Southern
Institute include:
- Leaving
Welfare for Work Isn't As Scary as
it Seems (for families
on cash assistance): This colorful
brochure tells families that they can
work full time and still receive some
benefits, including health coverage.
This is ideal for review with welfare
families at redetermination interviews
and in job readiness classes.
- Have
You Heard About Benefits for Working
Families??? (for general
community outreach): This brochure
is designed to help families who apply
for cash assistance to understand that
they can receive Medicaid and other
benefits without having to be on welfare.
It is appropriate for distribution
through schools, health providers,
churches and other community organizations
and to employers for dissemination
in the workplace.
- Facts
for Employers (for employers
of low-wage or minimum wage workers):
This brochure provides employers with
information on how to connect low-income
workers to benefits that basically
supplement low wages at no cost to
employers. It is an effective communication
tool for use with employers and business
groups.
Medicaid Outreach
Strategies
On site visits to 17 southern
states and the District of Columbia in 1997,
the Southern Institute convened discussions
with Medicaid and welfare officials on improving
access to child Medicaid coverage. Medicaid
outreach and eligibility simplification strategies
are outlined in the project report, Southern
Regional Initiative to Improve Access to
Benefits for Low Income Families With Children.
The site visits were sponsored by
The Robert Wood Johnson Foundation and the
Foundation for Child Development.
Uninsured Children
in the Southern Region
Click on the name of selected state to
obtain data included in a 1996 Southern Institute
report on uninsured children. The report,
titled Uninsured Children in the South,
Second Report, was sponsored by The
Henry J. Kaiser Family Foundation.
Covering Kids & Families
In large part because of its extensive experience
and research in policy issues related to improving
access to health coverage for low-income families
with children, the Southern Institute has been
designated the national program office for Covering
Kids: A National Health Access Initiative
for Low-Income Uninsured Children. Covering
Kids, a $47 million program of The Robert
Wood Johnson Foundation, has three primary
goals:
- to design and conduct outreach programs
that identify and enroll eligible children
into Medicaid and other coverage programs;
- to simplify enrollment processes; and
- to coordinate existing coverage programs
for low-income children.
For more information about Covering Kids & Families,
visit the program's website at: www.coveringkidsandfamilies.org.
Reports of Interest
- Cost
Still a Significant Barrier to Affordable
Child Care in Southern States , February/March
2002. (Press Release)
- The Southern Regional Initiative on Child
Care sponsored a Forum on Child Care Financial
Aid Issues on February 20, 2002, in Washington,
DC.
- Mark Greenberg, Senior Staff Attorney for
the Center for Law and Social Policy (CLASP),
provided a briefing on child care issues related
to the reauthorization of CCDF and TANF. Following
the presentation, a panel of experts engaged
in a dialogue on the issues.
- Helping
Families Achieve Self-Sufficiency: A Guide
on Funding Services for Children and Families
Through the TANF Program, U.S. Department
of Health and Human Services, Administration
for Children and Families, Office of Family
Assistance, 1999.
- Supporting
Families in Transition: A Guide to Expanding
Health Coverage in the Post-Welfare Reform
World,
a joint publication of the U.S. Department
of Health and Human Services Administration
for Children and Families and the Health
Care Financing Administration, March 1999.
Footnotes
1. General Accounting
Office, New Strategies to Insure Children,
(Washington, DC: US General Accounting Office,
GAO/HEHS-96-35, January 1996) 3; Linda J. Blumberg
and David W. Liska, The Uninsured in the
United States: A Status Report, (Washington,
DC: The Urban Institute, April 1996); and Ron
Pollack, Cheryl Fish-Parchman and Barbara Hoenig, Unmet
Needs: The Large Differences in Health Care
Between Uninsured and Insured Children,
(Washington, DC: Families USA, 1997).
2. Pollack, Fish-Parchman
and Hoenig, 1.
3. General Accounting
Office, New Strategies to Insure Children,
4.
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