1. Health Insurance Retention Seen As Key to Reducing the Number of Uninsured New York City, 3 December 2002--The number of uninsured, low-income children would decline by nearly 40 percent and the number of uninsured adults would decline by more than one-quarter if every person with public or private health coverage at the beginning of a given year retained it through the next twelve months, according to a new report from The Commonwealth Fund. The report, by Leighton Ku and Donna Cohen Ross of the Center on Budget and Policy Priorities, argues that improving insurance retention is both a cost-effective and under-appreciated way to increase the number of insured individuals. The authors recommend strategies that federal and state governments and employers could use to improve retention, such as 12-month continuous eligibility and automatic renewal for Medicaid and CHIP for low-income families, helping people retain coverage when they shift from welfare to work by simplifying rules that let them keep Medicaid coverage, and by changing open enrollment rules so they are eligible for their employer's health insurance plan when their public health insurance lapses. Insurance retention is critical, the authors say, because research shows that stable health insurance coverage improves access to health care and continuity of care. "Getting people insured is half the battle--keeping them insured is the other half," said Karen Davis, president of The Commonwealth Fund. "No one should lose health coverage because their family or economic circumstances change. Growing up, finding a job, or becoming unemployed shouldn't mean becoming uninsured." In their report, "Staying Covered: The Importance of Retaining Health Insurance for Low-Income Families," Ku and Ross analyze why people lose their insurance over the course of a year. A change in job or unemployment, divorce or death of a spouse, an increase in salary that disqualifies workers for public insurance, are all events that could mean a change in health insurance coverage. In addition, barriers such as complex eligibility rules and renewal procedures for public insurance, and waiting periods to enroll in employer plans, may prevent many of those who would otherwise be eligible from joining public or private insurance plans. Ku and Ross estimate that millions of people lose insurance for reasons that could be avoided by implementing one or more strategies detailed in the report. Some of the thirteen strategies outlined include: Improve Retention in Medicaid and CHIP * 12-month continuous coverage. States have the option to guarantee Medicaid or CHIP coverage for children for 12 months regardless of changes in family income or circumstances. Federal legislation could be modified to allow a similar provision for low-income parents. * Use passive renewal. Similar to the way private insurance is handled in the workplace, children's Medicaid or CHIP coverage could be automatically renewed if their parents report no changes in family circumstances. * Simplifying Medicaid and CHIP enrollment. States could do more to permit families to apply by mail or in person or at community settings, simplify application forms, and minimize verification requirements, easing reenrollment for those who have lost coverage. Help People Move Between Public and Private Health Insurance * Simplify Transitional Medical Assistance (TMA). A change in federal rules could make it easier for families moving from welfare to work to enroll in this program. Many eligible workers do not enroll in TMA because of complex rules and paperwork. * Make it easier for workers to shift to employer coverage from Medicaid or CHIP. Federal legislation could be modified to help employees who lose CHIP or Medicaid join their employer's health plan without having to wait for open enrollment. "On average, it costs our MetroPlus Health plan nearly two months of their health insurance premium to enroll and reenroll plan members," said Benjamin Chu, president of the New York City Health and Hospitals Corporation (NYCHHC). "These administrative costs would be much better directed at efforts to improve the health of our patients." MetroPlus Health is a plan owned by the NYCHHC serving the city's Medicaid, CHIP, and Family HealthPlus beneficiaries. Download the report in PDF format at http://www.cmwf.org/publist/publist2.asp?CategoryID=4. 2. California: Program To Help Identify Uninsured California Children Through School Lunch Program Begins The Coalition for Healthy Learning, a not-for-profit group of California businesses and health care leaders, is launching an initiative to help almost 700,000 low-income families in four California counties enroll their children in public health programs, the AP/Contra Costa Times reports. Beginning 1 July 2003 the initiative, called Express Lane Eligibility, will allow parents in Los Angeles, San Diego, Fresno, and Santa Clara counties to release financial information to social service agencies when applying for free school lunch programs. If the agencies determine that the children qualify for Medi-Cal or Healthy Families, California's Medicaid and CHIP programs respectively, they can be enrolled without filling out a separate application for the programs. About 70% of children who are in California's school lunch programs are uninsured, according to the Urban Institute. Wendy Lazarus, executive director of the Children's Partnership, which is spearheading the project, said the program will be particularly useful in identifying children in traditionally hard-to-reach groups, such as Latinos and children older than age 13. The outreach pilot program, established through a state law signed in October 2001 and partly funded by grants from the California Endowment and the David and Lucile Packard Foundation, was expected to begin last summer. However, California's budget deficit prompted Gov. Gray Davis (D) to cut almost $6 million in state funds for Medi-Cal and Healthy Families, the AP/Times reports. While funding for the program next year has not been secured, Lazarus said she is hopeful that the state will provide financial support for the program (Chu, AP/Contra Costa Times, 11/30). 3. Profile of Hawaii's Teens A new publication about our youth is available from Hawaii Kids Count. Project director Marcia Hartsock explains: "We have assembled data from administrative records and various surveys to be able to say with confidence that there is a positive change in recent trends regarding youth. There is also new information about the way our youth feel about their education, safety, families, and communities. While the data are at the state level and mask variations in different areas, there is more localized data for some of the indicators on the Center on the Family web site at http://www.uhfamily.hawaii.edu/Cof_Data/cfi/family_indicators.asp. 4. Toward a Healthy Hawaii 2010 County Data Reports What makes us healthy? What makes us sick? How does your own community measure up to others, your county, the state and the nation? Published by the Hawaii State Department of Health (DOH), "Toward a Healthy Hawaii 2010: Checking the Health of Your County" is the first collective, comprehensive set of health status data on Hawaii communities ever made available. The Healthy Hawaii Initiative, in partnership with DOH, Hawaii Outcomes Institute, and Hawaii Health Information Corporation, proudly presents four reports to the communities. They look at one hundred health indicators for twenty-four different communities throughout the state and indicators are compared with available national benchmarks and rates. These reports are the first steps toward developing an ongoing means of identifying and addressing the differing health needs of Hawaii's communities. Go to http://www.hawaiioutcomes.org/Healthy%20Hawaii%202010.htm to download the report.