1. Health Insurance Coverage Improves The Census Bureau reports that the number and proportion of uninsured children (0 to 18 years) declined from 11.1 million (15.4 percent) in 1998 to 10.0 million (13.9 percent) in 1999, mirroring the positive changes in the population overall http://www.census.gov/hhes/www/hlthins.html. 2. Congress May Extend Deadline to Spend Funds While 40 states stand to lose an estimated $1.9 billion in unspent CHIP funds, legislation unanimously approved by the House Commerce Committee on Tuesday might grant the states a two-year reprieve, the AP/Ft. Worth Star-Telegram reports. In 1997, Congress provided states with $40 billion over 10 years to implement and administer a CHIP, giving them three years, beginning 1 October 1997, to use the first installment of $4.2 billion. Forty states were expected to lose a total of $1.9 billion in federal CHIP funding by the end of September because they would not spend the entire first installment, the New York Times reported September 24. Ten states were expected to have spent their 1998 allocations. The Commerce-approved provision, sponsored by Rep. Brian Bilbray (R-California), would allow the 40 states to recoup about $1.2 billion of the 1998 funds and give them until 2002 to use the money, while the 10 states that spent their full allocation would receive the remaining $750 million. The measure would also extend the deadline for using 1999 funds from October 2001 to 2003. If Congress does not approve the legislation, the 10 state-Alaska, Indiana, Kentucky, Maine, Massachusetts, Missouri, New York, North Carolina, Pennsylvania and South Carolina-would receive the entire $1.9 billion, a potentially "huge windfall" for their public assistance programs. However, supporters remain "confident" that Congress will pass the measure, because it is part of a larger bill, H.R. 5291 that would raise Medicare reimbursement rates for health care providers, legislation Congress will likely approve. (American Health Line, 9/25/00) 3. Income Up and Poverty Down, But Children Still at the Bottom Despite good news in income and poverty, it is still true that the younger you are in America, the more likely you are to be poor. Despite the lowest child poverty rate since 1979, children still constitute the largest segment of the population living below the federal poverty line (16.9 percent), compared with an elderly poverty rate of 9.7 percent. Click here for the news briefing and links to data: Analysis of Census Bureau's Income and Poverty Report for 1999. 4. New Report Urges Reevaluation of CHIP Although expansion of insurance coverage for children eligible for the State Children's Health Insurance Program (State CHIP) is important, it is not a sufficient goal, says a new report by researchers at Johns Hopkins University. The report, entitled The Children's Health Insurance Program: Expanding Framework to Evaluate State Goals and Performance, urges states to draft higher standards for measuring improvement of the health of children enrolled in State CHIP. States should not only monitor how many children are enrolled in State CHIP, the report suggests, but also whether these children are receiving high quality health care services. The authors of the report present a more specific, comprehensive framework for evaluating State CHIP. Policymakers, the report argues, need to assure high standards of health care services through access to a regular, first-contact provider that is person-focused, not disease-oriented, establishes continuity in provider-patient relations and coordinates care provided elsewhere or by another provider. Further, the number of health professionals who "provide services to vulnerable populations" needs to increase, says the report. The report is published in the September issue of The Milbank Quarterly. Source: Shi, Leiyu, et al., The Children's Health Insurance Program: Expanding the Framework to Evaluate State Goals and Performance, The Milbank Quarterly, Vol. 78, No. 3, September 2000 and "States need stronger goals for children's healthcare," Reuters Health, http://www.reutershealth.com, 20 September 2000. 5. Two State Profiles of Pilot Programs to Increase Enrollment in CHIP The Department of Health and Human Services have recently announced the allocation of grants (totaling $700,000) to fund pilot programs that test various strategies to increase enrollment of eligible children in the State Children's Health Insurance Program (CHIP). Below are two specific pilot programs Pennsylvania and Ohio are enacting that will be receiving funding. Pennsylvania The HHS grant will fund a pilot project in a cluster of Philadelphia schools to test whether removing income verification makes a difference in the enrollment process. The project will use four different school settings in a district that is 100% eligible for free or reduced school meals and includes all Title I schools to try three strategies: * self-declaration of income will be used; * self-declaration and intensive outreach will be used; and * intensive outreach will be used. A fourth setting will be used as a control group. Pennsylvania has not removed income verification requirements for any other group than those in this project. What is being tested is whether removing income verification requirements helps families enroll in Medicaid and State CHIP. The pilot program will be managed by the Delaware Valley Hospital Council based in Philadelphia. For more information, contact Joan Apt at japt@dvhc.org. Ohio The Cuyahoga County Income Self-Declaration Pilot in Ohio will be a one-year pilot program using self-declaration of income as a means of increasing enrollment of families in Medicaid and CHIP. Self-declaration of income will be implemented for a 12-month period for new applicants as well as for those approaching eligibility redetermination (in most states, eligibility for Medicaid and/or CHIP must be reassessed to see whether families still qualify despite changes in income). Applicants will not be required to provide verification of income such as payroll stubs when health insurance is the only program being applied for. The evaluation plan includes the use of experimental (income self-declarers) and control group (income verifiers) comparisons, comparison of self-reported income with data from the unemployment insurance database, the collection of performance data, and the use of focus groups to assess the perceived impact of the removal of the barrier of income documentation.