1. West Virginia Family Courts to Provide Information About Children's Health Insurance Program Thousands of West Virginia parents will receive information from family law master offices to help them determine whether their child is eligible for health insurance under the West Virginia Children's Health Insurance Program known as WV CHIP. Chief Justice Elliott E. Maynard announced today that the Supreme Court of Appeals unanimously voted to require all family law masters and their staffs to provide an application and information packet for WV CHIP to every parent of a dependent child during the parent's first appearance before a family law master or family case coordinator in every case filed or pending in any family court in West Virginia. "Huge numbers of West Virginia families, who may not know about WV CHIP, are involved in family court disputes. This is a wonderful opportunity to get this important information into their hands," Chief Justice Maynard said. To oversee the Supreme Court's effort to increase awareness of WV CHIP, Chief Justice Maynard also created the Supreme Court Child Health Care Commission and appointed Justice Robin Jean Davis as Chair. "Justice Davis is the perfect person to lead us in this effort because she always has exhibited a special interest in children's issues," Chief Justice Maynard said. 2. Maximizing Medicaid Funding to Support Health and Mental Health Services for School-Age Children and Youth This is the Finance Project's most recent strategy brief that helps nonprofits maximize their options. Click here to download a PDF copy. 3. Uninsured: Conference Addresses Several Proposals Health advocates and professionals discussed the benefits and limitations of expanding public programs, broadening employer-sponsored insurance coverage and introducing tax credits as a means to reduce the number of uninsured in America, expressing optimism that such measures could be helpful but cautioning that an incremental and heterogeneous approach was the best strategy. Gathering at a conference in Washington sponsored by the Commonwealth Fund as part of its Task Force on the Future of Health Insurance, state health commissioners, lawmakers and public health experts shared both the successes and the failures they have witnessed in programs designed to provide coverage for the 43 million uninsured Americans. The goal is "to make health insurance a reality for all poor and low-income children," Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured said, adding, "We [also] have the opportunity by enrolling their parents to cut a big chunk out of the uninsured population." a. Expanding CHIP and Medicaid Conference participants generally praised the success of the Children's Health Insurance Program, and several stated that expanding both this program and Medicaid could significantly lower the number of uninsured. Rowland said that substantial progress has been made in CHIP, as 36 states now cover children in families who earn up to 200% of the federal poverty level. Forty-two states also have eliminated or do not employ asset tests, and 40 do not conduct face-to-face interviews, which has made enrolling children an easier process. The next step, she said, is to expand Medicaid to cover more adults, who constitute 75% of the uninsured population. Extending Medicaid to all low-income parents making up to 200% FPL--of whom 76% are not eligible--would lead to 4.3 million new Medicaid adult enrollees at an annual cost of $12.4 billion. And extending the program to all low-income childless adults--of which 95% are not eligible--would create 7.4 million new Medicaid enrollees at an annual cost of $18.8 billion. "Building on public programs makes the most sense and is the best strategy, and it won't disrupt existing Medicaid enrollees," Rowland concluded. b. State Successes State health officials from Wisconsin and New Jersey related their state's success in expanding coverage to both children and adults. BadgerCare, Wisconsin's program for low-income families that commenced last year, has succeeded in covering 91% of the state's previously uninsured children and 57% of previously uninsured adults, Joe Leean, secretary of the Department of Health and Family Services, said. Key to this success was a simplified and streamlined enrollment process that covers both parents and children, in addition to the bipartisan support that the program enjoys. Brian Baxter, deputy chief of policy and planning in the New Jersey Office of the Governor stated that high eligibility limits were among the main reasons for the state's success in covering the uninsured through its NJ FamilyCare program (formerly NJ KidCare). New Jersey now covers children in families with incomes up to 350% of the FPL, and is considering increasing the limit to 500%. In New Jersey, "It's not a question of who's eligible, but what premium they should pay," Baxter said. He and other state officials stressed that flexibility was needed from the federal government in implementing these state/federal government programs. Alan Weil, director of the New Federalism project at the Urban Institute, said, however, "because the federal government limits the allotment of CHIP funds to the states, the program is more desirable than Medicaid." Baxter added that "CHIP expansion is favorable to Medicaid expansion because the CHIP program does not bring the 'massive fear' many states hold about Medicaid, an uncapped program." c. The Limits of Employer-Sponsored Coverage The conference also covered employer-sponsored coverage, as speakers emphasized its importance in the American health insurance system but cautioned that its effectiveness in reducing the number of uninsured might be limited. Sixty-six percent of Americans under 65 are covered through their employers, who pay 30% of the nation's $1 trillion in annual health expenditures, Commonwealth Fund President Karen Davis said. Employer-sponsored insurance is attractive because it is affordable and offers easy enrollment. Yet small firms often do not offer coverage because they have to pay high premiums, and low-income workers often cannot afford it. One option for small businesses to provide coverage at an affordable price is to enter an insurance pool with other employers, yet several of these "have floundered, hit a plateau or collapsed," Jack Meyer, president of the Economic and Social Research Institute, said. He added that rising premiums, an increase in the number of part-time, temporary and undocumented workers and the prospect of a slowing economy present obstacles to reducing the rolls of the uninsured through employer-sponsored coverage. Advocating a heterogeneous approach, Meyer said that "substantial governmental subsidies and programs, including Medicaid and CHIP, can assist employer-sponsored coverage if they are prominently marketed. "If not, no one will know, no one will care, and no one will play," he said. d. Cognitive Dissonance on the Uninsured "While most Americans want to help the uninsured, the will to take substantive measures to affect a change does not necessarily exist," Robert Blendon, professor of health policy at the Harvard School of Public Health, said. Using survey data he has compiled as director of the Washington Post/Kaiser Family Foundation survey project, Blendon spoke of the cognitive dissonance that Americans hold about the uninsured. Sixty-six percent, for instance, believe that the government should provide health insurance to those without it, but 70% distrust government to do the right thing. "Before the issue of the uninsured really captures the attention of Americans," Blendon said, "it must be viewed as a broader social and moral problem." "If the moral issue is going to play out, people are going to have to believe that the uninsured are getting hurt," he said, adding that voters would be more inclined to support efforts to help the uninsured if they knew working people made up most of the uninsured population. Saying that Democrats and Republican voters held differing views on the importance of expanding health coverage, Blendon said that tax credits and expanding government programs presented the best options for bridging the ideological divide. And any sustained effort to help the uninsured is contingent on an organization or personality taking up the cause. "There is a latent interest in this issue, but it hasn't shown itself politically," he said. -John Kastellec, American Health Line, 12/12/00 4. School Nurses Play Important Role in Reducing Number of Uninsured Students in Massachusetts The role of the school nurse has changed significantly in the past few years as the demand for more health care prevention and intervention is increasing in our schools. Today, Massachusetts school nurses are not only dealing with everyday illnesses and injuries, they are also focusing their efforts on helping uninsured children and families get health insurance. School nurses in MA have begun a statewide campaign, in partnership with the Division of Medical Assistance and the Department of Public Health, to reach and enroll uninsured families in MassHealth and the Children's Medical Security Plan (CMSP), two state programs that provide free and low-cost health care coverage to MA residents. Many families see the school nurse as a reliable and trusted source of health information and guidance. "The school nurse is one of the few health care professionals who may see a child on a regular basis," said Anne Sheetz, Director of School Health Services of the Department of Public Health. Many school nurses are implementing innovative programs within their communities to locate and help enroll the uninsured. In several school districts, school nurses have lobbied to include an additional question on school forms which asks parents if their child has health insurance. In Springfield, MA, for instance, school nurses use school meal program applications which asks parents if they would like an application for free or low-cost health care coverage and offer assistance completing it. Massachusetts Division of Medical Assistance Press Release, 30 November 2000. Note: Thanks to Ruth Ota (DOH), Dee Helber (DOE), and HMSA Foundation there are similar initiatives in Hawaii.