The Southern Institute on Children and Families

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 nation’s 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.

The Burden of Proof: How Much is Too Much for Child Health Coverage? Report on Verification Issues Meeting with State and Federal Officials, Southern Institute on Children and Families, December 1998.
"Child Health Coverage: Medicaid Application Process," Southern Regional Initiative To Improve Access To Benefits For Low Income Families With Children, Southern Institute on Children and Families, February 1998.

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.

"Medicaid Eligibility Outreach," Southern Regional Initiative to Improve Access to Benefits for Low Income Families With Children, Southern Institute on Children and Families, February 1998.

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.

Alabama	Kentucky	Oklahoma
Arkansas	Louisiana	South Carolina
Delaware	Maryland	Tennessee
District of Columbia	Mississippi	Texas
Florida	Missouri	Virginia
Georgia	North Carolina	West Virginia

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.