Issues in Developing Programs for Uninsured Children: A Resource Book for States. 1. Coordination


Five of the nine state programs described extensive efforts to coordinate with other children's programs and agencies for outreach and the identification of potential enrollees. States detailed the advantages of being able to capitalize on other organizations' expertise in attracting enrollees to their program.

The existing networks of community health organizations and schools are logical areas for children's health insurance programs to market their programs.

  • CaliforniaKids partners with community organizations to identify and enroll eligible children. The organization's partners include: school nurses, Head Start and Healthy Start programs, Child Care Councils, Child Health, Disability and Prevention Program (CHDP), Access for Infants and Mothers (AIM), Boys and Girls Club, and Big Brothers, Big Sisters.
  • In Florida, county public health departments and providers distribute applications for Healthy Kids. In addition, child care programs also market Healthy Kids by distributing pamphlets and applications.
  • In Florida, county public health departments and providers distribute applications for Healthy Kids. In addition, child care programs also market Healthy Kids by distributing pamphlets and applications.

In many instances, existing organizations and administrative systems can be utilized to target the most needy children.

  • Florida uses the school lunch program as a mechanism for charging reduced premiums to families. All children are eligible for the program, so the school lunch program serves as an administratively simple way for Healthy Kids to determine family need and identify the most appropriate subsidy level. This process for verifying children requires schools to send Healthy Kids an electronic table of all enrolled students and their eligibility for free and reduced lunches.
  • In Massachusetts, the Children's Medical Security Plan coordinates with schools to send informational letters home with children. This coordination has been successful, especially in enrolling adolescents. In addition, WIC, MCH, family planning and community health clinics distribute informational materials on CMSP at their sites. Infants and toddlers are often reached through nurses, MCH programs, and the area hospitals (e.g., when children enter the emergency rooms for care, parents are questioned regarding their insurance status, and when applicable, they are referred to CMSP). CMSP coordinates closely with Medicaid, WIC, primary care sites, and the school health programs. For example, CMSP conducts joint marketing and outreach activities with Healthy Start to target families eligible for both programs. As CMSP has expanded its focus to include adolescents, the program has also worked closely with family planning clinics, state immunization programs and substance abuse programs.

Children's health insurance programs can capitalize on existing administrative skills and marketing knowledge of state agencies.

  • The Massachusetts Children's Medical Security Plan (CMSP) was moved from the Department of Insurance to the Department of Health to capitalize on the marketing and outreach experience of the Medicaid and Maternal and Child Health Departments. It was understood that the Department of Health would target all children not eligible for Mass Health (Medicaid) and undocumented children, and that the use of this outstanding relationship between MCH and Medicaid would assist with the success of CMSP. After the move of the program to the Department of Health, enrollment increased from 20,000 to 36,000 children due to outreach and coordination efforts with other programs.
  • In Minnesota, there has been a mixed effort to coordinate with other agencies to enroll potential beneficiaries. When MinnesotaCare was operated as a separate program focused on children, many state agencies referred children to the program. However, as the program has expanded to include all uninsured, outreach needs have increased substantially. It has been more difficult to keep up with those needs without more resources. Minnesota has embarked on a major outreach effort including a $1.5 million legislative appropriation to 26 separate grantees throughout the state, to reach targeted populations. Because enrollees transition in and out of eligibility for MinnesotaCare, a significant amount of time is devoted to coordinating with other public agencies. Minnesota has identified training new program staff about Medicaid as well as training Medicaid staff about MinnesotaCare to be essential in their outreach efforts. Minnesota has also developed a combined application form in which a potential enrollee can indicate an interest in being considered for both Medicaid and MinnesotaCare. Although the application is a combined effort, the eligibility determination continues to take place in two separate offices until the year 2000, when county agencies will have the option to administer MinnesotaCare.

One area of concern in reaching eligible children is reaching those with special health care needs.

  • Minnesota Children with Special Needs, Minnesota’s Title V program for children with special health care needs, has a long history of working closely with both Minnesota’s Medicaid and MinnesotaCare programs to assure that children with chronic illnesses or disabilities have access to a comprehensive array of services. To facilitate this process, MCSHN has a toll free number that is designed to answer a variety of questions from referral resources, providers, and families of children with special health care needs. Minnesota continues to struggle with the implementation of a one-stop-shopping model for children with special health care needs. However, progress has been made with a single application for families to access Medicaid, MinnesotaCare, or MCSHN services. Joint use of eligibility cards and payment systems has also reduced confusion for providers for families. Efforts continue to move to a more seamless system of eligibility and services for children with special health care needs and their families.