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RUMAR
DEPARTMENT OF HEALTH & HUMAN SERVICES
STATEMENT
Washington, D.C. 20201
JAN 23 1998
Dear State Health Official:
This letter highlights new and existing opportunities for outreach to uninsured children. We share
a mutual interest in and commitment to enrolling uninsured children in both Medicaid and the new
State Children's Health Insurance Program (CHIP). An estimated 3 million children are eligible
for Medicaid, but remain uninsured. Millions more will be eligible for CHIP because of historic,
bipartisan legislation passed by the Administration and Congress. Successfully enrolling these
eligible but uninsured children is critical to both the success of these programs and the health of
these children; as such, outreach is a high priority for the President, First Lady, and Department of
Health and Human Services.
In this letter, we describe examples of and options for successful outreach and enrollment and
Federal funding available for these activities. Most of these provisions are currently options
within Medicaid or reflect preliminary guidance for CHIP. Two of these provisions expanding
the entities that can determine presumptive eligibility and expanding access to a special fund for
outreach -- are proposals in the President's fiscal year 1999 Budget that would provide nearly
$200 million a year in additional Federal dollars to States that choose to take advantage of these
initiatives. If passed, they would be effective on October 1, 1998.
I. Funding for Outreach
States have several options for receiving Federal matching funds to find and enroll uninsured
children in Medicaid and/or CHIP. Medicaid will match States' expenditures associated with
outreach to Medicaid-eligible children. Similarly, CHIP funds may be used to pay for outreach to
CHIP-eligible children (up to the 10 percent limit, described below). Because of the importance
of outreach, the President's fiscal year 1999 Budget contains proposed legislation that, if enacted,
would provide a higher matching rate for outreach activities for all children, regardless of their
eligibility. This section describes these options.
Federal Matching of Outreach under Medicaid
There have been questions about what types of outreach activities Medicaid will fund.
The Federal government matches State Medicaid expenditures for outreach activities that
bring potential eligibles into the Medicaid system to determine if they qualify for Medicaid
benefits. These activities include: informing families about Medicaid through brochures
or other promotional material; assisting families in completing Medicaid applications; and
providing the necessary forms and packaging for Medicaid eligibility determinations.
These activities are considered allowable Medicaid administrative activities for the
purpose of Federal matching. Since the Medicaid program is an open-ended entitlement
program, there is no limit on the amount of allowable Medicaid outreach expenditures
States may claim for Federal matching.
2
Federal Matching of Outreach under CHIP
Title XXI places a strong emphasis on outreach. State child health plans cannot be
approved without a description of how States will educate families, assist them in enrolling
children in the appropriate program, and coordinate health insurance programs across the
State. There are several ways that CHIP outreach expenditures may be matched.
Non-Medicaid CHIP Option. Outreach activities related to a non-Medicaid CHIP
program only would be matched from the State's CHIP allotment. States may spend up to
10 percent of their total CHIP expenditures (Federal and State) on non-benefit activities,
including: outreach conducted to identify and enroll eligible children in CHIP;
administration costs; health services initiatives; and other child health assistance. These
expenditures are matched at the enhanced CHIP matching rate and count against both the
10 percent limit and the allotment.
Medicaid CHIP Option. Outreach activities related strictly to a Medicaid expansion
under CHIP can be matched either from the State's CHIP allotment or under regular
Medicaid, at the State's option. If a State elects to claim Federal matching for its outreach
expenditures from the CHIP allotment, such Federal payments will count against the
State's 10 percent limit and allotment and will be matched at the enhanced CHIP matching
rate. Once the State reaches its 10 percent limit and/or its CHIP allotment, it may then
claim Federal matching for any additional Medicaid outreach expenditures under the
Medicaid program. States may claim Federal matching for outreach expenditures under
the Medicaid program only if such expenditures are for CHIP-related Medicaid expansion
groups. Alternatively, a State may elect to claim Federal matching for outreach
expenditures for CHIP-related Medicaid expansion groups under the Medicaid program at
the regular Medicaid administrative matching rate. If claimed in this way, Federal
payments for these expenditures would not count against the 10 percent limit or the CHIP
allotment.
Joint Medicaid-CHIP Option. Joint outreach efforts for Medicaid and CHIP may
similarly be matched by either Medicaid or CHIP. Detailed guidance on these options was
provided in a December 8, 1997 letter to State Health Officials on financial issues.
Enhanced Matching for Children's Outreach Efforts [Proposed Legislation]
In the welfare reform bill that created the Temporary Assistance for Needy Families
(TANF) program, a $500 million Medicaid fund was established to help States ensure that
children and parents losing welfare know about their continued eligibility for Medicaid.
These funds, which are allotted to States, provide an enhanced Federal matching rate for
outreach and administrative costs related to this narrow group of Medicaid-eligible people.
Certain outreach activities are eligible to receive a 90 percent matching rate from the fund.
(See the May 14, 1997 Federal Register notice for details.) Few States, however, have
3
taken advantage of this fund so far, in part, due to the difficulty of targeting outreach only
to a subset of Medicaid-eligible children.
The President's fiscal year 1999 Budget includes a legislative proposal that, if enacted,
would expand the use of this fund. States would be able to receive a 90 percent matching
rate for outreach activities for all uninsured children, not just those who would have been
eligible for welfare. The Federal funds to cover the extra matching (above Medicaid's
regular matching amount) would come from this fund. In addition, the proposal would
remove the sunset on the fund in 2000 and add another $25 million to assist States with
increased outreach activities.
II. Expanding Sites for Enrolling Children
In the wake of welfare reform, families often misunderstand their children's continued eligibility
for Medicaid. They also may be unsure about differences between Medicaid and CHIP. Thus, it
has become more important than ever that States have and pursue options to conduct educational
activities and enrollment of children in a wider array of community settings.
Allowing Immediate Medicaid Coverage Through Schools, Head Start, and Child
Care Centers [Proposed Legislation]
The Balanced Budget Act (BBA) of 1997 gave States a new option in Medicaid to grant
"presumptive eligibility" to children. Certain children may receive immediate health care
coverage without having to wait for a full Medicaid eligibility determination. Under this
option, a "qualified entity"and/or its employees may presume that a child is temporarily
eligible for Medicaid if, using preliminary information, family income does not exceed the
State's applicable income eligibility level. The child's parent or guardian has until the end
of the following month to submit a full Medicaid application for the child. Until a final
eligibility determination on that application is made by the State, the child is covered for
Medicaid services. Although the CHIP statute does not expressly provide for presumptive
eligibility, States also could use this option in their eligibility for a CHIP separate State
program.
The BBA defines "qualified entities" as providers of health care items and services under
the Medicaid State plan (including IHS, Tribal and urban Indian health care providers that
participate in a Medicaid State plan) and entities that determine eligibility for Head Start,
WIC and child care subsidies under the Child Care and Development Block Grant. It also
requires that certain costs associated with presumptive eligibility be subtracted from the
State's child health allotment (see the December 8, 1997 letter on financial issues).
4
The President's fiscal year 1999 Budget proposes to make this presumptive eligibility
option more flexible and attractive to States. First, it would broaden the definition of
"qualified entities" to include sites such as schools, child care resource and referral
centers, child support enforcement agencies and CHIP eligibility workers. Second, it
would eliminate the requirement that States subtract the costs of presumptive eligibility
from their CHIP allotments. Instead, these costs would be matched as a regular Medicaid
State plan option. Both of these changes would give States greater incentives and
flexibility for using this important authority.
"Outstationing" Eligibility Workers in Communities
Outstationing eligibility workers is a promising outreach strategy for enrolling Medicaid
and CHIP-eligible children. "Outstationing" means locating eligibility workers in places
other than welfare offices to assist with the initial prccessing of applications. (The final
Medicaid eligibility determination must be made by the appropriate State agency.)
Current Medicaid law requires States to outstation eligibility workers in Federally
qualified health centers and disproportionate share hospitals. States also can receive
Federal matching for outstationing eligibility workers in other locations.
We encourage States to consider outstationing eligibility workers at sites that are
frequented by families with children such as schools, child care centers, churches, Head
Start centers, WIC offices, community centers, Job Corps sites, GED programs, local
Tribal organizations and Social Security offices.
Using Mail-In Applications
One option that allows States to ease the enrollment process is the use of mail-in
applications. Mail-in applications, especially for Medicaid, can significantly reduce the
barriers to enrollment that may occur with requiring in-person applications.
Transportation costs are eliminated, the stigma of going to a social services office is
removed, parents will not have to miss work, and community groups like PTAs and
church organizations can assist in distributing applications and information regarding
Medicaid and CHIP. Many, but not all, States use this option in Medicaid today. We
encourage all States to adopt this option.
III. Simplifying Enrollment
A key to successfully enrolling children at a wide range of sites is a simple application and
enrollment process.
5
Simplifying the Medicaid Application and Eligibility Process
One barrier to enrollment in Medicaid is the complexity of the application. Some States
have applications over 20 pages long, posing an often insurmountable challenge for
families. We encourage States to develop strategies to simplify these processes by:
preparing a simplified Medicaid application for the eligibility groups that include most
children; using a "less restrictive" eligibility methodology that drops the Medicaid assets
test for children; shortening the Medicaid application form generally; and allowing mail-in
applications. Also, there are few verification requirements under Federal law that are
mandatory. While it is important to maintain program integrity by verifying income,
excessive requirements can deter families from completing the application process.
Medicaid administrative funds can be used to redesign the Medicaid application form.
Attached are some examples of shortened and simplified Medicaid applications used in
some States (see attachment A).
Using a Single Application for Medicaid and CHIP
We encourage States to use one application for both Medicaid and CHIP. The advantages
of a single application form include a reduction in paperwork for the State and a simplified
process for families potentially eligible for Medicaid or CHIP. Attachment B includes a
model joint application form and its instructions. We also encourage States to use single
applications for health and non-health programs like TANF.
Eligibility Screening and Enrollment for Medicaid and CHIP
CHIP requires States to ensure that only targeted low-income children are furnished child
health assistance and that children found eligible for Medicaid through screening are
enrolled in Medicaid. At a minimum, State screening processes should assure that all
children who are potentially eligible for Medicaid under the poverty-level-related groups
are identified. The State may initially use a gross income test that compares total family
income to the applicable Medicaid standard. The initial gross income test would
immediately identify children whose family income is low enough that Medicaid eligibility
would be almost certain. A second test would be needed, however, to detect those
children whose gross family income exceeds the Medicaid standard but who are Medicaid-
eligible when income disregards are applied. Without this second test, the State would not
be meeting its responsibility to ensure that children eligible for Medicaid are identified and
enrolled in Medicaid. (Some States have used this technique with simplified Medicaid
applications.) Screening is not required for States that elect to expand Medicaid under
CHIP, because the child's eligibility for regular Medicaid will be determined as part of the
State's eligibility determination process.
6
The statute clearly says that States must include in their State child health plans a
description of procedures to ensure that children found to be eligible for Medicaid must be
enrolled in Medicaid; a simple referral procedure to Medicaid will not meet this
requirement. The Department of Health and Human Services (DHHS) will be providing
guidance on options to meet this requirement in the near future. Some examples include:
-
Single State agency for eligibility determination: States can use the Medicaid
State agency to make eligibility determinations for non-Medicaid CHIP expansions
as well as Medicaid CHIP expansions.
Joint application for both CHIP and Medicaid: States can use a joint CHIP and
Medicaid application. As noted earlier, DHHS has developed a model application
form for CHIP and Medicaid (see attachment B). States could use interagency
agreements to send applications to the appropriate place for processing.
Presumptive eligibility: If the President's fiscal year 1999 Budget proposal is
enacted, States will have the option of allowing their CHIP eligibility workers to
make presumptive Medicaid eligibility determinations as well as CHIP eligibility
determinations. (The final Medicaid eligibility determination must be made by the
appropriate State agency.)
Granting 12-Month Continuous Eligibility
Another way to increase the number of children with health insurance is to grant children
eligibility for Medicaid for a longer period of time. Many families fall in and out of income
eligibility due to job changes or fluctuations in paychecks. The BBA provides States the
option to provide individuals under age 19 with up to 12 months of continuous eligibility
after they are determined eligible for Medicaid, even if there is a change in the family's
income, assets, or size. Under this option, Medicaid eligibility is granted for a period of
up to one year regardless of changes in circumstances. States that use their CHIP funds
for separate State programs can also provide continuous eligibility, since they have the
flexibility to determine how frequently follow-up screening (redetermination) will be
conducted.
IV. Other Outreach Strategies
In addition to expanding sites for enrollment and simplifying the process, States have used a
number of valuable approaches to help them locate children and facilitate their enrollment in
Medicaid and other health programs. This has been especially true for children who are members
of special populations, such as children with special health care needs, homeless children and
migrant children. State strategies to reduce barriers to enrollment range from advertising on
billboards to linking health with other types of public programs like Head Start. Promising
examples of State outreach activities are described in attachment C.
7
Summary
Every successful outreach model requires cooperation among diverse entities. Potential partners
for outreach programs include school districts, community-based organizations, local health and
human service providers, Head Start programs and child care centers. In addition, collaboration
between the Federal and State governments, private businesses, foundations and advocacy groups
could also produce creative and effective outreach initiatives.
We believe that the new children's health insurance program provides a unique opportunity to
ensure that the millions of eligible children are enrolled in public or private health insurance plans
and receive essential health care services. We hope you will join us in meeting this challenge.
Sincerely,
Nancy-A Deparle
Nancy-Ann Min DeParle
Claude Earl Fox, M.D., M.P.H.
Administrator
Acting Administrator
Health Care Financing Administration
Health Resources and Service Administration
Enclosures
cc:
HHS Regional Directors
HCFA Regional Offices
PHS Regional Offices
TANF State Agencies
Title IV-D Agencies
Child Care Directors
Child Welfare Directors
Ms. Lee Partridge, American Public Welfare Association
Ms. Jennifer Baxendell, National Governors' Association
Ms. Joy Wilson, National Conference of State Legislatures
Ms. Cheryl Beversdorf, Association of State and Territorial Health Officials
Ms. Mary Beth Senkewicz, National Association of Insurance Commissioners
(Attachment A)
EXAMPLES OF SIMPLE MEDICAID APPLICATION FORMS
List of States that have Simplified the Medicaid Application Process
Delaware's Application
Georgia's Application
South Carolina's Application
States That Have Simplified the Medicaid Application Process
The following States have taken steps to simplify their Medicaid application processes, by
allowing mail-in applications, shortening the Medicaid application form, or eliminating the assets
test for children or by using a combination of these techniques.
Mail-In Applications (24)
Short Application (29) **
No Assets Test (36) ***
Alabama
Alabama
Alabama
Alaska
*
Alaska
Alaska
Connecticut
Arkansas
Arizona
Delaware
Colorado
Connecticut
District of Columbia
Georgia
Delaware
Hawaii *
Hawaii
District of Columbia
Illinois *
Illinois
Florida
Maine *
Indiana
Georgia
Massachusetts
Iowa
Illinois
Michigan (local decision)
Kentucky
Indiana
Minnesota
Michigan
Kansas
Mississippi
Mississippi
Kentucky
Missouri
Missouri
Louisiana
New Mexico *
New Hampshire
Maine
North Dakota
*
New Mexico
Maryland
Ohio
New York
Massachusetts
Oklahoma
Ohio
Michigan
Oregon
Oklahoma
Mississippi
Pennsylvania
Oregon
Missouri
Utah *
South Carolina
Nebraska
Vermont
South Dakota
New Hampshire
Virginia
Tennessee
New Jersey
Washington
Texas
New Mexico
Wyoming *
Utah
New York
Vermont
North Carolina
Virginia
Ohio
Washington
Oklahoma
West Virginia
Pennsylvania
Wyoming
South Carolina
South Dakota
Tennessee
Vermont
Virginia
Washington
West Virginia
Wisconsin
*
After the mail-in application is received, the Medicaid agency will conduct a telephone interview.
Applications are the same length or shorter than the HCFA model application
AR, CA, HI & UT count assets in determining Medicaid eligibility for some children.
Source: Center on Budget and Policy Priorities, August 1997
DELAWARE HEALTH
No
AND SOCIAL SERVICES
DIVISION OF SOCIAL SERVICES
Wrong Door
FAMILY AND COMMUNITY
MEDICAL ASSISTANCE APPLICATION
This form must be completed before we can see if you are eligible for medical assistance. If you need help
completing the form, ask your worker. Return this application within 30 days of the date you asked for
Medicaid. If you do not, this may change the date your Medicaid will start.
We must take action on your application for Medicaid within 45 days from the date we receive your application
in our office (90 days for disabled children or others who apply on the basis of disability).
We need you to give us proof of the following items for you and your family:
Birth (birth certificate, driver's license, marriage license)
Social Security number (copy of card or proof you have applied for one)
Lawful alien status (registration card, immigration papers)
Current income (pay stubs, letter from employer, award letter or check)
Child care costs (receipts or letter from provider)
Delaware residency and address (enclosed household form, utility bill, lease)
Medical insurance, such as Medicare (copy of card, benefit letter)
Pregnancy and due date (statement by medical professional)
Disability for Disabled Child Program (enclosed medical forms)
Emergency medical condition for illegal aliens (enclosed medical forms)
Resources for QMB, SLMB, Disabled Child and SSI related programs (bank statements, life
insurance policies, burial fund, savings bonds, trust fund)
You may need to give us more information. If you have already given this information to a Department of
Health and Social Services office, let us know. You may not have to give it again. Failure to provide the above
information may result in delayed or denied benefits.
HEAD OF HOUSEHOLD:
LAST NAME
FIRST NAME
M.I.
STREET ADDRESS
DEVELOPMENT OR APARTMENT NAME
APT.NO
CITY
STATE
ZIP CODE
DAYTIME TELEPHONE NUMBER
MAILING ADDRESS (IF DIFFERENT FROM ABOVE)
PLEASE LIST ANY OTHER NAMES THAT YOU HAVE USED
MAP-4
1
Revised 3/97
HOUSEHOLD MEMBERS
Please list everyone in your household (including yourself) and complete each space by their name.
ARE YOU
LAST NAME
FIRST NAME
M.I.
OFFICE USE ONLY
APPLYING
FOR THIS
(MCI #)
PERSON?
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
1. Have you ever been eligible for and received both a Social Security check and a Supplemental Security
Income (SSI) check in the same month?
Circle one: Yes No
If yes, list the last month and year you were eligible for and received both benefits:
2. Does anyone in your family have unpaid medical bills from the last three months?
Circle one: Yes No
Was your income the same as it is now during those months?
Circle one: Yes No
3. If you pay child care costs, please give names of the children and the monthly amount you pay for each
child. Please also include any fees for summer camp or nursery school.
NAME OF CHILD
MONTHLY
NAME OF CHILD
MONTHLY
AMOUNT
AMOUNT
MAP-4
2
Revised 3/97
HOUSEHOLD MEMBERS
SOCIAL SECURITY NUMBER
SEX
RACE/
IS THIS
ALIEN REGISTRATION NUMBER
ETHNIC
PERSON A U.S.
GROUP
CITIZEN OR A
LEGAL ALIEN?
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YOUR RIGHTS AND RESPONSIBILITIES
I have read or have had read to me all statements on this form. I understand the questions on this form
and the information is true and complete to the best of my knowledge. I understand that the State of Delaware
has a law that prohibits giving false information or withholding information to get any type of assistance,
including Medicaid, or to get more assistance than I am entitled to get. I understand that if I give any false
information or withhold any information, I may be prosecuted to the full extent of the law.
I agree to help establish my eligibility by giving as much information as I can about my circumstances
and by giving proof of statements on my application.
I certify, under penalty of perjury, that I am a U.S. Citizen or alien in lawful immigration status. I must
provide proof of lawful immigration status. Lawful alien status requires submission of certain information to the
Immigration and Naturalization Service for verification. Nonlawful aliens may be eligible for emergency services
only.
All information and documentation gathered for determining my Medicaid eligibility is confidential.
Medicaid has safeguards and limits disclosure of information about me. Disclosure of information concerning
my Medicaid eligibility to anyone not authorized to receive the information is a violation of State and Federal
laws and may result in legal sanctions. While Medicaid will keep my eligibility information confidential, these
provisions do not affect my right to give specific written consent to release information to other persons or
sources.
MAP-4
3
Revised 3/97
YOUR RIGHTS AND RESPONSIBILITIES
I understand that I am required by law to assign to the State all rights to medical support and other third
party payments (hospital and medical benefits) and to cooperate with the State in establishing paternity and
securing medical support. This assignment is a condition of Medicaid eligibility. Medicaid cannot be denied to
eligible children because of their parent's refusal to establish paternity or secure support from absent parents.
I
understand that pregnant women are not required to cooperate in establishing paternity and securing medical
support.
I agree to allow the Department of Health and Social Services, or its representatives, to have access to
all medical records that are related to payment and medical services by Medicaid. I agree to allow the
Department of Health and Social Services, or its representatives, to act as my agent in recovering money spent
by the Medicaid Program when other money from insurance, estates, etc., becomes available to pay my
medical bills.
I understand that I may appeal to the Division of Social Services or the U.S. Department of Health and
Human Services if I am not satisfied with any decision on my application or if I feel that I have been
discriminated against because of race, color, national origin, religion, sex or handicap.
I understand that I may be represented by an attorney at a fair hearing, or any other person I choose. If
I am not satisfied with the decision on my fair hearing, I understand that I may request a judicial review in
Superior Court in the County where I live. I also understand that I must file for a judicial review within 30 days of
the date of my fair hearing decision.
I certify that I have had the services of the Division of Child Support Enforcement explained to me and
have been offered an opportunity to participate in their program.
I agree to enroll in a Managed Care Organization if I am required to by the Medicaid Program.
I understand that pregnant or nursing women and children age five and under may apply for WIC
benefits by contacting the Division of Public Health at 1-800-222-2189.
I agree to report within ten days changes in my household situation that could affect my eligibility, such
as a change in how many people live with me, a change in income, or if I move.
This application must be signed by an adult household member (age 18 or over) or by an emancipated
minor (under age 18).
Sign, date and return the application as soon as possible. Include copies of all the items listed
on page one that apply to your family. If you have questions, call your local Medicaid office.
IMPORTANT REMINDER
Signature of Applicant or Representative
Date
Signature of DSS Worker
Date
MAP-4
4
Revised 3/97
Allanta, Georgia 30334
Post Office Box 38420
Recipient Inquiry Unit
Missicaid Program:
Patient Rights and Responsibilities
Georgia Department at Medical Assistance
Right
I agree 10 give correct information to see if I can
receive Medicaid.
from th
1 acree 10 provide the county information to prove
Start
any statements given in this application and hereby
give permission 10 the county to get such proof.
I understand that for Medicaid I must report any
changes in my circumstance within Icn (10) days of
becoming aware of the change.
150
Address
To:
I understand that if I DO NOT like the decision
made on my case, I have the right to a fair hearing.
I can request a hearing by writing or calling the
State
County Department of Family and Children Services
county where I applied.
FREE
If you want AFDC for any family member, you
A HEALTHY START IN LIFE
will have 10 sign a different application form.
I However, we will USC the date on this form to
FOR YOU AND YOUR BABY.
determine your cligibility.
FACTS: RIGHT FROM THE START
GET FREE PRENATAL CARE RIGHT
NOW.
SEE THE SAME DOCTOR FROM FIRST
EXAMINATION TO DELIVERY.
YOU CAN QUALIFY IF YOU'RE
70 Code
APPLYING IS SIMPLE AND EASY.
MARRIED OR SINGLE.
FREE MEDICAL CARE IS AVAILABLE
FOR ELIGIBLE CHILDREN BORN
YOU DONT HAVE TO BE PREGNA
AFTER SEPTEMBER 30, 1983.
TO RECEIVE FREE MEDICAL CARI
FOR YOUR CHILD.
Here
Stamp
Place
For more information, contact your county health
YOUR LOCAL HEALTH DEPART-
department or county Department of Family and
MENT CAN GIVE YOU A MEDICAII
Children Services.
CARD THE SAME DAY YOU VISIT.
Application Date.
MEDICAID NOW HELPS ALMOST
NAME
50,000 GEORGIA WOMEN LIKE YOU.
First
Initial
Last
Maiden Name
Telephone #
ADDRESS
Married or single. Insured or uninsured. You and
Street
Apt.
City
County
State
Zip Code
our children can receive FREE medical help immedi-
1.Is anyone in your house pregnant?
Yes
No If yes who?
cly. Apply today, Medicaid forms are now simple 10
Is she on Medicaid?
Yes
No
ad. The approval process is now faster. And more
2. Whom do you want 10 receive Medicaid?
ctors than ever before will care for you and your
hildren. Ask at your local health clinic how you can join
List all people in your home (write your name first):
Sex
C Right from the Start program. Get the right care. Get
First
M.I.
Last
Social Security No.
Date of
Race
Relationship
U.S. Citizen
Birth
yes/no
C right start. It's simple. It's casy. And it's smart.
MYSELF
Self
Right from the Start has the right stuff.
When you become pregnant you create life. It's a
iracle. Suddenly, a little person lives within you. To help
C baby grow inside, you must care for him or her from
C outside. See a doctor early and regularly. Get prenatal
rc. Only you can keep the baby inside happy. Eat right.
juit smoking or cut back. Don't drink alcohol, including
3. INCOME: Do you or does anyone in your home get money from:
eer or wine. Give your baby the right stuff Right from the
Amount Before
How Often
Name of Person(s)
cart.
Any Deductions
;
Received
Receiving
So, if you think you're pregnant but can't afford a
Current Job
Yes
No
octor we can help you. If you are pregnant but can't pay
Employer's Name:
our medical bills we can help you. And if you have
Social Security Income/SSI
Yes
No
bung children who have not seen a doctor regularly we
AFDC
Yes
No
in help you.
Pensions or Retirement Benefits
Yes
No
ET HELP NOW Right from the Start.
Child Support or Contributions
Yes
No
Apply for medical care inside and out.
Unemployment Benefits
Yes
No
Student Loan/Grant
Yes
No
If you are pregnant or have a child under a year
Id, you will qualify for Right from the Start Medicaid if
Other Income
Yes
No
our yearly income is about $14,000 or less. If you already
ave 1wo children, you can earn almost $21,000 a year and
4. Do you have health insurance on anyone for whom you are qualifying?
Yes
No
all qualify.
(Provider: Complete Form 285) Health insurance company
Your baby can stay in the Medicaid program until
Policy number
is first birthday. After that. the income requirements
5. Do you have any unpaid medical bills from the past three months?
Yes
No
ecome a little stiffer. but most children will still be
Medicaid Program I agree 10 give correct information to see if I can receive Medicaid. I agree to provide the county
information to prove any statements given in this application and hereby give permission w the county 10 gel such proof.
I
overed unul age :
understand that I am breaking the law if I give wrong information. I understand that for Medicaid, I must report any changes
Getting medical care for you and your children is
in my circumstance within ten (10) days of becoming aware of the change I understand that if I DO NOT like the decision
made on my case. I have the right to a fair hearing. I can request a hearing by writing or calling the county where I applied.
LSICE than ever before. If you think you might'qualify,
/ certify that the information / have provided is correct.
JSL fill out this application and send it in or contact your
/ have read (or had read 10 me) and understand the information on this form.
/ agree 10 apply for a social security number if / do not have one.
ounty health department or county Department of Family
and Children Services
Applicant's Signature
Date
Representative's Signature
Date
Title
South Carolina
Partners for Healthy Children
Dear Parent,
Welcome to Partners for Healthy Children, our new program of health coverage for children.
Partners for Healthy Children provides free health care to children in families with low
income. Health care can be expensive. I am pleased that South Carolina can offer this help to
your family as you struggle to meet your child's needs.
So I want to join in a partnership with you. We will provide Partners for Healthy Children
and, if your family qualifies, your child's health care will be free. But you need to join us as a
partner, too. You are in charge of the health care your child receives. You need to fill out and
mail an application for Partners for Healthy Children. After you get your Partners for
Healthy Children card in the mail, you will need to make appointments with a doctor and make
sure your child gets the health care he needs.
Look at the chart on the back of this letter. If your family income is no more than the amount
shown for your family size, your children should qualify for Partners for Healthy Children. To
apply, simply fill out the attached application form and mail it in.
If your income is greater than the amount on the chart, your children may still qualify. In that
case, go to one of the locations listed on the back of this letter and ask for assistance in applying
for Partners for Healthy Children.
I hope this will be a great year for your family and I hope Partners for Healthy Children will
help you provide the health care for your children that you decide they need.
Sincerely,
David M. Beasley
Office of the Governor
Post Office Box 11369
Columbia, South Carolina 29211
Do Your Children Qualify for
Free Health Care from
Partners for Healthy Children?
Number of people
Income levels to qualify for Partners for Healthy Children
in family
(Income slightly above may still qualify. See NOTE below.)
(Count parent(s)
and children)
Hourly wage
Weekly income
Monthly income
Annual income
2
$7.65
$306
$1,327
$15,915
3
$9.63
$385
$1,667
$19,995
4
$11.58
$463
$2,007
$24,075
5
$13.53
$541
$2,347
$28,155
6
$15.50
$620
$2,687
$32,235
7
$17.45
$698
$3,027
$36,315
8
$19.43
$777
$3,367
$40,395
The number of people in the family includes the parents and the children. Add together all the
income received by all family members and see if your income is not more than the amounts
above. If so, your children should qualify. If more than 8 people live in your family, please call
1-888-549-0820 for assistance.
NOTE: If your family income is slightly more than the amounts on the chart above, you may still
qualify but you will need to apply in person, at one of the following offices. Call the phone
number in your county to find out where and when to go to apply. Many county DSS offices have
Medicaid eligibility workers located at hospitals, health departments, or federally qualified health
centers where applications can be filed also.
Abbeville County DSS
Charleston County DSS
Edgefield County DSS
Lancaster County DSS
Orangeburg County DSS
459-5481
792-0444
637-4040
286-6914
531-3101
Aiken County DSS
Cherokee County DSS
Fairfield County DSS
Laurens County DSS
Pickens County DSS
642-3650
487-2704
635-5502
833-0100
898-5810
Allendale County DSS
Chester County DSS
Florence County DSS
Lee County DSS
Richland County DSS
584-7063
377-8131
669-3354
484-5376
735-7048
Anderson County DSS
Chesterfield County DSS
Georgetown County DSS
Lexington County DSS
Saluda County DSS
260-4100
623-2150
546-5134
957-7333
445-2139
Bamberg County DSS
Clarendon County DSS
Greenville County DSS
McCormick County DSS
Spartanburg County DSS
245-4363
435-4305
467-7700
465-2627
596-3099
Barnwell County DSS
Colleton County DSS
Greenwood County DSS
Marion County DSS
Sumter County DSS
541-1210
549-6090
229-5258
423-4623
773-5531
Beaufort County DSS
Darlington County DSS
Hampton County DSS
Marlboro County DSS
Union County DSS
525-7861
398-4420
943-3641
479-4520
429-1660
Berkeley County DSS
Dillon County DSS
Horry County DSS
Newberry County DSS
Williamsburg County DSS
761-8044
774-8284
365-5565
321-2155
354-5411
Calhoun County DSS
Dorchester County DSS
Jasper County DSS
Oconee County DSS
York County DSS
874-3384
563-4337
726-7747
638-4400
684-8108
Kershaw County DSS
432-7676
South Caronna
Partners for Healthy Children
1. Tell us who you are and where you live.
If you have Medicaid, you do
not need to fill out this form.
Last name (Parent's)
First Name (Parent's)
Middle Initial
Phone
Street Address
City
State
Zip Code
County
Mailing Address, if different
City
State
Zip Code
2. Tell us who in your family lives with you. List the parent shown in item 1, on the first line below.
Last name
First Name
Middle
Sex
Race
Date of
Social Security
How is this
Initial
Birth
Number
person related
List parent(s) and children
List parent(s) and children
to you?
3. Tell us how much income your family has.
Fill in the amount of money you make. If you are married and your spouse works, fill in the amount of money your
spouse makes, too. Check one box to show if the amount is hourly, weekly, monthly or yearly. Enter GROSS pay, not
take home pay. Enter zero ("0") if you or your spouse have no earned income.
Your Income
Spouse's Income
Amount you earn: $
Amount your spouse earns: $
Hourly
Weekly
Monthly
Yearly
Hourly
Weekly
Monthly
Yearly
Hours worked each week
Hours worked each week
Employer Name and Phone Number
Employer Name and Phone Number
4. Tell us if you have any other income.
List any additional income you or family members living with you may have from the sources listed below and tell us how
often you get this income (for example, once each week, every three months, once a year, etc.)
Source
Amount
How Often:
Who Gets this Money?
Interest from bank account
$
Child support
$
Alimony
$
Social Security payment
$
Other (Please explain)
$
5. Attach proof of income.
We need proof of your income. For earnings, provide copies of pay stubs for the last four weeks. If you do not have pay
stubs, you may provide a letter from your employer or a copy of your most recent state or federal income tax form. Other
documents can be used to provide proof of income. If you are not sure what to send, call our toll-free number 1-888-549-
0820 and we will help you.
6. Tell us about any health insurance you already have.
Tell us the name of your insurance company, the policy number and the insured persons name on the policy. Even if you
already have health insurance, you can still qualify for Partners for Healthy Children.
Insurance Company or Employer
Phone Number of Insurance
Policy Number or
Insured (Name on
Company or Employer
Group Plan Number
policy)
7. Tell us whether any child received medical services in the last three months.
Did any of your children living with you receive medical services in the past 3 months:
Yes
No
8. Please sign this statement.
I certify that the information I have provided above is true to the best of my knowledge and I give
permission for the State of South Carolina to make any necessary contacts to check my statements.
I
have read the list of my rights and responsibilities that is printed below. I know that I could be
penalized if I knowingly give false information. I certify that the children listed on this application are
U.S. citizens or lawful immigrants.
Signature of applicant:
Date:
9. Mail this completed, signed form, together with proof of income, to:
South Carolina Partners for Healthy Children
Post Office Box 100101
Columbia, South Carolina 29202-3101
If you need more information, please call this toll-free number: 1-888-549-0820.
Rights and Responsibilities
Partners for Healthy Children is a program funded through a partnership with
5. 1 know that I may ask for a hearing if I am not satisfied with any action taken
regional hospitals, state government and the federal government
by the State of South Carolina in connection with the Partners for Healthy
Children program. I may also ask for a hearing if I feel that I have been
1. 1 know that my children under age 19 who are eligible for Partners for
discriminated against.
Healthy Children can have free health checkups under a special Partners for
Healthy Children prevention program called Early and Periodic Screening,
6. 1 know that the State of South Carolina will request and use information from a
Diagnosis and Treatment (EPSDT) programs.
computer system called the State Income and Eligibility Verification System
(IEVS). This computer system compares the Partners for Healthy Children
2. I know that the information I have given is confidential. I agree that medical
information about me and other members of my family with information from
information about my children can be released only If needed to administer this
other agencies. Other agencies may include the Internal Revenue Service,
program.
Social Security Administration and Employment Security Commission.
3. I know that any information I have given may be reviewed and verified by
7. 1 know that Partners for Healthy Children does not pay medical expenses that
State of South Carolina staff. Also I understand that I must cooperate fully with
a third party, such as a private health insurance company, is supposed to pay. If
state and federal workers if my case is reviewed. No additional permission is
my children get Partners for Healthy Children, 1 give my rights to any third party
needed to get verification or other information.
payments to the Department of Health and Human Services. These payments
may include payments from hospital and health insurance policies. I know that if
4. I know that this application will be considered without regard to race, color,
I refuse to give my rights to third party payments to the Department of Health
sex, age, handicap, religion, national origin or political belief.
and Human Services, my children will not be eligible'to receive a Partners for
Healthy Children card.
(Attachment B)
MODEL JOINT APPLICATION FOR CHIP/MEDICAID FOR CHILDREN
Purpose: The attached model joint application can be used for both the Children's Health
Insurance Program (CHIP) and children's Medicaid eligibility (under the children's poverty level
related groups). States could allow individuals to use this form to apply for both programs and
the information on this form would be sufficient for determining which program a child is eligible
for. It includes only that information which is required in all circumstances and is provided as a
base form which a State can adapt to meet its own needs. As presented, the form is suitable for
completion by an intake worker. Modifications would be required to make the form suitable for
direct completion by the applicant.
Screening: This application will meet the statutory requirement in Title XXI that States identify
children who are eligible for Medicaid.
NOTE: In situations where the State has contracted out the CHIP program eligibility (i.e.,
determinations will be made by non-State employees), this form can be modified to be used as a
pure screening form (or a combination of an application for CHIP and screening form) by
removing all references to Medicaid. The statement about the use of the Social Security number
[33] would be required. Inclusion of the rights and responsibilities section (without reference to
Medicaid), however, would be at State option. Non-State employees cannot make a
determination of Medicaid eligibility. If the form is so modified, in order to permit the
information on the form to be submitted for use in making a Medicaid determination, the non-
State employees could have a separate page for those whom the screen indicates are Medicaid-
eligible. On that page, the individual should consent to submission of the information as part of a
Medicaid application, and accept the rights and responsibilities outlined on this draft (including a
statement under penalty of perjury that the information provided on the "attached screening
form" or "attached CHIP application" is correct). After this page is completed, the form could be
forwarded to the State for a Medicaid eligibility determination.
Mandatory Information About Medicaid: If a State uses a joint CHIP/Medicaid application
and denies the Medicaid application, then the State must thoroughly inform the individual about
the availability of Medicaid and his or her right to apply for Medicaid on a basis other than as a
poverty-level child. This includes an explanation of the Medicaid program and the various
eligibility groups, the advantages of Medicaid over CHIP and information about how and where
to apply for Medicaid.
Federal Verification Requirements: Under Federal law, there are no verification requirements
pertaining to eligibility for the children's poverty-level-related groups under Medicaid other than
those related to alien status of non-citizens, and the posteligibility requirements of §1137
pertaining to use of the individual's social security number and an income and eligibility
verification system. Eligibility of a citizen child may be established on the basis of a declaration
under penalty of perjury. States are permitted to require further verification as a condition of
eligibility.
Additional Simplification of Medicaid Eligibility Determination: If the total gross income of
the family is at or below the applicable Medicaid income standard, the questions in the shaded
areas need not be answered. The individual is obviously income eligible for Medicaid without
further information.
Explanation of Certain Fields: There are some questions on the application that may not elicit
all the information needed to make a determination. Under certain circumstances, additional
information will be required. For example:
If the answer to the question about citizenship [18] is no, actual status will need to be
determined, official documents submitted, etc.
If the child has insurance [22] and is Medicaid-eligible, information about the insurance
company and policy number will be needed; and
If the child had medical bills in the last 3 months [32] and is Medicaid-eligible, eligibility
information for the last three months will be needed to establish retroactive eligibility, in
addition to information about the bills.
In addition, the question concerning employment by a public agency in the State [25] is only
needed for CHIP eligibility and is not needed for Medicaid. This field does not ask directly about
the availability and nature of health insurance on the assumption that the eligibility worker would
have access to a list of public agencies which offer State health insurance of the type which
precludes CHIP eligibility. If this is not the case in your State, this field would need to be
expanded.
Examples of State Modifications:
A State may wish to include voter registration; or
A State may want to use this as an application for Medicaid for the adults which would
require additional information about the adults and stock affidavits concerning assignment
of rights and pursuit of support.
A State will need to add a question concerning each individual's resources (assets) if:
the State applies a resource test for the poverty level children; or
-
the State has not chosen to cover children born before 10/1/83 under the poverty
level group AND the State applies a resource test for the optional group of
categorically needy children ("Ribicoff children").
CHILDREN'S HEALTH INSURANCE PROGRAM / MEDICAID
JOINT APPLICATION FORM
I. Person Applying for the Child or Children
Name [1]
FIRST
MIDDLE
LAST
Home Phone [2]
Work Phone [3]
Home Address [4] Street
Apt. # [5]
City [6]
State [7]
Zip [8]
County [9]
Mailing Address (if different from above) [10] Street
Apt. # [11]
City [12]
State [13]
Zip [14]
County [15]
II. Family Members Living in the Home (Attach extra sheet if needed)
Children (under 19) living in the home
Date of
Citizen
Social Security Number
Mother's Name [20]
Father's Name [21]
Covered by Health
NAMES [16]
Birth [17]
(Yes or No) [18]
[19]
Insurance other than
Medicaid [22]
Adults living in the home
Social Security Number
If employed by a public agency in the State, what agency?
NAMES [23]
[24]
[25]
Joint Application Page 2
III. Income and Child Care Payments
List all the Income Received by Family Members Listed Above (Attach Extra Sheet if Needed)
Name of person(s) working
Who provides the money? [27]
How Often? [28]
What amount? [29]
or receiving money* [26]
Employer, program or person
Weekly, twice a month, monthly
Before taxes or any deductions
1.
2.
3.
*Be sure to include all sources of gross income (before taxes) such as wages, dividends & interest, TANF, SSI annuities, pension, disability, child support, alimony, cash gifts, & other unearned income.
List the payments made for child care (or care for an adult who cannot care for himself) so that someone in your household can work. [30]
Name of person(s) who works
Name of Person Care For
Under Age 2?
How Often?
What amount?
Yes
No
IV. Medicaid Questions
is any child: [31] Pregnant Yes
No
In an Institution: Yes
No
Do any of the children have unpaid medical bills from the last 3 months?
[32] Yes
No
Social Security Number (SSN) [33]
You must give us your SSN in order to receive Medicaid This is required by section 1137(a)(1) of the Social Security Act and the Medicaid regulations of 42 CFR 435.910. The Medicaid agency will use the SSN to verify
you Income, eligibility, and the amount of medical assistance payments we will make on your behalf It is possible that we will also use the SSN to determine another person's right to Medicaid or to comply with Federal law
requiring that we release information from Medicaid records. The information may be matched with the records in other agencies, such as the Social Security Administration or the Internal Revenue Service. These matches
may be done by computer or on an individual basis
Rights and Responsibilities [34]
I agree to the release of personal and financial information from this application form and supporting
I understand that this application is an application for one kind of children's health benefits under
documents to the agencies that run these programs so that they can evaluate it and verify eligibility. I
Medicaid and IS not a full Medicaid application. I understand that if I am not found eligible for this kind of
understand that the agencies that run the programs will determine confidentiality of this information
children's health benefits under Medicaid, I may be eligible for Medicaid benefits on some other basis and
according to the federal laws, 42CFR 431.300-431 307.1, and any applicable federal and state laws and
have a right to complete a full Medicaid application.
regulations.
I have the right to appeal any decisions made by a local Medicaid program. Information on the
Officials from the programs that I, or members of my household, have applied for may verify all
appeals process can be obtained from the local Medicaid agency.
information on this form.
I understand that anyone who knowingly lies or misrepresents the truth or arranges for someone to
I understand that I must immediately tell the Medicaid agency about any changes in information on
knowingly lie or misrepresent the truth is committing a crime which can be punished under federal law, state
this form.
law, or both. I understand that I may also be liable for repaying in cash the value of the benefits received
I understand that I may be asked to provide additional information.
and my be subject to civil penalties.
I understand my eligibility will not be affected by my race, color, national origin, age, disability, or sex,
I certify under penalty of perjury that everything on this application form is the truth as best I know.
except where this is restricted by law
Signature [35]
Date
Date Received by Agency [38]
(Attachment C)
DISCUSSION OF PROMISING OUTREACH STRATEGIES
Significant barriers exist to providing health care coverage for uninsured children and enrolling
them in Medicaid. States and local communities are implementing a variety of approaches to
reducing these barriers. Many States are simplifying the complicated application forms and
enrollment processes, as well as allocating more resources to developing innovative outreach
activities. The Department of Health and Human Services (DHHS) is prepared to assist States
and local communities by facilitating the exchange of information regarding successful outreach
endeavors and information related to enrollment simplification. The following are examples of
promising outreach strategies currently practiced or being considered in various places.
Implement an 800 hotline number for enrollment information in each State, to provide
information (in appropriate languages) on child health insurance programs, referrals, and
telephone assistance in completing application forms. To the extent possible, publicize a
single number; several 800 numbers may lead to confusion. Most States already have an
effective toll-free hotline through their Title V Maternal and Child Health offices that
could be serve as a base for disseminating information relating to Medicaid and CHIP.
Streamline the eligibility process, have simplified application forms in appropriate
languages, and allow application by mail. Ask only for necessary information. Allow for
enrollment on certain evenings and Saturdays at convenient sites. Allow appropriate
entities, especially in remote areas, to determine eligibility presumptively.
Use billboards in bus and subway stations and radio stations to publicize the programs,
including information that uninsured children of low-income working parents may also
qualify for Medicaid or CHIP. Place posters (that have been field-tested in that
community ) at locations frequented by target families -- e.g., thrift shops, discount stores,
fast-food restaurants, laundromats, and ethnic festivals.
Encourage prenatal care and child health through unified State-wide public service
outreach campaigns which are advertised with an identifiable logo and reader-friendly
materials that appeal to lower-income families.
Distribute information about child health insurance programs through child care centers,
Head Start programs, schools, child support enforcement agencies, community action
programs, refugee resettlement programs, TANF offices, family preservation and support
programs, Special Education and Social Security offices -- with materials in simple,
appropriate languages. Also, verbally ask the children in the above settings (as they take
the literature home) to tell their families that they may be eligible for health care.
Provide enrollment opportunities at local sites where children receive health care; school-
based health centers are a particularly good vehicle for identifying and enrolling children in
insurance programs.
Station eligibility workers in hospitals to assure prompt enrollment of newborns, in health
centers, and at locations where immunizations are provided.
Coordinate with other programs, such as TANF, child support enforcement agencies,
family support councils, local Tribes, WIC, food stamps, Title V, free or reduced-price
lunch programs, Head Start, Special Education and Social Security offices.
Establish a State-wide computer program, wherein applications for any one public
assistance program will (with the client's permission) be automatically "cross-referred".
Develop outreach strategies with local community-based organizations, and have them
assist in outreach efforts, including at events such as community fairs. Word-of-mouth
can be the best outreach tool in communities where there is mistrust of the system.
Provide speakers and program information to community, school and religious programs.
Use trained, trusted persons within the local community to do eligibility outreach and to
provide assistance to their neighbors in completing application forms.
De-stigmatize Medicaid to the extent possible. Some States have addressed this issue by
renaming the program with names such as "Dr. Dynasaur", or "KIDMED" or "Child
Health Plus." Encourage eligibility workers to treat clients with courtesy and respect.
Ensure that the card issued to the family is free of any perceived "welfare stigma." Have
posters reflect a positive image of Medicaid and those who use Medicaid.
Enlist the support of businesses and foundations to provide incentives (e.g., gift
certificates, coupons for free meals or merchandise, movie passes) for families who apply
for and/or use services.
18chip.wpd
Page 1
DRAFT REMARKS BY HILLARY RODHAM CLINTON
CHILDREN'S HEALTH OUTREACH ANNOUNCEMENT
CHILDREN'S HOSPITAL
FEBRUARY 18, 1998
Thank you. I am so honored to join you today as we take another
important step forward in putting quality health care within the reach of every
child in America. None of this would have been possible without the people in
this room and I want to especially thank the President, Secretary Shalala,
[other acknowledgments]
One of my favorite children's folktales is the one about Stone Soup --
where travelers arrive in a village with nothing to eat, but with a clever plan. In
the center of town, they boil a pot of water with a stone in it. And soon, the
curious villagers come by and are encouraged one by one, to add a carrot here,
a cabbage there -- ultimately transforming a stone into a wonderful "stone soup"
created by all and benefiting all.
what is Citip
Like this fable, the success story that we celebrate today is really the
$24 billion
timeless story of what works in meeting our biggest challenges. Last August,
when the President signed into law the largest expansion of health care in 30
years, he made not only a major federal commitment, but an historic promise to
millions of uninsured children and their parents: As a nation, we said: Whether
your children need check-ups or immunizations, broken bones healed or deadly
diseases treated, you shouldn't have to choose between caring for your kids and
bankrupting your family.
We knew that keeping that promise would be the hard part...and that the
hard work would come in the years ahead. We knew we needed a massive- national
outreach effort to give parents the information and other tools they need to sign campaign
up their children for Medicaid and the new Children's Health Insurance Program.
And, like the villagers making stone soup, we knew that our magic stone will
always be collaboration, everyone bringing something unique to the pot to make
the whole richer than any single ingredient.
effor too
As the President will announce today, that's exactly what's happening.
The Federal government is stepping up to the plate with new resources. States
are devising local solutions to fit their local needs. Businesses are working to
reach parents with information about insuring their children. Foundations are
supporting innovative outreach initiatives. Doctors and teachers are learning
how to be front-line soldiers in the battle to enroll kids. And today, the NGA is
sending the states a best practices report on CHIP to shine a spotlight on what's
working around the country.
As I've traveled the nation, talking to parents and meeting children in
18chip wpd
Page 2
need, I've often been struck by the fact that there isn't a problem in America
that isn't being solved by someone somewhere. Our challenge to do what
we're doing today - to find out what works for our children and then come
together as a nation to replicate At in every state and every community, in every
use it as
school and every child care center. As we approach the next century, there is
no greater gift we can give to our children, to our parents, to our future.
a model
Now it is my great honor to introduce
can me
slightly different
13:45
FAX
NATL ECONOMIC COUNCIL
005
UPDATE 126
Page 4
STATE CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP)
IMPLEMENTATION UPDATE
February 10, 1998
FEDERAL UPDATE
Public Information. The following is a list of the releases of information to da :
Program announcement (State Medicaid Directors' letter, August
27): Informed the states of the organization of the program at HHS its basic
parameters, and a summary of the statute.
State allotments (Federal Register notice, September 10): Announces he
states' preliminary allotments from the over $4 billion appropriation fo fiscal
year 1998.
Qs and As #1 (September 10): Responses to some of the most fr equi ntly
asked questions.
State plan template (September 15): Guide on the minimum requ irer ents for
a state children's health insurance plan
Qs and As #2 (October 3): Responses to some of the most frequent. asked
questions.
Medicald issues (State Medicaid Directors' letter, October 10): Desci Des the
Medicald provisions in the children's health program and includes m: del state
plan amendments for these options as well as a set of q.s. and iis Ci
Medicaid issues.
Qs and As #3 (November 26): Responses to some of the most "regi ently
asked questions.
State plan approval (State Medicaid Directors' letter, December 2): Describes
the process for filing from the states and review and approval by - is.
State financial reporting (December 8): Details the financial rules a: 1
reporting requirements for CHIP.
Legal immigrants (January 14): Describes rules regarding financing health
care for legal immigrant children.
Outreach (January 23): Describes options for receiving Federa fur Bing for
outreach as well as options that are effective.
10 FAI
NATL ECONOMIC COUNCIL
006
UPDATE 126
Page 5
All documents can be found on the internet; www.hcfa.gov.
19:46
FAI
NATL ECONOMIC COUNCIL
007
UPDATE 126
Page 6
STATES UPDATE
STATE
ACTIVITIES UPDATE
STATES WITH APPROVED CHILD HEALTH PLANS
Alabama
PLAN: Medicaid expansion for poor children up to age 19
STATUS: Plan submitted: 11/3/97; plan approved: 1/30/98. Implemer ition:
2/1/98
BACKGROUND After a contentious special legislative session, $5 millio was
budgeted for health with a contingent $10 million if revenues are iffice it.
The Governor signed the state plan on November 1. Although the plan nly
includes Medicaid benefits for children at or below 100 percent of the 1: verty
line, 8 State commission voted to create a non-Medicald program for ct: dren
between 100 and 200 percent of poverty. However, since they also p posed
to fund this expansion through a tobacco tax, the Governor is obje sting
STATES WITH SUBMITTED CHILD HEALTH PLANS (in chronological order)
Missouri
PLAN: Medicald expansion for children up to 200 percent of poverty
STATUS: Plan submitted: 9/26/97 (including Medicaid 1115 waiver TE jest);
request for additional information: 11/12/97; additional information su: hitted:
2/6/98. Expected implementation: 7/98.
BACKGROUND: The State has been seeking a Medicaid 1115 wei " at
combines children with adults. The proposal would expand Medicaid 200
percent of poverty through CHIP and from 200 to 300 percent of pov: ty
through a Medicaid 1115 walver. The State wants to waive Medicaid ;
requirement to cover non-ernergency medical transportation and 10 US' illegal
provider taxes as their source of State share.
Colorado
PLAN: Non-Medicaid expansion for children up TO 185 percent of pov: ty
STATUS: Plan submitted: 10/14/97; request for Information: 11/97; aditional
information submitted: 1/21/98. Expected implementation: 3/1/98.
BACKGROUND: The State had funded a State program expansio 1 the ugh
"Child Health Plan Plus" prior to the passage of the Balanced Builget ct. It
intends to build upon this expansion in a second phase, to be applied or next
year. Colorado's benefits are actuarially equivalent to the State emp. yee
health plan. The State is planning a second phase of the expansion
subsidize children in employer health plans.
Pennsylvania
PLAN: Non-Medicaid expansion for children up to 185 percent cf PC' arty
STATUS: Plan submitted: 11/3/97; request for additional information : 12/97:
additional information received: 2/4/98.
BACKGROUND: Governor announced on October 1 that he will exp. nd the
state's existing Children's Health Insurance Program (CHIP); its ben: its are
grendfathered in the statute. It would fully subsidize premiums up i 185
percent of poverty. and allow for enrollment of children on current atting list.
New York
PLAN: Non-Medicaid expansion for children up to 222 percent of P: erty
STATUS: Plan submitted: 11/5/97; request for Information: 1,6/98 additional
information received: 1/31/98. Implementation: 10/1/97.
BACKGROUND: Governor plans to expand Child Health Plus; CS be efits are
grandfathered in the statute. Democratic Assembly proposed an el emative
plan on 2/9/98 to cover children up to 300 percent of poverty wit more
generous benefits.
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California
PLAN: Medicaid expansion for children up to 100 percent of poverty;
non-Medicaid expansion for children up to 200 percent of poverty
STATUS: Plan submitted: 11/20/97; additional information requeste 198;
some additional Information received: 2/10/98. Expected implementa
7/1/98.
BACKGROUND: The "Healthy Families" plan passed the State legislature n
10/2/97. It expands Medicaid to 100 percent of poverty for all children nd
creates a new program for children 100 to 200 percent of poverty equiv ent
to benefits offered to State employees through the State group purchas 3
coop or employers.
Florida
PLAN: Medicaid expansion for poor children; non-Medicaid expansion fc
children between 100 and 185 percent of poverty
STATUS: Plan submitted: 12/4. Implementation: 1/1/98.
BACKGROUND: Expanding the Healthy Kids program whose benef IS ar
grandfathered in the statute. Uses school-based enrollment to facilitate access
to health services. Tobacco settlement money may be used as the sta:
contribution.
South Carolina
PLAN: Medicaid expansion for children up to 150 percent of poverty
STATUS: Plan submitted: 12/9; additional information requested: 1/98
additional information received 1/28/97. Implementation: 10/1/97.
BACKGROUND: "Partners for Healthy Children". State passed Medical
expansion over the summer, will cover children up to 19 to 150 percer OT
poverty through Medicaid on October 1. Uses simple mail-in appl cati: 15
distributed through schools, doctors' offices, neighborhood phann acie and
hospitals. May add a second, non-Medicaid expansion for children w'
income between 150 to 200 percent of poverty.
Ohio
PLAN: Medicaid expansion for children up to 150 percent of pov crty
STATUS: Plan submitted: 12/24/97; request for additional inform atto
1/26/98. Implementation: 1/98
BACKGROUND: The State had already planned this Medicaid ansh i and
the Governor has appointed support for expanding Medicaid to childri , UD to
200 percent of poverty and appointed a task force to make recomme dations
by 7/1/98
Michigan
PLAN: Non-Medicaid expansion to children up to 200 percent of po arty
STATUS: Plan submitted: 12/30/97. Expected impiementation: 4/9:
BACKGROUND: Michigan's Department of Community Health as c veloped a
non-Medicaid program called "MiChild".
Tennessee
PLAN: Medicaid expansion for children up to 200 percent of po vert
STATUS: Plan submitted 1/3/98 (expanding Medicaid 1115 wa ver); equest
for additional information: 1/26/98. Implementation: 4/1/97
BACKGROUND: Re-opaned enrollment in TennCare to uninsured cl dren in
April 1997 and again on 1/1/98 for a limited period (through 3/30. : nce the
State may use enrollment capsi. State has removed $250 deductib : and
lowered copayments to 2 percent (still may be out of compliance W. h CHIP
guidelines).
Illinois
PLAN: Medicaid expansion for infants up to 200 percent of poverty for
children 1 to 18 up to 133 persent of poverty.
STATUS: Plan submitted: 1/6/98. Implementation: 1/5/93.
BACKGROUND: Governor announced plan in early 12/97, and also ppointed
an 8-member, bipartisen legislative task force to look at additional ptions.
The Governor also announced an outreach effort that includes sig ng up
children tor Medicaid at schools, clinics, neighborhood center an : other
settings.
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Rhode Island
PLAN: Medicald expansion for children up to 250 percent of poverty
STATUS: Plan submitted 1/6/98. Implementation: 5/1/97.
BACKGROUND: The State expanded its Medicaid RiteCare program in Mil and
wants to receive enhanced Federal match for this group.
Oklahoma
PLAN: Medicaid expansion for children up to 185 percent of poverty
STATUS: Plan submitted: 1/12/98. Implementation: 12/1/97.
BACKGROUND: Implementing SoonerCare program under an 1115 waive
Part of the expension planned under SoonerCare would be covered throu h
CHIP.
Connecticut
PLAN: Medicaid expansion for children up to 185 percent of poverty;
non-Medicaid expansion for children between 185 and 300 percent of P verty
STATUS: Plan submitted: 1/15/98, Expected implementation: 4/1/98.
BACKGROUND: Governor Rowland signed e law creating HUSKY:
Healthcare for Uninsured Kids and Youth" on 10/30/97. Builds on 3 Me icaid
outreach effort funded earlier in 1997. The non-Medicaid program's be: efits
would be modeled on the State employee health plan. The State Inten: to
use a single application for both programs, the presumptive eligibility 0: ion to
facilitate enrollment; and schools and child care sites for enrollment.
Massachusetts
PLAN: Medicaid expansion for infants up to 200 percent of poverty, ch dren
ages 1 to 18 up to 150 percent of poverty; non-Medicaid expansion to
children between 150 and 200 percent of poverty.
STATUS: Plan submitted: 1/16/98 (including Medicaid 1115 waiver re: lest).
Expected implementation: 3/98.
BACKGROUND: State wants to expand its Medicaid 1115 waiver prop sal
"MassHealth" and its non-Medicaid program. the Children's Medic at SI curity
Plan. State funds are appropriated and supported by a tobacco tax.
Wisconsin
PLAN: Medicaid expansion for children (and parents) up to 185 peroe of
poverty
STATUS: Plan submitted: 1/21/98 (including Medicaid 1115 waiver ri juest).
Expected implementation: 7/1/98
BACKGROUND: Requesting a Medicaid 1115 for "BadgerCare" hich would
cover all children in uninsured families up to 185 percent of poverty : 15 their
parents. Premiums will be charged to children in newly eligible famil 3.
ACTIVITIES IN OTHER STATES
Alaska
PLAN: Medicaid expansion and non-Medicaid expansion for dren p to 200
percent of poverty (Governor's proposal)
STATUS: Proposal submitted to State legislature in session beginn ; 1/98.
Plan to submit plan 7/98. Expected implementation: 10/98.
BACKGROUND: Informal working group has been meeting; expecte to meet
with the Governor on October 3 to discuss their proposal. Governor appears
TO want to expand to 200 percent of poverty by the end of 1998.
Arizona
PLAN: None yet
STATUS:
BACKGROUND: Governor has stated that getting a children's healt program
going soon is a priority and included State funds in her projected b. get, She
will work with State legislature to fund the State contribution and : I plans for
the use of those funds.
FAB
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Arkansas
PLAN: None yet
STATUS: Debating whether to seek CHIP funding for its Medicaid 1 15
waiver expansion that began in October 1997.
BACKGROUND: Within weeks of the passage of CHIP, Arkansas received
Medicaid 1115 waiver to expand coverage to children up to 200 per cent i
poverty. Benefits in this waiver are below the standards outlined in CHIP The
State is considering whether it should submit its Medicaid expansior thr: gh a
Medicaid 1115 waiver or convert its Medicaid to a non-Medicaid pro gran for
the purposes of CHIP.
Delaware
PLAN: None vet
STATUS:
BACKGROUND: State Health Care Commission will submit a propos ai to the
legislature during this session.
DC
PLAN: Medicaid expansion for children up to 200 percent of poverty
(tentative)
STATUS: Plan to submit a plan 3/98.
BACKGROUND: in review process with Mayor, City Council and pt notin final
approval by the Financial Authority.
Georgia
PLAN: Medicaid expansion for children under age 6 up to 200 percen. if
poverty; non-Medicaid expansion for children ages 6 to 18 up to : 100 ircent
of poverty (Governor)
STATUS: Plan to submit plan by 7/1/98.
BACKGROUND: Health Policy Center Et Georgia State University the fficial
task force, recommended Medicaid expansion for children between 0 1: , and
200 percent of poverty Legislature meets in January
Hawaii
PLAN: None yet.
STATUS:
BACKGROUND: Considering expanding Its 1175 Medicaid waive whi h covers
children UP to 300 percent of povery.
Ideho
PLAN: Medicaid expansion to: children up to 160 percent of poverty
STATUS: Working on a state plan. Implementation: Medicaid: 10/1 7
BACKGROUND: Expanded Medicaid 10 children up to 160 percent poverty
in 10/97. Committee to discuss other long-term options beginn ng I 98.
Indiana
PLAN: None yet
STATUS: Plan to submit a plan 3/7/98.
BACKGROUND: Governor created a children's health task force.
Iowa
PLAN: None yet
STATUS: Working on a plan to submit by 7/98
BACKGROUND: Nine public forums occurred in 10/97. The State ublic
Policy Group, 8 task force, recommended in 11/97 a Medicaid exp: sion for
children up to 133 percent of poverty, and a non-Medicaid prograr for
children between 133 and 200 percent of poverty. A legislati to K force will
also present options.
Kansas
PLAN: Medicaid expansion for children up to 150 percent of JOVE Y. and a
non-Medicaid program for children berween 150 to 200 percent o' poverty
(tentative).
STATUS: Plan to submit plan In the Spring of 1998.
BACKGROUND: Two planning groups (Insurance Department and Department
of Social and Rehabilitation Services) to report to Governor a rd 3. te
legislature in 1/98. Prellminary recommendation described above
PAI
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Kentucky
PLAN: Medicaid expansion for poor children; non-Medicaid program for
children between 100 end 200 percent of poverty (Governor announc
1/7/98)
STATUS: Governor announced plan on 1/7/98, plan to submit a plan on
4/1/98. Expected implementation: 7/1/98.
BACKGROUND: Set up work group; considering a range of options, inclu ing
implementing and expanding their 1115 Medicaid waiver. Health Service
Secretary proposes to expand Medicaid to cover children ages 14 to 18 hose
family incomes are at 100 percent of poverty and a non-Medicaid 8) pan: on
for children between 100 and 200 percent of poverty.
Louisiana
PLAN: None yet
STATUS:
BACKGROUND: Governor-appointed and legislative task forces held pu: C
meetings; developing costs of options.
Maine
PLAN: Medicaid expansion for children up to 150 percent of poverty;
non-Medicaid program for children between 160 to 185 percent of pov: ty
(Commission)
STATUS: Plan submitted to State legislature; plan to submit Spring 199 ;
BACKGROUND: Governor & State legislature-appointed Maine Commin on on
Children's Health Care, which made its recommendations on 12/21/97. The
State already has sufficient State share funding reserved.
Maryland
PLAN: Medicaid expansion for children up to 200 percent of poverty
(Governor);
STATUS: Debate in the early part of the year
BACKGROUND: Maryland's Children's Health Program would have no JST
sharing for families up to 200 percent of poverty. The Legislature has,
proposed a Medicaid expansion for children up to 185 percent of pov: ty and
non-Medicaid expansion for children between 185 and 250 percent of poverty.
There is some question about how the State's current Medicaid 1115 program
will be integrated or cordoned off from the new program.
Minnesota
PLAN: None yet
STATUS:
BACKGROUND: State already covers children up to 275 percent of : iverty.
May seek a waiver to cover children at current levels (e.g., outre ach. or create
a new program.
Mississippi
PLAN: None yet
STATUS:
BACKGROUND: interagency task force is developing proposal.
Montana
PLAN:
STATUS:
BACKGROUND: Health officials plan to submit a funding plan durin 1999
Legislature session. Public hearing were held in November and Dec nber.
Nebraska
PLAN: Non-Medicaid program up TO 185 percent of poverty (Gover ;
announced on 1/12/98)
STATUS: Proposal still being developed. Plan to submit plan 3/30 98.
Expected implementation: 9/98
BACKGROUND: "Kids Connection". State working group will give
recommendations to Governor. Members agree that expandin 3 M.: icaid
would be the simplest approach, but are concerned that there won I be a
welfare stigma.
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Nevada
PLAN: Non-Medicaid expansion for children up to 200 percent of pov arty
(Governor announced on 1/7/98)
STATUS: Plan in development. Expected implementation: 6/98.
BACKGROUND: "Nevada Check-Up". Governor working with state healt
agency to plan non-Medicaid program based on the most common HMO the
state; he has announced plans to use Family Resource Centers, school bi ed
clinics and Early Children programs to deliver services.
New
PLAN; None yet
Hampsnire
STATUS:
BACKGROUND: Governor announced intention to develop plan on 1/7/91
State legislature may appoint a special panel to develop options.
New Jersey
PLAN: Medicaid expansion for children up to 133 percent of powerty are
non-Medicaid expansion for children between 133 and 200 percent of 11 verty.
STATUS: Governor signed legislation on 12/19/97; developing state 1 n.
Expected implementation: 2/1/98 for Medicald, 3/1/98 for non-Me lical:
BACKGROUND: "New Jersey KidCare". Governor has committed Ste share
and has appointed a commission to come up with recommendations to
permanently funding the program. Benefits based on the most comme HMO
in the State. Plan Includes outreach through schools, Scout groups, t ad
Start programs child-care agencies, and other community organization
New Mexico
PLAN: Medicaid expansion for children up to 235 percent of poverty
STATUS: Legislature working on the proposal. Expected impleme nta n:
3/1/98
BACKGROUND: May expand through a Medicaid 1115 waiver funde: by 8
16-cent tobacco tax.
North Carolina
PLAN: Non-Medicaid expansion for children up to 200 percent 01 pm ty
STATUS: Legislature working on a plan. Expected implementation: $ mimer
1998.
BACKGROUND: Task force recommended non-Medicaid expansi on 01
11/17/97. On 12/15/97, the Governor proposed this recommer dati: 1. North
Caroline is putting emphasis on providing coverage to children with lecial
needs. Also likely to be included in the naw package are denta and earing
coverage,
North Dakota
PLAN: None yet
STATUS:
BACKGROUND: No planning process in place
Oregon
PLAN: Non-Medicaid expansion for children up to 170 percent of p: rerty
(pending)
STATUS: State still in the planning process
BACKGROUND: Likely to build on existing 1115 Medicaid program and a
recently passed State subsidy program for low-income families It: Medicaid
expansion will begin in 1/98; its state program requires A waiv et si ce they
want to use children's health subsidies to purchase family policies The State
held a public hearing 10/21/97.
South Dakota
PLAN: None yet
STATUS:
BACKGROUND: Heslth advisory committee reviewing State optio:
Texas
PLAN: None yet
STATUS: State plans to submit a plan by 3/1/98
BACKGROUND: Working group of state agency and legislative gi ff to brief
lawmakers on present options in mid-October. Public hearing he! 1/7/98
Considering 1115 Medicaid waiver and ! or new program. The 161 stature
doesn't meet until January 1999.
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Utah
PLAN: Non-Medicaid expansion for children up to 200 percent of poverty
STATUS: Close to submitting a plan. Impleme ntation: 4/1/98
BACKGROUND: Governor's Health Policy Commission planning on building on
State insurance program. Benefits actuarially equivalent to Public Employer 3
Health Plan for state workers. On 12/6/97, the Governor proposed a bud; it
that Included $16 million for State matching funds and on 12/23/97
announced that the State health department would administer the pregra:
Vermont
PLAN: Medicaid expansion for children up to 300 percent of poverty
(tentative)
STATUS: Plans to submit a plan in 2/98
BACKGROUND: State officials will probably request an expansion it Me loaid
1115 waiver ("Dr. Dynasaur") to 300 percent of poverty.
Virginia
PLAN: Non-Medicaid expansion to 175 percent of poverty (Governol's
proposal 2/9/98)
STATUS:
BACKGROUND: The former Governor recommended on 12/15/97 that he
State expand coverage through a non-Medicaid program called "KidsCar- for
children up to 175 percent of povertv. Legislative committee recor me led
on 1/6/98 that the State expand through Medicaid to 200 percent of po erty.
Washington
PLAN: Non-Medicaid expansion to children up TO 250 percent of vert,
(Governor announced on 12/15/97)
STATUS: Disagreement in the State legislature
BACKGROUND: State already covers children up to 200 percent cf po. irty.
The State wants TO be able to access its allotment for newly covered i ildren
below 200 percent of poverty because the state legislature does not V' nt to
expand higher. The Washington Congressional delegation may introdu e
legislation to support this approach.
West Virginia
PLAN: None yet
STATUS:
BACKGROUND: Governor appoint task force and legislative leaders ar looking
at options for both expansion and the State share of the program
Wyoming
PLAN: None yet
STATUS:
BACKGROUND: Work group to plan for legislative session in Fotruar,
Looking at new program with implementation in the summer of 1998
PLANNING.818
Page 1
CHILDREN'S HEALTH IMPLEMENTATION
Non-Government Activities
ACTIVITY
IDEAS
COORDINATION
Administration work
WH: Like NEC meetings, have a monthly principals meeting on kids
group
implementation. Include key Secretaries, White House staff, etc. The goal
would be to both oversee HHS activities as well as consider big ideas,
interdepartmental collaboration, and external activities.
External steering
Foundation-funded: Encourage development of a nonprofit organization to
group
oversee the implementation and operation of the kids program (kind of like
Kaiser Commission on the Future of Medicaid). Include very public figures with
connections to businesses, providers, entertainment & sports, etc. Possibly
include President and / or First Lady. Goal would be to be a shadow group to
ensure that the goals of the program are fulfilled.
Nationwide town
Administration: Set a particular day to be national kids' town meeting day
meeting
(probably some time in November or December). Goal is discuss local
problems and solutions to kids' coverage. Note: state plans require public
process. Work with Congressmen, governors, mayors and town managers to
organize in local areas. Have a national message from the President at
prescribed time. We could produce fact sheets for each state on the problems
and process in that state. We could also connect this effort with a town-by-town
census of uninsured children conducted through schools.
Monthly Newsletter
Foundation-funded: Develop a monthly newsletter which contains: (1) latest
information from HCFA on implementation issues; (2) state updates on who is
doing what; (3) research / analysis / facts of interest; (4) announcements of
upcoming meetings, events, etc. Have NGA and NCSL endorse the newsletter
as well as some advocacy groups like CDF and Families.
DESIGN
Targeting
Researchers: Fact sheets on groups of uninsured children; paper on kids of
workers between jobs (Foundations, researchers). Policy brief on combined
program: Medicaid to 133%, kids grant program above it.
Simple application
VP: In the spirit of ReGo, have the VP lead working group to coordinate
process
simple, single application form for public benefits (Medicaid, kids health
insurance and, if possible, school lunch programs, Food stamps, WIC). Could
also work on internet information dissemination for applications and eligibility.
RWJ has funded a $13 million demonstrating some of these ideas.
Benefits
Children's groups: Assist in advocating for strongest package possible (e.g.,
identifying option in the state that covers the most benefits and promoting it)
Researchers/actuaries: Conference on actuarial value in October / November.
Pediatricians: Encourage to develop recommendations and "seal of approval"
for plans that meet minimum criteria.
Managed care plans: Develop coalition with providers like Pediatricians to
encourage particular benefits packages.
Delivery systems
Researchers / Foundations: Get some up-front, externally validated set of
guidelines for waiver for purchasing group coverage.
PLANNING.818
Page 2
Quality
NCQA: Ask if they would conduct voluntary accreditation for children's plans
Quality commission: Ask to focus on strategy for developing
recommendations for states.
State contribution
NPR-like challenges / fundraisers: Get business groups to match local
contributions toward state share of program.
Children's groups & state researchers: Monitor state contributions (Center
on Budget). Act as watchdogs.
Preventing crowd
Researchers: Develop and disseminate fact sheet / guidance on what works
out
(e.g., waiting period for uninsured).
Businesses: Encourage development of coalition to encourage
employer-sponsored insurance. Could be done through some sort of public
directory to employers offering basic coverage or some other public
OPERATION
Education &
National information hotline: Work with AT & T (Charlotte Hayes is there) to
enrollment
develop a national phone bank that refers people to appropriate state numbers /
agencies. Also will allow us to document the number / location of families
calling so that we can track process.
Schools/teachers: Work with NEA or other groups on education on options
through schools, including collecting information on uninsured children;
distributing information on available insurance options, etc.
Business contributions: Get McDonalds, Disneyland, Microsoft or Pizza Hut
or other nationwide businesses to put information on coverage options on trays,
boxes, Happy Meals, etc.
Providers: Chain drug stores may be interested in putting prompts on
prescriptions. Applications could be distributed with vaccinations.
Oversight
Reporter education: Public scrutiny is the best way to hold states accountable.
Perhaps engaging with reporters via a conference, fact sheet, etc would
education them on what the program's intent is and how to monitor.
Foundations: Fund groups like the Center for the Study of States and
consumer groups to oversee design, implementation, and operation of the
programs. Encourage Concord Coalition or similar groups to be active.
MONITORING
Baseline:
State employee
Unions, Advocates: Work with AFSCME to gather all information on state
plans
employee plans
State HMO
AAHP may be interested in conducting a survey to determine most popular
HMO.
State Medicaid
HHS/ Foundations: Carefully document states' eligibility in 1997.
State Spending
HHS/ Foundations: Review of state budgets.
Coverage
School survey: Empower groups like Teachers, Boy Scouts, Girl Scouts,
Junior Chamber of Commerces, etc. to use a single form to assess children's
health coverage in their towns / communities.
Researchers: Conference on how to modify existing data sets to evaluate
coverage trends
Process
PLANNING.818
Page 3
Technical
Foundation-funded: Clearinghouse with easily accessible information on past
assistance
and present activities.
Conference: Multi-faceted presentation of HHS interpretation, Congressional
expectation, governors' plans, and researchers' understandings. October to
November.
Outcomes
Researchers: Set up a public-private work group to develop the best strategy
to gather data and evaluation programs.
Jennifer L. Klein
ANN
09/04/97 05:02:09 PM
Record Type:
Record
To:
Christopher C. Jennings/OPD/EOP, Sarah A. Bianchi/OPD/EOP
CC:
Subject: Misc
It seems as though you two are having a crazy day, so please page me when you have a chance if
I'm not in the office. Three issues for you:
1.
What should we do about 48 hour mastectomies? Should Chris and I write a memo to the
First Lady about the problems with the issue? Can she call together women Members to discuss it?
2.
What should HRC do for Child Health Day?
3.
Where can she give a speech on quality? When?
Help.
JEN- WE'RE THINKING ABOUT A POSSIBLE
OCT 1 Release ON THIS?
Guidance on Targeting Uninsured Children through the
State Children's Health Insurance Program
Jeanne
Effective October 1, 1997, Federal funds will be available for the State Children's Health
Insurance Program (SCHIP). The President and Congress created this program to provide
meaningful health coverage for millions of uninsured children. This draft report is intended to
assist states in accomplishing this goal by addressing one specific topic: targeting. "Targeting"
means efficiently finding and enrolling uninsured children without inadvertently replacing
existing private or state coverage with the new Federal funds. Targeting is essential to the
success of this program.
This draft report begins by describing why children lack insurance since states' first task is
identifying which group of uninsured children to target. It then suggests policies that can be
effective in three areas:
Preventing "crowd out", or use of new funds to cover children who would other have
private coverage;
Coordination with Medicaid, to ensure that children eligible for Medicaid are enrolled
in that program; and
Outreach ideas for both programs.
OUTLINE
1.
BACKGROUND [extract from kids report]
No access to employer-based coverage
Access but unaffordable [possibly; depends on what we do with group waiver]
Job changes
Medicaid eligibles
2.
CROWD OUT
Summary of bill requirements
Summary of literature
Summary of state experience
IDEAS
3.
COORDINATION WITH MEDICAID
Summary of bill requirements
Examples of state programs (eg, Pennsylvania)
IDEAS
4.
OUTREACH
Summary of bill requirements
Examples of successful Medicaid and state programs
IDEAS
KIDCARE
FREE OR LOW-COST HEALTH INSURANCE IS
NOW HERE FOR KIDS WHO NEED IT.
You love your children and work hard to help them grow up
strong and healthy. But like many parents, you haven't been
able to give them health insurance. Now you can do something
about it because there's a new national initiative called
KIDCARE. With KIDCARE, your children may be eligible for
free or low-cost health insurance. Call our toll-free number.
Don't let your kids go another day without health coverage.
1-877-KIDCARE
Affordable Health Insurance Is
Now Here for Kids Who Need It
NEW! This year, a new nationwide health insurance program is beginning. Now, most families who
work hard to make ends meet can get low-cost or free health insurance for their children.
Each State is developing its own Children's Health Insurance Program to make health care more
affordable. In addition, Medicaid now provides free health coverage to most low-income children.
HEALTH INSURANCE MATTERS. Children with health insurance are more likely to:
Be healthy as newborns,
Receive needed immunizations as toddlers, and
Get treatment for illnesses such as recurring ear infections and asthma.
Without treatment, these diseases can slow a child's learning and have lifelong consequences.
Too MANY KIDS ARE UNINSURED. One out of every seven children in America is uninsured.
This could be the child who plays with yours at school, the child next door, or your own child. Why?
Too expensive: Private insurance can cost families thousands that they cannot afford.
Don't know about options: Even though affordable health care is available to many working
families, too few parents know about their options.
THESE CHILDREN NEED YOUR HELP. We encourage all concerned Americans to join this public-
private campaign to insure American children. You can help. Please:
Learn about your State programs. All States have Medicaid programs for children and
most States have begun their new Children's Health Insurance Programs. Find out who is eligible
for assistance and how families can apply.
Educate others. Tell friends, relatives, parents you meet at work, and all other working
families whose children or grandchildren may be uninsured about these options.
Community efforts. There are many groups around the nation that are involved in children's
health outreach. If you are interested, you may wish to contact one of these organizations for
information and ideas on how you and your community can become more involved.
FOR MORE INFORMATION, SEE NUMBERS ON THE BACK OF THIS FLYER
The White House (July 1998)
WHERE YOU CAN GET MORE INFORMATION
FEDERAL CONTACTS
OTHER SOURCES OF INFORMATION *
AT THE NATIONAL LEVEL
National Governors' Association
(www.nga.org)
Health Care Financing Administration (HCFA)
National Conference of State Legislatures
Lillian Gibbons - 410-786-8705
(www.stateserv.hpts.org)
(www.hcfa.gov/init/children.htm)
National Association of State Medicaid Directors
(medicaid.apwa.org)
Health Resources & Services Administration (HRSA)
Center on Budget and Policy Priorities
Marcia Brand - 301-443-4619
(www.cbpp.org)
(www.hrsa.dhhs.gov/childhealth)
Children's Defense Fund
(www.childrensdefense.org)
Families USA
(www.familiesusa.org)
National Academy of State Health Policy
(www.nashp.org)
Southern Institute on Children and Families
(www.kidsouth.org)
FEDERAL CONTACTS AT THE REGIONAL LEVEL
I. Boston Regional Office
VI. Dallas Regional Office
(CT, ME, MA, NH, RI, VT)
(AR, LA, NM, OK, TX)
HCFA - Maureen Farley - 617-565-1248
HCFA - Art Pagan - 214-767-6278
HRSA - Barbara Tausey - 617-565-1433
HRSA - Marianne Davenport - 214-767-3903
II. New York Regional Office
VII. Kansas City Regional Office
(NJ, NY)
(IA, KS, MO, NE)
HCFA - Jane Salchli - 212-264-3125
HCFA - Nan Foster Reilly - 816-426-3406 x3305
HRSA - Gilberto Cardona-Perez - 212-264-2566
HRSA - Bradley Appelbaum - 816-426-5292
III. Philadelphia Regional Office
VIII. Denver Regional Office
(DE, DC, MD, PA, VA, WV)
(CO, MT, ND, SD, UT, WY)
HCFA - Rosemary Feild - 215-861-4278
HCFA - Dee Raisl - 303-844-2121 x454
HRSA - Frank Heron - 215-861-4407
HRSA - Joyce Borgmeyer - 303-844-5955
IV. Atlanta Regional Office
IX. San Francisco Regional Office
(AL, NC, SC, FL, GA, KY, MS, TN)
(AZ, CA, HI, NV)
HCFA - Andriette Johnson - 404-562-7410
HCFA - Karen Fuller - 415-744-3600
HRSA - Dr. Ketty Gonzalez - 404-562-7980
HRSA - Irma Honda - 415-437-8078
V. Chicago Regional Office
X. Seattle Regional Office
(IL, IN, MI, MN, OH, WI)
(AK, ID, OR, WA)
HCFA - Barbara England - 312-353-8720
HCFA - Liz Trias - 206-615-2400
HRSA - Dorretta Parker - 312-353-4042
HRSA - Margaret West - 206-615-2518
Note: By August I, the phone numbers for where you can get State-specific information will be available from both
the Federal and Regional Contacts and at the Federal Contacts' websites.
* These are examples and do not represent all of sources of information. The White House does not endorse
these organizations or their positions. Numbers are from HCFA and HRSA are subject to change.
U.S. Government Printing Office: 1998 - 443-113/89128
Responsibility: Women's office.
1
Foundations and their partners - Annie E. Casey Foundation.
Responsibility: Jeanne/Jen.
ADCOUN.828
Page 1
DRAFT AGENDA FOR DISCUSSION
Goal:
To plan the radio campaign in the 10 target states in October
States:
Colorado
Delaware
Florida
Idaho
Indiana
Massachusetts
Oklahoma
Ohio
Pennsylvania
Utah
Questions:
In this test of the media campaign, do we want to use taped ads, have local
announcers read scripts, or both
If we use taped ads, who do we want to read them:
-
First Lady
-
General Powell
-
State and local politicians
-
Local athletes
-
Celebrities
-
Ordinary people
Can and how would we get these taped and produced
What mix of free and paid advertising do we want
-
Radio Disney may be interested in running the spots at prime time
-
What are the Ad Council distribution options
-
What type of niche could the paid ads fill
Do we want to try different strategies in different states to compare the
outcomes
KPLAN. 827
Page 1
CHILDREN'S HEALTH OUTREACH PLAN
For the month of October, we would test the basics of a national media campaign
in a subset of states. This test would involve using the toll-free number, tagline
and a consistent message in:
Pro bono radio spots, distributed through the Ad Council (checking today)
and Radio Disney (they have tentatively committed to running spots at good
times, but we need to finalize this; their stations are listed in parentheses
below)
Paid radio spots in communities with at-risk populations
Corporate and community group promotional material and efforts: a number
of corporations have said that they could target their efforts to particular
states and would be interested in this test; community groups are willing to
provide on-the-ground assistance to families in these states
NGA recommends the following states for testing based on two main criteria:
willingness to participate and the efficient operation of their current telephone
system (e.g., able to give both CHIP and Medicaid information and to send out
applications to callers).
Colorado
(Radio Disney: Denver)
Delaware
Florida
Georgia
(Radio Disney: Atlanta, Savannah)
Idaho
Indiana
Massachusetts
(Radio Disney: Boston)
Oklahoma
Ohio
(Radio Disney: Cleveland)
Utah
(Radio Disney: Salt Lake City)
Jeanne Lambrew
08/18/98 08:44:16 PM
Record Type:
Record
To:
See the distribution list at the bottom of this message
CC:
Subject: Summary of Kids' Outreach Meeting
Hello,
Ann, thank you very much for coming by -- as usual, your vision set the stage for a constructive
conversation. Chris, thanks for guiding this meeting to a successful closure. Neera and Barbara,
let me know if I missed some details or if there is something else to do. Jen, we are making
progress!
Today, we agreed to:
1. Hook up the toll-free number in all states in September to test it technically.
2. Conduct a "Phase I" media campaign. This includes running the media campaign like we had
originally planned in 8 to 10 states beginning in late September. We would use the toll-free number
(but not tell people that it is national) and get as many corporations, groups, etc as possible to
focus on those states. Some type of monitoring and evaluating will be built in.
3. Conduct a "Phase II" in mid-November to add another 15 or so states to the campaign.
4. Go nationwide in early January. Everyone agreed that this is enough time to work on
infrastructure, to work out the kinks in the toll-free number, and prepare for a nationwide push.
We will pick the 8 to 10 states for the Phase I by Thursday. We will also know by then what
America's Promise can do. Specifically, we want to know whether America's Promise will produce
the First Lady's radio spot and one with General Powell for testing in these states; whether the Ad
Council is willing to help distribute these spots; and which corporations can target these states.
We also want to get the camera-ready taglines in the next few days.
Once we have this information, we will (a) send a letter to kids' groups, the faith communities,
corporate friends etc. to inform them of this plan and see if they are interested in helping in these
states; (b) work with Megan on what Radio Disney can do; (c) work with Jon Jennings to get
sports teams in the targeted states helping out; (d) build HHS's funds and paid ads around what
America's Promise, Ad Council and Radio Disney are doing; and (e) consider what type of event (if
any) we want to launch this Phase I.
Again, please let me know if there are different or additional ideas of next steps, and thanks to all
for your help.
Barbara D. Woolley
08/03/98 02:16:28 PM
Record Type:
Record
To:
Jennifer L. Klein/OPD/EOP, Neera Tanden/WHO/EOP, Jeanne Lambrew/OPD/EOP, Ann F.
Lewis/WHO/EOP
CC:
Ruby Shamir/WHO/EOP
Subject: Kids Health - Camera Ready - Final Question - ASAP
We need to make a decision on the 2 options ASAP. Americas Promise folks like Option 2 because
they think Option 1 does not motivate folks (ie. bold is the part they would want removed). And,
they are concerned that those folks calling for a new initiative will hang up when they get the
Medicaid line.
Option 1: Original. "You love your children and work hard to help them grow up strong and
healthy. But like many parents, you haven't been able to give them health insurance. Now you
can do something about it because there's a new national initiative called INSURE KIDS NOW.
With INSURE KIDS NOW, your children may be eligible for low-cost or free health insurance. Call
our toll-free number. Don't let your kids go another day without health coverage.
Low-cost or free health insurance is here now for kids.
Option 2: "You love your children and work hard to help them grow up strong and healthy. But
like many parents, you haven't been able to give them health insurance. Now you can do
something about it. Don't let your kids go another day without health coverage.
Low-cost or free health insurance is here now for kids.
Children's Health Outreach Initiative
There is another important role for child care centers like the one we saw today. At least
10 million children are uninsured in America. Over 3 million of these children are
already eligible for Medicaid. Millions more will become eligible for the historic, new
Children's Health Insurance Program, enacted by the President and the bipartisan
Congress last year.
Clearly, one of the best places to sign up uninsured children is child care centers. To
encourage this, the President's 1999 Budget will allow States to enlist child care referral
centers, teachers, and others who work with children to help enroll children in health
insurance. We will also give States the tools and the funding to simplify enrollment, link
children's health programs, and conduct aggressive outreach campaigns.
I am pleased that Connecticut's plan to cover uninsured children includes innovative
ideas like outreach at child care centers and school-based clinics. We look forward to
working with you so that, together, we can help children get the basic health care that
they need to reach their full potential.
The President's Children's Health Outreach Initiative
Over 3 million children are uninsured but eligible for Medicaid. Millions more will become
eligible for the Children's Health Insurance Program (CHIP) created by historic, bipartisan
legislation passed last year. It is critical to the success of these programs and the health of
uninsured children to find and enroll children in health insurance. To this end, the President's
1999 Budget invests nearly $200 million per year in children's health outreach.
Fund for outreach. In welfare reform, a special $500 million pool was set aside to fund
activities to improve Medicaid enrollment of families affected by welfare reform. The
President's 1999 Budget includes a proposal that would expand the use of this fund.
States would be able to receive a 90 percent matching rate for outreach activities for all
uninsured children, not just those who would have been eligible for welfare. The Federal
funds to cover the extra matching (above Medicaid's regular matching amount) would
come from this fund. In addition, the proposal would remove the sunset of the fund in
2000 and add another $25 million to assist States with increased outreach activities.
Allowing immediate Medicaid coverage through schools, Head Start, and child care
referral centers. The Balanced Budget Act (BBA) of 1997 gave States a new option in
Medicaid to grant "presumptive eligibility" to children. Certain children may receive
immediate health care coverage without having to wait for a full Medicaid eligibility
determination. The President's 1999 Budget proposes to make this presumptive
eligibility option more flexible and attractive to States. First, it would broaden the
definition of who can determine eligibility to include sites such as schools, child care
resource and referral centers, child support enforcement agencies and CHIP eligibility
workers. Second, it would eliminate the requirement that States subtract the costs of
presumptive eligibility from their CHIP allotments. Instead, these costs would be
matched as a regular Medicaid State plan option. Both of these changes would give
States greater incentives and flexibility for using this important authority.
In addition, the Department of Health and Human Services (HHS) has identified a number of
ideas and options for States to simplify enrollment and integrate Medicaid and CHIP.
Model joint application form. The use of one application form for all health programs
would streamline enrollment and increase the number of children insured by Medicaid
and CHIP. HHS has developed a simple, two-page model application that meets Federal
requirements for both programs. It encourages States to develop similar applications.
Examples of successful outreach. HHS has worked with states to identify approaches
that are successful in identifying and enrolling uninsured children. The Administration
will promote these ideas and work with States on an on-going basis to remove Federal
barriers, encourage private sector involvement, and educate families about their options
(see letter to State Health Officials from HHS, dated January 23, 1998 for details).
Jeanne Lambrew
12/11/97 12:49:31 PM
Record Type:
Record
To:
Jennifer L. Klein/OPD/EOP
CC:
Subject: kids' outreach
I don't know I told you but we missed our deadlines for the coverage and Medicare memos, so that
the kids' ideas, listed below, are not final. But, since we have a little extra time, it would be great
if you could take a look at it for us. Any additions? I may add Head Start sites as presumptive
eligiblity sites as well.
Thanks, Jeanne
CHILDREN'S HEALTH OUTREACH
The Children's Health Insurance Program (CHIP) provides funds for coverage of
millions of working families' uninsured children, a population that previously had trouble
affording coverage. It also builds upon the Medicaid program, which covers nearly 20 million
children. But important work remains to be done. In particular, we need to work with states
to enroll the millions of uninsured children in these programs.
Medicaid eligible children are especially at risk of remaining uninsured. Over three
million uninsured children are eligible for Medicaid. Educating families about their options
and enrolling them in Medicaid has always been a problem, but it has recently become even
more challenging. The number of children covered by Medicaid leveled off in 1995 and,
according to the Census, dropped by 6 percent in 1996. While some of this decline may be
due to the lower number of children in poverty, another part may result from families'
misunderstanding of their children's continued eligibility for Medicaid in the wake of welfare
reform.
Options to Increase Outreach for Medicaid and the Children's Health Insurance Program
To address the need for children's health outreach, we propose a series of policy
options. Together, these initiatives could cost $1 to 2 billion over five years (or more
depending on policy choices about the enhanced match). Preliminary discussions with NGA
and some children's advocates suggest they strongly support these efforts. In addition, the
Administration is developing partnerships to encourage a complementary range of private
outreach activities.
Enhanced match for outreach. One option for improving state outreach is to provide
an enhanced match to enroll children who are eligible for but not previously enrolled in
Medicaid. At the end of each year, if a state can document that it has increased its enrollment
over its baseline, it would receive an increased matching amount per newly covered child
(possibly through administrative payments). This policy rewards states only if they succeed in
outreach, rather than matching activities that may or may not work. Depending on the amount
of the incentive and the administrative design, this option could cost to $0.5 to 1 billion over
five years.
Moving outreach to schools and child care sites. We could build upon the "
presumptive eligibility" provision in the Balanced Budget Act to make it easier to enroll
children in Medicaid and CHIP. The BBA option allows limited sites (e.g., hospitals) to give
low-income children temporary Medicaid coverage on the spot while they are formally
enrolled in CHIP or Medicaid. This proposal would broaden these sites to include schools and
appropriate child care sites, at the state's option. HCFA actuaries preliminarily estimate that
this proposal would cost $400 million over 5 years. Also, under the BBA, states that use
presumptive eligibility must pay for its costs out of the CHIP allotment, reducing the amount
available for other coverage. States have advised us that this requirement discourages them
from taking advantage of the presumptive eligibility provision. HCFA actuaries preliminarily
estimate that dropping this requirement would cost $25 million over 5 years.
Accessing 90 percent matching funds for outreach. A third way to increase funding
for children's health outreach is to increase states' flexibility in using a special Medicaid fund
set aside in TANF for outreach for children losing welfare. This $500 million fund is
currently allocated to states with a 90 percent matching rate for outreach activities to certain
children. We could expand its use to all children, not just welfare children. HCFA actuaries
preliminarily estimate that this policy would cost $100 million over 5 years. NGA supports
this change.
Simplifying enrollment. A simple, accessible enrollment process could encourage
more families to enroll their children in Medicaid or CHIP. To help create such a process, we
propose several actions, all of which are inexpensive. First, we could streamline the
application process by simplifying Medicaid eligibility and by encouraging the use of simple,
mail-in applications. HCFA has already developed a model single application form for both
Medicaid and CHIP. We could condition some of the financial incentives described above on
using a single or simple application. Second, we are reviewing the feasibility and cost of a
nationwide 1-800 number that will link families with their state or local offices. Such a
number could be placed in public service announcements, on the bottom of school lunch
program applications, and on children's goods like diaper packages.
Discussion
There is unanimous support across agencies for focusing on children's health outreach.
HHS and Treasury believe that such outreach should be the Administration's first priority.
NEC/DPC and OMB believe that aggressive outreach will be needed to meet or exceed the
Administration's goal of covering 5 million uninsured children. Although OMB is supportive,
it points out that because some children may be impossible to reach and some states may not
use these options, we are unlikely to enroll all 3 million children. NEC, also supportive,
raises the concern that spending on an outreach initiative may be a communications challenge
so soon after the enactment of the $24 billion base children's health program. However,
policy experts, Governors, and children's advocates alike will endorse this initiative.
One great challenge is the difficulty of finding savings from Medicaid to offset the
costs of this initiative. With this in mind, your advisors are considering the tobacco settlement
as a financing source. Specifically, we are exploring the advisability of allowing states to
retain the Federal share of the tobacco funds if they dedicate those funds to high-priority
Administration initiatives like child care, education, and health care. Governor Chiles would
support such an approach if we dedicate the funds to children's health care, not just outreach.
February 10, 1998
MEMORANDUM FOR JENNIFER KLEIN
FROM:
ASHLEY RAINES
Spaines
DIRECTOR OF OPD OPERATIONS
SUBJECT:
Cellular Telephone Bill
Attached is the January telephone bills for the cellular telephone assigned to you. Please
review the calls listed and certify these calls were made for official business purposes.
You are responsible for reimbursing the government for the cost of calls made for other than
official business. Please review the list, highlight any calls that were not made for official
business and return this memorandum to me by Tuesday, February 17th with a check
payable to the U.S. Treasury for the cost of those calls.
Please note that this bill cannot be paid until your certification of official calls and
reimbursement check (if applicable) has been returned to me.
Please call me at x62023 with any questions. Thank you for your attention to this matter.
Attachments
All calls listed are for official government business.
Attached is my check for non-official calls. The remaining calls were for
official government business.
Signature
Date
Bell Atlantic
A
Bell Atlantic Mobile
PAGE 47
TELEPHONE DETAIL
Klein
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Bell Atlantic Mobile
PAGE
48
CUSTOMER ACCOUNT NO: 000815136-00001
INVOICE NO: 0153384078
MOBILE TELEPHONE NO: 202-395-2131
INVOICE DATE: JANUARY 16, 1998
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Bell Atlantic Mobile provides billing services for AT&T Communications and Sprint Communications. Services provided by
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PLEASE RECYCLE
550161210002022
A NATIONAL EFFORT TO INSURE AMERICA'S CHILDREN:
WORKING TOGETHER FOR A HEALTHIER FUTURE
February 18, 1998
To meet the challenge of insuring millions of children, health care providers, foundations, corporations,
teachers, child care providers, advocates, and public health officials are coming together to inform families
about insurance options for their children. The following is a list of some major activities.
Enlisting Health Care Providers:
The American Medical Association, the American Academy of Pediatrics, the American Academy of
Family Physicians, the American College of Physicians, the American College of Obstetricians and
Gynecologists, and the American Nurses Association are educating physicians and nurses throughout
the country on how to enroll low-income uninsured children in CHIP and Medicaid.
Engaging Hospitals and Health Centers:
The American Hospital Association has launched the Campaign for Coverage.. A Community Health
Challenge to expand health care coverage to 4 million more Americans through outreach and
education efforts designed to bolster participation in CHIP, Medicaid, and other programs.
The National Association of Children's Hospitals and the National Association of Public Hospitals are
identifying and promoting innovative models of outreach and enrollment to uninsured children within
hospital facilities and throughout the community.
The Catholic Health Association has launched the Children's Health Matters campaign to provide
support to local hospitals and social service agencies in 23 states in their efforts to enroll Medicaid
eligible children.
The National Association of Community Health Centers is working through its 700 centers to identify
and enroll low-income uninsured children - including the 1.3 million such children they now serve -
through Medicaid/CHIP enrollment services at Community Health Centers.
Making Children's Health Insurance a Public Health Priority:
The National Association of County and City Health Officials, the American Public Health
Association, and the Association of Maternal and Children Health Programs are working to inform all
their members on ways to increase health insurance coverage for the children that they treat.
Investing in Innovative National, State and Local Outreach:
The Robert Wood Johnson Foundation will spend $13 million over the next 3 years to fund
innovative state-local coalitions to design and conduct outreach initiatives, simplify enrollment
processes, and coordinate existing coverage programs.
The Kaiser Family Foundation will spend up to $10 million over the next 5 years on studies to help
understand why eligible children are uninsured, how best to provide insurance coverage for them,
and which outreach initiatives work.
America's Promise, with support from the Robert Wood Johnson Foundation and in collaboration
with the American Academy of Pediatrics, will mobilize corporations and local communities
nationwide in children's health outreach efforts. Already, two of the nation's major pharmaceutical
companies have joined this effort -- SmithKline Beecham and Schering Plough.
The David and Lucile Packard Foundation will spend over a million dollars on children's health
programs such as the Children's Health Collaborative Project, a joint project of the National
Association for State Health Policy, the National Governors' Association, and the National Conference
of State Legislatures.
Mobilizing Major Corporations:
Bell Atlantic, in collaboration with the nation's Governors, will establish and support a single toll
free phone number that directs families to their local eligibility offices.
Pampers will distribute information on available health insurance options, including the toll-free
number, in its childbirth education packages, which are given to 90 percent of first-time mothers.
Safeway will display the toll-free number and information on children's health programs on their
shopping bags.
The National Association of Chain Drug Stores and the National Community Pharmacists
Association will distribute the toll-free number to more than 150,000 pharmacists in over 60,000
pharmacies and will provide them with information so that they may refer parents to state health
insurance programs.
Involving Teachers and Child Care Referral Centers:
The National Education Association is launching an unprecedented campaign to educate teachers on
how they can inform children and their families about health insurance, through national
newsletters, conferences, and special training sessions.
The National Association of Child Care Resource and Referral Agencies, which help over 1.5
million parents a year to find child care, will launch a campaign to inform parents of health
insurance options for their children.
Strengthening Grassroots Efforts to Sign Up Uninsured Children:
The Children's Defense Fund is disseminating information to over 10,000 individuals and
organizations on state plans to enroll more children in coverage.
The Center on Budget and Policy Priorities has increased its Start Healthy, Stay Healthy campaign,
which works with community organizations, schools, child care programs, health clinics, and
hospitals on ways to identify eligible children and get them enrolled in Medicaid and CHIP.
Families USA is providing technical assistance to advocates nationwide to devise innovative
strategies to enroll more children.
The March of Dimes has committed funds to support demonstration projects to help states plan or
implement creative outreach initiatives to reach and enroll children.
The Children's Health Fund is organizing a major outreach campaign designed to enroll eligible
children in Medicaid and CHIP, in order to reach an additional 50,000 uninsured children.
PRESIDENT CLINTON ANNOUNCES A SERIES OF NEW EFFORTS TO ENROLL
UNINSURED CHILDREN IN HEALTH INSURANCE PROGRAMS
February 18, 1998
Today, the President is announcing the first major state coverage expansions under the recently enacted
Children's Health Insurance Program (CHIP) and released information showing that many States will
soon follow. He also unveiled an unprecedented set of public/private initiatives designed to enroll the
millions of uninsured children who are eligible but not enrolled in Medicaid and other state-based
children's health programs. These initiatives have been designed in partnership with Governors, health
care providers, children's health advocates, foundations, businesses and many others who are committed
to providing health care coverage for the nation's uninsured children.
Over 10 million children in America are uninsured. Nearly 90 percent of these children have parents who
work, but do not have access to or cannot afford health insurance. Over 3 million of these uninsured
children are already eligible for Medicaid. However, many families are not aware that their children are
eligible for Medicaid, and others have difficulty filling out the application. Similar problems could
undermine the new Children's Health Insurance Program's goal to enroll millions of uninsured children.
With these challenges in mind, the President:
ANNOUNCED THAT COLORADO AND SOUTH CAROLINA HAVE JOINED ALABAMA
AS THE FIRST COVERAGE EXPANSIONS UNDER THE NEW CHILDREN'S HEALTH
INSURANCE PROGRAM (CHIP). Today, the President is announcing that Colorado and South
Carolina join Alabama as the first states to come into the children's health program. In late January,
Alabama received approval to expand its Medicaid program to children ages 14 to 18 up to 100
percent of poverty. South Carolina will expand its Medicaid program to provide coverage to all
children up to 150 percent of poverty. And, Colorado builds upon its current non-Medicaid program
to cover children up to 185 percent of poverty. The President is also announcing that many more
States are well on their way to expanding coverage to more uninsured children. Currently, 14
additional states have submitted plans to HHS for approval, and another 18 States have active working
groups or task forces to design plans to address the needs of uninsured children.
RELEASED A NEW PRESIDENTIAL DIRECTIVE TO LAUNCH A GOVERNMENT-WIDE
EFFORT TO ENROLL UNINSURED CHILDREN. In an executive memorandum to eight
Federal agencies with jurisdiction over children's programs - the Departments of Agriculture,
Interior, Education, HHS, HUD, Interior, Labor, and Treasury and the Social Security Administration
-- the President is directing the establishment of a multi-agency effort to enroll uninsured children.
These agencies run programs such as WIC, Food Stamps, Head Start, and public housing that cover
many of the same children who are uninsured and eligible for Medicaid or other health insurance. The
memorandum instructs these agencies: (1) to identify all their employees and grantees who might
come into contact with these children and ensure that these individuals are aware of the health
insurance programs available to children; (2) to develop an intensive children's outreach initiative,
such as distributing information, coordinating toll-free numbers, and simplifying and coordinating
application forms; and (3) to report back in 90 days on their plan to help enroll uninsured children.
HIGHLIGHTED BUDGET PROPOSALS THAT PROVIDE MEDICAID ENROLLMENT
INCENTIVES TO STATES. The President's FY 1999 budget invests $900 million over 5 years in
children's health outreach policies, including the use of schools and child care centers to enroll
children in Medicaid. The budget provides states with the option of automatically enrolling children
in Medicaid even before having received all of the complicated eligibility and enrollment forms (a
provision known as "presumptive eligibility"). It also expands the use of a Federally-financed
administrative fund so that it can underwrite the costs for all uninsured children - not just the limited
population allowed under current law.
ANNOUNCED A HISTORIC PRIVATE SECTOR COMMITMENT TO PROVIDE
OUTREACH. To complement the public outreach effort, the President is announcing unprecedented
new contributions from the private sector to help ensure that all children who are eligible for health
insurance receive it, including:
-
A new toll-free number that directs families around the nation to their state enrollment
centers. The President is announcing that Bell Atlantic will establish and operate a toll-free
number to help states enroll uninsured children. The number, which will be put in place during the
upcoming months, will be developed in cooperation with the nation's Governors. This will help
millions of families around the nation by directing them automatically to their local state Medicaid
enrollment agency.
-
Over $23 million in commitments from private foundations across the country. The Robert
Wood Johnson Foundation will spend $13 million over the next 3 years to fund innovative state-
local coalitions to design and conduct outreach initiatives, simplify enrollment processes, and
coordinate existing coverage programs. The Kaiser Family Foundation will spend up to $10
million over the next 5 years on studies to help understand why eligible children do not enroll in
existing programs and how best to provide insurance coverage for these children. America's
Promise, with support from the Robert Wood Johnson Foundation and in collaboration with the
American Academy of Pediatrics, will mobilize corporations such as SmithKline Beecham and
Sheering Plough and local communities nationwide in children's health outreach efforts.
-
New initiatives from corporate and advocacy organizations to reach out to uninsured
children. Pampers has volunteered to include a letter in its child birth education packages, given
to 90 percent of first-time mothers, providing families information about available health
insurance options. Grocery stores and chain drug stores across the country will provide
information about the new Bell Atlantic toll-free number to their customers. The National
Education Association is launching an unprecedented effort to educate teachers on how they can
inform children and their families about health insurance, through national newsletters,
conferences, and special training sessions. The American Hospital Association's Campaign for
Coverage will increase its nationwide initiative to engage hospitals in helping uninsured
Americans, including children.
ISSUED A CHALLENGE ACROSS AMERICA TO FIND NEW WAYS TO REACH OUT TO
UNINSURED CHILDREN. The President is challenging every physician, nurse, health care
provider, business, school, parent, grandparent, and community across the nation, to find new ways to
ensure that uninsured children eligible for health insurance are enrolled in Medicaid or CHIP. This
national commitment should not stop until every eligible child across the country is enrolled in one of
the existing health care programs.
1
Health Care PulseLine:
Preliminary Results
prepared for
America's Promise
WIRTHLIN WORLDWIDE
21 May 1998
2
RESEARCH METHODOLOGY
Two PulseLine Groups
- Parents of 'at risk' children
- Social Workers / Health Care Professionals that deal
with parents of 'at risk' children
Approximately 20 respondents per group
First hour of each group consisted of extensive quantitative
evaluation of potential promotional materials
-
'Ballot Box' technology for instantaneous data display
on multiple promotional iterations
Second hour consisted of in-depth qualitative Focus
Groups
W
WIRTHLIN WORLDWIDE
3
RESEARCH METHODOLOGY
Ten different 'story board' iterations
Each story board included:
- Potential initiative name
- Tagline
- Toll-free phone number
- Program descriptive
Respondents provided preferences for and against each
component of each story board
Given the instantaneous data display, the subsequent
qualitative follow-up was fluid, allowing exploration of key
issues unearthed in the quantitative portion
W
WIRTHLIN WORLDWIDE
Preference for Name of Initiative
4
(Among both groups)
KidCare
22%
Healthy Kids Matter
25%
Get All Kids Insured
14%
1-877-KIDCARE
4%
Healthy Kids Now
4%
America Cares For Kids
4%
HealthPromise for Kids
Insure Our Future
4%
Insure America's Children Now
7%
1-877-US4KIDS
4%
0%
10%
20%
30%
40%
First Preference
Second Preference
W
WIRTHLIN WORLDWIDE
5
Preference for Tagline
(Among both groups)
Free or low-cost health insurance is now
24%
available for millions of kids who need it.
Health insurance for children is now available
26%
for millions who need it.
Because all kids deserve to have health
16%
insurance.
If your child doesn't have health insurance, you
11%
need to call.
Sign up SO your kids are covered.
8%
At last, health coverage for America's kids
Because every child deserves the promise of a
healthy future
5%
Because health insurance is waiting for
5%
millions of kids who need it.
New health coverage for our kids. A better
3
3%
future for our families.
Because every child deserves to have health
3
3%
insurance.
0%
20%
40%
60%
80%
First Preference
Second Preference
I'll
WIRTHLIN WORLDWIDE
Preference for Toll Free Number
6
(Among both groups)
1-877-KIDCARE
12%
1-877-KIDSNOW
30%
1-877-US4KIDS
1
24%
1-877-456-CARE
1
24%
1-877-ALLKIDS
6%
1-877-USCHILD 1 6%
1-877-234-KIDS
0%
20%
40%
60%
80%
100%
First Preference
Second Preference
W
WIRTHLIN WORLDWIDE
7
Preferences for Initiative Spokesperson
Oprah Winfrey
23%
Bill Cosby
11%
Hillary Clinton
5%
Rosie O'Donnell
5%
Colin Powell
Janet Jackson
5%
Jimmy Smits
4%
Medical Professional
0%
5%
10%
15%
20%
25%
30%
35%
40%
Parents
Social Workers/HCP's
W
WIRTHLIN WORLDWIDE
8
Do you (your clients/patients) feel that it is valuable to take
children in for check-ups if they are not sick?
Yes
Yes
47%
90%
No
10%
No
53%
Parents / Caregivers
Social Workers / HCP's
W
WIRTHLIN WORLDWIDE
9
Would you (your clients/patients) rather the government provide
access to free health insurance for your (their) kids, or would you
(they) prefer to pay a small portion, say $10 per month?
Free
22%
Free
73%
Pay Portion
Pay Portion
27%
78%
Parents / Caregivers
Social Workers / HCP's
W
WIRTHLIN WORLDWIDE
10
COMMUNICATIONS IMPERATIVES
Cost will be the number one concern among this audience.
We absolutely must mention that this initiative is 'free' or
'low-cost'
Emphasize that this initiative is something that is available
NOW or available TODAY
Acknowledge the efforts of these people despite their
difficult situation
Provide assurance that our target audience is eligible for
this program
W
WIRTHLIN WORLDWIDE
11
COMMUNICATIONS IMPERATIVES
Emphasize that this program is 'new'. The fact that this is
not something that they've seen or heard about before is
appealing
Somewhat less important, but still on the mental radar
screen of these respondents, was the quality of this health
care. We should emphasize that this is not a
watered-down version of the insurance that middle-class
America receives
Our target audience lives from day to day - any references
to the future make them distrustful (again, confirming the
need to include the term 'today' or 'now' in our messages)
W
WIRTHLIN WORLDWIDE
12
COMMUNICATIONS IMPERATIVES
Avoid any terminology that connotes a 'Federal Program'.
Pride will influence many of the individuals we are targeting
into non-action. The term 'National Initiative' is a good
alternative.
Avoid limits such as millions and ten million. These people
are eternal pessimists. The majority of the group voiced the
opinion that 'if there are ten million slots, my child would be
number ten million and one.'
Avoid tone that 'we know what's best you.' Pride is very
important and they prefer to make up their own mind about
issues concerning their child. Phrases such as "you need to
call" or "don't risk your child's health" can be a turn-off. They
are, however, open to good advice.
W
WIRTHLIN WORLDWIDE
SEP-29-97 MON 10:36
HCFA-EXECUTIVE SEC.
FAX NO. 2026907675
P.02
cc: Melanne
Cluis
SUMAR
DEPARTMENT OF HEALTH & HUMAN SERVICES
Jen
Health Care Financing Administration
Deputy Administrator
Washington, D.C. 20201
SEP 28 1997
MEMORANDUM FOR THE FIRST LADY
FROM:
Nancy-Ann Min DeParle
NMD
Deputy Administrator
SUBJECT: Status of State Children's Health Insurance Program
I wanted to provide you with an update on the Department of Health and Human Services'
(HHS) efforts to implement the State Children's Health Insurance Program. We started
organizing even before the President signed the bill into law and already have provided States
with a significant amount of information to assist them in developing the State Plans required by
the law. In addition to several written communications, we have been talking with the States
through face-to-face meetings'in Washington, including the National Governors Association
(NGA) - sponsored summit on September 12th, and through informal contacts made by our
regional offices.
Implementation of the new program involves a team effort throughout the HHS. The new program
will be administered by the Center for Medicaid and State Operations (CMSO) within the Health
Care Financing Administration (HCFA). We are working with the Health Resources and Services
Administration (HRSA), which also administers programs such as the Maternal and Child Health
Services Block Grant, to implement and monitor the new program as a part of our overall strategy
to coordinate outreach to uninsured children Among other things, HRSA's involvement help to
underscore that we are not trying to push States into using Medicaid as the expansion model.
Guidance to States
We have provided States with a number of documents that will help them in developing their child
health plans:
On August 27th, we sent a letter to State officials providing an overview of the new
program, describing our implementation plans, and enclosing a detailed summary of the
law.
On September 10th, we published a Federal Register notice that set forth the fiscal year
1998 State allotments available to States, Commonwealths, and Territories for
expenditures on the new program. This notice also provided State-by-State information on
the enhanced Federal matching available to States.
Page 2 - The First Lady
In conjunction with the NGA meeting on September 11th, we provided States with the first
set of responses to the highest priority, most frequently asked questions about the program.
(We will release additional sets of questions and answers on a regular basis as we resolve
key policy issues.)
On September 12th, we provided States with a draft template and instructions to provide
information on the requirements and options in the law to assist States in submitting their
plans and relieve them from having to search through the law to ensure that they have made
the proper assurances.
We also created a WEB page to help States (and others) answer immediate questions about
the new law and its implementation. (The address is http://www.hcfa.gov/init/children.htm)
For your information, I have appended these materials in a notebook that accompanies this
memorandum.
In addition, we are developing materials to guide the review and approval of Title XXI plans.
These will include instructions to States for the submission, approval and amendment of Title XXI
plans, as well as instruction for HCFA Central Office, Regional Offices and DHHS partners on the
process to follow for review of States' plans. We will also provide more payment information to
States on the claims processing procedures and State matching requirements. We also are
preparing instructions and guidance for States to access Title XXI funds through Medicaid
expansions. Our goal is to provide these materials to the States in early October
We also are working to assist States in developing strategies to find and enroll uninsured children
without inadvertently replacing existing private or State coverage of children with the new Federal
program. We plan to provide examples of strategies or best practices used by States in three areas:
Preventing "crowd out" of current coverage to ensure that the new funds cover children
who would otherwise have private coverage;
Coordination with Medicaid to ensure that children eligible for Medicaid are enrolled in
that program and to simplify the eligibility process; and
Outreach ideas for both programs.
Finally, we are planning to invite States to a conference in early December to provide them with
additional technical assistance. We think that early December is a good time for such a meeting
because by then, States will have had time to more fully explore their options, and also because
many States will need to be prepared to work with their State legislatures in developing their plans
beginning in January 1998.
TO:
Katie, Emily, Jennifer, Barbara
FROM:
Jeanne
me
RE:
OUTLINE OF BIWEEKLY UPDATE
DATE:
September 17
Attached is a draft format for our biweekly update? Are there additional categories? Missing
information?
Another thought that I had is that we get a 50-state table that shows whatever we know is going
on in each state in a box.
We'll discuss at 12:30. Thanks!
Children's Health Insurance Program Update
DRAFT September 17, 1997
News / Releases
Last week, Administration officials and staff attended a National Governors' Association (NGA)
meeting on children's health. The two-day meeting included panel discussions and round tables
about the new program. At that time, we released two documents:
The Federal Register containing the state allotments
A first set of questions and answers about major issues
On Monday, September 15, DHHS sent to states and other interested parties a draft state plan
"template" to help guide states as they develop their state plans.
The next planned release of information is possibly October 1, the first effective date of the
program, including general guidance (on targeting. Other works in progress include: a second set
of q.s. and as; a letter outlining financial reporting forms; a letter describing the state plan
approval process; and a description of how the Medicaid option would work.
State News
Wisconsin intends to submit a concept paper [when]
California held a special session of their state legislature in August to discuss its state plan.
Meetings / Speeches
A series of regular meetings have been set up. These include: [biweekly NGA, groups, etc].
Chris Jennings and Nancy Ann Min DeParle spoke at the NGA meeting.
NCSL?
Upcoming Events
Secretary Shalala, March of Dimes, September 26
First Lady, October 6
P.02/05
1997
Children's Health
September
1997
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
I
2
HHS Steering Committee
3
HCFA Center on Beneficiary
4
5
6
Services, Baltimore, MD
(Fenton)
7
HHS Steering Committee
8
WH /DPC/HHS Meeting
9
HHS Steering Committee
10
MGA Meeting
II
HGA Meeting
12
D
CSG/Southern Gov's Annual
Advacacy Group Meeting at
Meeting, 9/7-9, Hot Springs, VA
HHS
APWA-Information Systems
I4
-HHS Steering Committee
15
WH/DPC/RHS Meeting
16
HHS Steering Committee
17
18
19
Mat'l Association of Insurance 20
Management Annual
-NCSL/Assembly of Federal
Will/WAND mtg
Commisioners Fall Meeting.,
Conference, 9/14-19. SL
Issues Chairs meeting. DC
CHIP KA Meeting (biweekly)
9/20-24. DC
Louis, NO
-N3t'l Advisory Committee on
OEOB
Rural Health, DE (Sertitte)
Wat'l (oalition on Health Care
-AHCPR, User Linison Program,
meeting
9/13-17, Charlottesville, VA
IGA
-Nat'l Latino Child. (speech)
21
HHS Steering Committee
22
WH/DPC/HHS Meeting
23
HHS Steering Committee
24
CSG/Nidwestern Legis.ative
25
Sec'ty sprech-March of Dimes,
26
27
Conference, 9/25-27, Lincoln,
NYC,HT
ASTHO 1993 Annual Meeting,
ME
9/23-26, Scottsdale, AI
SEP-15-1997 18:04
28
HHS Steering Committee
29
WH/DPC/HHS Meeting
30
P.03/05
October
1997
Children's Health
1997
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
HHS Steering Committee
I
2
3
4
CHIP IGA Meeting
5
HHS Steering Committee
6
WH/DPC/HHS Meeting
7
HHS Steering Committee
8
Mat'l Commission on
9
to
II
Partnerships for Children's
APWA-Organizational and
Health meeting (Sec'ty's
Professional Development
calendar)
Seminar, 10/6-7, Derrer, CO
(child care and other issues)
CHILDREN'S HEAL TH DAY
12
HOLIDAY
I3
WH/DPC/HHS Meeting
14
HHS Steering Committee
15
16
NCSL Health Seminar, 10/17-
17
18
19, Haples, FL (HHS invited)
CHIP IGA Meeting
IGA
19
HHS Steering Committee
20
WH/DPC/HHS Meeting
21
HHS Steering Committee
22
23
24
25
SEP-15-1997 18:04
APWA-Nat'l Association of
26
HHS Steering Committee
27
WH/DPC/HHS Meeting
28
HIS Steering Committee
29
30
31
State Medicaid Directors,
Annual Conference, 10/26-29,
CHIP IGA Meeting
Alexandria, YA
P.04/05
November
1997
Children's Health
1997
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
30
American Academy of
I
Pediatrics Annual Meeting,
II/I-S, New Orleans, LA
2
HHS Steering Committee
3
WH/DPC/HHS Meesing
4
HHS Steering Committee
5
6
7
8
NCSL, Assembly on Fed'l Issues,
and Assembly on State Issues
joint meeting, 11/5-7, DC
(Election Day)
CSG/Southern Legislative
9
HHS Steering Committee
Ю
HOLIDAY
II
HHS Steering Committee
12
HACO, Employment-Horman
B
14
IS
Conference Fall Issues Conf..,
Services Conference, 11/13-17,
11/9-12, Oklahoma City, OK
Veterans" Day
CHIP IGA Meeting
Tulsa, OK
American Public Health
Assoc. Annual Meeting, U.S.
13, Indianapolic, IN
IGA
16
HHS Steering Committee
17
WH/DPC/HHS Meeting
16
HHS Steering Committee
19
20
NOSL Health Seminar, 11/21-
21
22
23, Newport, RI (HHS invited)
KCSL Sr. legislative Drafting
Seminar, 11/19-22, Sacramento,
CA
SEP-15-1997 18:05
23
HMS Steering Committee
14
WH/DPC/HHS Meeting
25
HHS Steering Committee
26
HOLIDAY
27
28
29
CHIP IGA Meeting
THANKSGIVING
P.05/05
December
1997
Children's Health
1997
TOTAL P.05 TOTAL P.05
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
HHS Steering Committee
I
WH/DPC/HHS Meeting
2
HHS Steering Committee
3
National League of Cities
4
CSG 1997 Annual Meeting $
5
APWA-Mat'l Council of State
6
annual meeting, 12/4-7,
State Leadership forum, 12/5-
Human Svc Admin. & Mat'1
--CSG-WEST-50th Pacific Annir.
Philadelphia, PA
9, Honolulu, Hawaii
Council of Local Public
Meeting, 12/3-S,KohalzCoast,
Wellare Admin. Winter
Island of Hawai
meeting. 12/6-10, San
--American Legislative Exchange
Francisco, CA
Council,Freshman Legislator
Orientation, 12/3-6, DC
7
HHS Steering Committee
8
WH/DPC/HHS Meeting
9
HHS Steering Committee
10
II
12
B
CHIP IGA Meeting
14
HHS Steering Committee
IS
WH/DPC/HHS Meeting
16
HHS Steering Committee
17
18
19
20
IGA
21
HHS Steering Committee
22
WH/DPC /HHS Heeting
23
HHS Steering Committee
24
HOLIDAY
25
26
27
CHIP IGA Meeting
CHRISTMAS
SEP-15-1997 18:05
28
KHS Steering Committee
29
WH/DPC/HHS Meeting
30
HHS Steering Committee
Il
HOLIDAY
NEW YEAR'S DAY