Memorandum on School-Based Health Insurance Outreach for Children

Memorandum for the Secretary of Health and Human Services, the Secretary of Education, the Secretary of Agriculture

Subject: School-Based Health Insurance Outreach for Children

The lack of health insurance for millions of Americans remains one of the great challenges facing this Nation. To help address this issue, I worked with the bipartisan Congress to create the Children's Health Insurance Program (CHIP), the single largest expansion of children's health insurance in 30 years. The 1997 Balanced Budget Act allocated $24 billion over 5 years to extend health care coverage to millions of uninsured children in working families. CHIP builds on the Medicaid program, which currently provides health coverage to most poor children, and together, these programs could cover most uninsured children.

Yet too few uninsured children eligible for CHIP or Medicaid participate. Barriers to enrollment include parents' lack of knowledge about the options; cultural and language barriers; complicated application and enrollment processes; and the "stigma" associated with socalled welfare programs. The Vice President and I have made removing these barriers to enrollment a high priority. In 1997, I launched a major public-private outreach campaign called "Insure Kids Now." Foundations, corporations, health care providers, consumer advocates, and others have participated through activities such as setting up enrollment booths at supermarkets and promoting the national toll-free number (1- 877-KIDS NOW) on grocery bags, TV and radio ads, and posters. In addition, we created a Federal Interagency Task Force on Children's Health Insurance Outreach in February 1998, which has implemented over 150 new activities to educate and train Federal workers and families nationwide about the availability of Medicaid and CHIP.

Today I am directing the Secretaries of Health and Human Services, Education, and Agriculture to focus children's health insurance outreach on a place where we know we can find uninsured children: schools. State experience indicates that school systems are an ideal place to identify and enroll uninsured children in Medicaid or CHIP because schools are accepted by parents as a conduit for important information. In addition, health insurance promotes access to needed health care, which experts confirm contributes to academic success. We have learned that children without health insurance suffer more from asthma, ear infections, and vision problems—treatable conditions that frequently interfere with classroom participation; and children without health insurance are absent more frequently than their peers. As we strive for high standards in every school and classroom, it is essential that we help families ensure their children come to school ready to learn.

Therefore, I hereby direct you, in consultation with State and local agencies, to report to me a set of recommendations on specific actions to encourage and integrate health insurance enrollment and outreach for children into schools, consistent with the mission of your agency. This report shall include:

• Specific short- and long-term recommendations on administrative and legislative actions for making school-based outreach to enroll children in Medicaid and CHIP an integral part of school business. These may include:
• Technical assistance and other support to school districts and schools engaged in outreach;
• Suggestions on how to effectively use the school lunch program application process to promote enrollment in health insurance programs;
• Lists of practices that have proven effective, such as integration of outreach and enrollment activities into school events such as registration, sports physicals, and vision and hearing testing; and
• Model State CHIP and Medicaid policies and plans for school-based outreach.
• A summary of key findings from the national and regional conferences scheduled for this fall on the topic of school-based outreach. These conferences will bring together national and State education officials, Medicaid and CHIP directors, public policy experts, and community-based organizations to examine the use of schools to facilitate the enrollment of children in Medicaid and CHIP; evaluation tools to monitor the effectiveness of current schoolbased outreach efforts; and best practices in school-based outreach and enrollment for children's health insurance.
• Recommendations on methods to evaluate CHIP and Medicaid outreach strategies in schools. Performance measures should be an integral part of school-based CHIP and Medicaid outreach strategies, as they can inform policy-makers on the effectiveness of these strategies, as well as help to identify areas of improvement.

I direct the Department of Health and Human Services to serve as the coordinating agency to assist in the development and integration of recommendations and to report back to me in 6 months. The recommended actions should be consistent with Medicaid and CHIP rules for coverage of appropriate health- and outreach-related activities. They should be developed in collaboration with State and local officials as well as community leaders and should include recommendations on fostering effective partnerships between education and health agencies. These recommended activities should be complementary, aggressive, and consistent with my Administration's overall initiative to cover uninsured children.

WILLIAM J. CLINTON