1. SPECIAL POPULATIONS CHILDREN

2. POPULATION AND FAMILY CHARACTERISTICS

5. AMERICA’S CHILDREN CONTINUE TO GROW IN RACIAL AND ETHNIC DIVERSITY.

6. IN 2004, 65 PERCENT WERE WHITE, NON-HISPANIC; 15 PERCENT WERE BLACK, NON-HISPANIC;

7. 15 PERCENT HISPANIC; 4 PERCENT ASIAN/PACIFIC ISLANDER; 1 PERCENT AMERICAN INDIAN AND ALASKAN NATIVE.

8. 68 PERCENT LIVE WITH TWO PARENTS.

9. INDICATORS OF CHILDREN’S WELL-BEING

10. 19 PERCENT OF CHILDREN LIVE IN POVERTY.

17. 76 PERCENT OF CHILDREN HAD AT LEAST ONE PARENT WORKING FULL TIME.

18. MOST AMERICAN CHILDREN AND ADOLESCENTS HAVE A DIET WHICH IS POOR OR NEEDS IMPROVEMENT.

19. TEENAGERS ARE LESS LIKELY THAN YOUNG CHILDREN TO HAVE A USUAL SOURCE OF MEDICAL CARE.

20. 7.5 PERCENT OF INFANTS ARE BORN WITH LOW BIRTHWEIGHTS.

21. 71 PERCENT OF CHILDREN IN FAMILIES LIVING IN POVERTY RECEIVED THE COMBINED SERIES OF VACCINES.

22. THE MORTALITY RATE FOR WHITE CHILDREN IS 31.5 PER 100,000 POPULATION.

23. THE DEATH RATE AMONG BLACK MALE ADOLESCENTS IS 108.7 PER 100,000.

24. THE DEATH RATE AMONG WHITE MALE ADOLESCENTS IS 23.1 PER 100,000.

25. THE BIRTH RATE FOR TEENAGERS 15-17 IS 32
THE BIRTH RATE FOR TEENAGERS IS 32.1 LIVE BIRTHS PER 1000 FEMALES.

26. IN 1996, 2.6 MILLION SOUTHERN CHILDREN LIVED IN EXTREME POVERTY, WITH FAMILY INCOMES BELOW HALF THE FEDERAL POVERTY LINE. THAT MEANT CASH INCOME LESS THAN $120 PER WEEK FOR THREE PEOPLE. CHILDREN GO HUNGRY WHEN INCOME IS LOW.

27. 1.2 MILLION SOUTHERN HOUSEHOLDS EXPERIENCED HUNGER.

28. 3 MILLION SOUTHERN HOMES LACK SECURE ACCESS TO FOOD.

29. 7 OUT OF 10 POOR FAMILIES WITH CHILDREN HAD A FAMILY MEMBER WHO WORKED
7 OUT OF 10 POOR FAMILIES WITH CHILDREN HAD A FAMILY MEMBER WHO WORKED. ONE IN FOUR SOUTHERN WORKING PARENTS EARN HOURLY WAGES TOO LOW TO ESCAPE POVERTY.

30. POVERTY AFFECTS CHILDREN OF ALL RACES
POVERTY AFFECTS CHILDREN OF ALL RACES. HALF OF ALL SOUTHERN POOR CHILDREN ARE WHITE, BUT SOUTHERN BLACK CHILDREN ARE TWO-AND-A-HALF TIMES MORE LIKELY TO LIVE IN POVERTY THAN SOUTHERN WHITE CHILDREN.

31. SOUTHERN CHILD POVERTY IS GENERALLY HIGHEST IN THE CENTRAL CITIES OF METROPOLITAN AREAS.

32. NINE MILLION CHILDREN DO NOT HAVE HEALTH CARE COVERAGE IN 2007

33. POOR CHILDREN ARE TWICE AS LIKELY AS NON-POOR TO BE BORN WEIGHING TOO LITTLE,TO SUFFER STUNTED GROWTH, OR TO REPEAT A YEAR OF SCHOOL.

34. A BABY BORN TO A POOR MOTHER IN AMERICA IS MORE LIKELY TO DIE BEFORE ITS FIRST BIRTHDAY THAN A BABY BORN TO A HIGH SCHOOL DROPOUT, AN UNWED MOTHER, OR A MOTHER WHO SMOKED DURING PREGNANCY.

35. POVERTY MAKES CHILDREN HUNGRY, SICK, AND LESS ABLE TO LEARN.

36. THE STATE CHILDREN’S HEALTH INSURANCE PROGRAM

38. ENABLES STATES TO INSURE CHILDREN FROM WORKING FAMILIES WITH INCOMES TOO HIGH TO QUALIFY FOR MEDICAID BUT TOO LOW TO AFFORD PRIVATE HEALTH INSURANCE THROUGH SEPARATE STATE PROGRAMS, MEDICAID EXPANSION, OR A COMBINATION OF BOTH.

39. AS OF 2001, 50 STATES, THE DISTRICT OF COLUMBIA AND FIVE U. S
AS OF 2001, 50 STATES, THE DISTRICT OF COLUMBIA AND FIVE U.S. TERRITORIES HAVE IMPLEMENTED S-CHIP, COVERING OVER 4.6 MILLION CHILDREN.

40. THE NUMBER OF CHILDREN ENROLLED IN MEDICAID HAS INCREASED BECAUSE OF STATE-WIDE OUTREACH, ELIGIBILITY SIMPLIFICATIONS STREAMLINED ENROLLMENT PROCEDUES, AND PROGRAM MATURITY.

41. MORE THAN 75% OF CHILDREN EVER ENROLLED IN SCHIP IN FY 2001 WERE BETWEEN THE AGES OF 6 AND 18.
MEDICAID GENERALLY COVERS YOUNGER CHILDREN AT HIGHER INCOME LEVELS.

42. PRIOR TO S-CHIP’S CREATION, ONLY 4 STATES COVERED CHILDREN WITH FAMILY INCOMES UP TO AT LEAST 200 PERCENT OF THE FEDERAL POVERTY LEVEL (ABOUT $33,000 FOR A FAMILY OF FOUR).

43. TWO-THIRDS OF THE ELIGIBLE CHILDREN ARE IN TWO PARENT FAMILIES.
NEW LEGISLATION IN 2008 INCREASED ENROLLMENT FROM 7 MILLION TO 11 MILLION.

44. 75 PERCENT OF THESE PARENTS WORK…5 PERCENT ARE ON WELFARE.

45. Outreach Hot Spots Based on Proportion and Numbers of Uninsured
Holmes
Escambia
Jackson
Santa Rosa
Okaloosa
Walton
Washington
Gadsden
Nassau
Hamilton
Bay
Leon
Calhoun
Jefferson
Madison
Duval
Liberty
Wakulla
Suwannee
Baker
Taylor
Columbia
Union
Gulf
Franklin
Lafayette
Bradford
Clay
St. Johns
Gilchrist
Alachua
Dixie
Putnam
Flagler
High Priority
Minimum 16% uninsured and greater than 24% uncovered
Levy
Marion
Volusia
Citrus
Lake
Sumter
Seminole
Hernando
Orange
Medium Priority
Minimum 16% uninsured and less than 24% uncovered
Between 15.9% and 10% uninsured and 19% or more uncovered
Between 15.9% and 10% uninsured and less than 19% covered
Pasco
Brevard
Pinellas
Osceola
Hillsborough
Polk
Indian River
Manatee
Hardee
Okeechobee
Highlands
St. Lucie
De Soto
Sarasota
Martin
Charlotte
Glades
Low Priority
Less than 10.0 uninsured
Less than 10.0 uncovered
Hendry
Lee
Palm Beach
Broward
Collier
Monroe
Dade
Crosshatching indicates more than 15,000 uninsured children, regardless of proportion
Revised 2/02

46. TITLE XXI OF THE SOCIAL SECURITY ACT

47. EFFECTIVE DATE: MOST PROVISIONS TAKE EFFECT OCTOBER 1, 1997
EFFECTIVE DATE: MOST PROVISIONS TAKE EFFECT OCTOBER 1, STATES CAN START RECEIVING THE FUNDS THEN OR POSTPONE IMPLEMENTATION FOR UP TO 3 YEARS WITHOUT LOSING ANY FUNDS.

48. ELIGIBILITY: THE LEGISLATION SETS ELIGIBILITY CRITERIA
ELIGIBILITY: THE LEGISLATION SETS ELIGIBILITY CRITERIA. THE ELIGIBILITY CRITERIA ARE TO COVER UNINSURED CHILDREN WHO ARE:

49. NOT ELIGIBLE FOR MEDICAID
UNDER AGE 19; AND

50. NOT ELIGIBLE FOR MEDICAID
UNDER AGE 19; AND
AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL (FPL)

51. PROGRAM STRUCTURE

52. THE LEGISLATION ALLOWS STATES TO CHOOSE THE WAY THEY SPEND THEIR MONEY
THE LEGISLATION ALLOWS STATES TO CHOOSE THE WAY THEY SPEND THEIR MONEY. THEY CAN:

53. EXPAND MEDICAID;
CREATE OR EXPAND A STATE PROGRAM; OR
A COMBINATION OF BOTH.

55. STATES CAN ALSO SPEND UP TO 10% OF THE FUNDS TO PROVIDE COVERAGE THROUGH A COMMUNITY-BASED HEALTH DELIVERY SYSTEM OR BY PURCHASING FAMILY COVERAGE.

56. BENEFITS PACKAGE

57. IF A STATE CHOOSES TO IMPLEMENT A MEDICAID EXPANSION, STATES MUST OFFER THE NEWLY ELIGIBLE THE SAME MEDICAID BENEFITS PACKAGE FROM AMONG FIVE BASIC OPTIONS.

58. BLUE CROSS/BLUE SHIELD PREPERRED PROVIDER OPTION OFFERED TO FEDERAL EMPLOYEE OFFERED UNDER THE FEHBP

59. STATE EMPLOYEE HEALTH PLAN

60. HMO WITH THE LARGEST INSURED COMMERCIAL, NON-MEDICAID ENROLLMENT IN THE STATE

61. COVERAGE THAT IS THE ACTUARIAL EQUIVALENT TO ONE OF THE ABOVE

62. ANOTHER BENEFIT PACKAGE MUST BE APPROVED BY THE SECRETARY OF HEALTH AND HUMAN SERVICES.

63. COST SHARING FOR FAMILIES

64. STATES ARE ALLOWED TO IMPOSE PREMIUMS, DEDUCTIBLES, OR FEES FOR SOME SERVICES AND FOR SOME GROUPS.

65. NO CO-PAYMENTS ARE ALLOWED FOR PEDIATRIC PREVENTIVE CARE, INCLUDING IMMUNIZATIONS, AT ANY LEVEL.

66. AT OR BELOW 150% FPL, STATES CAN IMPOSE THE FOLLOWING:

67. PREMIUMS: $15-19 PER FAMILY PER MONTH

68. PREMIUMS: $15-19 PER FAMILY PER MONTH
DEDUCTIBLES: $2 PER FAMILY PER MONTH

69. PREMIUMS: $15-19 PER FAMILY PER MONTH
DEDUCTIBLES: $2 PER FAMILY PER MONTH
CO-INSURANCE: 5% OF NON-INSTITUTIONAL COSTS

70. PREMIUMS: $15-19 PER FAMILY PER MONTH
DEDUCTIBLES: $2 PER FAMILY PER MONTH
CO-INSURANCE: 5% OF NON-INSTITUTIONAL COSTS
CO-PAYMENTS: RANGE FROM $ .50 TO $3.00 PER SERVICE

71. INSTITUTIONAL CARE: 50% OF THE FIRST DAY’S COSTS.

72. FOR CHILDREN ABOVE THE 150%, STATES CAN IMPOSE PREMIUMS, DEDUCTIBLES OR OTHER COST-SHARING NOT TO EXCEED 5% OF FAMILY INCOME.

73. FUNDING
THE AGREEMENT AUTHORIZES $40 BILLION OVER 10 YEARS ($20 BILLION IN THE FIRST FIVE YEARS) TO SCHIP.

75. RURAL AND FRONTIER HEALTHCARE DELIVERY

76. THE DEMOGRAPHICS AND HEALTH CARE NEEDS OF RURAL AND FRONTIER POPULATIONS DIFFER FROM THOSE IN URBAN COMMUNITIES.

77. THE NUMBER OF ELDERLY IS INCREASING.
NEARLY 20 PERCENT OF THESE POPULATIONS ARE UNINSURED,
AND RESIDENTS HAVE TO TRAVEL LONG DISTANCES TO ACCESS NEEDED HEALTH CARE SERVICES AND FACILITIES.

78. RURAL AND FRONTIER COMMUNITIES ARE CONSTANTLY STRUGGLING WITH HOW TO BUILD AND SUPPORT THEIR LIMITED HEALTH CAPACITY AND INFRASTRUCTURE.

79. THEY FACE DIFFICULTIES IN RECRUITING AND RETAINING PROVIDERS, ESTABLISHING TELEMEDICINE SYSTEMS, AND MAINTAINING ADEQUATE EMERGENCY MEDICAL SERVICES.

80. UNIQUE CHARACTERISTICS

81. RURAL AND FRONTIER RESIDENTS COMPRISE APPROXIMATELY ONE FIFTH OF THE U
RURAL AND FRONTIER RESIDENTS COMPRISE APPROXIMATELY ONE FIFTH OF THE U.S. POPULATION.
HOWEVER, THEY DO NOT HAVE THE SAME LEVEL OF ACCESS TO BASIC HEALTH SERVICES THAT IS AVAILABLE TO OTHER AMERICANS.

82. POVERTY, INADEQUATE TRANSPORTATION, LARGE GEOGRAPHIC DISTANCES, AND AN AGING POPULATION AGE COMPLICATE HEALTH CARE DELIVERY IN RURAL AND FRONTIER COMMUNITIES.

83. FRONTIER AREAS DIFFER FROM RURAL AREAS IN THAT THEY ARE CHARACTERIZED BY EXTREME REMOTENESS, ISOLATION, AND POPULATION DENSITIES OF LESS THAN SEVEN PEOPLE PER SQUARE MILE. THESE FACTORS COUPLED WITH NONEXISTENT HEALTH CARE INFRASTRUCTURE MAKE DELIVERY OF HEALTH CARE A GREAT CHALLENGE.

84. YOUNGER PEOPLE HAVE BEEN LEAVING MANY RURAL AND FRONTIER COMMUNITIES FOR URBAN CENTERS, WHICH MAKES FILLING PROFESSONAL AND VOLUNTARY HEALTH CARE POSITIONS FROM WITHIN THE COMMUNITY MORE DIFFICULT.

85. FROM 1990 T0 1996, THE NUMBER OF ELDERLY AGES SIXTY-FIVE AND OLDER LIVING IN RURAL AND FRONT AREAS INCREASED BY 7.3 PERCENT. HOWEVER, THE GROWTH IN RURAL AND FRONTIER ELDERLY AGES EIGHTY-FIVE AND OLDER INCREASED MORE THAN TWENTY PERCENT.

86. INSURANCE COVERAGE

87. 19.8 PERCENT IN RURAL AREAS HAVE NO COVERAGE.
16.3 PERCENT IN URBANS HAVE NO COVERAGE

88. WHY?
HEALTH INSURANCE IS LESS AVAILABLE THROUGH EMPLOYERS.
FARM FAMILIES ARE LESS LIKELY THAN OTHER WORKING FAMILIES TO HAVE AN EMPLOYER WHICH PROVIDES COVERAGE.

89. POVERTY IS MORE WIDESPREAD IN RURAL AND FRONTIER AREAS, SO MANY RESIDENTS HAVE DIFFICULTY IN PURCHASING THEIR OWN INSURANCE.

90. RECRUITING AND RETAINING
PROVIDERS

91. THERE IS AN INSUFFICIENT SUPPLY AND/OR MIX OF HEALTH CARE PRACTITIONERS IN THE COMMUNITY TO PROVIDE NEEDED INPATIENT AND OUTPATIENT SERVICES.

92. HHS RECOMMENDS THAT THERE SHOULD BE ONE PRIMARY CARE PHYSICIAN FOR EVERY 2000 PEOPLE.
MOST RURAL AND FRONTIER AREAS HAVE A RATIO OF ONEPRIMARY CARE PHYSICIAN FOR EVERY 3500 PEOPLE.

93. RECRUITMENT DIFFICULTIES

94. NO BACKUP THUS HARD TO TAKE SICK LEAVE OR PERSONAL VACATION

95. NO BACKUP THUS HARD TO TAKE SICK LEAVE OR PERSONAL VACATION.
SALARIES ARE OFTEN LOWER.

96. NO BACKUP THUS HARD TO TAKE SICK LEAVE OR PERSONAL VACATION.
SALARIES ARE OFTEN LOWER.
MALPRACTICE INSURANCE VERY COSTLY.

97. LIMITED RANGE OF LOCAL AMENITIES….
SCHOOLS…RECREATION…CAREER OPPORTUNITIES FOR SPOUSES..
EXTREME ISOLATION FROM PROFESSIONAL COMMUNITIES OF PEERS.

98. BALANCED BUDGET ACT CREATED THE “MEDICARE RURAL HOSPITAL FLEXIBILITY PROGRAM” AS WELL AS “CHIP”

99. THE MEDICARE RURAL HOSPITAL FLEXIBILITY PROGRAM CAN HELP STATES AND RURAL COMMUNITIES TO ESTABLISH LIMITED SERVICE HOSPITALS REFERRED TO AS “CRITICAL ACCESS HOSPITALS”

100. HOSPITALS MAY BE DESIGNATED AS A “CRITICAL ACCESS HOSPITAL” IF THEY MEET THESE GUIDELINES.

101. LOCATED A SUFFICIENT DISTANCE FROM OTHER HOSPITALS.
MAKE AVAILABLE TWENTY-FOUR-HOUR EMERGENCY CARE.
MAINTAIN NO MORE THAN FIFTEEN PATIENT BEDS.

102. KEEP PATIENTS NO L0NGER THAN 96 HOURS
RURAL HOSPITALS WHICH CONVERT TO THIS STATUS DO NOT HAVE TO MEET ALL OF THE MEDICARE STAFFING REQUIREMENTS THAT APPLY TO FULL-SERVICE HOSPITALS.

103. CAH’S ARE REIMBURSED ON A REASONABLE-COST BASIS FOR SERVICES PROVIDED TO MEDICARE BENEFICIARIES.

104. STATES MUST SUBMIT A RURAL HEALTH PLAN TO CMS.

105. WHAT STATES NEED TO DO TO ADDRESS THE PROBLEM OF RURAL AND FRONTIER HEALTH.

106. EXPLORE HOW TO ENSURE AN ADEQUATE NUMBER AND APPROPRIATE MIX OF HEALTH CARE PROFESSIONALS.

107. EXPLORE HOW TO ENSURE AN ADEQUATE NUMBER AND APPROPRIATE MIX OF HEALTH CARE PROFESSIONALS.
PROMOTE THE USE OF TELEMEDICINE.

108. EXPLORE HOW TO ENSURE AN ADEQUATE NUMBER AND APPROPRIATE MIX OF HEALTH CARE PROFESSIONALS.
PROMOTE THE USE OF TELEMEDICINE.
INCREASE THE AVAILABILITY OF RURAL EMERGENCY MEDICINE SERVICES.
ADDRESS THE ISSUE OF LONG TERM CARE.
USE CHIP TO REACH THE CHILDREN.

110. END OF LECTURE FOR 7th PERIOD, NOVEMBER 2nd, 2011.
QUESTIONS?

111. OF COURSE, THIS WILL ALL TAKE LOTS AND LOTS OF MONEY.