1. Serving Health Insurance with School Lunch: The CHILD Project Connecting Health Insurance to Lunch Data Families USA Annual Conference January 28, 2010

2. Wisconsin Population Mostly white state Mostly white state Rural – 45 out of 72 counties are considered rural Rural – 45 out of 72 counties are considered rural 2 times more likely to be uninsured than non- Milwaukee urban counterparts 2 times more likely to be uninsured than non- Milwaukee urban counterparts Uninsured – leading the country (good and bad) Uninsured – leading the country (good and bad) Among all residents, 9% of whites lacked coverage at least part of the year, compared to 20% of blacks and 34% of Hispanic/Latinos. Among all residents, 9% of whites lacked coverage at least part of the year, compared to 20% of blacks and 34% of Hispanic/Latinos. Among kids, the percentages are 5 for whites and 13 for blacks Among kids, the percentages are 5 for whites and 13 for blacks

3. CHILD Project Goals Help schools act on their goals of improving the overall well-being of children Help schools act on their goals of improving the overall well-being of children Enable children to do well in school by removing barriers to health care access and thereby improving health outcomes among Wisconsins school children Enable children to do well in school by removing barriers to health care access and thereby improving health outcomes among Wisconsins school children –Increase enrollment in MA/SCHIP Engage and involve schools in promoting MA/SCHIP Engage and involve schools in promoting MA/SCHIP –Identify and reach students in need of health insurance –Establish outreach strategies and enrollment processes that all schools can adapt and use

4. Why this project, why now Data sharing/Express Lane and outreach emphasis in CHIPRA Data sharing/Express Lane and outreach emphasis in CHIPRA Schools are key partners Schools are key partners – Well-respected and trusted resource for families – First point of contact/semi-captive audience – Statewide reach – If successful, would provide an institutionalized process for ongoing work – School personnel and families concerned about health In Wisconsin, 83,000 children (7 percent) were uninsured for all or part of 2008 In Wisconsin, 83,000 children (7 percent) were uninsured for all or part of 2008

5. Reaching this population Awareness among eligible families remains incomplete and there are newly eligible families all the time Awareness among eligible families remains incomplete and there are newly eligible families all the time Many other barriers for this population Many other barriers for this population –Perceptions (income too high, insurance unnecessary) –Complicated family lives with competing priorities –Programmatic complexities (paperwork requirements, difficult to navigate alone) –Language difficulties and cultural beliefs Families trust schools and may prefer learning about and pursuing MA/SCHIP through more familiar environments Families trust schools and may prefer learning about and pursuing MA/SCHIP through more familiar environments Information campaigns alone may not be enough Information campaigns alone may not be enough

6. CHILD at work Entire Student PopulationFree/Reduced Price Lunch Population FRPL Estimated Eligible Students Without Health Insurance

7. CHILD at work Entire Student Population Free/Reduced Price Lunch Population FRPL Estimated EligibleStudents Without Health Insurance

8. Acronym-onius (Whatd he say?) CHILD – Connecting Health Insurance to Lunch Data CHILD – Connecting Health Insurance to Lunch Data FRPL - Free and reduced price lunch (meals) FRPL - Free and reduced price lunch (meals) FERPA - Family Educational Rights and Privacy Act FERPA - Family Educational Rights and Privacy Act HIS - Health insurance status HIS - Health insurance status HIPAA - Health Insurance Portability and Accountability Act HIPAA - Health Insurance Portability and Accountability Act DSA – Data sharing agreement DSA – Data sharing agreement IRB – Institutional review board (human subjects) IRB – Institutional review board (human subjects)

9. Data Sharing: Free and Reduced Price Meals Why coordinate? Why coordinate? –Often identical income requirements –Willingness/ability to enroll in a public benefit program –Data suggest that 17% of those enrolled in school meal programs are uninsured and eligible for MA/SCHIP USDA guidelines allow: USDA guidelines allow: –Allows sharing of information between free and reduced price meal programs and state Medicaid and SCHIP programs (does your organization qualify?) –Must offer families the opportunity to request information NOT be shared (opt out) –FRPL determining agency and MA/SCHIP agency must enter into a DSA

10. Data Sharing: Health Insurance Status School Districts may collect student health insurance status School Districts may collect student health insurance status School Districts may share health insurance status only when parents/guardians give active consent School Districts may share health insurance status only when parents/guardians give active consent The Family Educational Rights and Privacy Act (FERPA) requires the following elements be included for active consent: The Family Educational Rights and Privacy Act (FERPA) requires the following elements be included for active consent: –Name of student whose record is being released –Specify records that may be disclosed –State the purpose of the disclosure –Identify the party to whom disclosure will be made, and –Include the signature of the parent/guardian

11. Data Sharing - Key Questions How best to target: FRPL, HIS, both or neither? How best to target: FRPL, HIS, both or neither? If FRPL: If FRPL: –Are you considered central to the administration of MA/SCHIP? If not, will your state designate you as such? –Does the school district already include an Opt-Out question or form in its FRPL enrollment process? What, if anything, is done with that information? –What is the FRPL enrollment process? What is the school enrollment process? If HIS If HIS –Does the district gather health insurance status from students? If not, is it willing to collect it? –How will the district obtain informed consent to share the data? What are the timelines and deadlines for preparing these materials and forms? What are the timelines and deadlines for preparing these materials and forms? What is the capacity within and without the district to provide outreach and enrollment assistance? What is the capacity within and without the district to provide outreach and enrollment assistance?

12. Data Sharing: Challenges to expect, tools you can use Challenges Challenges –Keeping it legal –Easing privacy concerns –Navigating the schools process(es) –Capacity, yours and theirs Tools Tools –CHILD Benchmark Moments –FRPL Opt-out samples –HIS collection forms –DSAs –Outreach materials

13. Making School Partnerships Work 1. Assess local capacities and level of interest a.What are you already doing that could be adapted to include health insurance outreach and/or enrollment assistance? b.Who is there to help? Challenges: Identifying and connecting with the right people Identifying and connecting with the right people Navigating existing (and highly variable!) school systems Navigating existing (and highly variable!) school systems

14. Making School Partnerships Work 2. Enlist & Cultivate local partners a.Make/re-affirm local connections b.Provide training for MA/SCHIP enrollment Challenges: Fostering buy-in Fostering buy-in Keeping expectations realistic Keeping expectations realistic Need for on-going technical assistance Need for on-going technical assistance

15. 3. Determine outreach strategies a.Select and adapt materials for student population b.Strategies differ through targeting specific populations, and by level of intensity of personal contact Challenges: Choosing strategies that complement existing activities Choosing strategies that complement existing activities Data sharing agreements and data sharing itself can be time intensive and complex processes Data sharing agreements and data sharing itself can be time intensive and complex processes Making School Partnerships Work

16. 4. Implement outreach strategies Challenges: Time & Energy Time & Energy Following through beyond providing information Following through beyond providing information 5. Assess, evaluate, modify, assess, evaluate… Challenges: Isolating the effects of outreach efforts on changes in knowledge, attitudes, or coverage Isolating the effects of outreach efforts on changes in knowledge, attitudes, or coverage Making School Partnerships Work

17. Pupil services staff and directors: 66% said Yes that their school provides BC+ assistance 66% said Yes that their school provides BC+ assistance 52% said their BC+ knowledge Not good 45% said good and 3% said Not good 52% said their BC+ knowledge Not good 45% said good and 3% said Not good 83% would like to increase their BC+ knowledge 83% would like to increase their BC+ knowledge School staff in CHILD Districts 79% said BC+ knowledge has improved 79% said BC+ knowledge has improved 46% said definitely, 33% mostly yes when asked if BC+ assistance a role for schools 46% said definitely, 33% mostly yes when asked if BC+ assistance a role for schools 50% said yes and 33% said conditionally yes when asked if they would continue BC+ outreach when CHILD ended 50% said yes and 33% said conditionally yes when asked if they would continue BC+ outreach when CHILD ended Big Demand, Early Success

18. CKF-WI as a Resource We created a toolbox to provide professionals with resources they need to identify and assist the uninsured children and adults with whom they interact every day. www.ckfwi.org/toolsyoucanuse.htm www.ckfwi.org (608) 261-1455 Michael Jacob, mbjacob@wisc.edu mbjacob@wisc.edu