Serving Health Insurance Serving Health Insurance with School Lunch:with School Lunch:

The CHILD ProjectThe CHILD ProjectCConnecting onnecting HHealth ealth IInsurance to nsurance to LLunch unch DDataata

Families USAFamilies USAAnnual ConferenceAnnual ConferenceJanuary 28, 2010January 28, 2010

Wisconsin PopulationWisconsin Population

Mostly white stateMostly white state

Rural – 45 out of 72 counties are considered ruralRural – 45 out of 72 counties are considered rural 2 times more likely to be uninsured than non-2 times more likely to be uninsured than non-

Milwaukee urban counterpartsMilwaukee 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 Among all residents, 9% of whites lacked coverage at

least part of the year, compared to 20% of blacks and least part of the year, compared to 20% of blacks and 34% of Hispanic/Latinos.34% of Hispanic/Latinos.

Among kids, the percentages are 5 for whites and 13 Among kids, the percentages are 5 for whites and 13 for blacksfor blacks

CHILD Project GoalsCHILD Project Goals

Help schools act on their goals of improving the overall Help schools act on their goals of improving the overall well-being of childrenwell-being of children

Enable children to do well in school by removing barriers Enable children to do well in school by removing barriers to health care access and thereby improving health to health care access and thereby improving health outcomes among Wisconsin’s school childrenoutcomes among Wisconsin’s school children– Increase enrollment in MA/SCHIPIncrease enrollment in MA/SCHIP

Engage and involve schools in promoting MA/SCHIPEngage and involve schools in promoting MA/SCHIP– Identify and reach students in need of health Identify and reach students in need of health

insuranceinsurance– Establish outreach strategies and enrollment Establish outreach strategies and enrollment

processes that all schools can adapt and use processes that all schools can adapt and use

Why this project, why nowWhy this project, why now

Data sharing/Express Lane and outreach emphasis in Data sharing/Express Lane and outreach emphasis in CHIPRACHIPRA

Schools are key partnersSchools are key partners

– Well-respected and trusted resource for familiesWell-respected and trusted resource for families

– First point of contact/semi-captive audienceFirst point of contact/semi-captive audience

– Statewide reachStatewide reach

– If successful, would provide an institutionalized process for If successful, would provide an institutionalized process for ongoing workongoing work

– School personnel and families concerned about health School personnel and families concerned about health

In Wisconsin, 83,000 children (7 percent) were uninsured In Wisconsin, 83,000 children (7 percent) were uninsured for all or part of 2008for all or part of 2008

Reaching this populationReaching this population Awareness among eligible families remains Awareness among eligible families remains

incomplete and there are newly eligible families all incomplete and there are newly eligible families all the timethe time

Many other barriers for this populationMany other barriers for this population– Perceptions (income too high, insurance Perceptions (income too high, insurance

unnecessary)unnecessary)– Complicated family lives with competing prioritiesComplicated family lives with competing priorities– Programmatic complexities (paperwork Programmatic complexities (paperwork

requirements, difficult to navigate alone)requirements, difficult to navigate alone)– Language difficulties and cultural beliefsLanguage difficulties and cultural beliefs

Families trust schools and may prefer learning Families trust schools and may prefer learning about and pursuing MA/SCHIP through more about and pursuing MA/SCHIP through more familiar environmentsfamiliar environments

Information campaigns alone may not be enoughInformation campaigns alone may not be enough

CHILD at work

Entire Student PopulationFree/Reduced Price Lunch PopulationFRPL Estimated EligibleStudents Without Health Insurance

CHILD at work

Entire Student Population Free/Reduced Price Lunch Population

FRPL Estimated Eligible Students Without Health Insurance

Acronym-onius (“What’d he say?”)Acronym-onius (“What’d he say?”)

CHILDCHILD – Connecting Health Insurance to Lunch – Connecting Health Insurance to Lunch DataData

FRPLFRPL - Free and reduced price lunch (meals) - Free and reduced price lunch (meals) FERPAFERPA - Family Educational Rights and Privacy - Family Educational Rights and Privacy

ActAct HISHIS - Health insurance status - Health insurance status HIPAAHIPAA - Health Insurance Portability and - Health Insurance Portability and

Accountability ActAccountability Act DSADSA – Data sharing agreement – Data sharing agreement IRBIRB – Institutional review board (human – Institutional review board (human

subjects)subjects)

Data Sharing: Data Sharing: Free and Reduced Price MealsFree and Reduced Price Meals

Why coordinate?Why coordinate?– Often identical income requirementsOften identical income requirements– Willingness/ability to enroll in a public benefit programWillingness/ability to enroll in a public benefit program– Data suggest that 17% of those enrolled in school Data suggest that 17% of those enrolled in school

meal programs are uninsured and eligible for meal programs are uninsured and eligible for MA/SCHIPMA/SCHIP

USDA guidelines allow:USDA guidelines allow:– Allows sharing of information between free and Allows sharing of information between free and

reduced price meal programs and state Medicaid and reduced price meal programs and state Medicaid and SCHIP programs (does your organization qualify?)SCHIP programs (does your organization qualify?)

– Must offer families the opportunity to request Must offer families the opportunity to request information NOT be shared (opt out)information NOT be shared (opt out)

– FRPL “determining agency” and MA/SCHIP agency FRPL “determining agency” and MA/SCHIP agency must enter into a DSAmust enter into a DSA

Data Sharing: Data Sharing: Health Insurance StatusHealth Insurance Status

School Districts may collect student health School Districts may collect student health insurance statusinsurance status

School Districts may share health insurance status School Districts may share health insurance status onlyonly when parents/guardians give when parents/guardians give activeactive consent consent

The Family Educational Rights and Privacy Act The Family Educational Rights and Privacy Act (FERPA) requires the following elements be (FERPA) requires the following elements be included for active consent:included for active consent:– Name of student whose record is being releasedName of student whose record is being released– Specify records that may be disclosedSpecify records that may be disclosed– State the purpose of the disclosureState the purpose of the disclosure– Identify the party to whom disclosure will be made, Identify the party to whom disclosure will be made,

andand– Include the signature of the parent/guardianInclude the signature of the parent/guardian

Data Sharing - Key QuestionsData 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”? Are you considered “central to the administration of MA/SCHIP”? If not, will your state designate you as such?If not, will your state designate you as such?

– Does the school district already include an “Opt-Out” question or Does the school district already include an “Opt-Out” question or form in its FRPL enrollment process? What, if anything, is done form in its FRPL enrollment process? What, if anything, is done with that information?with that information?

– What is the FRPL enrollment process? What is the school What is the FRPL enrollment process? What is the school enrollment process?enrollment process?

If HISIf HIS– Does the district gather health insurance status from students? If Does the district gather health insurance status from students? If

not, is it willing to collect it?not, is it willing to collect it?– How will the district obtain informed consent to share the data? How will the district obtain informed consent to share the data?

What are the timelines and deadlines for preparing these What are the timelines and deadlines for preparing these materials and forms?materials and forms?

What is the capacity within and without the district to provide What is the capacity within and without the district to provide outreach and enrollment assistance?outreach and enrollment assistance?

Data Sharing: Challenges to Data Sharing: Challenges to expect, tools you can useexpect, tools you can use

ChallengesChallenges– Keeping it legalKeeping it legal– Easing privacy concernsEasing privacy concerns– Navigating the schools’ process(es)Navigating the schools’ process(es)– Capacity, yours and theirsCapacity, yours and theirs

ToolsTools– CHILD Benchmark MomentsCHILD Benchmark Moments– FRPL Opt-out samplesFRPL Opt-out samples– HIS collection formsHIS collection forms– DSAsDSAs– Outreach materialsOutreach materials

Making School Partnerships WorkMaking School Partnerships Work

1. Assess local capacities and level of interest1. Assess local capacities and level of interest

a.a. What are you already doing that could be What are you already doing that could be adapted to include health insurance adapted to include health insurance outreach and/or enrollment assistance?outreach and/or enrollment assistance?

b.b. Who is there to help?Who is there to help?

ChallengesChallenges: : Identifying and connecting with the right Identifying and connecting with the right

peoplepeople Navigating existing (and highly variable!) Navigating existing (and highly variable!)

school systemsschool systems

Making School Partnerships WorkMaking School Partnerships Work

2. Enlist & Cultivate local partners2. Enlist & Cultivate local partners

a.a. Make/re-affirm local connectionsMake/re-affirm local connections

b.b. Provide training for MA/SCHIP enrollmentProvide training for MA/SCHIP enrollment

ChallengesChallenges: : Fostering “buy-in”Fostering “buy-in” Keeping expectations realisticKeeping expectations realistic Need for on-going technical assistanceNeed for on-going technical assistance

3. Determine outreach strategies3. Determine outreach strategiesa.a. Select and adapt materials for student Select and adapt materials for student

populationpopulationb.b. Strategies differ through targeting specific Strategies differ through targeting specific

populations, and by level of intensity of populations, and by level of intensity of personal contactpersonal contact

ChallengesChallenges: : Choosing strategies that complement Choosing strategies that complement

existing activitiesexisting activities Data sharing agreements and data sharing Data sharing agreements and data sharing

itself can be time intensive and complex itself can be time intensive and complex processesprocesses

Making School Partnerships WorkMaking School Partnerships Work

4. Implement outreach strategies4. Implement outreach strategies

ChallengesChallenges:: Time & EnergyTime & Energy Following through beyond providing informationFollowing through beyond providing information

5. Assess, evaluate, modify, assess, evaluate…5. Assess, evaluate, modify, assess, evaluate…

ChallengesChallenges:: Isolating the effects of outreach efforts on changes Isolating the effects of outreach efforts on changes

in knowledge, attitudes, or coveragein knowledge, attitudes, or coverage

Making School Partnerships WorkMaking School Partnerships Work

Pupil services staff and directors:Pupil services staff and directors: 66% said “Yes” that their school provides BC+ 66% said “Yes” that their school provides BC+

assistanceassistance 52% said their BC+ knowledge “Not good” 45% said 52% said their BC+ knowledge “Not good” 45% said

“good” and 3% said “Not good”“good” and 3% said “Not good” 83% would like to increase their BC+ knowledge83% would like to increase their BC+ knowledge

School staff in CHILD DistrictsSchool staff in CHILD Districts 79% said BC+ knowledge has improved79% said BC+ knowledge has improved 46% said definitely, 33% mostly yes when asked if 46% said definitely, 33% mostly yes when asked if

BC+ assistance a role for schoolsBC+ assistance a role for schools 50% said yes and 33% said conditionally yes when 50% said yes and 33% said conditionally yes when

asked if they would continue BC+ outreach when asked if they would continue BC+ outreach when CHILD endedCHILD ended

Big Demand, Early SuccessBig Demand, Early Success

CKF-WI as a ResourceCKF-WI as a Resource

We created a toolbox to provide We created a toolbox to provide professionals with resources they need professionals with resources they need to identify and assist the uninsured to identify and assist the uninsured children and adults with whom they children and adults with whom they interact every day.interact every day.

www.ckfwi.org/toolsyoucanuse.htmwww.ckfwi.org/toolsyoucanuse.htm

www.ckfwi.org(608) 261-1455(608) 261-1455

Michael Jacob, Michael Jacob, mbjacob@wisc.edu