REACH BC+ R etention and E nrollment to A chieve C hildren’s H ealth and B uild C apacity

1. REACH BC+Retention and Enrollment to Achieve Children’s Health and Build Capacity Colorado All Kids Covered School Enrollment Forum March 12, 2010

2. Wisconsin’s Uninsured Population • Leading the country (good and bad) • 83,000 children (7 percent) were uninsured for all or part of 2008 • 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 • Rural – 45 out of 72 counties are considered rural; 2 times more likely to be uninsured than non-Milwaukee urban counterparts

3. REACH BC+ Goals • 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 Wisconsin’s school children • Increase enrollment in BadgerCare+ • Engage and involve schools in promoting BadgerCare+ • Identify and reach students in need of health insurance • Establish outreach strategies and enrollment processes that all schools can adapt and use

4. Why schools? • Families trust schools and may prefer learning about and pursuing health insurance options through more familiar environments • 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

5. Why this project, why now • Awareness among eligible families remains incomplete and there are newly eligible families all the time • 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 • Information campaigns alone may not be enough

6. Free/Reduced Price Lunch Population Students Without Health Insurance Entire Student Population FRPL Estimated Eligible Zeroing in on those in need

7. Data Sharing: Free and Reduced Price Meals • 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: • 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

8. Data Sharing: 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 • 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

9. Data Sharing - Key Questions • How best to target: FRPL, HIS, both or neither? • 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 • 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 is the capacity within and without the district to provide outreach and enrollment assistance?

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

11. Outreach Strategies • Basics • Use knowledge gained from previous efforts • Strategies may differ across school communities • School District input is crucial • Many levels of possible outreach • General outreach about BadgerCare Plus • Targeted outreach to free and reduced price meal recipients and uninsured families • Personal contact with uninsured families and/or those who request personal assistance

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

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

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

15. Making School Partnerships Work 4. Implement outreach strategies Challenges: • Time & Energy • 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

16. Big Demand, Early Success Pupil services staff and directors: • 66% said “Yes” that their school provides BC+ assistance • 52% said their BC+ knowledge “Not good” 45% said “good” and 3% said “Not good” • 83% would like to increase their BC+ knowledge School staff in CHILD Districts • 79% said BC+ knowledge has improved • 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

17. 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/Pages/3toolboxhome.html (608) 261-1455 Michael Jacob, mbjacob@wisc.edu Erin Mader, emader@wisc.edu