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Co-authored with Stephanie Hodson of United Ways of CA

One of United Ways of California’s goals is to improve the health of children and adults. We know that a lack of health care coverage often means that primary care is an unattainable luxury. Yet primary care is so important in preventing or treating illness before it becomes more serious. For children in low-income families, Medicaid and the Children’s Health Insurance Program (CHIP) can provide comprehensive, affordable health coverage when their parents may not have access to health benefits through their jobs or be able to afford coverage on their own.

Whether you are just getting started or looking to accelerate long-standing efforts to advance health coverage for children, here are steps that United Ways across the country are taking to increase our impact and help us reach our goals. We hope that others can utilize some of these tips.

First steps:
1.    LEARN STATE SPECIFICS. Familiarize yourself with your state’s children’s health coverage programs. Health coverage is available to most low-income children in every state; however, eligibility requirements, enrollment procedures and cost-sharing rules vary widely across the country. These and other aspects of the program will influence the ability of low-income children to secure health coverage in your state.

Descriptive information about your state’s CHIP and Medicaid programs and the application processes can be found using this link on the Center on Budget and Policy Priorities’ website:

2.    IDENTIFY COALITION PARTNERS. Find out who else is working on this issue- you could start by engaging local United Ways or your state’s Association of United Ways. Join an existing statewide or local coalition that is engaged in efforts to reach out and enroll eligible children. An experienced coalition partner should be able to add to your understanding of the challenges confronting uninsured children in your state: Who are they? Where in the state are they most likely to reside — in urban or rural areas? Are there communities where immigration status or limited English proficiency present challenges?

Moving Forward:
3.    ENGAGE TRADITIONAL AND NONTRADITIONAL PARTNERS. Engage a wide range of people including partners with whom you would regularly work and reach out to new partners as well.  Groups to consider include: community organizations, elected officials, business leaders, media, clinics, informal neighborhood leaders, ministers, medical professionals, school personnel — anyone who has contact or influence in the lives of families who might need health coverage who will have an interest in enrolling children in health coverage.  Help these advocates to identify ways they, and their colleagues, can contribute to getting more children enrolled..

When engaging partners in outreach and setting goals, it’s helpful to find out about coverage levels in your state.  Health coverage status and coverage rates for children and families in your state, can be viewed on the Georgetown University’s Center for Children and Families website:

4.     INCORPORATE HEALTH COVERAGE OUTREACH INTO EVERYTHING YOU DO Be creative!  Are there ways to integrate even a little outreach into the other work you do? If you are focused on early childhood, engage your childcare centers and providers in health insurance outreach. If you are engaged in workforce development, include health outreach assistance in the resources you provide or coordinate.

5.    ENLIST THE BUSINESS COMMUNITY.  Most employers would like to be able to offer more benefits. Helping dependent children get enrolled will fall to their bottom line with healthier kids, less absenteeism among parents and more loyal employees. Especially partner with those who are known to employ lower-wage workers. But don’t assume any business covers dependents!  Share resources to educate employees about income eligibility and provide employers with outreach material such as payroll stuffers and posters for break rooms. Your local United Ways may be particularly helpful with this step, as they regularly connect with the businesses in their communities.

When working with business leaders to build support, there are a few key factors to keep in mind:

  • Business leaders want and trust data, but only when it comes from a trusted source that has proven to be reliable.
  • Business leaders need to know how this will affect them.  The bottom line for some business leaders is that parents caring for sick kids mean absenteeism among their employees or reduced productivity affecting their bottom line.  For others, kids who show up to school sick or are unable to attend at all mean less chance of an educated and fully prepared future workforce.
  • Build a simple, straightforward case that avoids using health industry jargon with which they may not be familiar.  Back up your case with data on the success of CHIP and Medicaid.
  • Ongoing communication with business leaders helps to eliminate or alleviate opposition.  It is not always possible to bring business to a position of support on children’s health issues, but with consistent education around the importance of public health programs for kids, an absence of opposition from business leaders often speaks volumes on its own and is enough to allow policies to move forward.

6.    REACH NEWLY ELIGIBLE CHILDREN. As a result of the weak economy, many families are experiencing unemployment and have become uninsured for the first time. Many parents may not realize their children now qualify for health coverage or know how to access these vital programs. Promote health coverage sign-up opportunities where jobless individuals seek assistance including the unemployment office, job fairs or re-training programs. Target communities where there have been plant-closings or employers have downsized. Support “rapid response” activities, during which outreach workers can provide assistance applying for a host of benefits.

7.     USE 2-1-1. 2-1-1 is an easy to remember number available in over 90% of the U.S. that connects people to services for free.  2-1-1 has proven to be an effective channel for obtaining information regarding health insurance coverage and care. 2-1-1 call specialists can direct callers to the most convenient location to get application assistance or in some areas they may be able to complete the application over the phone.

8.     ADDRESS CONSUMER NEEDS. Identify and address obstacles to enrollment. Increase the likeliness of success by providing necessary supports including childcare, bilingual and culturally appropriate application assistance.

You or your partners may also be able to help make enrollment assistance more efficient by providing laptops, scanners or portable copiers to assist the enrollment process.

9.     ADVOCATE FOR EXPANDING ELIGIBILITY AND BENEFITS. Coalitions who actively urge state policymakers and program administrators to adopt options made available through CHIPRA can be particularly effective. Even before all of the provisions of ACA come into effect, states have the flexibility to increase income eligibility ceilings, to provide coverage to pregnant women, and provide dental coverage to children whose private insurance lacks that critical benefit.

10.     ADVOCATE FOR SIMPLIFYING ENROLLMENT AND RENEWAL. CHIPRA gives states tools and incentives for simplifying enrollment and renewal. For example, states can receive a “performance bonus” if they boost enrollment of children in Medicaid and reach specified targets. To be eligible for these extra federal funds, the state must first implement five out of eight strategies that have been shown to facilitate enrollment and renewal. Advocate with your partners for the state to take steps to qualify for the performance bonus and then invest in outreach necessary to meet the enrollment target.

Partner with others and ask that they join in the effort to advocate for kids coverage. Activities can range from sending lawmakers and/or program administrators coalition letters, writing op-eds, or even testifying before a legislative committee.  This resource page will provide you with information about CHIPRA requirements and options as well as access to the law itself:

11.     COMMUNICATE YOUR PROGRESS. Ensure that key stakeholders know about your advocacy, outreach and enrollment work and resources. Communicating about your activities can attract volunteers, and increase revenue and therefore, enroll more children in health insurance. Contact your local media. Put up flyers in libraries and parks. Announce progress in PTA meetings. Create a health coverage page on your website that includes information on eligibility and how to enroll. Talk about it at events. Identify potential partners that have informal and formal communication with families who might benefit.

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