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EXECUTIVE SUMMARY
Roughly 1.85 million children in California lack health insurance and are not receiving necessary and preventative medical care. The most reliable information indicates that approximately 1.1 million are eligible for, but not enrolled in, California's state-sponsored health insurance programs - Healthy Families and Medi-Cal for Children. In fact, a recent study found that in 1999, fewer California children are enrolled in Medi-Cal and Healthy Families than were enrolled in Medi-Cal alone in 1996.
As the place where the majority of eligible children can be found, schools are perhaps the most obvious mechanism for reaching large numbers of young people. Despite the scarce resources available to California public schools, the rationale for them to get involved is compelling. Schools generally are trusted, community-based entities that have established relationships with the parents of eligible children. Furthermore, schools have strong incentives to help more children obtain health insurance because absenteeism is associated with school failure. Moreover, every student absence represents a decline in the school's Average Daily Attendance. This tally forms the basis for the allocation of state educational funds, so schools suffer a direct financial loss when students miss classes.
Given the opportunities presented by linking Healthy Families/Medi-Cal with the schools, in 1998 Consumers Union established Healthy Kids, Healthy Schools. The project, funded by the Henry J. Kaiser Family Foundation and the David & Lucile Packard Foundation, seeks to work in partnership with schools to increase enrollment of children and youth in Healthy Families/Medi-Cal. During the past year, Healthy Kids, Healthy Schools has focused on linkages between Healthy Families/Medi-Cal and the federally-funded National School Lunch Program (the School Lunch Program).
This report describes our project and research regarding the School Lunch Program, and summarizes the challenges and opportunities we discovered in seeking to link the School Lunch Program and Healthy Families/Medi-Cal.
Summary of Lessons Learned
· Eligibility for the School Lunch Program Cannot Realistically Serve as a Full Proxy for Eligibility for Healthy Families/Medi-Cal: Unlike the School Lunch Program, Healthy Families/Medi-Cal eligibility has strict requirements regarding citizenship and immigration status. Other significant obstacles to full alignment are the differences in the definition and documentation of income. Full alignment would entail a major overhaul of all three programs on both the state and federal levels.
· With Changes to the School Lunch and/or Health Programs, the School Lunch Program Could Serve as a Vehicle to Determine Income Eligibility for Healthy Families/Medi-Cal: Because there are overlaps in income eligibility levels for the meal and health programs, with adjustments in income definitions and household composition rules, the School Lunch Program could be used for income eligibility determinations for Healthy Families/Medi-Cal for some children. However, there remains a fundamental concern about confidentiality raised by sharing information between the programs.
· Families' Historic Trust in the School Lunch Program Must Not be Jeopardized:
Efforts to directly link Healthy Families/Medi-Cal with the School Lunch Program must proceed carefully. School meal programs enjoy a high level of trust from participating families, especially immigrant families. In particular, the confidentiality protections of the School Lunch Program have been integral to its success.
· The School Lunch Program Can be a Valuable and Effective Outreach Vehicle for Healthy Families/Medi-Cal: All California students are notified of the School Lunch Program and many of those eligible for the School Lunch Program are also eligible for either Healthy Families or Medi-Cal. Pairing information about the health programs with School Lunch applications and/or approval letters has proved a very effective outreach strategy.
· To Ensure Success of the School Lunch Program as an Outreach and Enrollment Vehicle, Sufficient Resources and the Cooperation, Support and Participation of School Personnel and Others are Critical: To develop successful outreach and enrollment plans, "buy-in" from all involved personnel, including district and school administrators, is essential. Furthermore, districts and schools must consider building partnerships with community-based organizations and local governments. Collaboration among school districts, nonprofit organizations, state agencies and others is a key component to reaching uninsured children.
· While Outreach is Crucial, Efforts Must Also Focus on Follow-up Strategies:
Getting the word out to families is a necessary and important first step. However, follow-up is equally critical to ensure that families who request information receive it, fill out applications, and enroll if eligible. Once children are enrolled, districts can work with families to ensure that children stay enrolled and use the health services available to them.
· Schools That Have a Special Status Regarding the School Lunch Program Should Explore Different Approaches to Reaching Families Potentially Eligible for Healthy Families/Medi-Cal: Under federal law, a number of schools with a high proportion of children eligible for the School Lunch Program are not required to send out applications to families every year. Given the demographics of these schools, many of their students might be eligible for Healthy Families/Medi-Cal. Because these schools do not necessarily send applications for the School Lunch Program home on an annual basis, including information about the health insurance programs with applications or approval letters may not be feasible or effective. Instead, school officials could send this information with other correspondence, such as the notification that all students will receive free meals. These schools might also explore other outreach strategies not necessarily connected to the School Lunch Program.
· Advocates and Policymakers Should Explore Multiple Options to Reach and Enroll More Uninsured Children: Linking the School Lunch Program with Healthy Families/Medi-Cal is just one of several strategies that advocates and government officials are considering. Others that warrant further exploration include linking Medicaid and the Children's Health Insurance Program (CHIP) with other public benefits programs with comparable income eligibility levels; reconciling the eligibility requirements for Healthy Families and Medi-Cal; and fostering connections between schools and county social service agencies.
Enrolling every eligible child in state-sponsored health insurance is not an easy task. In California, linking the School Lunch Program with Healthy Families/Medi-Cal is one strategy for reaching eligible families that has shown promising results. While this vehicle may not suit every school in every state, preliminary data shows that the convenience and trust factors make consideration of this strategy worthwhile.
Schools have a significant interest in ensuring that their students' health care needs are met. When children are healthy, they are ready to learn. Giving schools and districts resources, and allowing them to tailor projects to meet the needs of their students, could mean a significant difference for children. Securing health care coverage for all of California's children is the first step to ensuring both healthier kids and healthier schools.
Consumers Union's West Coast Regional Office
