- Email: [email protected]
Children's health insurance program—An opportunity for improvement
-1
Li
Marian Debra
Lowe, Hardy
BS,
Improvement
&
Havens,
BS,
RN,
FNP
-
Uninsured children are at risk of preventable illness. The majority of uninsured children with asthma and one in three uninsured children with recurring ear infections never see a doctor during the year. Many are hospitalized for acute asthma attacks that could have been prevented or suffer from permanent hearing loss from untreated ear infections. (Dorn, Teitelbaurn, & Cortez, 1998, p. 26.)
RESPONSE TO A CROWING PROBLEM In 1996 an estimated 11.3 million children were uninsured, which represents the largest number of uninsured children ever recorded by the Census Bureau. In the historic enactment of the Balanced Budget Act of 1997, Congress created the State Children’s Health Insurance Program (SCHP), a $4 billion a year initiative that seeks to provide health insurance coverage for 5 million uninsured children (Balanced Budget Act of 1997). In total, the SCHIP legislation will provide $48 billion over 10 years: $40 billion for the new insurance program and $8 billion to provide funds to new Medicaid enrollees expected as a result of the SCHIP outreach effort, to fund a new pediatric diabetes program, and to restore Medicaid to children losing Social Security Insurance because of changed disability standards under the federal welfare system (PL 105-33). In fact, 90% of uninsured children have parents who work, and yet in 1996,70%
September/October 1998
of the persons added to the ranks of the uninsured were children. SCHIP offers states 3 options for expanding coverage to children in families whose income is above a state’s eligibility requirements for Medicaid but who cannot afford private insurance. To receive these funds, states must have their plan approved by the Health Care Financing Administration (HCFA). One piece of this plan must be a commitment by the state to pay seven tenths of what a state would have contributed under Medicaid. Part of the funding for SCHE’ comes from a 15-cent-per-pack increase in tobacco taxes to be phased in between 2000 and 2002. States can use these funds to provide health insurance through Medicaid expansion, a separate state program, or a combination of the two; however, up to 10% of the federal funds may be used to provide other forms of child health assistance, including contracts with providers for direct services, other health services initiatives to improve children’s health, outreach expenditures, and administrative costs. Children under the age of 19 years may be assisted through SCHII! However, screening children’s eligibility for the Medicaid program and enrolling
Marian
Lowe is an Associate
J Pediatr Health Care. (1998). Copyright 0099-l
at Capitol Associates,
AN UNKNOWN
PITFALL
The Vaccines for Children (VFC) program was established to ensure that children eligible for Medicaid receive the necessary preventive vaccines and to provide states with an incentive to deliver this service to young beneficiaries. States that elect to expand the Medicaid program under SCHIP retain the right to participate in the VFC program, which reimburses them for a specific list of vaccinations. However, in a letter to state health officials (Health Care Financing Administration, May 11,1998), HCFA explained a caveat that was dis-
Inc, in Washington,
DC.
72,273-275.
0 1998 by the National
767198
those children accordingly will be the state’s responsibility. States must also adopt procedures that will prevent SCHIP from substituting for employersponsored coverage. Premiums, deductibles, and co-insurance for families whose income is below 150% of the federal poverty level are capped at nominal amounts, and children with family incomes higher than 150% of the federal poverty level are charged on a sliding scale according to income. However, preventive care, including well-child and well-baby care and immunizations, are exempt from deductibles, copayments, and co-insurance.
Association
of Pediatric
Nurse Associates
& Practitioners.
25/8/92552
273
LEGISLATIVE NEWS
Lowe & Havens
BOX 1 State action on SCHIP No. of plans submitted: 39 (Ala, Ark, Calif, Colo, Conn, [la, Ga, Idaho, III, Ind, Iowa, Md, Mass, Mich, Minn, MO, Neb, Ohio,
DC, Me, Mont,
Nev, NH, NJ, NM, NY, NC, Okla, Ore, Pa, Puerto Rico,
RI, SC, SD, Tenn,
Tex,
Utah,
No. of plans approved:
Vt, Wis)
20
(Ala, Calif, Colo, Conn, Fla, Ill, Idaho, Mass, Mich, MO, NJ, NY, Ohio, Okla, Ore, Pa, RI, SC, Tex, Wis)
No. of separate state child health plans: 10 (Colo, Ga, Mich, Mont, Nev, NY, NC, Ore, Pa, Utah)* No. of Medicaid expansions: 22 (Ala, Ark, DC, Idaho, Ill, Ind, Iowa, Md, Minn, MO, Neb, NM, Ohio, Okla, Puerto Rico, RI, SC, SD, Tenn, Tex, Vt, Wis)* No. of combination plans: 7 (Calif, Conn, Fla, Me, Mass, NH, NJ)*
No. of state plan amendments mitted: 3 (Ala,
Calif,
sub-
Mich)
*Bold denotes states whose plan has been approved. From the Health Care Financing Administration. (Updated June 9, 1998.) Children’s Health insurance Program, Status report and contact information [On-line]. Available:
http:llww.hcfa.gov.
covered as implementation was rolled out.
of SCHIP
The VFC program was established in 1993 to serve children defined as “federally vaccine eligible” under section 1928 (b)(2), which includes both “uninsured” and “Medicaid eligible” children.. . Children who are newly eligible for Medicaid under Iitle XXI are federally vaccine eligible, as are all other children eligible for Medicaid. However, because of the Title XLX restrictions on eligibility for VFC, States that have designed a separate State health insurance program under CHIP (S-CHIP) may not treat children enrolled in such a program as federally vaccine eligible. (Health Care Financing Administration, May 11,199s.)
2 74
Volume
12 Number
5
To address this obvious disparity, HCFA has outlined several mechanisms by which states can continue to purchase vaccines at lower cost or include immunization in their benefits packages for children. ADVOCATES EXPANSION;
ADVISE MEDICAID STATES RESPOND
Many of the national organizations that were involved in the grassroots lobbying that helped bring SCHIP to fruition are advising states to choose Medicaid expansion rather than the optional separate insurance program or combination approach. The rationale behind this advice includes not only the vaccination benefit previously described but several other measures long sought by children’s advocates. Many of these benefits are specifically crafted to meet the needs of children. Advocates argue that Medicaid expansion provides the following advantages: j l Medicaid is designed to include the Early Periodic Screening, Diagnosis, and Treatment Program, which provides children with access to regular health screening, including preventive and necessary dental, vision, and hearing care. l Medicaid provides continuity of care for children whose family income may change and would cause them to shift in and out of the Medicaid program and a separate insurance program-perhaps losing their primary care providers. l Medicaid ensures appropriate care for children with special health needs, which is guaranteed under the rule of the Medicaid program but not in separate programs (Dorn, Teitelbaum, & Cortez, 1998; Mann, 1997; National Association of Child Advocates, 1997). Many experts also believe that, administratively, Medicaid expansion is preferable. Because Medicaid expansion would not necessitate the development of a new administration to oversee a separate health insurance program, experts agree that it avoids duplicative costs. Medicaid expansion also offers states open-ended federal matching payments, more consistent funding levels over time, and stronger negotiating advantages with plans and providers, and it minimizes the risk that a two-tier system of publicly funded coverage will develop. Conversely, ad-
vocates for separate health insurance programs for children assert that the Medicaid program creates an entitlement for children, promotes a welfare stigma, and is expensive and burdensome with many federal and state rules. The most telling evidence of state sentiment on the issue is that, of the 39 states that have submitted applications to HCFA, 22 plans indicate that the state will pursue Medicaid expansion. The remaining state plans were divided between separate programs and a combination of the two options. At the time this article was written, HCFA had approved 20 state plans; of these, 5 would create a program separate from Medicaid, 10 seek to expand Medicaid, and 5 propose to combine a separate children’s health program with Medicaid expansion. Box 1 summarizes state action on SCHIP to date. OUTREACH The success of SCHIP will depend largely on the ability of the states to reach young people and their families and facilitate enrollment in the new programs. Outreach has been one of the greatest shortfalls of the Medicaid program, as witnessed by the growing numbers of children who are eligible for but not enrolled in this program. A recent study estimated that, despite being eligible for Medicaid, approximately 4.7 million children age 18 years and younger are uninsured (Selden, Banthin, &Cohen, 1998). Whereas eligibility criteria were expanded throughout the past decade to include more children, experts found that for the most part, the rise in uninsured children can be attributed to the rising number of adolescents eligible for but not enrolled in the program. STATE-LEVEL
INVOLVEMENT
The aggressive outreach campaign necessary to provide the millions of uninsured children with access to needed health services provides a unique opportunity for collaboration between providers, schools, businesses, and local and state officials. As the gateway to the health care system, primary care providers such as pediatric nurse practitioners will play an integral role in identifying uninsured children and shepherding them through the enrollment process. Individual efforts such as
JOURNAL
OF PEDIATRIC
HEALTH
CARE
ipfl
LEGISLATIVE
BOX 2
NEWS
The 50 US governors
State
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington WestVirginia Wisconsin Wyoming
JOURNAL
Lowe & Havens
OF PEDIATRIC
Name
Fob James Jr (R) Tony Knowles (D) Jane Dee Hull (R) Mike Huckabee (R) Pete Wilson (R) Roy Romer (D) John G. Rowland (R) Thomas R. Carper(D) Lawton Chiles (D) Zell Miller (D) Benjamin J. Cayatano (D) Phil Batt (R) Jim Edgar(R) Frank L. O’Bannon (D) Terry E. Branstad (R) Bill Graves(R) Paul E. Patton (D) Mike Foster (R) Angus King (I) Parris N. Glendening (D) Argeo Paul CeJJucci (R) John Engler (R) Arne Carlson (R) Kirk Fordic (R) Mel Carnahan (D) Marc Racicot (R) Ben Nelson (D) Bob Miller(D) Jeanne Shaheen (D) ChristineTodd Whitman (R) Gary E. Johnson (R) George E. Pataki (R) James B. Hunt Jr (D) Edward T. Schafer (R) GeorgeV. Voinovich (R) Frank Keating (R) John Kitzhaber (D) Tom Ridge (R) Lincoln C. Almond (R) David Beasley (R) William J. Janklow (R) Don Sundquist (R) George W. Bush (R) Michael 0. Leavitt (R) Howard Dean (D) James S. Gilmore Ill (R) Gary Lock (D) Cecil H. Underwood (R) Tommy G. Thompson (Rf Jim Geringer (R)
HEALTH
CARE
Term
expires
Jan 1999 Dee 1998 Jan 1999 Jan 1999 Jan 7999 Jan 1999 Jan 1999 Jan 2001 Jan 1999 Jan 1999 Dee 1998 Jan 1999 Jan 1999 Jan 2001 Jan 1999 Jan 1999 Dee 1999 Jan 2000 Jan 1999 Jan 1999 Jan 1999 Jan 1999 Jan 1999 Jan 2000 Jan 2001 Jan 2001 Jan 1999 Jan 1999 Jan 1999 Jan 1998 Jan 1999 Jan 1999 Jan 2001 Dee 2000 Jan 1999 Jan 1999 Jan 1999 Jan 1999 Jan 1999 Jan 1999 Jan 1999 Jan 1999 Jan 1999 Jan 2001 Jan 1999 Jan 2002 Jan 2001 Jan 2001 Jan 1999 Jan 1999
Telephone
No.
(205)242-7100 (907)465-3500 (602)542-4331
(915) 4452841 (916)445-2841 (303)866-2471 (205)566-4840 (302) 739-4101 (904)488-4441 (404)656-1776 (808)586-0034 (208)334-2100
(217) 782-6830 (317) 232-4567 (515)281-5211
(913) 296-3232 (502)564-2611 (504)342-7015 (207)287-3531
(410) 974-3901 (617)
727-3600
(517) 373-3400 (612) 296-3391 (601) 359-3100 (573)751-3222 (406)444-3111 (402)471-2244 (702)687-5670 (603)271-2121
(609) 292-6000 (505)827-3000
(518) (919) (701) (614)
474-8390 733-5811 328-2200 466-3555
this will help reduce the number of children who lack a usual source of care. Coordinating efforts within the provider community is an opportunity for pediatric nurse practitioners and public officials to build lasting relationships and improve the health care of millions of children. Box 2 provides contact information for each US governor. We encourage providers to contact their governor and ensure that PNPs have a voice in the implementation of the largest expansion of health care since the inception of the Medicaid and Medicare programs in 1965.
REFERENCES Balanced Budget Act of 1997 (PL 105-33) [On-line]. Available: http://www.thomas.loc.gov Dam, S., Teitelbamn, M., & Cortez, C. (1998). An advocate’s too/ kit for the State Chikken’s Health insurance Program. Washington, DC: Children’s Defense Fond. Health Care Financing Administration. May 11, 7998, letter to state health officials from Sally K. Richardson, Director, Center for Medicaid and State Operations [On-line]. Available: http:// www.hcfa.gov Health Care Financing Administration. (Updated June 9, 1998.) Children’s Health insurance Program, status report and contact information [Online]. Available: http://www.hcfa.gov Mann, C. (1997). Why not Medicaid? Using child healthfunds to expand cozmzge through the Medicaid pw~grm. Washington, DC: Center on Budget and Policy Priorities. National Association of Child Advocates. (1997). Child Health Fact Sheet. The State Chiidren’s Health Insurance Program: Reasons for expanding Medicaid. Washington, DC: Author. Selden, T., Banthin, J., & Cohen, J. (1998). Medicaid’s problem children: Eligible but not enrolled. Health Affairs, 77,192~200.
(405)521-2345 (503)378-3111
(717) 787-2500 (401)277-2080 (803) 734-9818 (605)773-3212
(615) 741-2001 (512) 463-2000 (801) 538-1000 (802)828-3333 (804)786-2211 (206)753-6780 (304)558-2000
(608)266-1212 (307)777-7434
September/October
1998
2 7 5
Li
Marian Debra
Lowe, Hardy
BS,
Improvement
&
Havens,
BS,
RN,
FNP
-
Uninsured children are at risk of preventable illness. The majority of uninsured children with asthma and one in three uninsured children with recurring ear infections never see a doctor during the year. Many are hospitalized for acute asthma attacks that could have been prevented or suffer from permanent hearing loss from untreated ear infections. (Dorn, Teitelbaurn, & Cortez, 1998, p. 26.)
RESPONSE TO A CROWING PROBLEM In 1996 an estimated 11.3 million children were uninsured, which represents the largest number of uninsured children ever recorded by the Census Bureau. In the historic enactment of the Balanced Budget Act of 1997, Congress created the State Children’s Health Insurance Program (SCHP), a $4 billion a year initiative that seeks to provide health insurance coverage for 5 million uninsured children (Balanced Budget Act of 1997). In total, the SCHIP legislation will provide $48 billion over 10 years: $40 billion for the new insurance program and $8 billion to provide funds to new Medicaid enrollees expected as a result of the SCHIP outreach effort, to fund a new pediatric diabetes program, and to restore Medicaid to children losing Social Security Insurance because of changed disability standards under the federal welfare system (PL 105-33). In fact, 90% of uninsured children have parents who work, and yet in 1996,70%
September/October 1998
of the persons added to the ranks of the uninsured were children. SCHIP offers states 3 options for expanding coverage to children in families whose income is above a state’s eligibility requirements for Medicaid but who cannot afford private insurance. To receive these funds, states must have their plan approved by the Health Care Financing Administration (HCFA). One piece of this plan must be a commitment by the state to pay seven tenths of what a state would have contributed under Medicaid. Part of the funding for SCHE’ comes from a 15-cent-per-pack increase in tobacco taxes to be phased in between 2000 and 2002. States can use these funds to provide health insurance through Medicaid expansion, a separate state program, or a combination of the two; however, up to 10% of the federal funds may be used to provide other forms of child health assistance, including contracts with providers for direct services, other health services initiatives to improve children’s health, outreach expenditures, and administrative costs. Children under the age of 19 years may be assisted through SCHII! However, screening children’s eligibility for the Medicaid program and enrolling
Marian
Lowe is an Associate
J Pediatr Health Care. (1998). Copyright 0099-l
at Capitol Associates,
AN UNKNOWN
PITFALL
The Vaccines for Children (VFC) program was established to ensure that children eligible for Medicaid receive the necessary preventive vaccines and to provide states with an incentive to deliver this service to young beneficiaries. States that elect to expand the Medicaid program under SCHIP retain the right to participate in the VFC program, which reimburses them for a specific list of vaccinations. However, in a letter to state health officials (Health Care Financing Administration, May 11,1998), HCFA explained a caveat that was dis-
Inc, in Washington,
DC.
72,273-275.
0 1998 by the National
767198
those children accordingly will be the state’s responsibility. States must also adopt procedures that will prevent SCHIP from substituting for employersponsored coverage. Premiums, deductibles, and co-insurance for families whose income is below 150% of the federal poverty level are capped at nominal amounts, and children with family incomes higher than 150% of the federal poverty level are charged on a sliding scale according to income. However, preventive care, including well-child and well-baby care and immunizations, are exempt from deductibles, copayments, and co-insurance.
Association
of Pediatric
Nurse Associates
& Practitioners.
25/8/92552
273
LEGISLATIVE NEWS
Lowe & Havens
BOX 1 State action on SCHIP No. of plans submitted: 39 (Ala, Ark, Calif, Colo, Conn, [la, Ga, Idaho, III, Ind, Iowa, Md, Mass, Mich, Minn, MO, Neb, Ohio,
DC, Me, Mont,
Nev, NH, NJ, NM, NY, NC, Okla, Ore, Pa, Puerto Rico,
RI, SC, SD, Tenn,
Tex,
Utah,
No. of plans approved:
Vt, Wis)
20
(Ala, Calif, Colo, Conn, Fla, Ill, Idaho, Mass, Mich, MO, NJ, NY, Ohio, Okla, Ore, Pa, RI, SC, Tex, Wis)
No. of separate state child health plans: 10 (Colo, Ga, Mich, Mont, Nev, NY, NC, Ore, Pa, Utah)* No. of Medicaid expansions: 22 (Ala, Ark, DC, Idaho, Ill, Ind, Iowa, Md, Minn, MO, Neb, NM, Ohio, Okla, Puerto Rico, RI, SC, SD, Tenn, Tex, Vt, Wis)* No. of combination plans: 7 (Calif, Conn, Fla, Me, Mass, NH, NJ)*
No. of state plan amendments mitted: 3 (Ala,
Calif,
sub-
Mich)
*Bold denotes states whose plan has been approved. From the Health Care Financing Administration. (Updated June 9, 1998.) Children’s Health insurance Program, Status report and contact information [On-line]. Available:
http:llww.hcfa.gov.
covered as implementation was rolled out.
of SCHIP
The VFC program was established in 1993 to serve children defined as “federally vaccine eligible” under section 1928 (b)(2), which includes both “uninsured” and “Medicaid eligible” children.. . Children who are newly eligible for Medicaid under Iitle XXI are federally vaccine eligible, as are all other children eligible for Medicaid. However, because of the Title XLX restrictions on eligibility for VFC, States that have designed a separate State health insurance program under CHIP (S-CHIP) may not treat children enrolled in such a program as federally vaccine eligible. (Health Care Financing Administration, May 11,199s.)
2 74
Volume
12 Number
5
To address this obvious disparity, HCFA has outlined several mechanisms by which states can continue to purchase vaccines at lower cost or include immunization in their benefits packages for children. ADVOCATES EXPANSION;
ADVISE MEDICAID STATES RESPOND
Many of the national organizations that were involved in the grassroots lobbying that helped bring SCHIP to fruition are advising states to choose Medicaid expansion rather than the optional separate insurance program or combination approach. The rationale behind this advice includes not only the vaccination benefit previously described but several other measures long sought by children’s advocates. Many of these benefits are specifically crafted to meet the needs of children. Advocates argue that Medicaid expansion provides the following advantages: j l Medicaid is designed to include the Early Periodic Screening, Diagnosis, and Treatment Program, which provides children with access to regular health screening, including preventive and necessary dental, vision, and hearing care. l Medicaid provides continuity of care for children whose family income may change and would cause them to shift in and out of the Medicaid program and a separate insurance program-perhaps losing their primary care providers. l Medicaid ensures appropriate care for children with special health needs, which is guaranteed under the rule of the Medicaid program but not in separate programs (Dorn, Teitelbaum, & Cortez, 1998; Mann, 1997; National Association of Child Advocates, 1997). Many experts also believe that, administratively, Medicaid expansion is preferable. Because Medicaid expansion would not necessitate the development of a new administration to oversee a separate health insurance program, experts agree that it avoids duplicative costs. Medicaid expansion also offers states open-ended federal matching payments, more consistent funding levels over time, and stronger negotiating advantages with plans and providers, and it minimizes the risk that a two-tier system of publicly funded coverage will develop. Conversely, ad-
vocates for separate health insurance programs for children assert that the Medicaid program creates an entitlement for children, promotes a welfare stigma, and is expensive and burdensome with many federal and state rules. The most telling evidence of state sentiment on the issue is that, of the 39 states that have submitted applications to HCFA, 22 plans indicate that the state will pursue Medicaid expansion. The remaining state plans were divided between separate programs and a combination of the two options. At the time this article was written, HCFA had approved 20 state plans; of these, 5 would create a program separate from Medicaid, 10 seek to expand Medicaid, and 5 propose to combine a separate children’s health program with Medicaid expansion. Box 1 summarizes state action on SCHIP to date. OUTREACH The success of SCHIP will depend largely on the ability of the states to reach young people and their families and facilitate enrollment in the new programs. Outreach has been one of the greatest shortfalls of the Medicaid program, as witnessed by the growing numbers of children who are eligible for but not enrolled in this program. A recent study estimated that, despite being eligible for Medicaid, approximately 4.7 million children age 18 years and younger are uninsured (Selden, Banthin, &Cohen, 1998). Whereas eligibility criteria were expanded throughout the past decade to include more children, experts found that for the most part, the rise in uninsured children can be attributed to the rising number of adolescents eligible for but not enrolled in the program. STATE-LEVEL
INVOLVEMENT
The aggressive outreach campaign necessary to provide the millions of uninsured children with access to needed health services provides a unique opportunity for collaboration between providers, schools, businesses, and local and state officials. As the gateway to the health care system, primary care providers such as pediatric nurse practitioners will play an integral role in identifying uninsured children and shepherding them through the enrollment process. Individual efforts such as
JOURNAL
OF PEDIATRIC
HEALTH
CARE
ipfl
LEGISLATIVE
BOX 2
NEWS
The 50 US governors
State
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington WestVirginia Wisconsin Wyoming
JOURNAL
Lowe & Havens
OF PEDIATRIC
Name
Fob James Jr (R) Tony Knowles (D) Jane Dee Hull (R) Mike Huckabee (R) Pete Wilson (R) Roy Romer (D) John G. Rowland (R) Thomas R. Carper(D) Lawton Chiles (D) Zell Miller (D) Benjamin J. Cayatano (D) Phil Batt (R) Jim Edgar(R) Frank L. O’Bannon (D) Terry E. Branstad (R) Bill Graves(R) Paul E. Patton (D) Mike Foster (R) Angus King (I) Parris N. Glendening (D) Argeo Paul CeJJucci (R) John Engler (R) Arne Carlson (R) Kirk Fordic (R) Mel Carnahan (D) Marc Racicot (R) Ben Nelson (D) Bob Miller(D) Jeanne Shaheen (D) ChristineTodd Whitman (R) Gary E. Johnson (R) George E. Pataki (R) James B. Hunt Jr (D) Edward T. Schafer (R) GeorgeV. Voinovich (R) Frank Keating (R) John Kitzhaber (D) Tom Ridge (R) Lincoln C. Almond (R) David Beasley (R) William J. Janklow (R) Don Sundquist (R) George W. Bush (R) Michael 0. Leavitt (R) Howard Dean (D) James S. Gilmore Ill (R) Gary Lock (D) Cecil H. Underwood (R) Tommy G. Thompson (Rf Jim Geringer (R)
HEALTH
CARE
Term
expires
Jan 1999 Dee 1998 Jan 1999 Jan 1999 Jan 7999 Jan 1999 Jan 1999 Jan 2001 Jan 1999 Jan 1999 Dee 1998 Jan 1999 Jan 1999 Jan 2001 Jan 1999 Jan 1999 Dee 1999 Jan 2000 Jan 1999 Jan 1999 Jan 1999 Jan 1999 Jan 1999 Jan 2000 Jan 2001 Jan 2001 Jan 1999 Jan 1999 Jan 1999 Jan 1998 Jan 1999 Jan 1999 Jan 2001 Dee 2000 Jan 1999 Jan 1999 Jan 1999 Jan 1999 Jan 1999 Jan 1999 Jan 1999 Jan 1999 Jan 1999 Jan 2001 Jan 1999 Jan 2002 Jan 2001 Jan 2001 Jan 1999 Jan 1999
Telephone
No.
(205)242-7100 (907)465-3500 (602)542-4331
(915) 4452841 (916)445-2841 (303)866-2471 (205)566-4840 (302) 739-4101 (904)488-4441 (404)656-1776 (808)586-0034 (208)334-2100
(217) 782-6830 (317) 232-4567 (515)281-5211
(913) 296-3232 (502)564-2611 (504)342-7015 (207)287-3531
(410) 974-3901 (617)
727-3600
(517) 373-3400 (612) 296-3391 (601) 359-3100 (573)751-3222 (406)444-3111 (402)471-2244 (702)687-5670 (603)271-2121
(609) 292-6000 (505)827-3000
(518) (919) (701) (614)
474-8390 733-5811 328-2200 466-3555
this will help reduce the number of children who lack a usual source of care. Coordinating efforts within the provider community is an opportunity for pediatric nurse practitioners and public officials to build lasting relationships and improve the health care of millions of children. Box 2 provides contact information for each US governor. We encourage providers to contact their governor and ensure that PNPs have a voice in the implementation of the largest expansion of health care since the inception of the Medicaid and Medicare programs in 1965.
REFERENCES Balanced Budget Act of 1997 (PL 105-33) [On-line]. Available: http://www.thomas.loc.gov Dam, S., Teitelbamn, M., & Cortez, C. (1998). An advocate’s too/ kit for the State Chikken’s Health insurance Program. Washington, DC: Children’s Defense Fond. Health Care Financing Administration. May 11, 7998, letter to state health officials from Sally K. Richardson, Director, Center for Medicaid and State Operations [On-line]. Available: http:// www.hcfa.gov Health Care Financing Administration. (Updated June 9, 1998.) Children’s Health insurance Program, status report and contact information [Online]. Available: http://www.hcfa.gov Mann, C. (1997). Why not Medicaid? Using child healthfunds to expand cozmzge through the Medicaid pw~grm. Washington, DC: Center on Budget and Policy Priorities. National Association of Child Advocates. (1997). Child Health Fact Sheet. The State Chiidren’s Health Insurance Program: Reasons for expanding Medicaid. Washington, DC: Author. Selden, T., Banthin, J., & Cohen, J. (1998). Medicaid’s problem children: Eligible but not enrolled. Health Affairs, 77,192~200.
(405)521-2345 (503)378-3111
(717) 787-2500 (401)277-2080 (803) 734-9818 (605)773-3212
(615) 741-2001 (512) 463-2000 (801) 538-1000 (802)828-3333 (804)786-2211 (206)753-6780 (304)558-2000
(608)266-1212 (307)777-7434
September/October
1998
2 7 5