EXECUTIVE SUMMARY: REPORT TO THE PRESIDENT FROM THE 

INTERAGENCY TASK FORCE ON CHILDREN’S HEALTH 

OUTREACH 

As the first step in his public-private children’s health outreach campaign, the President 

directed his own workforce to initiate an historic commitment to enrolling uninsured 

children in State health insurance programs. In response, eight Federal agencies 

developed plans in three areas: how to educate their workforce; how this workforce can 

help educate families about State health insurance programs; and how to coordinate 

cross-agency and public-private efforts to identify and enroll children in these programs. 

Educating Federal Workers, State Workers, and Grantees about Children’s Health

Many Federal and State workers, contractors or grantees have direct contact with families 

with uninsured children. For example, the majority of uninsured children probably have 

participated in a school lunch program, subsidized child care, or Head Start. Recognizing 

this fact, the Departments proposed to, among other actions: 

• Send letters from the Cabinet Secretaries to about 350,000 Federal workers,

describing this children’s health outreach initiative, how to access it, and strongly 

encouraging them to help enroll uninsured children. 

• Train the staff of Federal / State information clearinghouses, technical 

assistance centers, providers and eligibility workers about children’s health.

Targets include: 

- National Health Service Corps and Area Health Education Centers that 

train about 21,000 students and 50,000 providers 

- Education Department’s 40 parent assistance programs and 312 

community learning centers serving over 50,000 students and community 

residents 

- Regional and State coordinators for 1,800 State Employment Security 

Agencies that provide job placement, counseling, and labor market information to 

job seekers 

Educating Families. Many Federal workers and grantees determine eligibility, counsel 

families and provide services in non-health programs. This gives them an opportunity to 
educate families and assist them in enrolling children in Medicaid or CHIP. The agencies 

have proposed to: 

• Distribute information on options and/or applications to families at: 

- 700 community health centers 

- 1,400 Head Start grantees, State Child Support and TANF sites 

- 400 IRS Walk-In Centers and 8,600 Voluntary Income Tax 

Assistance sites 

- 1,300 Social Security Administration field offices 

- 3,000 employers, schools, education organizations, and community 

and religious groups that comprise the Education Department’s 

Partnership for Family Involvement program 

- 185 Federally operated and Tribally contracted schools, 24 

reservation-based community colleges, and over 500 Indian Child Welfare 

programs 

- 15,000 public housing projects and 81 field offices and information 

sites 

- 113 Job Corps Centers and 700 One-Stop Career Centers 

Coordinating Efforts Across Agencies and with the Private Sector. Efforts to 

enroll uninsured children will be more effective if coordinated. To facilitate this, 

agencies could: 

• Link Internet sites, to provide both Federal workers and families using 

these sites with links to children’s health insurance outreach site (e.g., 

America’s Job Bank site, used by millions) 

• Coordinate outreach campaign with major national associations, 

advocacy groups, and other private organizations in outreach. Each 

Department has a set of outside organizations that could be partners in this 

outreach initiative. These include: 

- Elderly groups, to assist in enrolling uninsured 

grandchildren 

- Historically Black Colleges and Universities, to develop 

strategies for minority children 
- Earned Income Tax Credit outreach organizations, that 

target similar families 

- National Education Association, to focus on school-based 

approaches 

Cross-Cutting Issues. Two topics were special focuses of the task force. 

• Vulnerable children. Many children eligible for Medicaid or CHIP are 

difficult to reach due to sociocultural and linguistic differences, low 

literacy levels, geographic isolation, homelessness, or transient living 

situations that make it difficult for them to enroll in health insurance. A 

number of activities are proposed to address these unique problems, 

including: 

- Use of mapping to identify all service delivery sites 

for reservation-based sites that could be used for children’s 

health outreach to Indian families 

- Media campaign for Hispanic children developed 

through focus groups to identify barriers to enrollment and 

Spanish language material 

- Use of "distance learning," such as new 

telemedicine communication capabilities, to educate rural 

providers about children’s health insurance 

• Coordinating program enrollment. Integration of health and 

non-health program enrollment can increase the number of 

children with insurance. Models identified include: 

- Single application for multiple programs: 

Most States (e.g., Illinois, Iowa, Maryland, 

Michigan, Ohio) use joint applications for their 

social services programs 

- "Adjunctive" eligibility (allowing eligibility 

for one program to fulfil some or all of the 

eligibility requirements for another): Children are 

automatically eligible for Florida’s Healthy Start 

program if eligible for the school lunch program 

- Referral of families to Medicaid and/or 

CHIP: To efficiently target uninsured children, 

Tennessee compared lists of Food Stamps and 

TennCare recipients; families on Food Stamps but 
not in TennCare were sent a mail-in application and 

number for questions 

Full Report Available at www.hcfa.gov 

 

TABLE OF CONTENTS 

 

OVERVIEW: REPORT OF THE TASK FORCE ON CHILDREN’S 

HEALTH 

INSURANCE OUTREACH.. 1 

1. REPORT FROM THE SECRETARY OF HEALTH AND 

HUMAN SERVICES 20 

A. Health Care Financing Administration 21 

B. Health Resources and Services Administration 28 

C. Administration for Children and Families 36 

D. Agency for Health Care Policy and Research 41 

E. Centers for Disease Control and Prevention 44 

F. Indian Health Service 49 

G. Substance Abuse and Mental Health Services Administration 53 

2. REPORT FROM THE SECRETARY OF AGRICULTURE

59 

3. REPORT FROM THE SECRETARY OF EDUCATION 66 

4. REPORT FROM THE SECRETARY OF HOUSING AND 

URBAN DEVELOPMENT 73 

5. REPORT FROM THE SECRETARY OF THE INTERIOR 79 
6. REPORT FROM THE SECRETARY OF LABOR 86 

7. REPORT FROM THE COMMISSIONER OF SOCIAL 

SECURITY 93 

8. REPORT FROM THE SECRETARY OF TREASURY 96 

APPENDICES 100 

A. Executive Memorandum, February 18, 1998 100 

B. President Clinton’s Initiatives for Children’s Health 102 

C. Targeting Vulnerable Groups of Children 103 

D. Coordinating Eligibility in Health and Non-Health Programs

107 

E. Targeting Native American / Alaska Native Children Using Maps

111 

REFERENCES 119 

 

OVERVIEW: REPORT OF THE TASK FORCE ON 

CHILDREN’S HEALTH INSURANCE OUTREACH 

 

This report outlines a series of multi-agency proposals on children’s health 

insurance outreach. It is in response to a Presidential Executive 

Memorandum issued on February 18, 1998. The President requested that 

eight Departments develop options for assisting in the education of 

families and the enrollment of children in Medicaid and the new 

Children’s Health Insurance Program (CHIP). Given their broad-based 

contact with families targeted by this initiative, the Departments’ proposed 

activities could make an important contribution to reducing the number of 

uninsured children in America. All of the named activities could be 

implemented in the time frames described, should the President approve of 

the proposals. 

BACKGROUND 
Executive Memorandum on Children’s Health Outreach

On February 18, 1998, the President issued an Executive Memorandum to 

eight Federal Departments operating programs to assist working families 

requesting that they develop options to participate in his public-private 

initiative to enroll uninsured children in Federal-State health insurance 

programs (see Appendix A). This report outlines a wide range of options 

developed by the Departments of Treasury, Agriculture, Education, Labor, 

Housing and Urban Development, Health and Human Services, Interior 

and the Social Security Administration. At the President’s request, the 

Departments’ reports: (1) identify all employees and grantees who work 

with families; (2) develop an educational strategy to ensure that employees 

and grantees are educated about the availability of Medicaid and the 

CHIP; (3) develop an Agency-specific plan as part of the Administrationwide outreach plan; and (4) identify any statutory or legislative barriers 

which impact identification and enrollment of uninsured children in 

Federal-State insurance programs. The President also asked the 

Department of Health and Human Services to be the coordinating Agency 

for the development of a report on these activities and to ensure that 

Federal interagency activities are complementary, aggressive, and 

consistent with the overall initiative to cover uninsured children. 

Importance of Children’s Health Insurance

This call to Federal Agencies to assist in children’s health insurance 

outreach is one step towards the President’s goal of improving the health 

and development of American children (see Appendix B). As recent 

studies have confirmed, children without health insurance are more likely 

to be sick as newborns, less likely to be immunized, and less likely to 

receive medical treatment for illnesses such as recurrent ear infections and 

asthma. Without treatment, these diseases can have lifelong consequences 

(U.S. GAO, 1997; IOM, 1998). Yet, the problem of children lacking 

insurance is large. The Agency for Health Care Policy and Research 

(1998) found that 4.7 million uninsured children are eligible but not 

enrolled in Medicaid. Several million more have income too high for 

Medicaid but too low to afford private health insurance. 

To help these children, the President, with bipartisan support from the 

Congress, created the Children’s Health Insurance Program (CHIP). 

The Balanced Budget Act of 1997 allocated $24 billion dollars over the 

next five years to extend health care coverage to uninsured children 

through State-designed programs. CHIP enables States to insure children 

from working families with incomes too high to qualify for Medicaid 

through non-Medicaid State programs, Medicaid expansions, or a 

combination of both programs. Each State with an approved plan gets its 

expenditures matched with Federal funds up to a fixed State "allotment". 
As of mid-June, nearly 20 State plans have been approved, and almost all 

other State are developing plans for approval. 

CHIP builds on Medicaid, a joint Federal-State program, that provides 

health insurance for most poor children. All States extend Medicaid 

eligibility to children less than age 6 in families with income below 133 

percent of poverty; children between ages 6 and 14 in families with 

income below 100 percent of poverty; and, by 2002, children between 

ages 15 and 18 in families with income below 100 percent of poverty. 

Many States have taken advantage of options that allow them to cover 

children in families with higher income. 

While Medicaid and CHIP have the potential to cover many of the over 11 

million uninsured children in America, without an aggressive, broad-based 

effort to identify and enroll eligible children, they will not succeed. 

Experience with Medicaid has shown that many families do not know 

about their children’s eligibility. Working parents often assume that they 

cannot receive premium assistance for their children. Medicaid is 

considered by many a "welfare" program and the stigma of welfare 

remains strong in many areas. In some States, the application process can 

be long and arduous and beyond the ability of many families to complete. 

Cultural barriers, like difficulties in language comprehension, also pose a 

barrier for some families. 

To encourage full participation in these programs, the President has 

launched a children’s health insurance outreach initiative. The 1999 

Budget includes proposals to give States the funds and flexibility to find 

and enroll hard-to-reach children. Specifically, the President supports (1) 

allowing States to let schools, child care resource and referral centers and 

others who have contact with children to facilitate Medicaid enrollment 

and (2) broadening the use of an existing fund so that States may use it for 

activities to decrease the number of uninsured children. In addition, the 

President, the First Lady, and Secretary Shalala have repeatedly 

challenged both the public and private sectors to undertake a wide range of 

children’s health outreach efforts. In February 1998, they launched a series 

of administrative and private sector actions including distribution of a 

letter outlining options for outreach funding and application 

simplification; development of a national toll-free number to connect 

families with local eligibility offices; commitments by private businesses 

like supermarket and drug store chains to assist in educating families 

about Medicaid and CHIP; and a partnership with not-for-profit 

organizations to develop a mass media campaign to stress the importance 

of insurance for children. The Administration will continue to work 

through public and private actions to improve children’s health coverage. 

What is "Outreach"
Children’s health insurance outreach is a dynamic process in which broad 

networks of concerned Americans work together to identify, educate and 

enroll uninsured children in Medicaid or CHIP. These networks include 

people in the public and private sectors and at the Federal, State and local 

levels. Activities that could increase enrollment in health insurance 

programs include advertising on billboards, television and radio; sending 

messages in simple language and in multiple languages; using toll-free 

hotlines to answer questions and enroll individuals; spreading the word 

through community health advocates, children’s agencies, parents’ 

networks and religious groups; and targeting uninsured children where 

they spend most of their time: in schools, child care settings and Head 

Start sites. Outreach also involves Federal and State efforts to streamline 

the application and enrollment process by shortening forms, accepting 

mail-in applications, reducing processing time, and placing eligibility 

workers in convenient locations. Use of a joint application form for 

different programs can also enhance coordination of resources across 

programs serving the same children. 

Outreach activities are not new. All States -- to greater or lesser degrees -- 

currently conduct outreach for uninsured children (NGA, 1998). States 

may receive Federal matching payments for outreach for Medicaid and 

CHIP. In addition, private organizations like foundations, children’s 

advocacy groups, health care providers, and businesses have also 

sponsored some projects to educate and enroll children in health 

insurance. These groups have access to and communicate with families in 

different, potentially more effective ways. 

However, most experts would agree that, to date, many children’s health 

insurance outreach efforts have not been very successful. Thus, in 

partnership with the President, these public and private groups have been 

planning, coordinating and implementing a more aggressive outreach 

strategy. This includes efforts to identify and promote outreach models 

that work; engage a new, broader, and nationwide set of participants; and 

employ mass media in the same way that advertisers do. Part of this effort 

involves identifying how different Federal programs can target, educate 

and assist families in enrolling their children in Medicaid or CHIP. 

Federal Government’s Potential Contribution to Outreach

Federal departments can play a critical role in children’s health insurance 

outreach. Many children eligible for Medicaid or CHIP are currently in 

contact with one or more Federal programs, making these programs 

appropriate places for reaching out to uninsured children. Most children 

are enrolled in school, child care, or Head Start. Many participate in 

school breakfast and lunch programs. Others are enrolled in the Special 

Supplemental Nutrition Program for Women, Infants and Children (WIC) 
and the Federal Food Stamp Program. They attend public health clinics for 

immunizations and school nurses for injuries. Their parents interact with 

the IRS, job programs, or housing assistance. Some uninsured children are 

American Indians and benefit from Bureau of Indian Affairs and/or Indian 

Health Service programs. In addition to this vast workforce, Federal 

agencies also have a network of private sector counterparts and partners 

who can get involved in children’s health insurance outreach. Examples of 

programs that could assist in children’s health outreach are listed in Table 

1. 

Table 1. Federal Programs That Could Contribute to Children’s 

Health Outreach 

DEPARTMENT EXAMPLES OF PROGRAMS SERVING FAMILIES

HEALTH AND HUMAN SERVICES

 

Health Care 

Financing 

Administration

Medicaid: Insures about 18 million poor and near-poor children 

Children’s Health Insurance Program (CHIP): Will insure millions of children 

above Medicaid eligibility through a non-Medicaid, Medicaid, or combination 

plan.

 

Health Resources 

& Services 

Administration

Maternal and Child Health Bureau: Runs MCH program, Healthy Start Initiative to

reduce infant mortality & Prenatal Hotline linking callers to local health resources 

Bureau of Primary Health Care: Funds 700 community health centers, Health Care 

for the Homeless Program, and the National Health Service Corps

 

Administration for 

Children & Families

Head Start / Early Head Start: Provides preschool for low-income 830,00 children 

Child Care: Assists low-income families in obtaining safe, affordable child care 

Foster Care/Adoption Assistance: Provides stable environment for children

 

Agency for Health Care 

Policy & Research

Research on children’s health: Funds about $13.5 million in research relating to 

children’s health (e.g., emergency health services for children)

 

Centers for Disease 

Control & Prevention

Immunization: Funds vaccinations and a hotline for questions about immunization 

Childhood Lead Poisoning Prevention: Funds grantees to screen 1.8 m. at-risk kids

 

Indian Health Service

Reservation Based Health Services: Funds and/or operates a network of 49 

hospitals, 195 outpatient facilities and 297 health clinics
 

Substance Abuse & 

Mental Health 

Admin.

Comprehensive Community Mental Health for Children Program: Provides grants 

to States and Tribes to care for children with serious emotional disturbances

AGRICULTURE National School Lunch Program: Gives low-cost/free meals to 24 million children 

Food Stamp Program: Assists over 11 million children in obtaining healthy food 

WIC: Provides supplemental foods, nutrition education and health care referrals to 

7.4 million low-income women, infants and children

EDUCATION Special Education Grants: Funds States’ special education for 6 million children 

21st Century Community Learning Centers: Safe havens during non-school hours

HOUSING & URBAN 

DEVELOPMENT

Public/Indian Housing: Provides low-cost housing for 2.9 million households 

Multi-Family Housing: Reaches 2.6 million low-income households 

McKinney Act Programs: Assists 250,000 homeless people annually

INTERIOR Indian Child Welfare Program: Provides Tribes with resources to protect Indian 

children and prevent the separation of Indian families 

Office of Indian Education Programs: Provides education services to Indian kids

LABOR Unemployment Insurance: Provides assistance to 6 million unemployed people 

Job Corps: 113 centers that provide vocational training to disadvantaged youth

SOCIAL SECURITY 

ADMINISTRATION

Supplemental Security Income: Provides income floor for 1 m. disabled children 

Surviving Children: Provides benefits to children of deceased workers

TREASURY IRS Walk-In Centers: Operates over 400 offices that assist taxpayers, including 

low-income families, applying for the Earned Income Tax Credit (E.I.T.C.)

Interagency Task Force on Children’s Health Insurance Outreach

To respond to the President’s Memorandum, an Interagency Task Force 

on Children’s Health Outreach was created. This Task Force included 

representatives from the White House and the eight Departments included 

in the Memorandum. The Department of Health and Human Services 

(DHHS) coordinated this effort. The Task Force met on a weekly basis to 

learn about existing public health insurance programs, to discuss specific 

ideas, and to coordinate activities. Each Department was tasked with 

developing an action-oriented plan to assist in children’s health insurance 
outreach, focusing on programs that serve low-income children. Because 

of its unique role as taskforce lead and its traditional involvement in the 

health care field, DHHS asked seven of its own agencies to develop 

outreach plans as well. The subsequent chapters of this report contain 

those plans. 

In this review, two particular topics merited special attention. First, 

outreach strategies may differ for certain vulnerable children. Proposals to 

address their unique barriers are outlined in Appendix C. Second, 

coordination of program eligibility and application processes can increase 

the number of children insured. Models of successful coordination are 

described in Appendix D. 

 

SUMMARY OF PLANS FOR CHILDREN’S HEALTH 

INSURANCE OUTREACH 

The Departments have proposed an impressive and diverse set of actions 

to engage in children’s health insurance outreach. All together, more than 

150 activities are proposed (see Table 2 at the end of the overview). Some 

are one-time actions, while others are ongoing, ensuring that their effects 

are not temporary. Activities proposed by the Departments have been 

divided into three general categories: (1) educating Federal workers, State 

workers and grantees about children’s health insurance outreach; (2) 

educating families about their children’s potential eligibility for health 

insurance; and (3) coordinating efforts across Departments and with 

private sector groups. 

Educating Federal Workers, State Workers, and Grantees

One of the major strengths of the Federal government is its workforce. 

There are about 1.2 million Federal government, executive branch, nondefense and postal service employees. A number of these Federal 

employees directly administer programs that assist low-to middle-income 

families (e.g., SSA’s field office workers, Treasury’s Walk-In Center 

workers, and Indian Health Service workers). Other Departments work 

primarily through State-based or Tribal programs (e.g., Agriculture’s Food 

and Nutrition Services, DHHS’s Maternal and Child Health program, 

Interior’s Indian Child Welfare Program). Virtually every one of the eight 

Federal Departments work with private grantees, contractors, and 

technical assistance providers (e.g., Education’s Parent Centers, HUD’s 

Public Housing projects, and Labor’s Job Corps). 

Because this network of Federal, State and other workers has direct 

contact with low-income and working families, a central activity proposed 
by all of the Departments is to educate these workers about the health 

insurance options for children. The following are proposed strategies for 

educating Federal workers: 

• Send letters from the Cabinet Secretaries to Federal workers. 

About 350,000 Federal employees could receive a letter, e-mail or 

other form of communication from their Secretary describing this 

children’s health insurance outreach initiative and asking for their 

help. 

• Target Federal employees through newsletters with updates on 

outreach activities. Newsletters for SSA (OASIS), Agriculture 

Food and Nutrition Service (The Friday Letter), Education 

(EdInfo), Interior (Pathways), Labor (The Labor Exchange), and 

DHHS’s Health Care Financing Administration (HCFA 

Healthwatch) reach hundreds of thousands of employees and 

alumni. These Departments could use these newsletters to publish 

periodic updates on children’s health insurance outreach activities 

and how employees can refer and enroll children. 

• Educate grantees or potential grantees about Medicaid and 

CHIP. Departments have thousands of grantees who could be 

informed about CHIP and Medicaid. For example, DHHS could 

send letters to its 221 rural health grantees and HUD could place 

information on its call for proposals, thus educating 80,000 

applicants for grants. 

• Inform clearinghouses, technical assistance centers, providers 

and eligibility workers about children’s health. Departments 

could train people who interact with families about children’s 

health insurance eligibility and application process. Examples 

include: 

- DHHS could add children’s health insurance 

components to training of National Health Service Corps 

providers; Area Health Education Centers that train about 

21,000 students and 50,000 providers; public health 

grantees (e.g., childhood lead poisoning prevention 

workers, immunization providers), welfare and child 

support technical assistant contractors, and Tribal health 

workers. 

- DHHS (CDC) and HUD could use "distance 

learning" or satellite telecommunications to educate 

workers nationwide. 

- Agriculture could educate and inform its 

Cooperative State Research, Education and Extension 
Service, which can disseminate information at the local 

level. 

- Education could train Parent Centers, community 

centers and other clearinghouse workers that interact with 

potentially eligible families. 

- Interior could train agencies, Tribal contractors, and 

social services program personnel and produce a 10-minute 

video about outreach. 

- Labor could add outreach to training for regional 

and State coordinators for State Employment Security 

Agencies and Welfare-to-Work grantees. 

- SSA could include outreach information in its 

35,000 teacher’s kits. 

To support this education initiative, DHHS and the White House will 

develop a simple, explanatory flyer about CHIP, Medicaid and outreach 

for Federal workers. Interior will adapt this flyer for use among Native 

American program workers. 

Educating Families

Once Federal workers are educated, many are in positions to: (1) identify 

eligible children, (2) educate the parents of eligible children about 

Medicaid or CHIP, and (3) assist in enrolling eligible children. Assistance 

in enrollment could take several forms. Workers could refer families to the 

name and number of the State agency responsible for children’s health 

insurance. By September, they could also give the family a single, national 

toll-free number that will direct families to local eligibility offices. In 

addition, some private organizations are developing simple cards and 

posters that could be displayed in sites frequented by eligible families. 

Applications for CHIP and Medicaid could also be placed at these cites. 

State agencies could arrange to either allow health insurance eligibility 

workers to come to different program sites or allow those different 

program eligibility workers to determine eligibility for Medicaid or CHIP. 

The following summarizes the actions proposed by the Departments to 

educate and assist families: 

• Distribute information and/or applications for CHIP and 

Medicaid through: 

- DHHS: 700 community health centers (HRSA); 

grantees who conduct children’s health research (AHCPR); 
State Child Support, TANF, Head Start sites (ACF); State 

and local health departments (CDC); School Health 

Programs (HRSA); and Health Facilities for Indian people 

(IHS). 

- Agriculture: WIC, Food Stamps and School Lunch 

Programs when possible. 

- Education: 3,000 employers, educators, community 

and religious groups that comprise its Partnership for 

Family Involvement program. 

- HUD: 15,000 public housing projects, 30,000 

assisted multi-family housing developments, and 81 field 

offices and information kiosks. 

- Interior: 185 Federally operated and Tribally 

contracted schools, 24 reservation-based community 

colleges, and over 500 Indian Child Welfare programs. 

- Labor: 113 Job Corps Centers; 700 One-Stop 

Career Centers; and 15 regional and district offices that 

distribute 200,000 "Pension and Health Care Benefits" 

brochures that will include Medicaid and CHIP 

information. 

- SSA: 1,300 field offices. 

- Treasury: 400 IRS Walk-In Centers, 8,600 

Voluntary Income Tax Assistance sites 

• Refer callers of information hotlines to health insurance 1-800 

numbers. Education, Agriculture, SSA and State Maternal and 

Child Health programs could add a "referral screen" to their tollfree/departmental numbers to direct families toward health 

coverage. 

Coordinating Efforts

Effective, ongoing communication about Medicaid and CHIP across 

Departments is essential to this initiative’s success. Some of these linkages 

already exist. For example, SSA and DHHS already coordinate eligibility 

for certain children, and Agriculture’s WIC program workers must refer 

potentially eligible people to Medicaid. However, in some cases, the 

relationships across Departments and with the private sector are new. The 
following includes examples of activities proposed to facilitate 

coordination: 

• Link Internet sites: All of the Departments could link their 

Internet sites to the appropriate DHHS site on children’s health 

insurance. For example, millions of job seekers access America’s 

Job bank and could learn about health coverage. Some 

Departments, like Agriculture, could post articles about outreach 

on their own sites. 

• Engage major national associations, advocacy groups, and 

other private organizations in outreach. Each Department’s 

programs have outside organizations that could be partners in this 

outreach initiative. These include: 

- DHHS: Cosponsor outreach conference with 

Historically Black Colleges and Universities 

(HCFA/HRSA); notify 200 agencies on child health e-mail 

list (AHCPR). 

- Agriculture: Send letter to major associations and 

advocacy groups on outreach; add outreach information to 

database on food recovery programs, accessed by more 

than 30,000 individuals. 

- Education: Work with National Education 

Association on effort to educate teachers at its July 

conference; disseminate information through mass e-mails. 

- HUD: Send letter regarding the initiative to public 

interest groups and ask them to promote children’s health 

outreach. 

- Interior: Encourage national Indian teachers unions 

and grassroots organizations that serve Indian families to 

assist in outreach by educating parents about Medicaid and 

CHIP. 

- Labor: Work with 2,000 small businesses to help 

them help their employees. 

- SSA: Use new database of 5,000-10,000 community 

groups to educate about outreach. 

- Treasury: Encourage groups that conduct Earned 

Income Tax Credit outreach to add children’s health 

insurance information to the material. 
• Develop and distribute model applications for integrating 

School Lunch and children’s health programs. DHHS, 

Agriculture and Education could develop and distribute prototype 

applications to facilitate enrollment in Medicaid or CHIP. 

Statutory and Regulatory Barriers 

The President’s February 18, 1998 Executive Memorandum asked each of 

the eight Departments to identify any statutory or regulatory barriers that 

impede the identification and enrollment of uninsured children in 

Medicaid and CHIP. For the most part, the Departments reported that 

there is considerable flexibility under current law to coordinate health and 

non-health program enrollment. Some Departments did note that only 

some (not all) non-health program eligibility workers can use the new 

children’s "presumptive eligibility" option in Medicaid. The Balanced 

Budget Act of 1997 gave States the option to let Medicaid providers and 

eligibility workers for Head Start, WIC and child care subsidies under the 

Child Care and Development Block Grant grant Apresumptive eligibility@

or temporary Medicaid coverage to children who appear to qualify. Costs 

associated with this option are subtracted from States’ CHIP allotments. 

Some of the Departments (e.g., Education, HUD, Interior) have eligibility 

workers who probably work with many families with uninsured children, 

but cannot now grant presumptive eligibility. The President’s 1999 budget 

specifically addresses this issue. It would give States greater flexibility in 

the definition of "qualified entities@ to include sites such as schools, child 

care resource and referral centers, child support enforcement agencies and 

CHIP eligibility workers. It would also eliminate the subtraction of 

presumptive eligibility expenditures from State CHIP allotments, 

removing a disincentive to take this option. 

Cross-Cutting Issues

The Interagency Task Force determined that two topics deserve special 

attention: children in vulnerable populations with unique access problems 

and coordination of health and non-health program eligibility. 

Targeting Vulnerable Groups of Children. Many children eligible for 

Medicaid or CHIP are difficult to reach because of barriers to 

understanding and/or responding to outreach geared to the mainstream 

population. Vulnerable populations often face sociocultural, 

socioeconomic, and linguistic differences; low literacy levels; geographic 

isolation; homelessness; or transient living situations that make it difficult 

for them to enroll in health insurance. As a result, these groups tend to 

have higher rates of uninsurance. 
A number of the activities proposed by the Departments are targeted at 

reducing these barriers (see Appendix D for a full description). Examples 

include: 

• Native American and Alaska Native children: An interagency 

work group could promote the use of mapping to identify all 

service delivery sites and reservation-based sites that could be used 

for children’s health outreach and will develop a culturally relevant 

brochure for Indian families. (See Appendix E) 

• Hispanic children: DHHS could conduct focus groups to identify 

barriers to enrollment for different Hispanic groups and then could 

develop strategies to overcome them. 

• Rural children: DHHS’s Office of Rural Health could notify its 

grantees about the importance of children’s health outreach; 

Centers for Disease Control’s "distance learning" programs could 

educate rural providers about children’s health insurance. 

Coordinating Eligibility in Health and Non-Health Programs. While 

much of the focus of the Federal Interagency Task Force has been on 

education about children’s health insurance, the differing eligibility rules, 

applications, and enrollment processes for health and non-health programs 

can create barriers to enrollment. A subgroup of the Task Force looked at 

the major social programs to identify issues in coordination of program 

eligibility; and models of Federal and State-level collaboration (see 

Appendix D). 

Three major barriers can prevent coordination of Medicaid, CHIP and 

non-health programs. The first is the financial and non-financial eligibility 

rules. Different programs often have -- because of law, regulations, or 

State choice -- different definitions of family size, type of income counted 

toward eligibility, income disregards, upper income limits, and allowable 

resources. A second issue is the documentation required from the 

applicant. Families are usually required to bring proof of income, 

resources, birth certificates and other types of documentation -- even when 

a different agency might have already verified that information for their 

own program. Third, the application process itself may require multiple 

visits to different sites that may be geographically inaccessible or whose 

hours may be restricted. 

Some Federal and State programs have overcome these barriers by 

coordinating these health programs with other non-health programs. 

Examples include: 

• Using same application for multiple programs ensures that a 

child eligible for two or more public programs gets enrolled both is 

through the use of a single, joint application. For example, many 
States (e.g., Delaware, Maryland, South Dakota) use a single 

application for Medicaid and other programs such as TANF, Food 

Stamps, and WIC. 

• Employing "adjunctive" eligibility means that eligibility for one 

program may be used to fulfil some or all of the eligibility 

requirements for another. For example, Florida’s Healthy Start 

Program makes children eligible for the free or reduced school 

lunch program automatically eligible for its State health insurance 

program. 

• Referring families to Medicaid and/or CHIP from non-health 

programs is an efficient way to target uninsured children. For 

instance, to identify uninsured children eligible for its Medicaid 

expansion ("TennCare"), Tennessee compared the lists of families 

with children participating in Food Stamps and TennCare. The 

families participating in Food Stamps but not in TennCare were 

sent an information letter, a mail-in application with a preaddressed, postage-paid envelope, and a toll-free number for 

questions. 

• Assisting families at other program’s eligibility offices can 

make the health application process easier. For example, Louisiana 

contracts with Head Start staff and other community-based 

organizations to assist families in completing Medicaid 

applications. 

 

CONCLUSION 

Insuring America’s children is a national priority. Children who miss 

school because they are sick or who cannot see well because they lack 

glasses may not develop to their full potential. Two programs offer 

millions of uninsured children health coverage: Medicaid and the new 

Children’s Health Insurance Program. Enrolling uninsured children in 

these programs will take an aggressive, sustained, public-private, Federal, 

State, and local effort. As demonstrated by the activities described in this 

report, Federal Departments can make an important contribution toward 

this outreach effort. We look forward to working with the President on 

implementation of this initiative. 

 Table 2. Comprehensive List of Proposals for Children’s 

Health Insurance Outreach 

 (Note: Numbers correspond to numbering of proposals in reports) 
 

EDUCATING WORKERS

EDUCATING FAMILIES COORDINATION

DEPARTMENT OF HEALTH AND HUMAN SERVICES

 HEALTH CARE FINANCING ADMINISTRATION

1 Establish network of outreach 

specialists (Fall 1998)

10 Provide technical assistance to improve 

cultural competency of outreach efforts 

(Beginning in Summer 1998)

12 Encourage distribution of CHIP 

toll-free number (Beginning in 

Fall 1998)

2 Develop Regional Interagency Work 

Groups (Beginning in September 

1998)

11 Outreach to grandparents through Medicare 

(Beginning in September 1998)

13 Work with minority groups to 

promote outreach (Ongoing)

3 Create an on-line clearing house for 

outreach information (Fall 1998)

 

 

4

Distribute flyer on outreach to 

workers (Summer 1998)

 

 

5

Identify outreach needs of State 

Medicaid and CHIP officials 

(October 1998)

 

 

6

Facilitate partnerships between State 

health and non-health program 

officials (Beginning in Summer 1998)

 

 

7

Identify and share best practices 

(Beginning October 1998)

 

 

8

Assist States in reducing barriers to 

enrollment through a Task Force 

(Beginning in Summer 1998)

 

 

9

Publish articles on children’s health 

insurance coverage (Ongoing)

 

 

 HEALTH RESOURCES AND SERVICES ADMINISTRATION

1 Convene Regional meetings with 

other Federal workers, particularly 

ACF (Ongoing)

8 Disseminate information on Medicaid and 

CHIP through 700 community-based health 

centers and 50 State MCH programs. (Fall 

1998)

10 Work with border communities’ 

programs on outreach (FY 1999)

2 Train providers on outreach including 

the National Health Service Corps 

and Area Health Education Centers 

9 Build and coordinate community coalitions 

with a focus on hard-to-reach populations 

(Beginning in June 1998)

11 Train outreach workers in 

Empowerment Zones and 

Enterprise Communities’ health 
health providers. (July 1998) 1998)

3 Distribute best practices in 

coordination between insurance and 

Maternal and Child Health programs 

(Ongoing)

 

12

Refer Title V and Healthy Start 

toll-free hotline callers to CHIP / 

Medicaid information services 

(Ongoing)

4 Encourage outreach through 26 

School Health Programs (Beginning 

in June 1998)

 

 

5

Broaden technical assistance to 

grantees and community-based 

organizations (Beginning in June 

1998)

 

 

6

Require Ryan White grantees to 

educate staff about Medicaid and 

CHIP (August 1998)

 

 

7

Send letter to 221 rural grantees to 

encourage them to get involved in 

State outreach plans (June 1998)

 

 

 ADMINISTRATION FOR CHILDREN AND FAMILIES

1 Brief and distribute outreach 

information to all ACF office staff 

and other Federal partners (Ongoing)

5 Encourage State Child Support offices to 

routinely put information on health 

insurance in child support orders. 

(Ongoing)

9 Coordinate efforts with other 

Federal and State agencies 

(Ongoing)

2 Distribute outreach information to 

State and local directors (Beginning 

in Summer 1998)

6 Encourage distribution of CHIP and 

Medicaid promotional material and 

applications in Welfare/TANF offices, 

Head Start program locations, etc. 

(Ongoing)

 

 

3

Invite State directors to participate in 

conferences and forums (Ongoing)

7 Conduct outreach to Tribes, Native 

Hawaiians and Pacific Islanders (Beginning 

in January 1998)

 

 

4

Engage ACF grantees and technical 

assistance contractors in outreach 

efforts (Ongoing)

8 Encourage States to place outstationed 

workers in Child Care and Head Start sites 

(July 1998) 

 

 

 AGENCY FOR HEALTH CARE POLICY AND RESEARCH

1 Inform employees through e-mails; 

desk-to-desk handouts; follow-up 

reminders (Beginning in Summer 

1998)

2 Encourage grantees and contractors to 

educate families about outreach (Summer 

1998)

4 Notify outside individuals and 

groups about outreach via its child 

health listserve (200-plus 

subscribers) (Summer 1998)

 Encourage grantees in co-sponsored 

research to educate families about outreach 

(Beginning in Summer 1998)

5 Support evaluations of CHIP and 

Medicaid outreach through its 
3 programs (Ongoing)

 CENTERS FOR DISEASE CONTROL AND PREVENTION

1 Send letters to grantees to describe 

how they might assist in outreach 

(Summer 1998)

4 Assist State and local health departments in 

helping to insure children (Summer 1998)

7 Link appropriate Internet locations

to HCFA’s children’s Internet site 

(Summer 1998)

2 Allow States to use database of 

"pockets of need" to target eligible 

children (Summer 1998)

5 Add Medicaid/CHIP toll-free number to 

CDC publications, pamphlets, etc. (Fall 

1998)

8 Coordinate with WIC program for 

children’s health outreach 

(Summer 1998)

3 Use distance-based learning (e.g., 

satellite sessions) to educate about 

outreach (Summer 1998)

6 Educate parents and grandparents about 

outreach through non-children’s programs 

(e.g., cancer screening programs) (Summer 

1998)

 

 

 INDIAN HEALTH SERVICE

1 Organize a headquarters leadership 

team to promote outreach (July 1998)

6 Establish stakeholder advisory committee to 

provide input on outreach to American 

Indians and Alaska Natives (September 

1998)

10 Enhance interaction within DHHS 

and across Federal agencies on 

outreach (Ongoing)

2 Send directives to agency specialty 

annual meetings (e.g., National 

Councils of Chief Medical Officers) 

to include workshops and plenary 

session on outreach (Summer, 1998)

7 Develop culturally sensitive messages on 

outreach for American Indians and Alaska 

Natives (Beginning in October 1998)

11 Identify and develop partnerships 

with public and private advocacy 

groups to provide education and 

assistance to Indian families 

(Beginning in August 1998)

3 Provide access to training on CHIP 

and related programs to other 

Department, State, or private workers 

who serve American Indians (Fall 

1998)

8 Create a survey to monitor access and 

satisfaction of Indian families with CHIP/ 

Medicaid; use existing data to target 

communities (Beginning in October 1998)

 

 

4

Include CHIP as a topic in future 

meetings scheduled with Indian 

Tribes (Quarterly)

9 Use "train the trainer" techniques to educate 

community members who can provide 

information to the rest of the community 

(October 1998)

 

 

5

Distribute brochure about CHIP / 

Medicaid designed for people 

working with American 

Indians/Alaska natives (July 1998)

 

 

 SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

1 Provide briefings for project officer 

staff about outreach (July 1998)

8 Distribute information on CHIP and 

Medicaid through State alcohol and drug 

abuse agencies ( Summer 1998)

10 Develop SAMHSA Internet site on

children’s health (Summer 1998)

2 Create workgroup on outreach for 

children with special needs; fund 

educational campaign (Beginning 

June 1998)

9 Send mailing to Starting Early Starting 

Smart grantees about outreach (October 

1998)

11 Mobilize stakeholders to assist 

States with outreach (Ongoing)
3 Track outreach and mental health and 

substance abuse benefits in CHIP 

(Fall 1998)

 

 

4

Add chapter on outreach to CHIP 

benefits book (Fall 1998)

 

 

5

Send updates on outreach to 

substance abuse and mental health 

directors, grantees and organizations 

(every 6 months)

 

 

6

Sponsor regional meetings w/ 

substance abuse /mental health 

programs on CHIP that include 

outreach (FY 1999)

 

 

7

Develop and implement media 

strategy to educate substance abuse 

providers about CHIP and outreach 

(September 1998)

 

 

DEPARTMENT OF AGRICULTURE

1 Send a message from the Secretary to 

92,000 employees about outreach 

(August 1998)

7 Include referral to the Medicaid/ CHIP tollfree line on the USDA information phone 

number (1999)

12 Link FNS and USDA websites to 

DHHS’s; add information to FNS 

& USDA sites (Jan. 1999)

2 Put a message on wage and earning 

statements for employees (January 

1999)

8 Display and make available Medicaid/ 

CHIP information at the USDA Visitors’ 

Center in DC (Fall 1998)

13 Develop and distribute prototype 

applications for integrating 94,000 

school lunch and children’s health 

programs with D-Ed and DHHS 

(September 1998)

3 Provide information on CHIP and 

Medicaid outreach to 28 FNS 

regional and State program directors 

(September 1998)

9 Send memorandum to 7 WIC regional 

directors and 88 State agencies about new 

option to determine Medicaid presumptive 

eligibility for children (September 1998)

14 FNS will send information to 

national associations, advocacy 

groups and other organizations to 

encourage them to provide 

information on Medicaid and 

CHIP (Fall 1998)

4 Issue memorandum to FNS regional / 

State agency program directors 

encouraging them to coordinate with 

State Medicaid and CHIP directors; 

publish information on outreach in 

newsletters; display info. on 

children’s health at meetings 

(September 1998)

10 Send memorandum to 28 FNS regional, 

State and local program directors 

encouraging them to give information to 

families about health options and, if 

feasible, consolidate program applications 

with Medicaid/CHIP (September 1998)

15 Encourage Food Stamp nutrition 

education programs and 

cooperators to provide information

on CHIP/Medicaid (Fall 1998)

5 Update FNS regional program 

directors on State CHIP plan 

approvals (Periodically)

11 Provide information on children’s health 

outreach through cooperative research, 

education and extension service (September 

1998)

16 Provide DHHS with a contact list 

for FNS regional and State 

conferences for display of 

outreach material (Ongoing)

6 Send electronic messages to 

cooperative research, education and 

extension service program 

administrators, directors and 

 

17

Include information on outreach in

the USDA National Hunger 

Clearinghouse data base that over 

30,000 individuals and groups 

access (January 1999)
(September 1998)

DEPARTMENT OF EDUCATION

1 Send memo from the Secretary to all 

4,800 employees and a companion 

newsletter article to 12,400 

subscribers (July 1998)

7 Include information on health insurance on 

the Department’s 1-800 number (July 1998)

9 Encourage all stakeholders to 

engage in outreach through 

mailings and meetings (Beginning 

in July 1998)

2 Encourage Asst. Secretaries to 

develop specific strategies for 

children’s health outreach and 

educate speech writers about the 

initiative (Beginning in June 1998)

8 Mobilize Partnership for Family 

Involvement: (3,000 employers, educators, 

community and religious groups) to educate 

families about children’s health insurance 

(Beginning in June 1998)

10 Link appropriate Departmental 

Internet locations to DHHS’s 

children’s Internet site (Beginning 

in June 1998)

3 Provide periodic updates in news 

letters and bulletins regional 

representatives (Beginning in 

Summer 1998)

 

11

Disseminate information through 

both Departmental and outside 

group Listserves (June through 

August 1998)

4 Include information on outreach in 

new employees’ packets (Ongoing)

 

12

Distribute information at major 

conferences of PTA, NEA, US 

Conference of Mayors, etc 

(Beginning in June 1998)

5 Educate relevant clearinghouses, 

technical assistance centers 

/providers, parent centers, and 

grantees (September-October 1998)

 

13

Develop and distribute models for 

integrating school lunch and 

children’s health programs with 

USDA and DHHS (September 

1998)

6 Develop outreach plans for major 

programs (e.g., special education; 

migrant education) (Beginning in 

June 1998)

 

14

Work with Chicago Public School 

District to develop targeted 

outreach model (Summer 1998)

DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT

1 Send a letter and e-mail to all 9,500 

employees on outreach (July 1998)

7 Place CHIP/Medicaid outreach information 

on HUD’s computer "kiosks" at 

headquarters and 81 field offices 

(September 1998)

14 Send a letter to all Secretary’s 

Representatives, State 

Coordinators and Area 

Coordinators requesting they 

contact Medicaid/CHIP State 

offices (July 1998)

2 Provide information about outreach to 

80,000 grant applicants (Beginning in 

July 1998)

8 Send a letter about outreach to HUD 

grantees providing assistance to homeless 

families requesting that CHIP/Medicaid 

information is a part of their outreach and 

assessment (July 1998)

15 Incorporate information on 

outreach in "Community 

Builders’" training (Beginning in 

June 1998)

3 Send a letter describing outreach 

initiative to directors of 72 Urban 

Empowerment Zones/ Enterprise 

Communities (July 1998)

9 Send a letter asking directors of 3,400 

public housing authorities administering 

15,000 public housing developments to 

provide information to residents, applicants 

& post information (July 1998)

16 Link appropriate HUD Internet to 

DHHS’s Internet site (June 1998)

4 Provide outreach information to 

colleges and universities participating 

in Community Outreach Partnership 

Centers and Historically Black 

Colleges & Universities Program 

(July 1998)

10 

Send a letter to project owners and 

managers of HUD assisted and insured 

Multifamily properties providing 

 
(Fall 1998)

 

5

Provide information about outreach in 

technical assistance meetings, 

conferences, satellite broadcasts, and 

written material (Beginning in June 

1998)

11 Expand the WIC / public housing 

collaboration (MOU) to include the 

CHIP/Medicaid outreach initiative (July 

1998)

 

 

6

Provide information to 585 State and 

local jurisdictions administering 

HOME program funding, 

encouraging involvement (July 1998)

12 Send information regarding CHIP/ 

Medicaid to beneficiaries of the Native 

American Mortgage Loan Program 

(Beginning in July 1998)

 

 

13

Add CHIP/Medicaid information for 

parents and community groups on lead 

hazards (Beginning in July 1998)

 

 

DEPARTMENT OF THE INTERIOR

1 Send memo on outreach to BIA area 

offices, field offices, Tribal social 

services contractors, Office of Indian 

Education Program line officers, 

Bureau-funded schools, Tribal leaders 

(July 1998)

7 Develop and distribute culturally relevant 

information (e.g., poster, supplementary 

packets of information) for families to a 

wide range of sites (Beginning in Summer 

1998) 

12 Encourage national unions (NFFE 

and IEF) to notify their 

membership of CHIP and outreach

(September 1998)

2 Include in newsletter (Pathways and 

OIEP) feature articles and updates 

about Medicaid expansion/ CHIP 

(Ongoing)

8 Encourage intake workers to ask about 

children’s health needs and distribute 

referral information (August 1998)

13 Provide information about 

Medicaid/ CHIP to grassroots 

organizations that serve Indian 

families (June 1998)

3 Provide technical assistance to 

agencies, Tribal contractors, social 

services program staff on Medicaid/ 

CHIP and how to incorporate it into 

intake procedures (Ongoing)

9 Prepare press releases about Medicaid / 

CHIP for Indian newspapers (July 1998)

 

 

4

Provide briefings and programmatic 

updates via e-mail which area social 

workers will transmit to agencies and 

tribes without e-mail (Ongoing)

10 Encourage schools, tribal colleges, 

departments of education, OIEP line 

officers to send home notices about 

Medicaid/ CHIP; focus on it at the monthly 

parents’ meetings; hold information 

sessions/ distribute info. (Beginning in 

September 1998)

 

 

5

Disseminate outreach information to 

Office of Indian Education Program 

staff (August 1998 to January 1999) 

11 Sponsor public service announcements on 

Indian radio stations on Medicaid/ CHIP 

(October 1998)

 

 

6

Develop and distribute 10-minute 

video about outreach for Tribes, 

schools, agencies (February 1999)

 

 

DEPARTMENT OF LABOR

1 Send letter to 17,000 employees 

about outreach (July 1998)

8 Encourage States to outstation eligibility 

workers at Job Corps Centers (Fall 1998)

14 Create internet links, including a 
Bank used by millions of job 

seekers (Summer 1998)

2 Provide employees with updates on 

children’s health outreach (Ongoing)

9 Include Medicaid and CHIP information in 

200,000 brochures on pension and health 

benefits and material on HIPAA (Beginning 

in July 1998)

15 Send mailings to DOL 

constituencies (Fall 1998)

3 Ask the Federal Executive Board to 

coordinate all DOL agencies in the 

Regions to keep Federal employees 

informed on an ongoing basis 

(Ongoing)

10 Include Medicaid / CHIP message in 

information from the Employment 

Standards Administration (e.g., with Family 

and Medical Leave info.) (Beginning in 

September 1998)

 

 

4

Send letters to State Unemployment 

Insurance offices about Medicaid and 

CHIP (July-September 1998)

11 Encourage OSHA offices to distribute 

information on outreach through its offices 

and Consultation Program that visits about 

25,000 businesses (September 1998) 

 

 

5

Include outreach in major 

employment training conference (July 

1998)

12 Distribute information to miners through 

district offices and inspectors (September 

1998)

 

 

6

Send notices about outreach to the 

employment and training community 

(e.g., 113 Job Corps Centers; 700 

One-Stop Careers Centers) (JulySeptember 1998)

13 Distribute information through Office of 

Small Business Programs that has contact 

with 2,000 small employers (September 

1998)

 

 

7

Educate 1,300 "Honor Roll" members 

of Woman’s Bureau about outreach 

(July 1998)

 

 

SOCIAL SECURITY ADMINISTRATION

1 Send a Commissioner’s broadcast on 

outreach to 65,000 employees (June 

1998)

5 Display information on children’s health 

insurance in 1,300 SSA field office 

reception areas (Fall 1998)

7 Create internet link to DHHS’s 

children site, add to the SSA’s 

children’s page (Summer)

2 Publish an article in newsletter 

distributed to 65,000 employees and 

the Alumni Association about 

outreach (August 1998)

6 Develop a referral screen for health 

insurance on the SSA 800 number (Fall 

1998)

8 Provide HCFA with a mailing list 

of children denied SSI or who 

receive benefits on a different 

basis. (Fall 1998)

3 Distribute children’s health outreach 

material at SSA booths at about 110 

health fairs and at conferences, 

forums (Ongoing)

 

9

Collaborate with DHHS to use 

new database of 5,000 to 10,000 

community groups for outreach 

(Fall 1998)

4 Include outreach information in 

35,000 SSA teacher’s kits (January 

1999)

 

 

TREASURY DEPARTMENT

1 3 5
the Secretary to all 158,000 

employees (July 1998)

flyers) at the 400 IRS walk-in centers, 

provide information to 8,600 Voluntary 

Income Tax Assistance sites (FY1999)

community groups through the 

Electronic Fund Transfer (EFT99) 

initiative (Fall 1998)

2 Help make information available with 

E.I.T.C. outreach (Ongoing)

4 Invite State outreach workers to the annual 

E.I.T.C. awareness days at IRS walk-in 

centers (FY 1999)

6 Link Treasury and IRS Internet 

site to DHHS children’s health site

(Fall 1998)

 

 

 

 

2. REPORT FROM THE SECRETARY OF HEALTH AND HUMAN 

SERVICES 

 

The Department of Health and Human Services (DHHS) is the Nation’s 

largest health insurer. The Department’s mission is to enhance the health 

and well-being of Americans by providing for effective health and human 

services. DHHS Secretary, Donna Shalala has made children’s health one 

of her top initiatives and is committed to insuring America’s children. Her 

Department oversees the Medicaid program, which, in 1996, provided 

comprehensive health insurance coverage to over 18 million low-income 

children. DHHS also is the Department responsible for the administration 

of the new State Children’s Health Insurance Program (CHIP). This 

program provides approximately $20 billion over the next five years to 

extend health insurance at no or low cost to millions of uninsured children 

with incomes above Medicaid eligibility levels. 

DHHS is in a unique position to conduct outreach and to support other 

Federal Departments in their own outreach efforts. DHHS Agencies and 

their State partners have had years of experience in enrolling low-income 

children in these and other social service programs. Thus, DHHS could 

educate the other Federal Departments about Medicaid and CHIP, share 

with them our knowledge of effective outreach strategies and provide 

them with informational and enrollment materials to conduct their own 

outreach activities. 

The DHHS Agencies also could educate their own workers about 

Medicaid and CHIP who can distribute enrollment information to families 

in their roles as health and social service officials, providers, community 

volunteers, and neighbors. DHHS could work with States to reduce the 
logistical, administrative, cultural and legal barriers to enrolling in 

Medicaid and CHIP. Lastly, DHHS could develop partnerships with 

public and private businesses and associations with national scope and 

local roots to spread the word about Medicaid and CHIP throughout the 

country. 

The Department asked the following Agencies to develop outreach plans: 

the Health Care Financing Administration (HCFA), the Health Resources 

and Services Administration (HRSA), the Administration on Children and 

Families (ACF), the Agency for Health Care Policy and Research 

(AHCPR), the Centers for Disease Control an Prevention (CDC), the 

Indian Health Services (IHS), and the Substance Abuse and Mental Health 

Services Administration (SAMHSA). As a result of DHHS’ unique role in 

administering many of the key programs that serve low-income children, 

each of the Agency reports will be presented individually. 

The following sections contain reports from each of these Agencies 

describing the specific outreach activities they could undertake to enroll 

children in Medicaid and CHIP. 

A. HEALTH CARE FINANCING ADMINISTRATION 

 

I. CURRENT PROGRAMS AND OUTREACH 

ACTIVITIES FOR CHILDREN 

HCFA’s mission is to ensure quality health care coverage for its 

beneficiaries. This Agency is the largest purchaser of health care in the 

United States, currently providing benefits to approximately 72 million 

beneficiaries through Medicaid and Medicare. It will also oversee State 

Children’s Health Insurance Program (CHIP). Through this new insurance 

program, we have the opportunity to cover millions more of the Nation’s 

currently uninsured children. 

A. Programs that Serve Middle to Low-Income Children 

Medicaid ($91 billion Federal, $69 billion State in FY 1996) provides 

comprehensive health insurance coverage for low-income children, 

families, seniors, and persons with disabilities. Authorized under Title 

XIX of the Social Security Act, Medicaid is a joint Federal and State 

funded program that is administered by the States with oversight from 

HCFA. Children constitute nearly half of all Medicaid beneficiaries. In 

1996, approximately 22 percent of all America’s children were covered by 

Medicaid. An estimated 4.7 million uninsured children could be covered 
by Medicaid today but they have not enrolled. Target population: 18 

million low-income children, among others. 

State Children’s Health Insurance Program (CHIP) ($4.275 billion 

budgeted in FY 1998) is authorized under Title XXI of the Social Security 

Act. CHIP is the largest national expansion of health insurance coverage 

for low-income children since the enactment of Medicaid in 1965. CHIP 

provides States with a legislatively specified amount of Federal matching 

funds to provide comprehensive health coverage to uninsured children 

with family income above Medicaid eligibility standards. With CHIP 

funds, States generally are able to increase eligibility for health insurance 

up to 200 percent of the Federal Poverty Level for children under age 19. 

Target population: Low-income children under age 19 with income above 

Medicaid eligibility levels. 

B. Current Activities in Children’s Health Outreach 

Through discussions with State and Federal health officials and advocates, 

HCFA has identified several approaches for successful outreach: 

• Bring simplified eligibility information and enrollment processes 

to where families live and feel comfortable; 

• Get the message out in different ways and in different venues 

because people often must hear a message several times before 

they act on it; 

• Provide hands-on assistance in completing applications; and 

• Use linguistically and culturally appropriate messages and 

messengers so that people understand the information and trust the 

programs. 

These approaches require extensive field operations. By joining with other 

Federal and State health programs, advocates, primary care providers, 

faith communities, community-based organizations, schools, and child 

care and Head Start centers, we can greatly expand the reach and 

effectiveness of existing field networks. These groups work with 

uninsured children everyday and share an interest in seeing them covered. 

HCFA and State Medicaid and CHIP Agencies can provide these partners 

with materials and training. These partners can provide frontline workers 

to identify uninsured children and help families fill out and follow-up on 

applications. 

Therefore, HCFA’s broad strategy for current and proposed outreach 

initiatives is to: 

• Facilitate partnerships between State agencies that administer 

Medicaid and CHIP and other Federal and State health programs, 
community organizations, advocates and providers to assist in the 

design and conduct of outreach programs; 

• Provide these partners with accurate and up-to-date information on 

Medicaid and CHIP; 

• Identify and share examples of simplified applications, effective 

outreach strategies, and methods to reduce barriers in the 

enrollment process; and 

• Work with State Medicaid and CHIP Agencies to collect data to 

measure the effectiveness of our combined outreach efforts. 

Below is a description of HCFA’s current outreach activities: 

Training HCFA Staff on CHIP. HCFA and the Health Resources and 

Services Administration (HRSA) trained 400 HCFA Central and Regional 

Office staff to ensure their understanding of CHIP legislation, the State 

Plan approval process, and strategies for effective outreach. HCFA 

continues follow-up training for its staff through issue-specific teleconferences held twice a month. In addition, HCFA Central Office holds 

monthly conference calls with all Regional Offices to consolidate our 

perspective on effective outreach strategies. 

Training and Technical Assistance to States on Medicaid and CHIP 

Outreach. Early this year, HCFA and HRSA held regional conferences to 

assist States in designing their CHIP programs. Conference attendees 

included State and Federal officials and legislators, advocates, health care 

providers, and consumers. We explained the new options CHIP provides 

for States to increase health care coverage for uninsured children. We also 

discussed effective outreach programs. State and community leaders 

shared the outreach strategies they currently use to reach low-income 

individuals. Conferees considered what outreach strategies work best for 

certain minority populations and for persons in rural and urban settings. 

Outstationing Eligibility Workers. HCFA and HRSA also are jointly 

sponsoring a $1 million demonstration in twelve States to work with 

Medicaid Agencies on increasing their effective use of outstationed 

eligibility workers in Federally Qualified Health Centers (FQHCs). 

Although State Medicaid Agencies have been required to have 

outstationing arrangements with FQHCs since July 1991, we have learned 

that they are not in place in some areas and could be more effective in 

others. This project is designed to identify effective outstationing 

arrangements and to share this information with States. 

Sharing Strategies to Reduce Enrollment Barriers. HCFA is promoting 

strategies to reduce barriers for enrolling in both Medicaid and CHIP. On 

January 23, 1998 we wrote to State health officials on this subject. The 

letter contains 2 pages of promising outreach strategies and examples of 
both shortened Medicaid applications and joint applications for Medicaid 

and CHIP. The letter also encourages States to use mail-in applications. 

To reduce logistical barriers and stigmatization associated with Medicaid, 

HCFA recommends that States outstation eligibility workers at community 

sites such as schools, child care and Head Start centers. The letter 

highlights new statutory options available to States to grant presumptive 

eligibility and 12 months of continuous eligibility for children in 

Medicaid. 

 

II. PROPOSED PLANS FOR CHILDREN’S HEALTH 

OUTREACH 

1. Establish network of outreach specialists. In summer 1998, HCFA 

could establish a network of outreach specialists who would be 

responsible for the Medicaid and CHIP outreach initiatives described in 

this report. The network could consist of staff from HCFA’s Central 

Office and each of its Regional Offices. The team would be led by a 

Central Office coordinator. The Agency would train these outreach 

specialists and keep them current with new developments. HCFA 

envisions an outreach effort that is community-based. The outreach 

strategies, however, need to be portable. This network would enable the 

close coordination between Central and Regional Offices necessary to 

identify and share successful outreach strategies in use around the country 

and to keep States current on program and policy changes. HCFA could 

establish speakers’ guidelines that Central and Regional Office outreach 

specialists would follow when educating Federal workers about Medicaid 

and CHIP. The guidelines would be established by Fall 1998. 

A. Educating Workers about Medicaid and CHIP 

Federal Workers

To meet the challenge in the President’s Executive Memorandum, every 

participating Federal agency must mount a successful outreach program. 

As the Federal agency responsible for Medicaid and CHIP, HCFA needs 

to provide its Federal agency partners with up-to-date and accurate 

information to conduct their own outreach efforts. Outlined below are the 

activities HCFA proposes to meet this responsibility: 

2. Mirror the Interagency Children’s Health Outreach Task Force in 

the regions. Beginning in September, HCFA Regional Offices could 

convene quarterly tele-conference meetings of the regional components of 

the agencies and departments participating in the Task Force. This group 

would discuss how they can work together to implement the outreach 
initiatives each has undertaken as a result of the President’s Executive 

Memorandum. 

3. Create an on-line clearinghouse for outreach information. HCFA 

could create a webpage, linked to its existing child health page, to provide 

other Federal agencies with the information necessary to continue, 

enhance, and monitor their own outreach efforts. This on-line 

clearinghouse could include a summary of the outreach component, 

eligibility requirements, and delivery system for each approved CHIP 

State Plan and Medicaid expansion demonstration. It could provide 

feedback to our partners on the effectiveness of our combined outreach 

efforts. This information would be updated monthly until all CHIP State 

Plans are approved and quarterly thereafter. The on-line clearinghouse 

could be linked to State Medicaid and CHIP Agencies’ homepages so that 

visitors can click on them for more detailed information about a specific 

State’s Medicaid or CHIP program. HCFA could ask the Interagency 

Children’s Health Outreach Task Force to report to us on outreach 

strategies and materials they have found to be effective. This information, 

in addition to other documents containing examples of best practices, 

could be downloaded from the homepage. The on-line clearinghouse for 

outreach could become operational in Fall 1998. 

4. Distribute flyer on Medicaid and CHIP. HCFA could distribute a 

flyer to its Federal workers developed by the Interagency Children’s 

Health Outreach Task Force as an easy reference on Medicaid and CHIP. 

The flyer contains an overview of Medicaid and CHIP and describes how 

people can get involved in outreach. HCFA could begin distributing this 

flyer in the Summer of 1998. 

State Workers

While HCFA oversees Medicaid and CHIP, it is the States who actually 

administer the programs. As a result, HCFA must work in partnership with 

States to accomplish the President’s outreach goals. HCFA also must 

continue to facilitate partnerships between State Medicaid and CHIP 

Agencies and other Federal and State health programs, community 

organizations, advocates, and providers to help States better design and 

conduct outreach programs. Below are activities HCFA proposes to 

accomplish this: 

5. Identify outreach needs of State Medicaid and CHIP programs.

HCFA could contract to conduct focus groups with State Medicaid and 

CHIP Officials to identify their outreach needs and ways in which HCFA 

can assist them in meeting those needs. The contractor could also meet 

with States, advocates, providers, and community organizations to collect 

information on exemplary outreach initiatives and to learn how to 
effectively partner with these organizations. The contractor would report 

its findings by September 1998. HCFA could use the findings to develop 

outreach tools and could disseminate innovative outreach strategies to 

States as best practices in October, 1998. 

6. Facilitate partnerships between Federal and State workers. HCFA, 

and the Regional Offices in particular, could facilitate partnerships 

between State Medicaid and CHIP Agencies and other Federal and State 

health programs, advocates, health care providers, faith communities, 

community-based organizations, schools, and child care and Head Start 

centers to help States better design and conduct outreach programs for 

Medicaid and CHIP. The members of these organizations interact with 

uninsured children everyday and many have developed their own 

approaches for reaching and enrolling them. HCFA could assist States in 

identifying potential partners and could sponsor meetings of these groups 

to explore how they can work together on outreach. We also could assist 

States in educating new partners about Medicaid and CHIP so that they 

can appropriately identify children and help families accurately complete 

and follow-up on applications. The facilitation of partnerships would be an 

ongoing activity for HCFA beginning in Summer 1998. 

7. Identify and share outreach "best practices." HCFA could work with 

States and our other partners to define criteria for determining best 

practices in outreach and could solicit them for examples of such. 

Regional Office staff also would use these criteria to identify outreach best 

practices in the course of carrying out daily programmatic and outreach 

activities. These best practices would be accessible through HCFA’s online clearinghouse and distributed in hard copy to all States as outreach 

guidelines. Regional Offices could convene meetings of the States in their 

region so that they can learn from each other what does and doesn’t work 

for Medicaid and CHIP outreach. These activities would be ongoing for 

HCFA beginning in October 1998. 

8. Assist States in reducing barriers to enrollment. To assist States in 

reducing barriers to enrollment, HCFA could form a Task Force 

comprised of State health agencies, advocates and providers to provide 

guidance on how to simplify applications and the whole enrollment 

process. HCFA could collect and share examples of how States have 

attempted to destigmatize Medicaid and to increase cultural competency in 

the enrollment process. We would work with States to change the 

incentive for eligibility workers from screening people out to screening 

them in. The Agency would encourage States to elect presumptive 

eligibility and 12-month continuous eligibility for Medicaid children and 

assist them in implementing these options. These activities could begin 

during Summer 1998. 
Others Workers

To further the understanding of Medicaid and CHIP beyond the groups 

already mentioned, HCFA could: 

9. Publish articles on children’s health insurance coverage. HCFA 

could include future articles regarding Medicaid and CHIP in its 

newsletter, HCFA HealthWatch, which is distributed to health providers, 

State Medicaid and CHIP Directors, advocacy groups, beneficiaries, and 

special interest groups. Articles could focus on successful outreach 

strategies used by our Federal and State partners. HCFA could also write 

an article for the HealthyMothers/ HealthyBabies newsletter describing 

how this organizations’ local chapters can help in Medicaid and CHIP 

outreach efforts. Lastly, HCFA could dedicate an entire issue of Health 

Care Financing Review, the Agency’s quarterly publication, to children’s 

health issues. We could solicit articles to be published in Winter 1998. 

B. Educating Families and Enrolling Children in Medicaid and 

CHIP 

Ultimately, it is families of uninsured children who need to hear the 

message about Medicaid and CHIP and must understand how to enroll 

their children. HCFA understands that for outreach to be successful the 

message must be customized for specific segments of the population being 

targeted for outreach. In order to accomplish this HCFA could: 

10. Provide technical assistance to improve cultural competency of 

outreach efforts. HCFA could work to increase the cultural competency 

of Medicaid and CHIP outreach programs. HCFA could devote $350,000 

to conduct consumer focus groups to assist in the design and test the 

effectiveness of culturally sensitive mass media messages for CHIP. These 

messages could be made available for use by State Medicaid and CHIP 

Agencies, State and Local Health Departments, and advocacy groups. This 

money could also be used to advertise CHIP messages in selected radio 

and TV markets that provide ethnic programming. HCFA could also 

conduct focus groups to identify the outreach needs of newly arrived and 

well-established Hispanic immigrants and share this information with 

States. These two projects could begin during Summer 1998. In addition, 

HCFA could encourage State Medicaid Agencies to partner with providers 

who serve Asian Americans and Pacific Islanders (AAPI). Through these 

partnerships, States can educate providers about Medicaid and CHIP and 

providers can educate States about effective methods for reaching out to 

AAPI immigrants. HCFA could also create regional databases of 

organizations that serve AAPIs so that we can identify and work with 

groups that have first-hand knowledge of AAPI communities. This project 

could begin in Fall 1998. 
11. Outreach through grandparents. Today, many children are raised 

with the involvement of their grandparents. HCFA will look for 

opportunities to communicate with grandparents through Medicare 

materials. HCFA could include a message that encourages grandparents to 

find out about the children’s health insurance program on its initial 

enrollment package for new beneficiaries. We also will explore using 

National Medicare Hotline agents to refer callers to the CHIP toll-free 

number if they have questions about coverage for their grandchildren. 

(Beginning in September 1998) 

C. Coordination with Other Programs 

To facilitate outreach conducted by other Federal departments and 

agencies named in the President’s Executive Memorandum, HCFA could: 

12. Encourage nationwide distribution of CHIP toll-free number. The 

Administration, National Governors’ Association, and private groups are 

creating a national CHIP slogan and establishing a toll-free number that 

would link callers to the agency administering CHIP in his/her State. 

HCFA could partner with national public and private businesses and 

associations that may be willing to use their own resources to promote this 

number. This activity could begin as soon as the CHIP toll-free number is 

operational (Beginning in Fall 1998). 

13. Work with minority advocacy groups to promote outreach. HCFA 

could partner with organizations representing minority groups to explore 

how they can assist State Medicaid and CHIP Agencies in conducting 

outreach. For example, the Agency may work with La Raza, the National 

Congress of Black Churches, Historically Black Colleges and Universities, 

Tribal Colleges and Universities, and Washington Internships for Native 

Students. HCFA could provide them with information and materials about 

Medicaid and CHIP that they could distribute to their members (Ongoing). 

 B. HEALTH RESOURCES AND SERVICES 

ADMINISTRATION 

I. CURRENT PROGRAMS AND OUTREACH ACTIVITIES 

FOR CHILDREN 

The mission of the Health Resources and Services Administration (HRSA) 

is to improve the Nation’s health by assuring access to quality health care 

for under served, vulnerable and special-needs populations and promoting 

appropriate health professions workforce capacity and practice. HRSA has 

an ambitious portfolio of projects that seek to improve the health and wellbeing of children. Of HRSA’s $3.67 billion budget for FY 98, roughly one 

third is invested in young people. HRSA’s child health programs are 
successful because of the partnerships the agency has developed to 

identify eligible children and assist them in gaining access to quality 

health care services. HRSA has been actively engaged in outreach for 

Medicaid and new CHIP programs. 

A. Programs that Serve Middle to Low-Income Children 

The Maternal and Child Health Bureau ($842.5 million in FY 1998). 

While it has a special focus on children with special health care needs, low 

income families, families with diverse racial and ethnic heritages, and 

families living in rural or isolated areas without access to care, the 

Maternal and Child Health Bureau (MCHB) provides leadership, 

partnership, and resources to advance the health of all of the Nation’s 

mothers, infants, children, and adolescents. 

The Maternal and Child Health Services Block Grants (Title V) are 

awarded to 59 States and territories to conduct outreach activities that 

enhance Medicaid enrollment and improve access to preventive and 

primary health services for women, infants, children and adolescents. State 

Title V programs have outreach expertise and play a central role in 

designing and implementing outreach activities in each State, training 

providers and outreach workers, and assuring administration and oversight 

of outreach activities. 

The Healthy Start Initiative funds programs to reduce infant mortality in 

targeted high-risk communities and supports their replication across the 

Nation. As a supplement to the Healthy Start Program, HRSA recently 

launched the first-ever Prenatal Care Hotline (800-311-BABY), which 

links callers to State and local health care resources. The National 

Emergency Medical Services (EMS) for Children Program funds grants to 

the States for the development and enhancement of EMS programs for 

children with critical illnesses and life-threatening injuries. Finally, the 

Traumatic Brain Injury Demonstration Grant Program provides for studies 

and programs for traumatic brain injury in children. 

The Bureau of Primary Health Care (FY 98 budget - $966 million). The 

Bureau of Primary Health Care (BPHC) seeks to increase access to 

comprehensive primary and preventive health care and to improve the 

health status of under served and vulnerable populations who experience 

financial, geographic, or cultural barriers to care, through the programs 

described below. 

The Community Health Center Program (CHC) funds over 700 public and 

nonprofit private entities, under Section 330 of the Public Health Service 

Act, to provide access to preventive and primary health care services for 

people in areas where economic, geographic, or cultural barriers limit 
access to primary and preventive health care for a substantial portion of 

the population. 

The Health Care for the Homeless Program (HCH) improves access for 

homeless individuals to primary health care and substance abuse 

treatment. The 123 HCH grantees develop or participate in local coalitions 

of health care providers and social service agencies to identify community 

resources for the provision of shelter, food, clothing, employment training, 

and job placement for homeless individuals. 

The National Health Service Corps (NHSC) increases access to preventive 

and primary care services for people in health professional shortage areas 

by assisting in the development, recruitment, and retention of communityresponsive, culturally competent, primary care providers. Approximately 

350 scholarships are awarded annually. 

HIV/AIDS Bureau ($1.15 billion in FY 1998). The HIV/AIDS Bureau 

administers the Ryan White Comprehensive AIDS Resources Emergency 

(CARE) Act, which seeks to improve the quality and availability of care 

for people with HIV/AIDS and their families. The Bureau funds a number 

of programs to benefit low-income, uninsured and underinsured 

individuals and families affected by HIV/AIDS. 

The CARE Act has four titles. Title I provides formula and supplemental 

grants to Eligible Metropolitan Areas that are disproportionately affected 

by the HIV epidemic. Title II provides formula grants to States, the 

District of Columbia, Puerto Rico and eligible territories to provide health 

care and support services for people living with HIV disease, including 

home and community-based health care and support services, continuation 

of health insurance coverage through a Health Insurance Continuation 

Program, and pharmaceutical treatments through an AIDS Drug 

Assistance Program. Title III supports outpatient HIV early intervention 

services for low-income, medically under served people in existing 

primary care systems. Finally, Title IV programs coordinate HIV services 

and access to research for children, youth, women, and families in 

comprehensive, community-based, family-centered systems. In addition, 

Ryan White supports the training of AIDS providers and reimburses dental 

services to persons with HIV/AIDS. 

The Bureau of Health Professions ($290 million in FY 1998). Through 

Titles VII and VIII of the Public Health Service Act, the Bureau 

administers health professions education and training programs that 

promote a health care workforce with the skills necessary to deliver costeffective quality care, improve cultural diversity in the health professions, 

and meet the needs of vulnerable populations. The Bureau supports 
training of primary care providers and family medicine and pediatric 

residencies. 

Office of Rural Health Policy ($47.1 million in FY 1998). HRSA's 

Office of Rural Health Policy works within DHHS and with other Federal 

agencies, States, national associations, foundations, and private-sector 

organizations to seek solutions to health care problems in rural 

communities. The Office administers the Rural Health Outreach Grant 

program which promotes collaborative arrangements among providers to 

bring basic health care services to under served populations in rural areas. 

The Office also funds grant programs to develop vertically integrated 

systems of care in rural communities and to demonstrate the use of 

telecommunications technologies in improving access to care. 

B. Current Activities in Children’s Outreach 

Current Activities to Educate Workers about Medicaid and CHIP 

Informing grantees and constituencies about outreach for Medicaid 

and CHIP. HRSA has sent letters to its grantees about CHIP, Medicaid, 

and outreach issues. These letters stress the need for grantee participation 

in the collection of data on outreach efforts and children’s insurance 

status. States’ Title V directors hold monthly calls to discuss Medicaid and 

CHIP implementation, including successful outreach strategies. HRSA 

also informs constituent organizations about important issues around 

outreach and children’s health, including States’ primary care associations 

and organizations, the National Association of Community Health 

Centers, the Association of State and Territorial Health Officers (ASTHO) 

(with monthly calls with its management committee), the National 

Association of City and County Health Officers, the National Association 

of States Legislatures, the National Governors Association, and the 

Association of Maternal and Child Health Programs (AMCHP). 

Sharing successful outreach models. HRSA has published information 

on successful, easily replicated models for outreach for uninsured children 

and special populations in Reaching Our Children, Community Outreach

(Volume IV: The Healthy Start Initiative, already available), and other 

publications. Successful outreach models are collected and featured on 

HRSA’s newly established child health websites (see 

http://www.hrsa.dhhs.gov/ childhealth and 

http://www.bphc.hrsa.dhhs.gov). 

Collecting data about effective outreach practices. HRSA will collect 

information on outreach and child health insurance status from its 

grantees. The Uniform Data System, a tool used to collect data from 

community health centers regarding clients and services delivered, has 
been modified. It now requests information about the number of children 

served who are insured by State CHIP plans and Medicaid. Title V 

performance indicators also require States to identify the percentage of 

children without health insurance, the percentage of children with special 

health care needs to receive comprehensive services, etc. This information 

will be valuable to HRSA’s staff in examining the success of outreach and 

enrollment strategies. 

Joint multi-state project to expand Medicaid enrollment by 

outstationing eligibility workers. The Bureau of Primary Health Care has 

initiated a joint HCFA- HRSA, $1 million demonstration project in 12 

States that began in April of l998 to improve utilization of outstationed 

eligibility workers. The demonstration encourages comprehensive and 

innovative approaches to Medicaid enrollment in Federally Qualified 

Health Clinics (FQHCs) and document the impact on improving Medicaid 

enrollment. 

Outreach conference. The Bureau of Primary Health Care held an 

outreach conference in Washington D.C., June 17-19, 1998, to provide 

workshops on funding, policy recommendations, and skills building for 

outreach workers. Policy makers, community health workers, outstationed 

eligibility workers, health center executives, HMO and private health 

industry representatives, and key persons from non-profit and community 

based organizations attended. 

Using interdepartmental collaboration to provide information about 

outreach. HRSA’s Midwest Field Cluster convened an outreach 

conference on April 8 - 9, l998, involving 10 States. This conference was 

planned with input from Regional Federal staff, including HRSA, HCFA, 

ACF, HUD, and the EPA. It will serve as a model for similar conferences 

that might be convened in other regions. 

Using toll-free numbers to provide direct patient information. Title V 

programs sponsor toll-free numbers in every State, that provide 

information about health care services and providers under Title V and 

Medicaid for pregnant women and infants. Currently, these lines educate 

callers about Medicaid and refer callers to Medicaid eligibility workers, 

and (as CHIP comes on line in each State) CHIP eligibility workers. Last 

year, more than 1 million callers received assistance. 

Educating and enrolling families. HRSA’s Bureaus share the goal of 

educating families and assisting them in enrolling children in Medicaid 

and CHIP. Grantees funded through the Bureau of Primary Health Care 

and the Office of Rural Health Policy provide clients with direct 

application assistance for Medicaid and other programs; the Maternal and 

Child Health Bureau works with parent advocates to identify and enroll 
children with special health care needs in Medicaid; and Ryan White 

grantees funded through the HIV/AIDS Bureau are required to assess 

clients for eligibility for Federal, State or private health coverage before 

providing Ryan White CARE Act funded services. 

Working with advocacy groups. HRSA works with advocacy groups to 

develop and implement outreach strategies. The Maternal and Child 

Health Bureau has contacts with organizations representing families, 

including Family Voices, which represents families of children with 

special health care needs. 

Working with other Federal groups that have a child health focus. 

HRSA’s Bureaus meet with major Federal organizations that represent or 

affect their target populations and encourage collaboration at the national 

level, including the Maternal and Child Health/Medicaid Technical 

Assistance Group (TAG), the Maternal and Child Health/Administration 

for Children and Families Technical Assistance Group (ACF TAG), and 

the Secretary’s Advisory Council on Infant Mortality. These groups all 

have an interest in outreach for children’s health. 

Assessing States’ outreach strategies as they design and implement 

CHIP. The Bureau of Primary Health Care has commissioned the Texas 

Association of Community Health Centers to work with the primary care 

associations in the five States receiving the largest CHIP allotments to 

assess CHIP opportunities and to document the impact of the CHIP 

design/implementation on Federal programs such as community health 

centers. Effective strategies for ensuring Bureau-supported program 

participation in CHIP, including their role in providing outreach, will be 

identified and shared with other States. 

Linking health providers. The Maternal and Child Health Bureau’s Title 

V programs are required to coordinate their activities with other programs 

that serve mothers and children, including Medicaid, EPSDT, WIC, health 

and developmental disability programs, and family planning programs. 

For example, in Tennessee the State Title V program provides outreach to 

all families in TennCare, the Tennessee Medicaid managed care program. 

In North Carolina, the Baby Love Program is jointly administered by three 

agencies, the State’s Title V agency, the Division of Medical Assistance, 

and the Office of Rural Health and Resource Development. Healthy Start 

projects’ front line workers and supervisors assure linkages among health 

provider networks, social service agencies, and non-traditional providers 

that assist in identifying children who are eligible for child health 

insurance programs. Healthy Start grantees are expected to coordinate 

with State and local agencies on resource availability, especially Medicaid 

and CHIP. Finally, State Offices of Rural Health also are encouraged to 

work with existing programs and coordinate activities across the range of 
State and Federal initiatives that help serve rural populations, including 

programs that identify eligible children and provide health services for 

them. 

Requiring SSDI to describe its collaboration. State Systems 

Development Initiatives (SSDI), a $5.9 million grant program to each 

State and jurisdiction for maternal and child health network building, 

proposes to require projects to report on how they collaborate for outreach 

with other maternal and child health projects in that State, including: State 

primary care and State Medicaid programs, WIC, Social Security 

Administration, health professions education (including AHEC), special 

education, early intervention, social services/child welfare, rehabilitation 

services, corrections; and State mental health, alcohol and substance abuse 

programs. 

Educating Rural Grantees. The Office of Rural Health Policy included 

an article in the spring, 1998 edition of it’s publication Rural Health News,

highlighting successful outreach efforts for improving access to health 

care services for low-income families and children. 

 

II. PROPOSED PLANS FOR CHILDREN’S HEALTH 

OUTREACH 

A. Educating Workers about Medicaid and CHIP 

Federal Workers

1. Convene regular meetings with other Federal workers at the 

Regional level. HRSA’s Regional Offices, principally through their 

maternal and child health coordinators, would provide information to other 

regional Federal staff about CHIP, Medicaid enrollment, and outreach on a 

regular basis. Several regions already hold regular meetings, and this 

practice should be expanded to all regions. For example, in Region IX 

(San Francisco), HRSA, HCFA and ACF are meeting on a biweekly basis 

to develop CHIP outreach strategies. In Region II (New York), HCFA and 

HRSA are collaborating to provide information to the Federal workforce 

around CHIP, with a particular emphasis on outreach, through formal 

presentations to ACF, the Office of the Inspector General, the Welfare 

Task Force, and the Office of Civil Rights. (Ongoing) 

2. Train health professionals who serve underserved communities 

about outreach. The Bureau of Primary Health Care will begin a new 

National Health Service Corps training program around community-based 

issues and outreach with field and State offices. This will serve as a 
vehicle for delivering messages about CHIP, Medicaid, and outreach. The 

Bureau of Health Professions’ 140 Area Health Education Centers 

(AHECs), which support community-based health professions training, 

could distribute information about outreach for Medicaid and CHIP by 

utilizing AHEC center directors to provide information to over 21,000 

health professions students and 50,000 health care providers in FY 98. 

Both projects could be completed, without additional resources, by July 

l998. 

3. Distribute best practices in coordination with Maternal and Child 

Health and State child health insurance programs. The Maternal and 

Child Health Bureau has contracted with the Lewin group to examine the 

relationship between Title V programs and six previously existing Stateonly child health insurance programs. This study will be completed at the 

end of May, l998. Information gained from this study could be used to 

provide technical assistance to State Title V directors that helps them to 

maximize their Title V resources around outreach and other areas. 

State Workers

4. Encourage outreach through School Health Programs. The Bureau 

of Primary Health Care is developing a campaign for the 26 Bureaufunded Healthy Schools/Healthy Communities School Health Programs, 

on CHIP and Medicaid eligibility and enrollment. The Bureau could use a 

multimedia approach to educate school health clients and their parents 

about Medicaid and CHIP eligibility. Flyers could be distributed, a video 

on CHIP and Medicaid could be played, and posters could be displayed in 

clinic waiting rooms. This activity could begin in June of l998. 

Other Workers

5. Broaden children’s health outreach technical assistance to grantees 

and community-based organizations. HRSA’s Bureaus propose to 

broaden their efforts to provide technical assistance on child health and 

outreach to grantees and community-based organizations beginning in 

June 1998. The Maternal and Child Health Bureau, working with the 

Association of State Maternal and Child Health Programs, State Maternal 

and Child Health Directors and Children with Special Health Care Needs 

Directors, could identify outreach and enrollment problems and solutions 

as States implement CHIP programs. In particular, technical assistance 

would focus on identifying and enrolling uninsured and special population 

children, breaking down barriers, and ensuring that these children have 

access to care. Information would be provided through State-wide 

Maternal and Child Health toll-free information lines, articles in 

organizational newsletters, key information on all websites with linkages 
to specific HRSA programs, and presentations at continuing education 

meetings for grantees. 

6. Require Ryan White grantees to educate staff about Medicaid and 

CHIP. HRSA’s HIV/AIDS Bureau would develop a Policy Directive

requiring grantees to educate appropriate staff about State-specific 

Medicaid and CHIP eligibility requirements and develop procedures for 

facilitating client enrollment. Case managers, benefits counselors, social 

workers, and others who assess eligibility for services or make referrals 

for services could receive special training. This activity would be 

completed by August of l998. 

7. Encourage rural grantees to ensure that State outreach plans 

addressed the needs of rural communities. The Office of Rural Health 

Policy could send a letter to its 221 grantees from its four programs 

(Outreach, Network, Telemedicine, and State Offices) informing them 

about CHIP and Medicaid and encouraging them to get involved in their 

individual State CHIP activities. This activity could be completed by the 

end of June l998. 

B. Educating Families and Enrolling Children in Medicaid and 

CHIP 

8. Disseminate Medicaid and CHIP information through 700 

community-based health centers and 50 State MCH programs. The 

Bureau of Primary Health Care and the Maternal and Child Health Bureau 

could disseminate State-based Medicaid and CHIP information through its 

700 health centers and 50 State MCH programs. CHCs could utilize flyers 

developed at the Department level to educate their workers, then develop 

materials for their centers that are multilingual and culturally competent. 

The Bureau of Primary Health Care could encourage community health 

centers to print the CHIP hot line number on the immunization cards 

handed out to parents of newborns and toddlers. Community health 

centers could begin to distribute the new immunization cards as soon as 

the State they are located in has an approved CHIP plan. (Fall 1998) 

9. Building and coordination community coalitions. HRSA proposes to 

develop a community mobilization effort that promotes community-based 

outreach for CHIP and Medicaid. Members of the coalition could include 

the Urban League, the Parent Teacher Association (PTA), the Kiwanis 

Club, the National Association for the Advancement of Colored People 

(NAACP), and other groups that have a community oriented focus. 

Activities would include mass mailings, participation in community pride 

days, and local town meetings. In addition, HRSA could work with the 

American Association of Retired Persons (AARP), the Administration on 

Aging, and the Retired Senior Volunteer Program to target grandparents 
who are care givers of CHIP and Medicaid eligible children. These 

activities could begin by June of l998. 

C. Coordination with Other Programs 

10. Working with border communities. The Bureau of Primary Health 

Care and the Border Health Program are exploring the opportunity for a 

demonstration project in two border settings that would integrate 

behavioral health and primary care services for at-risk children ages 0-7 in 

two border health centers. Outreach to children would be a critical 

component of the program and the evaluation. This project could begin in 

FY 1999 and would cost $250,000 per border setting. 

11. Training outreach workers in EZ/EC communities. The Bureau of 

Primary Health Care could target Federally designated Empowerment 

Zones and Enterprise Communities (EZ/EC) for community 

empowerment, economic stimulation, job creation around outreach, and 

the provision of primary health care. Health centers are an ideal 

environment for training outreach workers because of the center’s socially 

supportive environment. Many residents would be able to find 

employment and training opportunities within walking distance of their 

homes. This approach could result in economic development which would 

anchor outreach services as a vital part of the community health structure. 

This activity could begin August 1, l998. 

12. Referring Title V hotline callers to CHIP information sources.

Title V (Maternal and Child Health) and Healthy Start toll-free hotlines 

could direct callers inquiring about health insurance to CHIP information 

sources. This activity began in March 1998. When the national CHIP tollfree line is operational, it could also be linked (Fall 1998). 

 C. ADMINISTRATION FOR CHILDREN AND FAMILIES 

 

I. CURRENT PROGRAMS AND OUTREACH ACTIVITIES 

FOR CHILDREN 

A. Programs That Serve Middle To Low-Income Children 

The Administration for Children and Families, together with its partners -- 

States, localities, and non-profit organizations -- supports strategies and 

creates opportunities for low-income and disadvantaged families and 

individuals to lead economically and socially productive lives; for children 

to develop into healthy adults; and for communities to become more 

prosperous and supportive of their members. Because of its vast human 
services networks with States, local and tribal government organizations, 

community-based organizations, child care and Head Start Centers, ACF 

is in a unique position to assist in providing information about outreach 

and enrollment services to assure that eligible children actually are 

enrolled in CHIP and Medicaid. 

Temporary Assistance for Needy Families (TANF) ($16.5 billion in 

1997/98), authorized under Title IV-A of the Social Security Act, 

amended by P.L. 104-193, promotes work, responsibility and self 

sufficiency and strengthens families through funding of State-designed 

and administered programs that provide support to needy children and 

move their parents into work. Target population: All families that meet 

States’ new public assistance criteria. 

Child Support/IV-D Program ($12 billion collected in 1997/98), 

authorized under Title IV-D of the Social Security Act, as amended, 

locates parents, establishes paternity and support obligations and modifies 

and enforces those obligations (to assure financial support is available to 

children) through State agencies that administer the program. Target 

population: The 11.5 million families whose child has a parent living 

elsewhere. 

Head Start/Early Head Start ($4.35 billion in 1997/98), authorized 

under Section 639 of the Head Start Act, as amended, provides 

comprehensive child development services to children and families, 

primarily for preschoolers from low-income families through grants to 

1,400 local, public and private non-profit agencies. Target population: 

About 830,000 low-income, pre-school children. At least 10 percent of the 

enrollment opportunities in each program must be made available to 

children with disabilities. 

Foster Care ($3.5 billion in 1997/98), Adoption Assistance ($701 

million in 1997/98), Independent Living ($70 million in 1997/98), 

Sections 470 and 477 of Title IV-E of the Social Security Act, as 

amended; Section 205 of the Child Abuse Prevention and Treatment and 

Adoption Reform Act of 1978, as amended; and Section 104(a)(1) of the 

Abandoned Infants Assistance Act of 1988, as amended; for children who 

cannot remain safely in their homes, foster care provides a stable 

environment that assures a child’s safety and well-being while their 

parents attempt to resolve the problems that led to the out-of-home 

placement or when the family cannot be reunified, until the child can be 

placed permanently with an adoptive family. Independent Living 

programs provide education and employment assistance, training in daily 

skills, and individual and group counseling to youth reaching adulthood. 

Target population: All children that are in foster care and teenagers who 

were or are in foster care ages 16+. 
Child Care ($3.1 billion in 1997/98), authorized under sections 658A 

through 658S of the Omnibus Budget Reconciliation Act of 1981, as 

added by P.L. 101-508, amended by P.L. 102-586, 103-171 and 104-193, 

assists low-income families and those transitioning off public assistance to 

obtain child care that is safe, healthy and affordable so that they can work 

or attend training/education programs. Target population: All children 

under the age of 13 and all youth under court supervision, older youth that 

are mentally and/or physically challenged to the age of 19. (Note: Serving 

older youth over age 13 is a State option) 

Community Services Block Grant ($415 million in 1997/98), authorized 

under Section 672 of the Community Services Block Grant Act, as 

amended, provides an array of social services and programs to assist lowincome individuals and alleviate the causes and conditions of poverty 

through flexible funding at the State and local level. Target population: 

Low-income children, individuals and families that meet the poverty 

income guidelines. 

Refugee Resettlement ($396 million in 1997/98), authorized under Title 

IV of the Immigration and Nationalization Act and Section 501 of the 

Refugee Education Assistance Act of 1980 (P.L. 96-411) and Section 

414(a) of the Immigration and Nationalization Act under P.L. 104-134 

[103-333], assists refugees and entrants who are admitted into the United 

States to become employed and self-sufficient as quickly as possible by 

providing grants to States and other grantees for employment-related 

services, social adjustment, transitional cash and medical assistance, and 

other services. Target population: Refugees and Cuban and Haitian 

entrants who are admitted into the United States. 

Child Welfare ($292 million in 1997/98), authorized under Sections 470 

and 477 of Title IV-E of the Social Security Act as amended, funds State 

programs that provide services focused at assisting at-risk children and 

their families in achieving the best and most appropriate outcomes for the 

children: preventive intervention services to strengthen the family unit; 

services to move children more rapidly from foster care to safe, permanent 

homes; and reunification services to facilitate the return home of the child 

if in the child's best interest. Target population: All children, newborns to 

18 years of age that may be at risk for abuse and/or neglect. 

Developmental Disabilities ($114.2 million in 1997/98), authorized under 

Sections 130, 143, 156 and 163 of the Developmental Disabilities 

Assistance and Bill of Rights Act of 1990, as amended, funds programs 

which assist States to assure that individuals with developmental 

disabilities and their families participate in the design of and have access 

to culturally competent services, supports, and other assistance and 

opportunities that promote independence, productivity, and integration and 
inclusion into the community. Target population: All children and adults 

with developmental disabilities. 

Youth Programs ($58.6 million in 1997/98) [requested reauthorization], 

supports services provided through local agencies to reduce sexual abuse 

of runaway, homeless and street youth; provide alternate activities for atrisk youth and further the goal of providing safe passages for the Nation's 

youth, giving them the tools they need to successfully move from 

childhood to adulthood by stimulating positive development and 

preventing high-risk behavior. (A major focus includes looking at what 

works in all areas of development and disseminating best practices and 

proven products.) Target population: Provides shelter, food, clothing, 

counseling and other supports to 80,000 + young people ages 11 through 

18. 

Native Americans ($35 million in 1997/98), authorized under Sections 

816(a) and 803A(f)(1) of the Native American Programs Act of 1974, as 

amended, promotes economic and social self-sufficiency of American 

Indians, Alaska Natives, Native Hawaiians, and Native Pacific Islanders 

by supporting programs and encouraging local strategies in economic and 

social development. Target population: American Indians, Alaska Natives, 

Native Hawaiians and Native American Pacific Islanders. 

B. Current Activities in Children’s Health Outreach 

Collaborate with DHHS partners on interagency implementation and 

planning committee meetings. ACF staff have begun and will continue 

to collaborate with other DHHS partners on interagency 

implementation/planning committees at Regional and Central Office 

levels. ACF Regional staff have begun and will continue to review State 

CHIP plans, in cooperation with HCFA, to ensure that ACF constituencies 

are being included. 

Developing of website links to HCFA’s CHIP information site. 

Sent letters to grantees and colleagues. ACF program offices have 

written letters to grantees and colleagues to inform them about CHIP 

implementation and the importance of their involvement in the process, 

e.g. Community Service Block Grant State Administrators. 

Discuss the importance of CHIP at meetings and conferences. ACF is 

currently and will continue to discuss the importance of involvement in 

CHIP implementation at grantee meetings and conferences, e.g. State 

Child Care Administrators meeting in July 1998; Tribal Child Care 

Conference in May 1998; National Community Action Agency 

Conferences in April, May and June; Developmental Disabilities 
Commissioners Forum (TBS); Family Independence Forum (TBS); 

national Head Start Meetings in February and April; and numerous 

Regional Office conferences. 

 

II. PROPOSED PLANS FOR CHILDREN’S HEALTH 

OUTREACH 

Our major program offices, as well as our ten Regional offices, have 

submitted specific CHIP outreach plans. These plans identify the 

following major areas for ACF focus: coordination efforts with Federal 

and State health agencies to ensure that outreach opportunities are 

included; general information dissemination regarding CHIP/Medicaid; 

technical assistance and training to ACF staff and partners regarding 

CHIP/Medicaid and outreach opportunities; and assistance with a national 

media campaign. ACF could also focus CHIP and Medicaid promotional 

efforts in those communities that have families considered to be "under 

served" by State Primary Care Access Plans (as submitted to the Bureau of 

Primary Health Care based on poverty rates, minority populations, and 

ratio of physicians to population) and Empowerment Zone/Empowerment 

Community initiatives. These proposed activities would be part of ongoing 

outreach and would not require additional funding resources. 

A. Educating Workers about Medicaid and CHIP 

Federal Workers

1. Brief and distribute outreach information to Regional office staff 

and other Federal partners. ACF Regional staff have been and could 

continue to work with HCFA to periodically brief Regional office staff 

and other Federal partners on CHIP/Medicaid implementation and 

progress. ACF could also conduct monthly ACF, CHIP and Medicaid 

outreach and implementation update meetings that involve representatives 

from all Regional offices and central office staff. Distribute information to 

all ACF offices (10 Regions and 9 Central Offices) through mailings, 

weekly Regional/Central Office video conference video calls and E-mail 

as important Medicaid/CHIP outreach and implementation materials are 

received/acquired. (Ongoing) 

State Workers

2. Distribute outreach information to State and local partners. Using 

materials and language created by HCFA as guides, ACF could develop 

and distribute program specific Information Memoranda/Dear Colleague 

letters to 50 State and U.S. Territories Welfare/ACF Program Directors on 
CHIP/Medicaid outreach and implementation, e.g., State/Tribal 

/Territorial Child Care Administrators, State Child Welfare Directors, 

Social Services State Directors, State Developmental Disabilities 

Councils, Protection and Advocacy Agencies and University Affiliated 

Programs, Runaway and Homeless Youth grantees, Head Start grantees, 

State Refugee Coordinators. (Initial Introductory letter in Summer 1998, 

updated thereafter as necessary) 

3. Invite State Directors to participate in conferences and forums.

ACF program offices could invite and encourage State Welfare/ACF 

Program Directors to participate in conferences and forums that contain 

CHIP and Medicaid outreach information or updates, by providing 

feedback and specific examples of barriers and opportunities in providing 

outreach to CHIP/Medicaid eligibles. (Ongoing) 

Other Workers

4. Actively enroll ACF grantees and technical assistance contractors 

in outreach effort. In cooperation with HCFA staff, ACF could continue 

to actively work with ACF grantees and technical assistance contractors 

by providing them with CHIP and Medicaid information and briefings 

(i.e., understanding enrollment application procedures, etc.); inviting and 

encouraging them to participate in conferences and forums that contain 

CHIP information and updates; including CHIP in grantee and technical 

assistance contractor meetings, conferences and forums by adding CHIP 

and Medicaid related topics and speakers to agendas; providing updates on 

CHIP implementation in news letters and bulletins that target ACF 

programs, grantees and technical assistance contractors; and requesting 

that ACF grantees and technical assistance contractors share exemplary 

outreach strategies, tools and best practices. (Ongoing) Note: For specific 

ACF programs included in this activity, refer to listing of programs under 

the first section. 

B. Educating Families and Enrolling Children in Medicaid and 

CHIP 

5. Encourage State Child Support offices to promote outreach. ACF 

could encourage State Child Support offices via letter, to routinely petition 

court and administrative authorities to include CHIP and Medicaid 

information in new and modified child support orders and provide periodic 

mailings to families with children that have no health coverage in Child 

Support cases. (Initial notice in February 1998, updates thereafter as 

needed) 

6. Encourage distribution of CHIP and Medicaid promotional, 

enrollment, and application materials. ACF could encourage programs, 
grantees and contractors to provide Medicaid and CHIP enrollment 

applications and assistance to customers and client families. Additionally, 

ACF could, when possible, display and distribute CHIP and Medicaid 

promotional materials at prominent and visible locations in States where 

ACF programs/grantees/contractors are located (e.g., Welfare/TANF 

Offices, Head Start/Early Head Start program locations, Tribal 

Government Offices). (Ongoing) 

7. Provide technical assistance for outreach to Tribes, Native 

Hawaiians and Pacific Islanders. ACF/Native Americans Programs 

could supplement a technical assistance contract to include CHIP and 

Medicaid outreach activities to allow them to outreach to urban Indians, 

off-reservation groups and Native Hawaiians and Pacific Islanders at no 

additional cost to the contract. (Ongoing) 

8. Send letter to States encouraging outstationing in areas with high 

Child Care, Early Head Start and Head Start enrollments. These 

workers would assist families in understanding the importance of CHIP 

and Medicaid enrollment and provide for the grantees a vehicle for 

information and assistance. (July 1998) 

C. Coordination with Other Programs 

9. Coordinate efforts with other Federal and State agencies. ACF 

could coordinate efforts with HRSA, HCFA and other DHHS agencies as 

they begin to implement outreach strategies in communities (see activities 

under II, A-C). ACF could ensure that all community-based 

organizations/programs (e.g. Community Service Block Grant and Head 

Start grantees) are collaborating with other DHHS community based 

programs and agencies to facilitate and simplify outreach efforts and 

strategies. (Ongoing) 

 D. AGENCY FOR HEALTH CARE POLICY AND 

RESEARCH 

 

I. CURRENT PROGRAMS AND OUTREACH ACTIVITIES 

FOR CHILDREN 

The Agency for Health Care Policy and Research (AHCPR) is the lead 

agency charged with supporting research designed to improve the quality 

of health care, reduce its cost, and broaden access to essential services. 

AHCPR's broad programs of research bring practical, science-based 

information 
to medical practitioners and to consumers and other health care 

purchasers. 

A. Programs that Serve Middle to Low-Income Children 

In 1997 AHCPR supported approximately $13.5 million in research 

projects related to children’s health. Projects included development and 

testing of a consumer-focused survey on the quality of children’s health 

care, a study testing alternative approaches to implementing HHSdeveloped guidelines for asthma care in children, a study testing a 

computer-based decision-support system to help providers identify 

newborns at risk of jaundice, and several studies of emergency services for 

children. AHCPR-supported researchers on these and other AHCPRsupported projects have contact with organizations that serve children 

(e.g., hospitals, health care providers) or with children and their families 

directly. AHCPR does not fund service programs per se. 

B. Current Activities in Children’s Health Outreach 

Conduct Children’s Health Initiative workshop for States. AHCPR has 

traditionally held workshops for State and local policy makers on issues in 

children’s health such as quality, reaching children with special health 

care needs, and access. This year, AHCPR consulted with State policy 

makers with responsibility for implementing CHIP; this year’s workshop 

will be responsive to their needs related to CHIP and related programs. 

AHCPR’s User Liaison Program will hold a 2-day workshop for State and 

local policy makers on the Children’s Health Insurance Initiative on June 

30-July 1, 1998. The purpose of the workshop is to present health services 

research and best practices from State programs to State and local policy 

makers, including Medicaid Directors, Maternal and Child Health 

Directors, and Public Health Officers from States that are in the process of 

developing policies for implementation of the Child Health Insurance 

Initiative. The workshop will include sessions presenting research and 

"best practices" on outreach models. 

 

II. PROPOSED PLANS FOR CHILDREN’S HEALTH 

OUTREACH 

A. Educating Workers about Medicaid and CHIP 

Federal Workers

1. Inform Federal employees about outreach. AHCPR would take a 3-

step approach to inform its staff of approximately 270 FTEs: 
• E-mail to all staff describing CHIP and Medicaid, the problem of 

uninsured but eligible children, the HHS and Administration-wide 

outreach initiative, and how staff can use the materials to reach out 

to targeted eligible children and families in their communities. 

(June 1998) 

• Desk-to-desk handout of HHS/Administration-developed flyer and 

other HHS/ Administration-developed informational materials on 

outreach for employees to use in their capacities as health care 

providers, volunteers in community agencies, and neighbors. 

(Summer 1998) 

• Follow-up with Office and Center Directors (supervisors) to 

remind employees of the outreach initiative. (Fall 1998) 

B. Educating Families and Enrolling Children in Medicaid and 

CHIP 

2. Encourage grantees and contractors to educate families about 

outreach. Send letter to the principal investigator(s) and team of each 

"child health" grantee and contractor, enclosing the Department-developed 

flyer and other Department-approved outreach materials. The letter would 

ask each grantee team to do one or both of the following: 

• Distribute the flyer directly to families with children with whom 

the grantee team comes in contact; 

• Post the flyer in places where families with children can see it (or 

see that the relevant departments in the grantee institution do so). 

Letters could be prepared and sent when departmental flyer is available 

(planned for summer 1998). 

3. Encourage grantees in co-sponsored research projects to educate 

families about Medicaid and CHIP outreach. AHCPR could continue to 

co-sponsor research projects with other agencies (e.g., HRSA, NIH). For 

example, AHCPR is collaborating with HRSA on four research projects 

on emergency services for children and on a project investigating office 

systems to improve preventive care for children. NIH is co-funding 

development of a child health status measure for children ages 5-11, as 

well as an evidence report on attention deficit hyperactivity disorder. 

AHCPR could ensure that these grantees are informed about children’s 

health outreach. (Summer 1998 and ongoing) 

C. Coordination with Other Programs 

4. Notify outside individuals and groups about outreach via its child 

health listserv (200-plus subscribers). AHCPR could send e-mail that 

alerts subscribers to the availability of CHIP and Medicaid, the problem of 
uninsured but eligible children, and the HHS and Administration-wide 

outreach initiative. The information provided would be based on the flyer 

and related materials for Federal workers being prepared by HHS and the 

Administration. (Summer 1998 and ongoing) 

5. Support evaluations of CHIP and Medicaid outreach. AHCPR is 

involved in developing a departmental and national framework for 

"learning from CHIP." We are including a focus on evaluating varying 

approaches to outreach as part of the evaluation framework. In addition, a 

cross-departmental group is developing a paper synthesizing the rigorous 

evidence on "what we know or could know" about effective CHIP and 

Medicaid outreach from completed work in broadly varying areas (e.g., 

marketing, social marketing of all kinds). (Ongoing) 

 E. CENTERS FOR DISEASE CONTROL AND 

PREVENTION 

 

I. CURRENT PROGRAMS AND OUTREACH ACTIVITIES 

FOR CHILDREN 

A. Programs that Serve Middle to Low-Income Children 

The Centers for Disease Control and Prevention (CDC) has been active in 

the fight against disease for more than half a century. The mission of CDC 

is to promote health and quality of life by preventing and controlling 

disease, injury, and disability. As such, CDC works through partnerships 

with State and local health departments, educational institutions, and other 

private and public organizations to ensure healthy lives in a healthy world. 

CDC has a long and unique history in this country and throughout the 

world of preventing disease, injury, and disability in children. In fact, 

CDC spends close to half (42 percent) of its total $2.8 billion budget on 

activities related to children. Current child health activities at CDC include 

research, surveillance, and interventions with an emphasis on prevention 

and control in immunization, lead poisoning prevention, birth defects, 

tobacco control, adolescent and school health, infectious disease, violence 

and unintentional injuries prevention, nutrition, physical activity, sexually 

transmitted disease prevention, oral health, prevention of developmental 

disabilities, and chronic diseases such as asthma. 

Considering the immense scope of CDC’s child health activities, the 

agency is limited in the number of programs which offer direct services to 

children. In the broadest of terms, CDC’s children’s outreach activities can 

be placed in five categories: immunization, childhood lead poisoning 
prevention, sexually transmitted disease prevention, HIV/AIDS 

prevention, unintentional injury prevention, and youth work-related/farmrelated safety. 

Immunization ($407 million for Section 317; $487 million for VFC in 

FY 1998) is authorized under Section 317 of the Public Health Service Act 

and Public Law 103-66, the Omnibus Reconciliation Act of 1993, which 

authorizes the Vaccines for Children Program (VFC). The VFC program 

provides public-purchased vaccines to both private and public providers 

for children 0 to 18 years of age who are Medicaid enrolled, have no 

health insurance, or are American Indian/Alaska native. In addition, 

children who have health insurance that does not cover immunizations are 

eligible if they receive vaccines at a Federally Qualified Health Center or a 

Rural Health Clinic. CDC’s National Immunization Program also 

maintains a hotline to answer questions concerning immunization or 

vaccines. From March 1997 to March 1998, the hotline handled over 

30,000 calls. Target population: Children in "pockets of need"; i.e., 

primarily children living in poverty. 

Childhood Lead Poisoning Prevention ($58.7 million in FY 1997) is 

authorized under Section 317A of the Public Health Service Act. It is 

estimated that there are 1 million children in the Nation with elevated 

blood lead levels. Targeting communities with demonstrated high risk for 

lead poisoning, CDC funds a grant program aimed at screening at-risk 

children, identifying the source of the exposure, monitoring medical and 

environmental management of lead-poisoned children, and educating the 

family members/community about the effects of lead poisoning. Because 

lead poisoning disproportionately affects racial and ethnic minority 

children and children of low-income families, these targeted communities 

tend to be in poverty stricken areas. In 1996 alone, CDC programs in State 

and local health agencies screened over 1.8 million children. Target 

population: Although grantees target large minority and low-income 

populations, those who receive benefits from the screening program 

include infants and children from 6 months to 6 years of age and family 

members who care for lead-poisoned children. 1.8 million children were 

screened in 1996. 

Sexually Transmitted Disease Prevention ($113.7 million in FY 1998) 

is authorized under Section 318(a) of the Public Health Service Act. CDC 

funds State and local health departments (in addition to non-governmental 

organizations) to conduct STD screening and counseling among all 

populations. Some grants are directly aimed at at-risk youth. CDC 

currently funds several cooperative agreements to screen young women 

for STDs. Rates of chlamydia and gonorrhea are highest among 15-19 

year olds and STDs facilitate the sexual transmission of HIV. Clinics and 

screening projects nation-wide serve each year more than one-half million 
women. Well over a quarter of a million of those women are under 20 

years of age. Target population: Although an actual assessment of 

numbers of youth helped by the many activities of the nation’s STD 

programs is not available, in 1996 there were more than 673,000 STD 

cases reported to CDC, with over 38 percent of them occurring among 

youth under 20 years of age. 

HIV/AIDS Prevention ($58.7 million in FY 1997) is authorized under 

Sections 301, 307, 310, 311, 317, and 1102 of the Public Health Service 

Act. CDC has a variety of programs aimed at reaching high-risk youth 

associated with HIV/AIDS. During FY 1997, it funded youth-serving 

programs at State, local, and community levels, including 94 CommunityBased Organizations (CBOs). Of particular interest is the National AIDS 

Hotline which received 65,333 calls from persons under 18 years of age 

(the figure is not available for the Spanish speaking lines). Target 

population: Youths in high-risk situations. 

Unintentional Injuries ($1,390,000) is authorized under Section 394A of 

the Public Health Service Act. Bicycle helmet usage and residential fire 

protection (through the use of smoke detectors) are two unintentional 

injury programs whose target population is children. Through a grant 

program, CDC funds States to conduct public education programs on 

bicycle helmet safety, helmet give-aways, neighborhood canvassing, 

multilingual educational materials, etc. Residential fire protection through 

the use of smoke detectors is aimed most specifically at low-income 

households with children under 5 and adults 65 and older. Grantees make 

use of outreach workers for door-to-door canvassing or other forms of 

public assistance programs (WIC, Head Start, etc.) to identify those in 

need. Target population for bicycle helmet programs: Children 5 to 12 

years of age in given communities with a high percentage of youth-related 

bicycle injuries and fatalities. Target population for residential fire 

protection: Low-income households with children under 5 and adults 65 

and older who have no smoke detector; several programs target lowincome households with children aged 5 and under, living in rural mobile 

or single duplex homes, and no smoke detector in the home. 

Youth Work-related/Farm-related Safety ($1.3 million in FY 1998) is 

authorized under Sections 301, 304, 306, 308, 310, and 311 of the Public 

Health Service Act and Sections 20, 21, and 22 of the Occupational Safety 

and health Act of 1970. CDC currently funds several community 

education projects focusing on young workers’ safety and the hazards of 

farm work. Several of these grantees strive to reach unique groups of 

farming and ranching using culturally sensitive approaches. Target 

population: Youth in rural farming and ranching communities. 

B. Current Activities in Children’s Health Outreach 
Secure hot-link to HCFA CHIP website and establish partnerships. In 

response to CHIP, CDC has secured the hot-link to the HCFA CHIP 

website. We have also begun discussions with program staff at CDC to 

determine how State and local health officials can become involved with 

the CHIP and Medicaid outreach effort using organizations like the 

management committee of the Association of State and Territorial Health 

Officers (ASTHO). 

 

II. PROPOSED PLANS FOR CHILDREN’S HEALTH 

OUTREACH 

A. Educating Workers about Medicaid and CHIP 

Federal/State/Other Workers

1. Send mailing to grantees about Children’s Health Insurance.

Through our grantees, CDC is in a unique position to reach and assist in 

providing information and enrollment forms to a large number of children. 

Because most of the workers involved with CDC projects are grantees, 

CDC feels the best strategy for educating these outreach workers is a 

tailor-made mailing which could focus on how a grantee in a particular 

program would become involved in CHIP and how they can assist in 

outreach. For instance, an outreach worker in the lead screening program 

who visits a high-risk home to screen children for lead poisoning would 

also be encouraged to hand out information on CHIP and/or Medicaid, 

assist in completing the application form, and even mail the form. Another 

example is an occupational safety and health official who visits migrant 

communities and farms to educate the workers on farm safety. The first 

targeted audience would include immunization grantees, lead poisoning 

grantees, STD/HIV grantees, unintentional injuries grantees, work-related 

youth grantees -- actual direct services to children programs. Soon 

thereafter, another mailing would be sent to the other CDC programs that 

deal with other family members such as the breast and cervical screening 

program and the diabetes screening program. Those grantees would be 

encouraged to ask adults that are being seen if their children or 

grandchildren have insurance. If not, the grantees would follow through in 

much the same way the grantees for direct children’s services do. 

(Summer 1998) 

Several non-governmental agencies are currently partners with CDC, 

assisting with our school-based education programs throughout the States. 

Among the organizations are the National Network of Runaway and 

Youth Services, Advocates for Youth, the National School Health 

Education Coalition, and Girls Incorporated. These types of groups are in 
a unique position to reach a large number of children in a variety of 

settings. CDC proposes that these types of groups assist in outreach 

through the use of educational materials, enrollment applications, etc. 

Again, these groups would be reached through a mass-mailing according 

to grantees. Mailing could begin on these groups as soon as CDC receives 

outreach materials to accompany the letter. (Summer 1998) 

2. Allow States to use existing database to target eligible children.

CDC maintains a database that has the ability to profile "pockets of need" 

children in certain cities (currently 62 clusters). When queried, this 

database can profile psychographic characteristics, consumer and media 

habits that would be of great assistance to outreach workers as they search 

for eligible children and determine the most effective means of reaching 

them. CDC could make this information available to the States. (Summer 

1998) 

3. Use distance-based learning to educate about Medicaid and 

outreach. CDC uses several different types of distance-based learning for 

training health professionals around the country. One such mechanism is 

the Public Health Training Network. CDC uses a satellite that can be uplinked from various parts of the country at once to conduct training 

sessions, conference, seminars, etc. The possibility exists to put 

information about CHIP or the 800 number on the screen either before or 

after the session. CDC is also exploring the possibility of conducting a 

satellite training session on CHIP and Medicaid during the summer of 

1998. 

B. Educating Families and Enrolling Children in Medicaid and 

CHIP 

4. Assist State and local health departments in helping to insure 

children. CDC has several strategies for actually reaching and assisting 

enrollment children in Medicaid and CHIP. Perhaps most important is the 

use of the State and local health departments and State and local education 

agencies. CDC is the only Federal public health agency with grant 

relationships with all fifty State health agencies and all fifty State 

education agencies as well as many of the Nation’s largest cities. Although 

traditional health departments do not see the large numbers of low-income 

families they once did, the State and local health agencies remain a critical 

link in the effort to identify and assist in enrolling children into either 

CHIP or Medicaid. Each of the State agencies have access to a large 

number of children through several different programs. CDC could 

encourage each of these agencies to ensure that a child is enrolled in CHIP 

or Medicaid every time a child is seen for whatever reason. This could be 

done by providing information, completing applications, and mailing the 

application possibly as early as summer of 1998. 
5. Add the CHIP/Medicaid toll-free number to CDC publications.

Another strategy involves using the national 800 number being set up for 

the CHIP program. CDC has an extensive inventory of publications, 

pamphlets, educational materials, etc. that routinely make their way into 

the States. An effective use of the 800 number would be to publish the 800 

number on printed material sponsored by CDC. Because the CDC 

clearinghouse already has many of the materials on hand, CDC is 

exploring a way to possibly use stickers to put the 800 number on existing 

materials that are requested by grantees and organizations. (Fall 1998) 

6. Educate parents or grandparents through non-children’s 

programs. CDC has several non-children’s health programs that by nature 

lend themselves to reaching children in need. One such example is the 

breast and cervical screening program. CDC sees this program as a link to 

mothers and grandmothers who may be interested in learning more about 

CHIP or who are Medicaid eligible. The diabetes screening program also 

affords an opportunity to reach fathers, mothers, and other family 

members. Those program grantees would be encouraged to ask adults that 

are being seen if their children or grandchildren have insurance. If not, the 

grantees would follow through in much the same way the grantees for 

direct children’s services do. This activity is scheduled to begin in the 

Summer 1998. 

Two other important CDC programs with direct links to children are the 

teen pregnancy program and the prenatal smoking cessation program. 

Both of these programs could provide for immediate evaluation for 

enrollment in either CHIP or Medicaid. This activity could begin in 

Summer 1998. 

C. Coordination with Other Programs 

7. Add Internet links. Approximately 96,209,000 hits have been received 

on CDC homepage just in the past year. CDC has provided a hot-link 

directly to the HCFA website for those wishing to learn more about the 

program. There are several other websites which CDC has identified as 

potential bridges to the HCFA site. CDC is currently under discussions 

with these owners to determine the best way to hot-link these various sites. 

(Summer 1998) 

8. Develop coordination of WIC, immunization and children’s health 

insurance programs. A critical component to CDC’s effective 

immunization delivery system is the linkage with the U.S. Department of 

Agriculture’s (USDA) Special Supplemental Nutrition Program for 

Women, Infants, and Children (WIC). The WIC program is the largest 

single point of access to health-related services for low-income preschool 

children. Children who apply for WIC services are screened for 
immunization records thereby allowing for the discovery of under- or 

unimmunized children. CDC could work with the Department of 

Agriculture, HCFA and HRSA to see if we can expand this linkage for 

children’s health insurance. (Summer 1998) 

 

 F. INDIAN HEALTH SERVICE 

 

I. CURRENT PROGRAMS AND OUTREACH ACTIVITIES 

FOR CHILDREN 

A. Programs that Serve Middle to Low-Income Children 

The Indian Health Service (IHS) is the principle Federal agency with 

responsibility for the provision of comprehensive health care services to 

the approximately 1.5 million American Indians and Alaska Natives 

(AI/AN) living in the United States. The Indian people are among the 

most disadvantaged minority in this country not only in terms of social 

and economic indicators, but also in most aspects of health status. The 

provision of health services to Federally recognized Indians has grown out 

of a special relationship between the Federal Government and Indian 

Tribes. This Government-to-Government relationship is given form and 

substance by numerous treaties, laws, Supreme Court decisions, and 

Executive Orders. In meeting its goal to raise the health status of Indian 

People to the highest possible level, the IHS provides clinical and 

preventive health care services, Contract Health Services, and ensures that 

American Indians and Alaska Natives receive needed clinical, preventive, 

and rehabilitative services. 

All of the IHS’s resources, approximately $2.4 billion annually, are 

directed toward the health care needs of American Indians and Alaska 

Natives. The organizational structure of the IHS is decentralized, with 12 

Regional administrative units called Areas. The Areas are subdivided into 

150 service units which operate 49 hospitals (12 tribal), 195 health centers 

(134 tribal), 8 school health centers (4 tribal), 289 health stations (89 

tribal) and 152 Alaska Village Clinics. 

IHS also funds 34 urban Indian health programs, that provide health care 

for members of the AI/AN population residing in urban areas. The urban 

Indian health service delivery system is a major component of the total 

Indian health care system, specifically authorized by the Indian Health 

Care Improvement Act. 
Title XXI requires States to describe how their plans will include Indian 

children. This requirement is intended to further enhance the partnerships 

between the States and tribes, as referenced in the Presidential Executive 

Order on consultation with tribes. Eligible Indian children are entitled to 

receive CHIP services even if they already receive their health care 

services from the IHS. 

B. Current Activities in Children’s Health Outreach 

The Indian Health Service is committed to working with Federal agencies, 

State agencies, and tribal health programs by assisting the development 

and implementation of State CHIP plans. IHS is working directly with 

Indian communities to encourage them to seek greater access to both 

Medicaid and CHIP. Several ongoing programs within the IHS have 

assisted the outreach work to Indian communities and their youth: 

Distribution of information on CHIP and outreach through its agency 

infrastructure. Specifically the following activities have occurred: 

• The administrative and clinical components of the Office of Public 

Health, IHS through the Division of Managed Care, and Division 

of Clinical and Preventive Services have been given the principal 

task of providing an education program to IHS Tribal and urban 

Indian health workers on CHIP. 

• The IHS Council of Clinical Directors and the IHS Council of 

Chief Medical Officers have been provided general information on 

CHIP and have discussed how their advocacy and support can 

assist in effective outreach efforts. The members have been active 

in local meetings with tribes and staff to provide a clinical 

perspective to the discussions. 

• Through HCFA-sponsored Regional meetings, IHS has facilitated 

discussions with tribal workers, government organizations, and 

community representatives. For example, a meeting with 

representatives from the Western Governors’ Association has 

resulted in the issuance of a "3 Point" resolution focusing on the 

health care needs of AI/AN children. This resolution has provided 

a forum in which information about the importance of Medicaid 

and CHIP outreach can be shared and discussed. 

• The monthly IHS leadership conference call is used as a 

mechanism to exchange current information and strategies on 

Medicaid and CHIP Outreach activities. 

Consultation with Indian Tribes and Alaska Native Corporations in 

providing information on CHIP. As a result of the Executive 

Memorandum issued by President Clinton, the IHS has made the 
commitment to include discussions about Medicaid and CHIP in all future 

meetings. These meetings have resulted in activities such as: 

• IHS distributed the names of the HCFA Regional Contacts for 

American Indian Issues. 

• The agencies’ public relations office has provided information 

about Medicaid and CHIP to local and Regional offices that have 

Tribal newspapers and newsletters. 

• Short public service announcements have been made on Indian 

radio and television programs. 

Targeting vulnerable communities. IHS is assisting in the mapping of 

residences of Indian families. This data will be used to help target areas of 

high Indian census, where outreach activity for CHIP can be directed. 

 

II. PROPOSED PLANS FOR CHILDREN’S HEALTH OUTREACH 

A. Educating Workers about Medicaid and CHIP 

Federal and Tribal Workers

In order to educate Federal and Tribal workers about the importance of 

Medicaid and CHIP outreach, the IHS will: 

1. Organize a headquarters leadership team. IHS could organize a 

headquarters leadership team consisting of staff from the Office of Public 

Health, Maternal and Child Health, Health Education and the Managed 

Care Division, to champion the outreach activities within the agency and 

Indian tribes. The team could be in place by the end of July 1998. 

2. Send directives to participants of specialty meetings. In an effort to 

increase awareness of CHIP and outreach, IHS could send directives to 

each of the agency speciality annual meetings (National Councils of Chief 

Medical Officers, Clinical Directors, Nurse Administrators, Service Unit 

Directors, Eye Care, and Radiologists) to include workshops and plenary 

sessions on CHIP and outreach. They could be notified at the upcoming 

quarterly meetings. (Summer 1998) 

3. Provide access to CHIP and Medicaid training to IHS workers. IHS 

could provide workers with access to training on CHIP and the Medicaid 

program that are sponsored by other Federal agencies and State or Private 

organizations who serve American Indians and Alaska Natives. This could 

be an activity that the local level and the tribes would coordinate. 

(Summer 1998) 
4. Include CHIP as a topic in future meetings scheduled with Indian 

tribes. National meetings are usually held in September with the National 

Indian Health Board, which is representative of all the Area health boards. 

Area health board meetings are held quarterly. 

5. Distribute American Indian and Alaska Native CHIP brochure. In 

collaboration with the Bureau of Indian Affairs, IHS will design culturally 

appropriate CHIP brochure specifically for American Indian and Alaska 

Natives. This brochure will be distributed in the summer of 1998. 

B. Educating Families and Enrolling Children in Medicaid and 

CHIP 

IHS could continue to work in consultation with Indian Tribes and States 

to provide information to Indian Families. This could include: 

6. Establish a key stakeholder advisory committee. IHS could establish 

a key stakeholder advisory committee consisting of representatives of the 

Tribal Self-Governance Advisory Committee and Area health boards to 

provide adequate input on the current strategy and activities directed 

toward increasing outreach activities to AI/AN. This activity could begin 

in September, 1998. 

7. Develop culturally sensitive messages on outreach. IHS could define 

key terms related to CHIP so that communication between Indian clients 

and State enrollment workers can be enhanced and assisted. This could be 

an outcome from the jointly sponsored training sessions that would begin 

by the end of October, 1998. 

8. Create a survey to monitor access and satisfaction of Indian 

families with CHIP and Medicaid. Also, IHS could identify potential 

Indian beneficiaries by using HCFA projections on uninsured children by 

State and county, while focusing on sites of large Indian census. This 

activity could begin in October, 1998. 

9. Provide CHIP and Medicaid outreach training to American Indian 

and Alaska Native community leaders. IHS could use the "Train the 

Trainer" technique to provide education to select community members 

who can then provide the information to the rest of the community. These 

sessions could occur by October, 1998. 

C. Coordination with Other Programs 

10. Improve communication on cross-agency issues within HHS and 

across Federal agencies. IHS and HCFA have met on a regular basis 

since the inception of CHIP and could continue these meetings in the 
future. The IHS has also initiated interaction with social service workers 

from the Bureau of Indian Affairs at both the local and Regional levels to 

increase the interaction between the two agencies. BIA programs have 

great potential in terms of providing information to Indian families who 

are eligible for CHIP. IHS could also continue meeting with the major 

Federal organizations working with children’s health issues. One of the 

major focuses is developing a means of monitoring the impact of the work 

that is currently underway with CHIP, in terms of both access and service 

delivery. The IHS works with several service providers which have great 

access to low-income people including WIC, the Department of 

Agriculture food distribution program, and Head Start. IHS could 

encourage better outreach services to the communities served. 

11. Identify and develop partnerships. IHS could identify and develop 

partnerships with public and private advocacy groups working with CHIP 

to help provide education and assistance to Indian Families. This activity 

could begin in August, 1998. 

 G. SUBSTANCE ABUSE AND MENTAL HEALTH 

SERVICES ADMINISTRATION 

 

I. CURRENT PROGRAMS AND OUTREACH 

ACTIVITIES FOR CHILDREN 

The Substance Abuse and Mental Health Services Administration 

(SAMHSA) and its three Centers, the Center for Mental Health Services 

(CMHS), Center for Substance Abuse Treatment (CSAT), and Center for 

Substance Abuse Prevention (CSAP), in partnership with State, local, and 

community-based organizations, strive to improve the quality and 

availability of prevention, early intervention, treatment and rehabilitation 

services for persons with addictive and mental health disorders. In the area 

of children and adolescents, SAMHSA pursues its mission by assisting 

States to promote seamless, comprehensive services for children and 

adolescents at risk for substance abuse or emotional disturbance. Early 

childhood substance abuse prevention and treatment and mental health 

programs are more critical than ever given the negative impact of violence 

on our society. The more we provide effective early interventions, the 

more likely we are to reduce the long-term costs to society. SAMHSA’s 

FY 1998 budget for children’s and youth programs is $224.5 million. 

A. Programs that Serve Middle to Low-Income Children 

The Comprehensive Community Mental Health for Children 

Program ($72 million in FY 1998), authorized under Title V of the Public 
Health Service Act, provides grants to States, political subdivisions of 

States, and Native American Tribes to implement systems of care and to 

provide direct services to children with serious emotional disturbances. 

This program includes 31 five-year projects that support service systems 

to provide diagnosis and evaluation, outpatient, emergency, intensive 

home-based, day treatment, therapeutic foster care and group home, 

transitional and case management services and respite care. These 

programs are designed to fill gaps in services, promote collaboration 

among community agencies, and to ensure case management. They 

require individual service plans for children and their families and 

encourage family involvement. Target population: 25,000 children up to 

age 21 with serious emotional disturbance. 

The Youth Substance Abuse Prevention Initiative ($66.7 million in FY 

1998), is a Secretarial Initiative designed to reduce substance abuse among 

youth. One of the activities of the initiative is to form a parenting group in 

order to initiate a parents’ movement around substance abuse prevention. 

Parents from all socioeconomic backgrounds, especially the working poor, 

will be involved. Target population: Youth ages 12-17. 

The High Risk Youth Demonstration Grant Program ($6 million in 

FY 1998), authorized under Title V, supports the development and 

implementation of innovative and effective models for the prevention of 

alcohol and drug use among high-risk youth ages 4-18. Target population: 

Approximately 50,000 youths. 

The Starting Early Starting Smart Initiative ($6.6 million in FY 1998), 

authorized under Title V of the Public Health Service Act, is one of 

SAMHSA’s Knowledge, Development and Application (KD&A) 

Programs which provide grants to aid in the transfer of knowledge from 

research to practice. Starting Early Starting Smart is a public/private 

collaboration with the Casey Family Program and SAMHSA’s three 

Centers, the Health Resources and Services Administration, the 

Administration for Children and Families, and the National Institutes of 

Health designed to test the effectiveness of integrating substance abuse 

and mental health services in primary care or early childhood settings for 

young children who have multiple risk factors for substance abuse or 

mental health problems. Target population: Children with substance use 

and/or mental illness disorders from various racial/ethnic background, 

ages 0-7. In general, the KD&A programs will address children, ages 0-

21. The number of children served has not been determined. 

The Residential Treatment Services Grants for Pregnant and 

Postpartum Women and Their Infants ($1 million in FY 1998) and The 

Residential Demonstration Treatment Grants for Women and Their 

Children Program ($4.6 million in FY 1998), authorized under Title V of 
the Public Health Service Act, provide in addition to substance abusespecific services, other services which address the physical, emotional, 

psychosocial, and economic needs of the women and children served. 

These services include but are not limited to: childbirth education, 

parenting classes, housing assistance, employment referral, and counseling 

and treatment services. The goals of the program are to provide 

comprehensive treatment for addicted women; to decrease substance 

abuse, drug-related crime, homelessness, and child abuse among this 

population of women; to increase the social, emotional, and educational 

functioning of addicted women and their children; to provide children’s 

services to improve development and educational functioning and family 

relationships. Target population: 1,433 substance-abusing women and 

their children have been served by the Residential Treatment Services 

Grants for Pregnant and Postpartum Women and Their Infants program 

of whom 716 were children. The number of substance-abusing women and 

their children served by the Residential Demonstration Treatment Grants 

for Women and Their Children Program were 1,693 of which 923 were 

children. 

B. Current Activities in Children's Health Outreach 

SAMHSA, in coordination with other Federal and State agencies and 

national organizations, has provided several workshops, trainings, updates, 

and written correspondence to inform Federal, State, and other substance 

abuse and mental health practitioners about the State Children’s Health

Insurance Program (CHIP) and outreach as described below. 

In October 1997, a SAMHSA CHIP Steering Committee and a 

subcommittee on Outreach were formed to address outreach specific 

issues relating to CHIP and Medicaid. 

In November and December 1997, a training on CHIP which emphasized 

the importance of outreach was provided in collaboration with the Health 

Resources Services Administration (HRSA) and the Health Care 

Financing Administration (HCFA) for SAMHSA’s State Block Grant 

Project Officers, other staff, and Management Team. 

During February and March, SAMHSA conducted several meetings for 

various audiences which provided either a plenary session or workshop on 

CHIP and included information on the importance of States performing 

outreach to find children with special needs and enrolling them into 

Medicaid or CHIP. For example: 

• February 1998, "National Workshop for Community Coalitions 

Grantee Conference." 

• March 1998, Children’s Health Insurance Constituency Meeting. 
• March 1998, the Annual Women’s Grantee meeting. 

• In April 1998, SAMHSA conducted a CHIP workshop at its Fourth 

State System Development Conference. A HRSA representative 

presented on the President’s Executive Memorandum on Outreach 

and encouraged State and Alcohol Drug Abuse Directors to 

identify and enroll eligible children into Medicaid or CHIP. More 

than 400 individuals-from Federal, State, and public and private 

organizations in the substance abuse field attended. Information on 

CHIP and Medicaid was available at our exhibit table. 

In March 1998, the President of the National Prevention Network 

(supports networking, resource sharing, and information exchange among 

State alcohol and other drug prevention professionals and individuals) sent 

a letter to all National Prevention Network and Single State Agency 

Directors informing them of CHIP and how it provides an opportunity to 

provide substance abuse prevention services to uninsured children. The 

letter also encouraged States to participate in outreach and identify 

uninsured children and enroll eligible children into Medicaid and CHIP, 

submit a CHIP plan, and become involved in their State’s CHIP planning 

process. 

In April 1998, an updated "Dear Colleague" letter was mailed by 

SAMHSA’s Administrator to mental health and substance abuse treatment 

and substance abuse prevention directors, grantees, and constituency 

organizations. The letter focused on outreach and encouraged States to 

enroll eligible children in Medicaid or CHIP. 

In May 1998, SAMHSA sponsored its annual grantee meeting for the 

Comprehensive Mental Health Services for Children Program. A 

workshop was provided on CHIP and the importance of educating families 

and enrolling children in Medicaid and CHIP. 

SAMHSA’s Technical Assistance Centers have been monitoring the 

implementation of CHIP. One activity has been the development of a 

linked website that disseminates information regarding CHIP and 

Medicaid including outreach. 

SAMHSA sponsored a national, mental health block grant program 

meeting in May 1998 which included a workshop on CHIP focusing on 

encouraging States to promote outreach and discussed how families can 

assist States in outreach efforts to identify and enroll children with special 

needs in Medicaid and CHIP. 

 
II. PROPOSED PLANS FOR CHILDREN'S HEALTH 

OUTREACH 

SAMHSA’s proposed plan for conducting outreach to uninsured children 

with substance use disorders and/or serious emotional disturbances include 

the following: 

A. Educating Workers about Medicaid and CHIP 

Federal Workers

1. Provide briefings of State Block Grant Project Officers about the 

Children’s Health Initiative. SAMHSA could conduct several briefings 

to update State Block Grant Project Officers about CHIP and Medicaid 

focusing on encouraging States to promote outreach. These briefings could 

tentatively begin in May and conclude in July 1998. HRSA and HCFA 

would be invited as presenters to participate in the training. 

2. Create SAMHSA workgroup and encourage outreach to children 

with special needs. Currently, SAMHSA is organizing a workgroup to 

further promote coordinated outreach strategies germane to Federal, State 

and local substance abuse treatment grantees to increase their awareness of 

the importance of identifying and enrolling eligible children with special 

needs into Medicaid or CHIP. A contract will be awarded in FY 1998 to 

the National Mental Health Association to enhance the educational 

activities with their State affiliates related to CHIP and to assist States in 

conducting outreach to find children with special needs. 

3. Track CHIP outreach and coverage of substance abuse and mental 

health. SAMHSA Centers will collaborate to develop a CHIP tracking 

system to monitor the inclusion of substance abuse and mental health 

benefits in CHIP plans and State outreach efforts. (Fall 1998) 

State Workers

4. Add chapter on outreach to CHIP workbook on behavioral health. 

SAMHSA is planning for the development of a workbook to assist States 

with the analysis of CHIP benefits packages from the behavioral health 

actuarial and fiscal perspective. One chapter could also focus on 

recommended outreach methods for States to find eligible children and 

enroll them into Medicaid or CHIP. Expected publication date is Fall 

1998. SAMHSA could also revise a recently developed policy paper, 

"Mental Health Components of a Quality System of Care for Children and 

Adolescents," to add a section on encouraging States to participate in 

outreach by identifying and enrolling eligible uninsured children into 

Medicaid or CHIP. 
Others Workers

5. Mail an updated "Dear Colleague" letter every six months to 

substance abuse and mental health directors, grantees, and 

constituency organizations on CHIP and Medicaid. SAMHSA could 

encourage them to identify eligible uninsured children for enrollment into 

Medicaid or CHIP. The letter could provide detailed instructions on who 

they are, where they are located, and how to enroll eligible uninsured 

children in Medicaid or CHIP. SAMHSA could monitor this activity 

through the SAMHSA CHIP tracking activity proposed in the "State 

Workers" section. 

6. Sponsor Regional meetings on CHIP with State Alcohol and Drug 

Abuse Treatment Directors, State CHIP Administrators, State Mental 

Health Commissioners, and State Substance Abuse Prevention 

Directors. SAMHSA could hold a series of 5 to 6 CHIP Regional 

meetings throughout the United States during Fiscal year 1999. SAMHSA 

could collaborate with other Federal and State agencies, and HRSA and 

HCFA Regional offices in the planning of this meeting. One of the 

purposes of the Regional meetings is to facilitate partnership development 

for the State Substance Abuse Directors with their State partners (Mental 

Health, CHIP Administrator, Substance Abuse Prevention) to leverage 

State resources committed to conduct outreach activities, and assist State 

Substance Abuse Agencies to build and strengthen a successful enrollment 

and outreach strategy for reaching uninsured children among the special 

substance abuse populations. 

Key areas for discussion by the participants at the Regional meetings to 

assist State Substance Abuse Agencies with outreach efforts include: a 

"brainstorm" session to simplify effective outreach strategies for reaching 

uninsured children of substance abusing parents; provide information on 

CHIP development and updates; conduct presentations on "hot topics" 

relating to CHIP and Medicaid, and identify technical assistance needs 

specific to individual States and their Federal Substance Abuse Prevention 

and Treatment grantees and discretionary grantees to establish successful 

outreach and enrollment efforts. Planning for the Regional meetings will 

begin in May 1998 and the meetings are expected to conclude by May 

1999. 

7. Develop and implement market and media strategy to educate 

substance abuse treatment providers about CHIP and outreach.

SAMHSA could launch a coordinated effort to develop a market strategy 

for distributing information and a media strategy directed at various subpopulations who are supported using Substance Abuse Prevention and 

Treatment Block Grant funds. Outreach strategies for distributing CHIP 
and Medicaid information to substance abuse treatment providers and 

constituency as follows are proposed: 

• Developing a fact sheet or brochure to disseminate quarterly to the 

substance abuse stakeholders to include updates on CHIP and 

"Effective Outreach Models that Work"-- best practices. 

• Maintaining updated CHIP information on the Treatment 

Improvement Exchange Forum and website, which is accessible to 

substance abuse State directors, constituency organizations, etc. 

Some activities would be on-going once they are implemented; for other 

projects, the expected completion date is September 30, 1998. 

B. Educating Families and Enrolling Children in 

Medicaid and CHIP 

8. Distribute information on CHIP and Medicaid through State 

alcohol and drug abuse agencies. SAMHSA could develop a fact 

sheet/brochure on CHIP and Medicaid that would be available for State 

alcohol and drug abuse agencies to provide to their patients and grantees. 

SAMHSA would work with States to develop the brochure and encourage 

mailings to their respective grantees. The start date is June 1998 and 

expected completion is September 1998. 

9. Send mailing to Starting Early Starting Smart grantees about 

outreach. SAMHSA could collaborate with the Casey Family Program to 

mail a letter to Starting Early Starting Smart grantees about CHIP and 

Medicaid. The letter would focus on outreach by encouraging grantees to 

identify and enroll eligible children in Medicaid or CHIP and to assist in 

promoting outreach among other early intervention and primary care 

providers of services to young children. The start date would be October 

1998. 

C. Coordination with Other Programs 

10. Create SAMHSA CHIP/Medicaid webpage. SAMHSA could 

develop a CHIP page on its website to provide updates on CHIP and 

Medicaid to substance abuse and mental health directors, providers, 

grantees, and constituency organizations. Information on the importance 

of outreach will be included. Expected completion date is May 1, 1998. 

11. Mobilize stakeholders to assist States with outreach. SAMHSA is 

currently working with the following organizations regarding CHIP and 

could continue on an on-going basis to collaborate with these 

organizations to inform the States about outreach such as developing a 
compendium of resources and contacts, and providing technical assistance 

to States that can assist them with their outreach efforts. 

• National Association of State Mental Health Program Directors 

(NASMHPD) 

• National Technical Assistance Center for Children’s Mental Health 

at the Georgetown University, Child Development Center 

• Federation of Families for Children’s Mental Health 

• Children’s Division of the National Association of State Mental 

Health Program Directors (NASMHPD) 

• National Prevention Network Directors 

• National Association of State Alcohol and Drug Abuse Directors 

(NASADAD) 

• American Psychiatric Association 

 2. REPORT FROM THE SECRETARY OF AGRICULTURE 

 

I. CURRENT PROGRAMS AND OUTREACH 

ACTIVITIES FOR CHILDREN 

A. Programs that Serve Middle to Low-Income Children 

Two Agencies in the Department of Agriculture operate programs that 

affect families that may also be eligible for the Children’s Health 

Insurance Program (CHIP) or Medicaid: the Food and Nutrition Service 

(FNS) and the Cooperative State Research, Education and Extension 

Service (CSREES). 

Food and Nutrition Service. The Food and Nutrition Service administers 

the nutrition assistance programs of the U.S. Department of Agriculture. 

FNS’s goals are to provide needy people with access to a more nutritious 

diet, to improve the eating habits of the nation’s children, and to stabilize 

farm prices through the distribution of surplus food. FNS works in 

partnership with the States and local agencies in all its programs. The 

following is a description of its major programs: 

Food Stamp Program (FSP) ($25.1 billion in FY 1998) is authorized under 

the Food Stamp Act of 1977, 7 U.S.C 2011-2036. The FSP helps put food 

on the table for about 9 million households and 22 million individuals 

each day. Of these Food Stamp households, 59.5 percent have children. It 

provides low-income households with coupons or an electronic benefit 

card that can be used like cash at most grocery stores to ensure that they 

have access to a healthy diet. The Federal government pays for the 

benefits issued through the FSP and shares with the States the cost of 
administrative expenses. State agencies operate the FSP through their local 

offices and use State Merit System employees to determine eligibility. 

These same State employees may also interview households for TANF 

and Medicaid. Target population: Low-income individuals and families. 

The gross monthly income of most households must be 130 percent or less 

of the Federal poverty guidelines for the household’s size. U.S. citizens 

and some aliens who are admitted for permanent residency may qualify 

for FSP benefits. The program serves over 11 million children. 

National School Lunch, School Breakfast, and Special Milk Programs 

($5.6 billion appropriated for FY 1998) are authorized by the National 

School Lunch Act, 42 USC 1751; and Child Nutrition Act of 1966, 42 

U.S.C 1771 and 42 USC 1772. The school nutrition programs provide 

cash and commodity assistance to assist schools in making nutritious, lowcost and free meals or milk available to all school children. To qualify for 

free and reduced price meals, households must be at or below 130 percent 

of the Federal poverty guidelines for free meals or milk and between 130 

to 185 percent of the Federal poverty guidelines for reduced price meals. 

Applications, designed at the State and local levels, are distributed 

annually. Households complete the application at home, usually without 

any assistance. In lieu of an application, the school can obtain information 

directly from the local Food Stamp or TANF office about households’ 

participation in those programs. These households are automatically 

eligible for free meals or milk. Target population: All children of high 

school grade or under in participating schools. About 56 percent of the 

meals are served to children at or below 185 percent of the Federal 

poverty guideline. The program serves about 24 million children. 

Special Supplemental Nutrition Program for Women, Infants and Children 

(WIC) ($3.926 billion appropriated for FY 1998) is authorized by the 

Child Nutrition Act of 1966, 42 U.S.C 1786. 

The WIC Program provides, at no cost, supplemental foods, nutrition 

education, and health care referrals to low income, pregnant, postpartum, 

and breast-feeding women, and infants and children up to age 5 who are 

determined by a health professional to be at nutritional risk. Program 

benefits include breast-feeding promotion and support, substance abuse 

education, and referrals to local health care and social service programs 

such as Medicaid, Maternal and Child Health Care, immunizations, and 

Food Stamps. Legislation requires WIC agencies to provide written 

information about the Medicaid program and referrals to individuals who 

appear to be income eligible but currently not participating in the 

Medicaid Program. To be income eligible for WIC, applicants must have 

an income at or below 185 percent of the Federal poverty guidelines or be 

determined automatically income eligible based on eligibility for programs 

such as Medicaid, Food Stamps, or Temporary Assistance For Needy 
Families. Target population: As of the beginning of FY 1998, the WIC 

Program served an average monthly participation of about 7.4 million 

women, infants, and children of which almost 5.7 million were infants and 

children. 

Child and Adult Care Food Program (CACFP) ($1.4 billion appropriated 

for FY 1998) is authorized under the National School Lunch Act, 42 

U.S.C. 1776. The Child and Adult Care Food Program provides healthy 

meals and snacks to children and adults in day care facilities through cash 

reimbursements to sponsoring organizations for meals served. Higher 

levels of reimbursement are provided for meals to children at or below 185 

percent of the Federal poverty level. Sponsoring organizations that are 

eligible for reimbursement include licensed or approved non-residential, 

public or private non-profit child care centers, certain for-profit child and 

adult care centers, licensed day care homes, and Head Start Centers. 

Target population: Children 12 years and younger. The program serves 

about 2.3 million children. 

Emergency Food Assistance Program (TEFAP) ($170 million 

appropriation in FY 1997, $145 million appropriation in FY 1998) is 

authorized by the Emergency Food Assistance Act of 1983, 7 U.S.C. 

7501-7516. Through TEFAP, foods and administrative support are 

provided to State agencies to assist the needy. States provide the foods to 

local food banks, food pantries, or soup kitchens, for distribution to needy 

households, or provision of meals to the needy. TEFAP foods may be 

utilized in both household distribution and meal service. Target 

population: Low income individuals and families with or without children. 

Commodity Supplemental Food Program (CSFP) ($76 million in FY 

1997, $96 million in FY 1998; 20 percent of appropriation and 20 percent 

of food funds carried over from the previous year is for State and local 

agencies program administrative costs) is authorized by the Agriculture 

and Consumer Protection Act of 1973, 7 U.S.C. 612c note. CSFP, which is 

operative in 18 States and on two Indian reservations, helps to improve the 

health of low-income infants and children up to age 6, pregnant, postpartum, and breast-feeding women, and elderly persons 60 years of age 

and older, by providing a package of USDA foods each month, and 

nutrition education. USDA Assistance is provided to households through 

State and local administering agencies. Target population: Women, 

infants, and children must be income eligible for another Federal, State, 

or local food, health, or welfare program for low-income individual. The 

average monthly participation of infants and children in fiscal year (FY) 

1997 was 105,833. 

Food Distribution Program on Indian Reservations (FDPIR) ($71.8 

million in FY 1997, $75 million in FY 1998, of which $20.8 million is 
earmarked for administrative funds for State agencies and Indian tribal 

organizations) is authorized by the Food Stamp Act of 1977, 7 U.S.C. 

2011-2036. FDPIR provides a package of USDA foods each month to 

low-income households on Indian reservations, and to low-income Native 

American households living near Indian reservations, as an alternative to 

the Food Stamp Program. State agencies and Indian tribal organizations 

administer the program at the local level. Target population: Income 

eligibility is based on the Food Stamp Program's net monthly income 

guidelines plus the standard deduction. Average monthly participation of 

adults and children in FY 1997 was 124,000 (no separate count for 

children). 

Homeless Children Nutrition Program (HCNP) ($3.4 million appropriated 

for FY 1998) is authorized under the National School Lunch Act, 42 

U.S.C. 1766b. The Homeless Children Nutrition Program provides food 

assistance to homeless children under the age of 6 in participating 

emergency shelters. The program is administered directly by FNS 

Headquarters. Private nonprofit organizations, State or local government, 

and other public entities are eligible to participate as sponsoring 

organizations if they operate congregate food service in shelters serving 

preschool children. Currently, about 85 private nonprofit organizations 

and 1 public organization are approved to sponsor programs in 

approximately 117 emergency shelters. Target population: About 2,500 

homeless children monthly. 

Cooperative State Research, Education, and Extension Service 

(CSREES). In cooperation with partners and customers, CSREES 

provides the focus to advance a global system of research, extension and 

higher education in the food and agricultural sciences and related 

environmental and human sciences to benefit people, communities, and 

the Nation. CSREES programs increase and provide access to scientific 

knowledge; strengthen the capabilities of land-grant and other institutions 

of research, extension and higher education; increase access to and use of 

improved communication and network systems; and promote informed 

decision making by producers, families, communities, and other 

customers. A major program is listed below: 

Expanded Food and Nutrition Education Program (EFNEP) ($58 million 

appropriation in FY 1997) is authorized by the Agriculture and Food 

1981-Nutrition Education Program and the National Agricultural 

Research, Extension, and Teaching Policy Act of 1977, 7 U.S.C. 3175. 

EFNEP assists limited resource youth and families with young children in 

acquiring the knowledge, skills, attitudes, and behavior changes necessary 

for nutritionally sound diets, personal development, and improvement of 

the total family diet and nutritional well-being. The program is delivered 

by the Land-Grant University Cooperative Extension System in 
partnership with USDA/CSREES. There are 778 County Extension offices 

and 56 Land-Grant University Cooperative Extension systems. Target 

population: In FY 1994, 426,837 youth and 198,931 families; about 

737,000 family members were indirectly reached through the adult 

participant. 

B. Current Activities in Children’s Health Outreach 

As a result of the President’s directive in February, FNS has: 

Sent Memoranda to Department and FNS leadership. Sent memoranda 

to Secretary Glickman on 3/23/98 and to the FNS Administrator on 

2/13/98 notifying them about the CHIP/Medicaid outreach initiative. Sent 

memorandum to the 7 FNS Regional Administrators on 3/9/98 notifying 

them about the CHIP/Medicaid outreach initiative. Suggested they include 

CHIP/Medicaid on meeting agendas and disseminate CHIP/Medicaid 

information. Copies were also sent to all 28 FNS Regional Program 

Directors on 3/10/98. Regions have included CHIP/Medicaid on their 

Regional meeting agendas. 

Sent informational CHIP and Medicaid messages to FNS Regional 

Personnel, State Agencies, and State Representatives. Sent electronic 

messages, during period from 12/97 to present, (1) notifying FNS 

Regional Program Directors of State CHIP/Medicaid contacts, HCFA 

contacts, and the HHS Internet Website; (2) providing CHIP/Medicaid 

information to Regional Program staff to share with State agencies 

including legislative information, and information about HHS Regional 

CHIP conferences; (3) encouraging Regional and State staff to attend 

Regional HHS' CHIP/Medicaid conferences. Encouraged State agencies to 

attend meetings concerning CHIP/Medicaid, including meetings to 

develop State Plans. Many State agencies have attended meetings in the 

State on CHIP/Medicaid; and (4) requesting assistance in designating 

CHIP coordinators. Each region has since designated a CHIP coordinator 

and many regions have shared CHIP information with their State agencies. 

Distributed copies, 4/98, of the six-month progress report, Implementation 

of the Children's Health Insurance Program, to each FNS Regional 

program staff CHIP coordinator. Provided updates on CHIP State Plans to 

Regional Offices. Sent letter to State officials considering CHIP 

implementation in Western Region to encourage coordination of outreach 

efforts with FNS programs that serve children. Provided list of State 

director contacts for FNS programs. 

Participated in CHIP and Medicaid Meeting and Conferences. FNS 

has participated in meetings/conferences with representatives from HHS 

and other Federal agencies, such as interagency councils and forums and 
arranged for HFCA staff to make CHIP/Medicaid presentations at 

program, national, and Regional meetings. (12/97 to present). 

Published an article about the CHIP/Medicaid initiative in the FNS 

Friday Letter in Vol. 21 No.3, 3/98. This FNS newsletter is distributed to 

1,600 Federal employees. 

Included CHIP/Medicaid talking points in speeches given by the 

Under Secretary, Food, Nutrition, and Consumer Services, and other 

FNS officials, during period from 4/98 to present. Examples of 

conferences include the National Association of Food Distribution 

Programs on Indian Reservations and the National Association of WIC 

Directors. 

Established communications within FNS to add outreach information 

on FNS’ website with linkage to HHS CHIP website. Sent a 

memorandum to FNS Internet Website Staff on 3/27/98 to create a 

"What's New" article on the CHIP/Medicaid initiative and linkage to HHS' 

CHIP Website. 

 

 

 

Co-sponsored Regional conference on CHIP and Medicaid. Cosponsored, along with other agencies and HHS' Chicago and Kansas City 

Regional offices, a conference on CHIP/Medicaid outreach (April 1998). 

 

II. PROPOSED PLANS FOR CHILDREN’S HEALTH OUTREACH 

A. Educating Workers about Medicaid and CHIP 

Federal Workers 

1. Send a message from the Secretary, USDA, about CHIP/Medicaid 

to all employees. This message could be provided to over 92,000 

employees. (August 1998) 

2. Put a message about CHIP/Medicaid on the Wage and Earnings 

Statements received by over 92,000 USDA employees. (January 1999) 
Federal, State and Other Workers 

 

3. Coordinate with HHS to provide information about Medicaid and 

CHIP to the 28 FNS Regional Program Directors and State agencies.

(September 1998) 

4. Issue memoranda by September, 1998 to the 28 FNS Regional 

Program Directors encouraging participation in outreach, 

reemphasizing the need for FNS Regional offices and State agencies to: 

• Coordinate discussions and presentations about CHIP/Medicaid at 

various FNS Regional and State meetings/conferences. FNS will 

provide the list of HHS CHIP contacts. 

• Submit articles/updates on CHIP/Medicaid for publication in 

Regional and State newsletters. Examples include the quarterly 

Inter Tribal Council of Arizona, Inc. Newsletter, "Healthy 

Happenings," and the monthly Texas WIC newsletter, "WIC 

News." 

• Contact State CHIP representatives to coordinate outreach efforts 

to minimize duplication of effort among programs serving children 

and to participate in CHIP planning and implementation meetings. 

• Make available CHIP and Medicaid information at FNS Regional 

and State meetings/conferences. 

5. Apprise FNS Regional Program Directors and State agencies as 

CHIP State Plans are approved through sending electronic messages as 

soon as updates are received from HHS. (Ongoing) 

6. Send electronic messages to CSREES program administrators, 

program directors, and community-based educators to inform them 

of the CHIP/Medicaid outreach initiative. The Cooperative State 

Research, Education, and Extension Service in partnership with the LandGrant University System will send these messages. (September 1998) 

B. Educating Families and Enrolling Children in Medicaid and 

CHIP 

7. May revise USDA's Information Phone Number to include a 

message about CHIP/Medicaid with referral to the national 800 

number. The Information Phone Number receives approximately 500 

calls per day. (Undetermined) 

8. Display and make available CHIP and Medicaid information at the 

USDA Visitors' Information Center in Washington, D.C. On a yearly 
basis, an estimated 10,000 people visit the USDA Visitors' Information 

Center. (Fall 1998) 

9. Send a memoranda to the 7 WIC Regional Directors and the 88 

WIC State agencies that re-emphasizes that Title XIX sites WIC as a 

program that may perform presumptive Medicaid eligibility 

determinations. (September 1998) 

10. Issue memoranda by September, 1998 to the 28 FNS Regional 

Program Directors encouraging them to help educate families by: 

• Disseminating information about CHIP and Medicaid to 

individuals/families who may be potentially eligible for benefits. 

• Displaying and/or distributing CHIP/Medicaid promotional 

materials in places where FNS programs are located. 

• Incorporating, when feasible, CHIP/Medicaid eligibility as part of 

current or future joint application processes. 

• Providing guidance for the Child Nutrition FNS Program Directors 

on allowing parents to waive their rights to confidentiality under 

the School Nutrition Programs to allow use of children's free and 

reduced price eligibility status for CHIP/Medicaid purposes. 

• Encouraging coordination of co-located programs that serve 

children with the CHIP/Medicaid outreach effort to minimize 

duplication of effort. 

• Encouraging State agencies to, where feasible, outstation or 

establish offsite visits of CHIP/Medicaid eligibility workers and/or 

include a CHIP/Medicaid message on program toll- free hot lines. 

 

11. CSREES could provide information on children’s health outreach.

The Cooperative State Research, Education, and Extension Service in 

partnership with the Land-Grant University System could provide 

information via the system for local clientele and media. In addition, 

through the partnership we could share the CHIP and Medicaid materials 

with the System. They could, in turn, share these materials with 

appropriate local clientele groups and community collaborators working 

with families in all 50 States, Territories, and the District of Columbia, 

representing 105 Land-Grant Universities. (September 1998) 

C. Coordination with Other Programs 

12. Include information about the CHIP/Medicaid outreach initiative 

on FNS' and USDA's Website with linkage to HHS’ CHIP/Medicaid 

Website. (January 1999) 
13. Develop and distribute prototype applications for integrating the 

94,000 National School Lunch Program schools and children’s health 

programs. Collaborate with the Departments of Education and Health and 

Human Services to develop for distribute to the Child Nutrition State 

agencies and Chief State School Officers, one or more prototype school 

lunch program applications that can be used to facilitate enrollment in 

Medicaid or CHIP. (September 1998) 

14. FNS could provide Medicaid and CHIP information to major 

national associations, advocacy groups, and other organizations (Fall 

1998) that encourages them to: 

• Include information about the CHIP/Medicaid outreach initiative 

on their Websites. 

• Publish CHIP/Medicaid articles in their newsletters. 

• Include CHIP/Medicaid presentations/workshops in their 

conferences and meeting agendas. 

15. Encourage Food Stamp nutrition education programs and 

cooperators to provide information on CHIP/Medicaid. Issue 

electronic message to Food Stamp Regional Program Directors requesting 

that the 41 State agencies with approved optional Food Stamp Program 

Nutrition Education plans notify and request the assistance of their 

Nutrition Education Cooperators (e.g., Extension Service, Health Services, 

etc.) in providing CHIP/Medicaid informational materials. (Fall) 

16. Provide a list of FNS' Regional and State conferences to HHS for 

possible conference displays of CHIP/Medicaid information.

(Ongoing) 

17. Include CHIP/Medicaid information in the USDA National 

Hunger Clearinghouse database, accessed by State and local entities, 

non-profit organizations, food banks, and other individuals and 

groups that help low-income Americans with nutrition, health, and 

self-sufficiency issues. The Clearinghouse is a repository for the latest and 

best information on fighting hunger in this country, including food 

recovery and gleaning; it is accessed by more than 30,000 individuals and 

groups each year. (January 1999) 

3. REPORT FROM THE SECRETARY OF EDUCATION 

 

I. CURRENT PROGRAMS AND OUTREACH ACTIVITIES 

FOR CHILDREN 
A. Programs that Serve Middle to Low-Income Children 

The Department of Education’s mission is to ensure equal access to 

education and to promote educational excellence throughout the nation. 

Children’s health plays a critical role in achieving these goals. 

The U.S. has over 86,000 public elementary and secondary schools and 

26,000 private schools. The Department of Education programs, many of 

which target low-income and disadvantaged students, reach every State 

and region in the country as well as the territories of American Samoa, 

Guam, Northern Marianas, Puerto Rico, and the Virgin Islands. These 

provide an expansive network for dissemination of information about the 

children’s health initiative. The Department works with school districts, 

institutions of higher education, State educational agencies, national 

education organizations, and other private entities in our efforts to 

improve educational opportunities for all students. 

Title I Grants to Local Educational Agencies ($7.375 billion in FY 

1998). Title I, authorized under the Elementary and Secondary Education 

Act (ESEA), provides supplemental education funding to local educational 

agencies (LEAs) and schools, especially in high poverty areas, to help 

low-achieving students achieve to high standards. Funds flow to almost all 

school districts in the country. Target population: Funding is based on 

counts of children from low-income families, weighted by State per pupil 

expenditure. Eligible schools have a percentage of students from lowincome families exceeding the district-wide average or at least 35 percent. 

Currently, services are provided to approximately 10 million children in 

about 50,000 schools, including two-thirds of the country’s elementary 

schools. 

Special Education Grants to States ($3.8 billion in FY 1998). Special 

Education Grants to States, authorized under Part B of the Individuals with 

Disabilities Education Act (IDEA), provides formula grant assistance to 

States to support special education and related services to children with 

disabilities ages 3 through 21. Funds are awarded by formula on the basis 

of the number of children with disabilities. Under IDEA, State educational 

agencies are required to coordinate with other State agencies that are 

obligated to pay for services required under the IDEA such as certain 

health-related services. It is estimated that approximately 60 percent of 

children served in special education are Medicaid eligible. Target 

population: Children with disabilities ages 3 through 21. Approximately 6 

million children served in 1997. 

Grants for Infants and Families ($350 million in FY 1998 ). The Grants 

for Infants and Families Program, authorized under Part C of IDEA, 

provides financial assistance to States to implement Statewide 
comprehensive interagency systems to make available early intervention 

services to infants and toddlers with disabilities. Medicaid is a primary 

source of funding for direct services provided under this program. Target 

population: Infants and toddlers with disabilities and developmental 

delays and their families. Approximately 190,000 infants and toddlers 

served in 1997. Children at risk of developmental delays may be served at 

a State’s discretion. 

Adult Education: State Grants ($345.3 million in FY 1998). Adult 

education State grants, authorized under the Adult Education Act, 

provides formula assistance to States to support programs that assist 

educationally disadvantaged adults in developing basic skills, including 

literacy, achieving certification of high school equivalency, and learning 

English. Many of these adults are the parents or caregivers of potentially 

eligible children. Target population: Disadvantaged adults, including 

limited-English proficient and incarcerated and institutionalized 

individuals. Approximately 4 million adults served in 1997. 

State agency programs -- Migrant ($305.5 million in FY 1998). The 

Migrant Education program, funded under Title I, provides assistance to 

State educational agencies to improve education programs for children of 

migratory farm workers and fishers. Over two-thirds of migratory children 

come from households with incomes below the Federal poverty level. 

Funds may be used for after-school and summer programs, family literacy 

programs in which adults learn alongside of their children, GED programs, 

and mentoring programs. Target population: Children of migratory farm 

workers and fishers, over 80 percent Hispanic. Approximately 564,000 

children were served in 1997. 

Federal TRIO Programs -- Upward Bound and Talent Search ($215 

million in FY 1998). The TRIO programs, authorized under the Higher 

Education Act, fund postsecondary education outreach and student support 

services designed to encourage youth from disadvantaged backgrounds to 

enter and complete college. At least two-thirds of the eligible participants 

must be low-income, first-generation college students. Target population: 

Youth from disadvantaged backgrounds, ages 11 to 27. In 1997, Upward 

Bound served nearly 45,000 students, and Talent Search served nearly 

300,000 students. 

Bilingual Education: Instructional Services ($160 million in FY 1998). 

Bilingual Education Instructional Services, authorized under the ESEA, 

provides competitive grants to local educational agencies to assist them in 

providing quality programs for limited-English proficient (LEP) students. 

Target population: The program supports about 700 projects, serving 1.3 

million LEP students. 
Even Start ($124 million in FY 1998). The Even Start program, 

authorized under the ESEA, provides services to improve the educational 

opportunities of children and parents by providing early childhood 

education, adult education, and parenting education in integrated family 

literacy programs. The Department makes formula grants to States, and 

the States make competitive grants to about 700 partnerships of local 

educational agencies and other organizations. Target population: Lowincome families, including parents eligible for services under the Adult 

Education Act and their children birth through age 7. In 1997, 

approximately 34,000 families, including 36,000 adults and 48,000 

children, were served. 

Indian Education -- Grants to Local Educational Agencies ($59.75 

million in FY 1998). Indian Education Grants, authorized under ESEA, 

provide formula awards to local educational agencies and schools 

supported and operated by the Bureau of Indian Affairs (BIA) to improve 

elementary and secondary programs that serve Indian children to increase 

school readiness and integrate educational and other services. Target 

population: Indian students from preschool to secondary school. The 

program serves about 1,073 LEAs and 146 BIA schools. 

21st Century Community Learning Centers ($40 million in FY 1998).

The 21st Century Community Learning Centers program, authorized 

under the ESEA, provides grants to rural and inner city schools to provide 

extended learning and a safe haven for youth during non-school hours. 

Centers may serve the needs of all members of the community. The 

legislation specifically includes health services as an authorized activity. 

Target population: Lower-income youth and other community members. 

In 1998, this program will serve about 312 schools and an estimated 

50,000 students or other community members. In 1999, this number could 

expand to 4,000 schools and 500,000 students. 

Goals 2000: Parental assistance ($25 million in FY 1998). The Parental 

assistance program, authorized under Title IV of Goals 2000, currently 

supports 40 parent information and resource centers, run by nonprofit 

organizations that collaborate with institutions of higher education and 

social service agencies to increase parents’ knowledge of child-rearing, 

strengthen partnerships between parents and professionals to meet their 

children’s educational and developmental needs. Target population: Lowincome, minority, and limited-English proficient parents. 

Parent Information Centers ($18.5 million in FY 1998). The Parent 

Information Centers program, authorized under IDEA, currently funds 70 

centers that provide training and information to meet the needs of parents 

of children with disabilities in that area. The program also anticipates 

supporting 10 Community Resource Centers, operated by local parent 
organizations, that help provide underserved parents the training and 

information they need. Target population: Parents of children with 

disabilities, particularly underserved parents. 

B. Current Activities in Children’s Health Outreach 

Formed a working group to develop outreach strategies for 

Children’s Health Initiative. Since the President’s directive in February, 

the Department of Education has formed a working group, led by Libby 

Doggett and Carol Cichowski and including members from most of the 

principal offices of the Department. This group has met weekly to develop 

outreach strategies for the children’s health initiative. Members of this 

working group have also been active participants of the Interagency Task 

Force and the Communications and Minority Outreach subcommittees. 

 

II. PROPOSED PLANS FOR CHILDREN’S HEALTH 

OUTREACH 

The Department of Education provides funding and guidance through 

formula grants to States and districts to support their own programs, and 

we provide funding for technical assistance, research, and information 

clearinghouses to assist educators and parents in every area of education. 

For this reason, the Department is best able to reach the goals of the CHIP 

initiative by providing information and materials to State and local 

educational agencies, technical assistance providers, and information 

clearinghouses. It would then be up to the State and local administrators to 

determine effective ways of reaching potentially eligible students. 

Strategies involving teachers would be more appropriately handled by the 

NEA and other teacher organizations, but we could coordinate our efforts 

with them to the greatest extent possible. 

We also have numerous grantees that target special populations, including 

low-income, limited-English proficient, migrant, and special education 

students. By providing materials and guidance to these grantees, we hope 

that they will embrace the importance of this initiative and infuse that 

mission into their daily work. 

A. Educating Workers about Medicaid and CHIP 

Federal Workers

1. Send a memo from the Secretary of Education to all of the 

Department’s 4,800 employees explaining the importance of enrolling all 
children in Medicaid and CHIP and stressing the link between children’s 

health and learning. 

Publish the same message and a supplementary article in Inside Ed, the 

Department of Education’s newsletter that goes to all employees. The 

Department also sends out two publications via E-mail, Ed Info and Ed 

Initiatives, that could include information on Department outreach efforts. 

More than 12,400 direct subscribers receive EDInfo and ED Initiatives, in 

addition to approximately two to three times that many who receive it 

from cross-postings on other listservs. In addition, ED Initiatives is sent to 

all Department employees. (July 1998) 

2. Ask each Assistant Secretary to educate all staff, with special 

emphasis on Department speech writers, about CHIP and Medicaid and 

discuss specific strategies to get the word out to the Department of 

Education’s customers, including schools and families. This could include 

infusing the importance of children's health for learning into the ongoing 

work of the Department of Education and into speeches given by 

Department leaders. (June 1998) 

3. Provide a briefing and periodic updates to all of the Secretary’s 

Regional Representatives about CHIP and Medicaid by utilizing the 

Office of Intergovernmental and Interagency Affairs weekly conference 

calls with its Regional Offices. Solicit their ideas of further outreach 

activities and local events, and get their feedback about how the outreach 

strategies are working. Provide periodic updates to all staff on CHIP 

implementation in Department of Education news letters and bulletins. 

(Beginning in June, 1998) 

4. Include information on children’s health insurance in all 

orientation packets for new employees. (Ongoing) 
Grantees

5. Inform all relevant Department of Education clearinghouses, 

technical assistance centers/providers, parent centers , and other 

Department grantees of the Federal effort to enroll all eligible children in 

CHIP and Medicaid. Encourage them to use materials that are already 

developed or to develop other appropriate materials about Medicaid and 

CHIP and to distribute these through their networks and post them on their 

websites. These may include: National Information Center for Children 

and Youth with Disabilities (NICHCY), the Parent Training and 

information Centers and Regional Resource and Federal Centers supported 

under the IDEA, State Literacy Resource Centers, and the Adult Education 

and Literacy Clearinghouse. This could be done most efficiently through 

the Department’s central mailhouse. Develop cover letter appropriate to 

these grantees. (September to October 1998) 

6. Work with program offices to determine effective program-specific 

outreach strategies for major formula grant programs, focusing on 

Title I, Special Education, Migrant Education, Indian Education, Adult 

Education, and Even Start. (June to July and ongoing) This could include 

outreach to grantees at the Department’s Regional Improving America’s 

Schools Act conferences (October to December, 1998). 

B. Educating Families and Enrolling Children in Medicaid and 

CHIP 

7. Include information about the children’s health insurance initiative 

on the Department’s 800 number, 1-800-USA-LEARN. (July 1998) 

8. Mobilize the Department of Education’s Partnership for Family 

Involvement in Education, a group of over 3,000 organizations (with 

four sectors -- employers, education, community and religious) working to 

increase family involvement in education. Membership in the Partnership 

is voluntary and the level of participation is determined by each member. 

In 1998, the Department provided $1.3 million for administrative and 

publication expenses to support the Partnership. No additional funds 

would be needed for these activities, depending on 1999 funding. 

Include materials in monthly Partnership mailings explaining the 

importance of enrolling all children in Medicaid and CHIP and stressing 

the link between children’s health and learning. 

Submit an article for publication in Community Update, the Partnership 

newsletter which reaches over 200,000 parents, educators, and 

organizations involved in school improvement efforts. Published monthly, 

the newsletter features "best practices" and model programs from around 
the nation and focuses on how communities can learn from each other to 

improve their schools. (June-July) 

Send a follow-up mailing to Partnership for Family Involvement 

organizations, with examples of specific actions groups are taking to 

support the effort to enroll all eligible children. (October-January) 

Collaborate with Partnership for Family Involvement organizations to 

conduct targeted events in local communities. (Ongoing) 

C. Coordination with Other Programs 

9. Identify all major education stakeholders in outreach efforts to 

their members. Determine which organizations we can most effectively 

reach, and which are already being reached by other agencies. Conduct 

targeted meetings and collaborate on outreach strategies with identified 

education stakeholders. (Beginning in June 1998) These may include: 

• Specific groups who either reach out to special populations 

(advocacy groups such as ASPIRA, Literacy Volunteers of 

America, the Advisory Group on Higher Education for Native 

Americans, the National Black Children's Development Institute, 

the Child Care Action Campaign and the NAACP) or 

• Groups that have resources to bring to the effort (such as the 

Council of Chief State School Officers, Council of Great City 

Schools, National Association of State Directors of Special 

Education, National Association of Elementary School Principals, 

the National Association of Secondary School Principals, and 

foundations). 

10. Provide information on the Department’s website and establish a 

hotlink to HHS’s CHIP website. Include appropriate information 

including the Secretary’s e-mail message and activities being undertaken 

by principal offices as they relate to programs and CHIP/Medicaid. 

Update the website regularly with information on CHIP-related activities. 

(Beginning in June 1998) 

11. Use the Office of Public Affairs Listserve of public affairs directors 

of key stakeholder organizations to engage their publications and write 

articles about CHIP and Medicaid, the important links between a child’s 

health and education, and successful outreach strategies. Place applicable 

information on other relevant Listserves including the NEC*TAS 

Interagency Coordinating Council Listserve, the FICC Listserve, the 

Teacher Listserv, the Communities Can Listserv, and the National 

Institute for Literacy Listserve, with instructions to widely distribute the 

information. (June to August 1998) 
12. Obtain Department endorsement for HHS-produced materials, or 

produce Department materials about Medicaid and CHIP. Distribute 

these materials in the Department’s exhibit booth at major national 

conferences such as PTA, NEA, AFT, US Conference of Mayors, National 

Association of Counties, Congressional Black Caucus Annual Meeting, 

Urban League, and NAACP, as well as the Department’s Improving 

America’s Schools Act conferences. (Beginning in July, 1998) 

13. Develop and distribute prototype applications for integrating the 

94,000 National School Lunch Programs and children’s health 

programs. Collaborate with the Departments of Agriculture and Health 

and Human Services to develop for distribute to the Child Nutrition State 

agencies and Chief State School Officers, one or more prototype school 

lunch program applications that can be used to facilitate enrollment in 

Medicaid or CHIP. (September 1998) 

14. Work with the Chicago Public School District to: (1) launch a pilot 

outreach project to use mapping techniques to identify areas where 

significant numbers of children who appear to lack health coverage either 

through Medicaid or CHIP live; (2) assist innovative outreach efforts 

implemented by the Chicago school district (in conjunction with their 

State agencies) and determine feasibility for replication potential for all 

public school districts; (3) identify and recommend waivers for the 

Chicago public schools that are needed to allow innovative outreach 

enrollment efforts to be implemented; and (4) establish a communication 

forum between the Department of Education, HHS, USDA, Chicago, and 

other school districts to determine the extent to which promising outreach 

efforts implemented in Chicago can be replicated in other school districts. 

(July to November, 1998) 

4. REPORT FROM THE SECRETARY OF HOUSING AND 

URBAN DEVELOPMENT 

 

I. CURRENT PROGRAMS AND OUTREACH 

ACTIVITIES FOR CHILDREN 

A. Programs That Serve Middle To Low-Income Children 

The Department of Housing and Urban Development (HUD) was created 

in 1965 with the mission of empowering people and communities. HUD 

administers more than 100 programs aimed at providing affordable 

housing, home ownership opportunities, and creating community 

economic development. Through these programs HUD provides services 
to millions of families across the nation, many of whom have children 

eligible for CHIP or Medicaid. 

HUD's CHIP/Medicaid outreach efforts could be implemented through 

several program areas. Three of these, the Office of Public and Indian 

Housing, the Office of Housing/Federal Housing Administration, and the 

Office of Community Planning and Development, are major program 

areas that also administer smaller programs and initiatives, described 

below. 

Office of Public and Indian Housing (PIH). Programs administered by 

PIH include: 

Public and Indian Housing: HUD’s 3,400 public and Tribally Designated 

housing authorities administer approximately 15,000 public housing 

developments providing approximately 1.2 million units of housing for 

low-income individuals and families. The Office also administers a 

number of supportive service programs designed to assist residents with 

job training, transportation, child care, resident opportunities, and other 

supportive services. Target population for all PIH programs: Low-income 

residents of public and Indian housing. 

Section 8 Rental Certificates and Rental Vouchers Programs and Contract 

Renewals: ($8.2 billion in FY 1998) provides funding to local public 

housing agencies so that they may provide approximately 1.4 million 

rental certificates or rental vouchers to subsidize rental costs for qualified 

very low-income households. 

Hope VI ($441 million in FY 1998) provides funds for local agencies to 

revitalize distressed public housing communities 

Public Housing Drug Elimination Program ($288 million in FY 1998) 

provides funds to reduce or eliminate drug-related crime in public and 

Indian housing neighborhoods. This program also supports the Public 

Housing Youth Sports Program, which provides funds to establish 

positive, drug-free, cultural, and educational activities for youth residing 

in Public Housing. 

Early Childhood Development Program (ECD) ($21 million in FY 1994) 

provides funds to locate or expand child-care facilities in or near public 

housing developments and in Empowerment Zones and Enterprise 

Communities. 

 
Economic Development And Supportive Services Program (EDSS) and 

Tenant Opportunities Program ($2.5 million in FY 1998) provides funds 

to public housing agencies, Indian tribes and their Tribally Designated 

Housing Entities and residents to create and operate programs that 

increase resident self-sufficiency and support independent living for 

elderly and disabled residents (including those who are primary care 

givers of children). 

Office of Housing/Federal Housing Administration (FHA). Programs 

administered by the Office of Housing/FHA include: 

Assisted Multi-Family Housing Program provides direct subsidies or 

mortgage insurance through this program to help provide affordable 

housing for more than 2.6 million low-income families in approximately 

30,000 multi-family, assisted-housing developments nationwide. For FY 

1998, the Office of Housing could also provide up to $15 million for 

outreach and training grants to organizations to help provide information 

to residents of assisted multifamily housing developments. Target 

population: Low-income residents of HUD-assisted multi-family housing 

developments. 

Housing Counseling Program ($20 million in FY 1998) provides funding 

to more than 1,200 housing counseling agencies that qualify to apply for 

HUD funding. Counseling agencies help home buyers, homeowners and 

renters learn more about the home buying process and responsible home 

ownership and tenancy. Target population: Open to all, but mainly targets 

lower-income people and first-time buyers. 

Neighborhood Network Program (No specifically targeted Federal 

funding) encourages property owners and residents of assisted multifamily housing developments to develop computer learning centers that 

provide residents for job training and employment opportunities. 

Approximately 400 Neighborhood Network Centers are currently in 

operation nationwide. Access to the Internet and a Neighborhood 

Networks Website are also provided. 

Office of Community Planning and Development (CPD). Programs 

administered by CPD include: 

The HOME Program ($1.5 billion in FY 1998) allocates funds to 585 

State and local jurisdictions for affordable housing. Since 1992, more than 

315,000 low-income renters and home owners have received housing 

assistance through this program. Target population: Families with 

incomes at 80 percent of median income or less, with most assistance 

going to families at 60 percent of median income or less. 
HUD’s McKinney Act Programs ($823 million in FY 1998) provide 

grants to provide emergency shelter, supportive housing and services that 

will enable homeless people to live as independently as possible. Target 

population: Homeless individuals and families. 

Housing Opportunities For Persons With Aids (HOPWA) ($204 million in 

FY 1998) provides housing assistance and supportive services for lowincome people with HIV/AIDS and their families. Target population: 

HOPWA primarily benefits low-income persons living with AIDS and their 

families, especially those who are homeless or at great risk of becoming 

homeless. 

Historically Black Colleges And Universities (HBCU) ($6.5 million in FY 

1998) awards grants to HBCUs to address community development in 

their localities. Target population: The HBCU program primarily benefits 

low- and moderated income residents of the community in which the 

HBCU is located. 

Empowerment Zones And Enterprise Communities Initiative

(EZ/EC) targets tax incentives, performance grants, and loans to 

designated low-income areas, called Empowerment Zones or Enterprise 

Communities, to create jobs, expand business opportunities, and support 

sustainable community development (including health and other human 

services and environmental remediation). Target population: Residents 

and businesses in areas of inner cities designated as Empowerment Zones 

or Enterprise Communities. 

Office of Lead-Based Paint Hazard Control ($50 million in FY 1998) 

administers program providing funding to State and local governments to 

evaluate and reduce lead-based paint hazards in private housing rented or 

owned by low-income families, reducing the exposure of young children 

to lead-based paint hazards in their homes. Target population: Lowincome families, especially those with children, residing in the housing 

assisted under this program. 

Community Outreach Partnerships Center Program (COPC) ($7 

million, FY 1998) helps colleges and universities apply their human, 

intellectual, and institutional resources to economic development, local 

housing, neighborhood revitalization, health care, job training, crime 

prevention, education, planning, and community organizing. Target 

population: Determined by colleges and universities, no HUD restrictions 

on target population. 

B. Current Activities in Children’s Health Outreach 
Since President Clinton signed the Children’s Health Insurance Outreach 

Memorandum in February 1998, the Department of Housing and Urban 

Development has implemented the following outreach and coordination 

strategies: 

Provided demonstrations of the Department’s award-winning 

Communities 2020 computer mapping technology to other agencies 

and organizations involved in the CHIP/Medicaid Initiative. The 

technology, which has been widely acclaimed as a planning and 

coordinating tool, has been made available, at a nominal cost, for use by 

local, State, and other Federal agencies, private and/or not-for profit 

organizations, and interested individuals. 

Developed a Website on HUD’s award-winning homepage for 

presenting basic information about CHIP/Medicaid, with linkages to 

Websites with more detailed information. HUD’s Homepage receives 

more than 30,000 hits per month. 

 

II. PROPOSED PLANS FOR CHILDREN’S HEALTH 

OUTREACH 

A. Educating Workers About Medicaid and CHIP 

Federal Workers

1. Issue a departmental-wide electronic communication from the 

Secretary. This communication could be transmitted via the HUD Focus 

Message, which reaches almost all of the Department’s 9,500 employees, 

and send a letter from the Secretary to reinforce the message and ensure 

that those employees without regular access to a computer are aware of the 

CHIP/Medicaid initiative. (July 1998) 

Other Workers

2. Provide information about the Children’s Health Insurance 

Initiative to applicants for funding through the Department’s 

competitive programs for assisting families with children. More than 

80,000 organizations request information for funding through HUD’s 40 

competitive programs. Information could be provided to applicants in 

appropriate Technical Assistance meetings, workshops, conferences and 

satellite broadcasts, in application packages, appropriate program fact 

sheets, booklets, and Question and Answer (Q&A) documents. Technical 

Assistance workshops and conferences reach thousands of providers of 

housing and services each year. (Beginning in July 1998) 
3. Send a letter from the Secretary to all implementation directors of 

the 72 Urban Empowerment Zones/Enterprise Communities, the local 

governing structures, local government officials and representatives of the 

residents/stakeholders of the EZ/EC communities informing them of the 

Initiative, and encouraging these individuals and groups to support or 

implement efforts to enroll uninsured but eligible children into the 

Medicaid or CHIP. (July 1998) 

4. Provide outreach information to colleges and universities 

participating in Community Outreach Partnership Centers and 

Historically Black Colleges and Universities programs, encouraging 

involvement in local, State, or Regional outreach efforts. (July 1998) 

5. Provide information in appropriate technical assistance meetings, 

conferences, satellite broadcasts, and written materials, encouraging 

participants to assist local, State, and Regional outreach efforts. 

(Beginning July 1998) 

6. Provide information to 585 State and local jurisdictions 

administering HOME program funding, encouraging involvement in 

State and local outreach efforts. (July 1998) 

B. Educating Families and Enrolling Children in Medicaid and 

CHIP 

7. Place CHIP/Medicaid information on HUD’s kiosks at headquarters 

and in the Department’s 81 field offices across the country. The userfriendly kiosks harness state-of-the-art computer technology to provide the 

general public with useful information about housing and services and are 

expected to serve thousands persons each year. (September 1998) 

8. Send a letter to HUD grantees providing assistance to homeless 

families from the Deputy Assistant Secretary for Economic 

Development, who is responsible for administering HUD’s homelessness 

assistance programs, requesting that grantees make CHIP/Medicaid 

information available as part of their outreach, intake/assessment process 

and that they also establish connections to local Medicaid/CHIP providers 

so as to link eligible families to the appropriate source for children’s 

health insurance. (July 1998) 

9. Send a letter from the Assistant Secretary for Public and Indian 

Housing to the Executive Directors of the nation's 3,400 Public 

Housing Authorities, requesting that the Housing Authorities encourage 

the Executive Directors of the 15,000 public housing developments 

administered by these Authorities to: make space available, when possible, 

for eligibility workers to provide information and enroll children who are 
eligible for Medicaid/CHIP, and/or provide information to families with 

children applying for or renewing Section 8 certificates and vouchers, and 

to individuals and organizations administering grants for social services. 

The letter could also urge Housing Authorities to post notices and provide 

information regarding CHIP/Medicaid in areas of public housing where 

families congregate or interact, particularly at child care facilities, and 

encourage resident organizations in the housing developments to provide 

information and help ensure enrollment of eligible children. (July 1998) 

10. Send a letter from the Assistant Secretary for Housing/FHA 

Commissioner to project owners and managers of HUD assisted and 

insured Multifamily properties, providing them with information regarding 

the Initiative, and requesting that they assist in disseminating the 

information to residents with children. (Fall 1998) 

11. Expand the Department’s Memorandum of Understanding 

(MOU) with the U.S. Department of Agriculture to include the 

CHIP/Medicaid initiative. Currently the MOU provides for pilot projects 

in public housing developments in eight cities to help ensure that eligible 

families are enrolled in the Women, Infants, and Children (WIC) food and 

nutrition program. The two Departments have committed to work 

cooperatively to locate space and establish locations for nutrition and 

education programs, provide special consideration for grants to public 

housing developments that incorporate program operation at their sites, 

refer residents to appropriate programs, and disseminate information. 

Information regarding the CHIP/Medicaid Initiative may be made 

available as well. (July 1998) 

12. Send information regarding CHIP/Medicaid from HUD’s Office of 

Native American Programs to families who have purchased homes 

under the Department’s Section 184 Indian Home Loan Guarantee 

Program as the children in these families are likely to be eligible for CHIP. 

Families applying for Section 184 loans could be provided with 

CHIP/Medicaid information. Approximately 350 families have purchased 

homes under the Section 184 loan program, and approximately 500 

families apply each year. (Beginning in July 1998) 

13. Send CHIP/Medicaid information from HUD's Office of Lead 

Paint Hazard Reduction to parent and community groups educating 

families about lead hazards. HUD will fund new partnerships with parent 

and community groups, including United Parents Against Lead, to educate 

families about the dangers of lead paint. CHIP/Medicaid information 

could be included in informational mailouts. By the year 2000, these 

groups will educate more than 10,000 families. (Beginning in July, 1998) 

C. Coordination with Other Programs 
14. Send a letter from the Secretary to all Secretary’s Representatives, 

State Coordinators, and Area Coordinators, requesting that they work 

with other agencies in coordinating and implementing the Initiative. State 

Coordinators will be especially urged to contact and work with the 

director of the State’s Medicaid/Chip program to help ensure coordination 

of interagency efforts to implement the Initiative statewide. (July 1998) 

15. Incorporate information on CHIP/Medicaid in HUD’s Community 

Builders’ training and encourage Community Builders to work with 

other agencies in coordinating and implementing the Initiative in the 

localities they serve. Community Builders are HUD’s new front-line 

customer service representatives in the community and can link 

communities and individuals to other Federal resources as well as HUD 

resources. (Beginning in July, 1998) 

16. Include a CHIP/Medicaid website on those Neighborhood 

Networks Center computers that are connected to the internet. (July 

1998) 

5. REPORT FROM THE SECRETARY OF THE INTERIOR 

 

I. CURRENT PROGRAMS AND OUTREACH ACTIVITIES 

FOR CHILDREN 

A. Programs that Serve Middle to Low-Income Children 

Created in 1849, the U.S. Department of the Interior is responsible for 

protecting and providing access to the Nation’s natural and cultural 

heritage and to honor its trust responsibility to Indian Tribes. Of the eight 

Interior bureaus, only the Bureau of Indian Affairs deals directly with 

families and children. 

The Bureau of Indian Affairs (BIA) provides services to 554 Federally 

recognized Indian Tribes either directly or through contracts, grants, and 

compacts with tribes. The BIA, Office of Tribal Services, provides social 

services to families, children, the elderly and persons with disabilities. The 

BIA, Office of Indian Education Programs, has the responsibility of 

providing educational programs for more than 50,000 elementary and 

secondary school students, and helping fund 24 Tribally Controlled 

Community Colleges. 

The Office of Tribal Services (OTS) is the primary BIA office that 

provides social services to targeted Indian children and families at middle 
to low-income. OTS provides services through four fundamental 

programs: 

Welfare Assistance Program ($86,520,000 in FY 1997) is authorized 

under the Snyder Act of 1921 and offers three types of programs that 

provide essential services: General Assistance, Child Welfare Assistance, 

and Emergency Disaster and Burial Assistance. These programs provide 

for the basic needs (shelter, food, clothing, and utilities) of low-income 

Indian families. Approximately 85 percent of the welfare assistance 

program is contracted by Indian Tribes or tribal organizations. Target 

population: Low-income Indian individuals or families who are members 

of a Federally recognized Indian Tribe and are residing on an Indian 

reservation or in a designated near-reservation area. Recipients must: (1) 

meet income and liquid asset criteria and (2) have applied for and been 

denied from all other forms of Federal, State, and local assistance. In FY 

1996, the average monthly general assistance caseload nation-wide was 

34,000 persons. The child welfare assistance caseload averaged 3,400 

persons per month. 

Indian Child Welfare Program (ICWA) ($14,092,000 in FY 1997) is 

authorized by the Indian Child Welfare Act of 1978. Under the ICWA 

program, the BIA functions as a grantor to every Federally recognized 

Indian Tribe; it is a 100 percent tribally contracted program. The ICWA 

program provides Tribes with resources to protect Indian children, prevent 

the separation of Indian families, and to exercise tribal authority over 

Indian children in need of out-of-home placement. Target population: 

Although ICWA programs are reservation-based, they serve all Indian 

children, both on and off reservation, in need of out-of-home placements. 

Children must be an enrolled, or enrollable, member of a Federally 

recognized Indian Tribe. Approximately 12,000 Indian children and 

families were served by more than 500 Tribal ICWA programs in FY 

1996. 

Housing Improvement Program (HIP) ($15,760,000 in FY 1997) is 

authorized under the Snyder Act of 1921. HIP has three assistance 

categories: (1) safety and sanitation repairs to houses that remain 

substandard pending replacement, (2) repairs which will bring housing up 

to standard condition, and (3) new housing. The goal of HIP is to 

eliminate substandard housing and homelessness on reservations, and it is 

about 85 percent tribally contracted. Target population: HIP is available 

to needy Indian families who do not qualify for other 

Federal/State/Tribal/local housing programs. Applicants must be (1) a 

member of a Federally recognized Tribe, (2) residing on a reservation, (3) 

meet income guidelines and liquid asset criteria, and (4) own a home or 

have land appropriate for a house. Applicants who meet eligibility criteria 
are served in order of priority (applying a "neediest of the needy" 

standard) until funds are exhausted. 

Child Protection Program ($0 in FY 1997) is authorized under Title IV of 

Public Law 101-630, the Indian Child Protection and Family Violence 

Prevention Act of 1990. A tribally operated program, it is intended to 

protect Indian children from abuse and neglect. Currently BIA Law 

Enforcement provides training in background investigations for tribal 

personnel and processes FBI fingerprint and name checks for the Tribes. 

The Act authorizes Indian Child Resource and Family Services Centers 

and base funding for tribally-operated programs to protect Indian children 

and reduce the incidence of family violence on Indian reservations. When 

funds are available ($5.0 million is included in the FY 1999 President’s 

Budget), BIA will act as a grantor to all Bureau and tribal programs. 

Target population: Indian children who are at risk for abuse and neglect. 

In 1997, there were about 26,000 referrals to more than 500 Bureau and 

tribal programs for child abuse and neglect investigations. 

Office of Indian Education Programs (OIEP) is the second major BIA 

office that provides services to middle to low-income Indian families. It 

provides educational services to children and families through 8 primary 

programs: 

Indian Student Equalization Program ($293,703,000 in FY 1997) is 

authorized under the Snyder Act (1921). The Indian Student Equalization 

Program (ISEP) funds school operations and teachers’ salaries at Bureaufunded primary and secondary schools. ISEP also provides funding for the 

Bilingual, Gifted and Talented, and Intensive Residential Guidance 

programs. Target population: In School Year (SY) 1997-98, 185 Federally 

operated and tribally contracted schools will serve an estimated 50,820 

students enrolled/enrollable members of Federally recognized Indian 

Tribes. 

Title I Program ($45,458,316 in FY 1997) is authorized by the Improving 

America’s Schools Act (1994). The Title I program provides set-aside 

funding to directly assist Federally operated and tribally contracted 

schools in promoting academic achievement and challenging standards. 

Target population: All enrolled/enrollable Indian students attending 

Bureau-funded schools are served by the Title I program. 

Title II Program (Eisenhower Math & Science Professional Development 

Program) ($1,545,125 in FY 1997) is authorized under the Improving 

America’s Schools Act (1994). The Title II program provides set-aside 

funding for teacher and administrator professional development in 

Federally operated and tribally contracted schools. Target population: The 
Title II program, benefits all enrolled/enrollable Indian students attending 

Bureau-funded schools. 

Title IV Program (Drug Free Schools and Communities Act of 1994)

($5,309,780 in 

FY 1997) is authorized by the Improving America’s School Act of 1994. 

The Title IV program provides the Office of Indian Education Programs 

with set-aside funding to assist Federally operated and tribally contracted 

schools in developing violence prevention programs and strengthening 

programs that involve parents and prevent substance abuse. Target 

population: All enrolled/enrollable Indian students attending Bureaufunded schools are served by the Title IV program. 

Title IX Program (Indian Education Formula Grant Program) ($2,198,876 

in FY 1997) is authorized by the Improving America’s Schools Act of 

1994. These funds, set-aside for the Office of Indian Education Programs, 

are provided directly to Federally operated and tribally contracted schools, 

provide the resources for meeting the special academic and culturallyrelevant education needs of Indian students. Target population: The Title 

IX program provides funding for all enrolled/enrollable Indian students 

attending Bureau-funded schools. 

Family and Early Childhood Education Program (FACE) ($5,471,000 in 

FY 1997) is authorized by the Snyder Act (1921). The FACE program 

encourages family literacy. It provides infant and early childhood 

education accompanied by adult education in both home and school-based 

settings. Target population: The FACE program targets reservation-based 

Indian families. Twenty-two program sites, located within Bureau-funded 

schools, serve about 1,810 children (ages 0-5) and 1,830 adults from a 

total of 1,500 families. 

Special Education Program ($22,727,012 in FY 1997) is authorized under 

the Individuals with Disabilities Education Act (1991). The Special 

Education program provides funds to supplement services to children with 

disabilities. Target population: Enrolled/enrollable Indian children with 

disabilities, ages 5-21, attending Bureau-funded schools are eligible for 

the Special Education program. About 9,355 students receive services 

through the Special Education program. 

Tribally Controlled Community Colleges (TCCC) ($29,911,000 in FY 

1997) are authorized by the Tribally Controlled Community College 

Assistance Act (1978). The funding provided to TCCCs allows for the 

operation of Tribal community colleges and furthers higher education in a 

supportive environment close to Indian reservations. Target population: 

Twenty-four reservation-based community colleges are funded by the 
TCCC program. Funding to TCCCs is based on their Indian Student 

Count, or number of enrolled/ enrollable Indian students. In FY 1996, a 

total of 1,225 students graduated from the 24 TCCCs. 

B. Current Activities in Children’s Health Outreach 

Since the President signed the Children’s Health Insurance Outreach 

Memorandum in February, the Bureau of Indian Affairs has enacted the 

following outreach strategies: 

Address Medicaid and CHIP expansion in Assistant Secretary- Indian 

Affairs Speeches. The Assistant Secretary - Indian Affairs speaks to 

Indian Tribes, tribal organizations, Federal and Tribal employees, and with 

university students. At each speaking engagement, the Assistant SecretaryIndian Affairs introduces the Medicaid expansion and new CHIP program. 

He discusses its applicability to and potential impact on Indian 

communities. These were key talking points in April, as the Assistant 

Secretary visited Tribes and Bureau-funded schools in recognition of 

Child Abuse Prevention month. As other speaking engagements arise, 

children’s health insurance will continue to be a focus. This on-going 

educational strategy will continue into Spring 1999. 

Incorporate Medicaid and CHIP information into Area/agency/tribal 

contractor program training. The BIA is coordinating with the Health 

Care Financing Administration (HCFA) to explore options to train social 

service and education staff regarding the Medicaid expansion and the new 

CHIP program. An inventory of existing BIA programmatic training has 

been compiled, and concrete plans for CHIP training sessions within 

existing program trainings are being made. Potential Regional HCFA 

trainers are being identified to provide training to BIA and Tribal 

employees. Medicaid/CHIP training for BIA and tribal education and 

social services staff will begin during Summer 1998 and continue as 

necessary. 

Disseminate Medicaid and CHIP information at the Tribal SelfGovernance conference; at the 16th Annual "Protecting our 

Children" conference; at the National Congress of American Indians 

Welfare Reform Forums; at national Indian Education organizations’ 

conferences; at OIEP’s 12 Area spring consultation sessions. Because 

many of these conferences/events will be conducted prior to the 

development of the HCFA Medicaid/CHIP flyers, the information 

presently disseminated is word-of-mouth. BIA speakers on panels and 

giving keynote addresses at these conferences all discuss the Children’s 

Health Initiative and direct audiences to HCFA and their website for 

further information. Tribes and tribal organizations are encouraged to 

work with their States in the development of the State plan and to 
negotiate with States in the outstationing of eligibility workers and the 

expenditure of outreach funds to benefit Indian communities. As other 

conferences and presentation opportunities arise throughout the Summer 

and Fall of 1998, BIA staff will continue to highlight the Medicaid/CHIP 

programs. 

Link appropriate Internet locations to the Department of Health and 

Human Service’s Children’s Health Internet website. By May 15, 

1998, all of the appropriate BIA/HHS Internet links could be operative. 

Coordinate with all other Federal agencies providing services to 

reservation-based Indian families to identify common outreach 

strategies and disseminate Medicaid and CHIP information to all 

Indian families with minimal duplication of effort. Through the 

American Indian subgroup of the interagency Federal Task Force on the 

implementation of Medicaid/CHIP, many Federal agencies delivering 

services on Indian reservations will provide service delivery sites to the 

BIA Central Office to assist in the coordination of information 

dissemination. A national map and several Regional maps identifying all 

reservation-based Federal/tribally contracted service delivery sites were be 

produced (see Appendix E). 

 

II. PROPOSED PLANS FOR CHILDREN’S HEALTH 

OUTREACH 

A. Educating Workers about Medicaid and CHIP 

Federal and Tribal Workers

1. Send a memo regarding the expansion of Medicaid and the new 

CHIP program to BIA Area Offices, agencies, field offices, tribal 

social service contractors, Office of Indian Education Program line 

officers, and Bureau-funded schools and to all Tribal Leaders. The 

Assistant Secretary-Indian Affairs could send a memo to all Federal and 

Tribal social service and education workers. A separate letter specifically 

addressed to Tribal Leaders could also be sent out under the Assistant 

Secretary’s signature. These mailings, accompanied by the HCFA flyer 

developed for Federal and Tribal workers, would give a program 

overview, discuss the benefits of the Medicaid/CHIP programs for Indian 

Country, and encourage Tribes and Federal and Tribal workers to take 

advantage of these resources by enrolling eligible Indian children. These 

mailings could be sent out 30 days after the receipt of the flyers describing 

children’s health insurance outreach (July 1998). 
2. Include articles and periodic updates regarding Medicaid/CHIP in 

quarterly BIA Office of Tribal Services, Office of Indian Education, 

and Assistant Secretary’s newsletters. Articles introducing the 

Children’s Health Initiative and its related insurance programs were 

featured in the May editions of the Office of Tribal Services and Office of 

Indian Education newsletters. Follow-up articles could appear in July and 

September issues. The Assistant Secretary of Indian Affairs could feature 

a Medicaid and CHIP article in the premier issue of his newsletter, in 

June, with quarterly updates to follow. 

3. Provide technical assistance to BIA agencies, tribal contractors, and 

social service program personnel in disseminating accurate Medicaid 

and CHIP information; in developing culturally relevant materials; 

and in incorporating Medicaid and CHIP information into intake 

procedures for BIA social service programs. With tribal input, BIA 

Central Office staff has taken the lead in developing a culturally 

appropriate Medicaid and CHIP brochure for Indian families. Immediately 

upon distribution of the culturally relevant Medicaid and CHIP brochure, 

BIA Central and Area office staff could assist agencies, Tribes, and tribal 

organizations in developing and disseminating any other Medicaid and 

CHIP materials that may be needed. As BIA and tribally contracted social 

service programs begin to incorporate Medicaid and CHIP information 

into their intake procedures, BIA Central and Area Office staff could assist 

program directors, administrators, and staff in the provision of relevant 

materials and in the development of dissemination procedures. Much of 

the necessary coordination and exchange of information is already taking 

place at the local level. In situations where States have not provided 

assistance to Tribes, BIA Central Office could assist Tribes in gathering 

the relevant State Medicaid and CHIP information and incorporating 

Medicaid and CHIP information into intake procedures for BIA and tribal 

social service programs. BIA Central and Area Office staff could provide 

on-going Medicaid and CHIP technical assistance to Indian Tribes and 

tribal organizations. 

4. Provide Medicaid and CHIP briefings and programmatic updates 

via e-mail. On May 1, 1998, BIA Central Office provided its first 

Medicaid/CHIP briefing. BIA Area social workers could transmit these 

messages to agencies and Tribes that do not have Internet access. After the 

initial introductory message, monthly updates could include status of State 

plans, Tribal access to Medicaid and CHIP programs, State and Tribal 

coordination on issues surrounding children’s health care, and innovative 

outreach efforts targeting at Indian communities. 

5. Disseminate Medicaid and CHIP information to Office of Indian 

Education Programs (OIEP) staff. Between August 1998 and January 

1999, the OIEP could provide Medicaid and CHIP brochures and give 
appropriate presentations to all Federal and Tribal education staff. This 

information could be provided through a variety of media, including 

distributing materials and giving presentations at: quarterly school 

principal and OIEP line officer meetings, health education workshops, 

teacher and staff orientation sessions, and through Tribally Controlled 

Community Colleges. 

6. Develop and distribute 10-minute video about Medicaid and CHIP 

outreach for Tribes, schools, agencies. By February 1999, OIEP could 

develop and distribute a 10-minute video that gives a Medicaid and CHIP 

program overview, discusses the benefits of the Medicaid and CHIP 

programs for Indian Country, and encourages Federal and Tribal 

employees to assist potentially eligible Indian families to apply for 

children’s health insurance programs. 

B. Educating Families and Enrolling Children in Medicaid and 

CHIP 

7. Develop and distribute culturally relevant information for families 

to a wide range of sites. BIA Central Office could develop posters, 

brochures, and supplementary information packets to social service 

delivery sites, tribal community centers, tribal offices, Bureau-funded 

schools, Indian Education offices, Tribally Controlled Community 

Colleges, and tribal Departments of Education. Thirty days after receipt of 

the Medicaid and CHIP Indian family brochures, BIA Central Office 

could forward the brochures to all social service and education related 

service delivery sites. Posters and supplementary packets of information 

could be forwarded as they become available. All of these media would be 

available to Federal and Tribal employees to assist Indian families in 

learning about and accessing children’s health insurance. 

8. Encourage agency and tribal social service intake workers to ask 

applicants about children’s health needs and distribute appropriate 

referral information. Indian families will benefit greatly from social 

service intake workers sharing Medicaid and CHIP information with 

potentially eligible families and referring them to State Medicaid 

eligibility workers for enrollment. BIA Central Office could send letters to 

agency and tribal social service staff and use Medicaid and CHIP program 

training to impress upon workers the necessity of asking parents about 

their children’s health care needs by August 1998. 

9. Prepare press releases about Medicaid and CHIP for Indian 

newspapers. By July, 1998, the BIA Office of Public Affairs could 

develop Medicaid and CHIP press releases for Indian newspapers 

throughout the country for publication. Quarterly updates on the status of 

State Medicaid and CHIP plans, State and Tribal coordination on 
children’s health issues, and outreach efforts targeting Indian communities 

could also be forwarded for publication. 

10. Encourage Bureau-funded schools, Tribally Controlled 

Community Colleges, and tribal Departments of Education to send 

Medicaid and CHIP notices home with students, to focus on the 

Children’s Health Initiative on one of the monthly parents’ nights, 

and to hold informational sessions to distribute Medicaid and CHIP 

information. During the 1998-99 school year, the BIA could encourage 

Tribes and Bureau-funded schools to focus on the Children’s Health 

Initiative and to use every available medium to disseminate 

Medicaid/CHIP information to Indian families. OIEP could send the 

Medicaid and CHIP brochures designed for Indian families to all Tribes 

and Bureau-funded schools; suggestions for how Tribes and schools can 

use these brochures and hold forums for discussion to improve children’s 

access to health care will accompany the brochures. 

11. Sponsor Medicaid and CHIP public service announcements on 

Indian radio stations. By October 1, 1998, the BIA Central Office could 

submit public service announcements to be broadcast on Indian radio 

stations throughout the country. 

C. Coordination with Other Programs 

12. Encourage national unions (National Federation of Federal 

Employees and Indian Education Federation) to notify their 

membership of Medicaid/CHIP and the outreach initiative. By 

September 30, 1998, the Office of Indian Education Programs could have 

sent Medicaid/CHIP notification memos to its national unions and 

forwarded sample letters and brochures for the unions to mail out to their 

membership. 

13. Provide Medicaid and CHIP information to grassroots and 

advocacy organizations that serve Indian families. Upon thirty days of 

receipt of the Medicaid/CHIP Indian family brochures, the BIA Central 

Office could forward brochures and a program overview letter with 

referral contacts attached to Indian grassroots and advocacy organizations 

throughout the country. 

 

6. REPORT FROM THE SECRETARY OF LABOR 

 
I. CURRENT PROGRAMS AND OUTREACH ACTIVITIES 

FOR CHILDREN 

The U.S. Department of Labor’s (DOL) mission is to help American 

workers, job-seekers and employers. Its responsibilities include: protecting 

the wages, health, safety, and employment and pension rights of working 

people; promoting equal employment opportunity; administering job 

training, unemployment insurance and workers’ compensation programs; 

strengthening free and collective bargaining, and collecting, analyzing, 

and publishing labor and economic statistics. DOL’s programs and 

services affect children indirectly through their parents who work. 

A. Programs that Serve Middle to Low-Income Children 

Employment and Training Administration ($11.5 billion in FY 1997) 

assists American workers in obtaining information, job-search services, 

income maintenance, and education and training necessary to find and 

keep good jobs, and assists businesses in securing skilled workers and the 

training they need. Its major programs include: 

Unemployment Insurance (UI) ($6.2 billion collected in FY 1997) 

provides unemployed workers with temporary income support to facilitate 

their return to employment. It is funded by State and Federal employer 

taxes and is administered by States through 1,800 local offices with 

38,000 employees. Target population: Unemployed workers filing jobless 

claims. The number varies, but currently about 2.2 million insured 

unemployed receive benefits each week, and 7.6 million people received 

some benefits in FY 1997. 

Job Corps ($1.2 billion in FY 1997) is a national residential program that 

provides disadvantaged youth vocational, academic and social skills 

training, counseling, and health-related advice through 113 centers. Target 

population: 68,000 disadvantaged youth between ages of 16 and 24. 

Welfare-to-Work grants for Temporary Assistance to Needy Families 

(TANF) ($2.2 billion for two years) provides formula grants to States and 

competitive grants to local communities for transitional assistance to move 

the hardest-to-serve welfare recipients into unsubsidized jobs. Target 

population: Hardest-to-serve recipients of TANF. 

Summer Works (JTPA Title II-B) ($871 million in FY 1997) provides 

summer jobs, training and educational services through States and 

localities during the summer months. Target population: 530,000 

economically disadvantaged 14 to 21 year-olds. 
School-to-Work (STW) ($200 million, plus $200 million from Education 

Department in FY 1997) gives Urban/Rural Opportunities Grants to local 

initiatives in high poverty areas to increase opportunities for youth for 

further education and training and to prepare them for first jobs in highskill, high-wage careers. Target population: Youth in about 90 highpoverty rural and urban areas 

Economically Disadvantaged Adults (JTPA Title II-A) ($1 billion in FY 

1998) provides employment, training and job-placement services to adults 

with few skills and little work experience. Funding is coordinated with 

other Federal, State, and local programs. Target population: 351,000 

economically disadvantaged adults. 

National Programs (JTPA) ($670 million in FY 1998) provide grants to 

local public agencies and nonprofits to deliver employment and training 

services to specific target groups. Target populations: Economically 

disadvantaged Indians and Native Americans; migrant and seasonal farm 

workers; low-income people aged 55 and older, and people with 

disabilities. 

State Employment Security Agency (SESA) Liaisons (U.S. Employment 

Service) ($760 million in FY 1998) include more than 1,800 local offices 

that provide job placement, counseling, skills assessment, job-search 

assistance, labor market information to job-seekers, and referrals to 

employers. It also administers the Welfare-to-Work and Work 

Opportunity Tax Credits. Target population: Job-seekers and employers. 

Bureau of Apprenticeship and Training (BAT) oversees the National 

Apprenticeship System with the National Association of State and 

Territorial Apprenticeship Directors to assist industry in developing, 

expanding and improving apprenticeship and training programs. 

One-Stop Career Centers ($163 million in FY 1997) include more than 

700 locations that provide job-seekers with information on employment, 

education and training services, and link employers with qualified job 

applicants. Partners include programs for economically disadvantaged and 

dislocated workers, older workers and veterans, and the Employment 

Service and UI. Target population: Job-seekers and employers. 

Out-of-School-Youth and other Demonstration Program ($30 million; 

$250 million advance appropriation for FY 1999 pending) operates in six 

sites, with more planned, to increase the employment rate of poor out-ofschool youth from less than 50 percent to 80 percent. ETA also funds 

other demonstrations whose beneficiaries could be eligible for CHIP or 

Medicaid. 
Pension And Welfare Benefits Administration (PWBA) ($82 million in 

FY 1998) enforces and administers the Employee Retirement Income 

Security Act (ERISA) and the Health Insurance Portability and 

Accountability Act (HIPAA), and provides educational and technical 

assistance under the Consolidated Omnibus Budget and Reconciliation 

Act (COBRA). The agency also develops policies and laws to simplify 

compliance and encourage the growth and preservation of employmentbased benefits, and helps workers get information on benefit rights. Target 

population: 200 million pension, health and other employee benefit plan 

participants and beneficiaries; more than 3 million plan sponsors, and the 

employee benefit community. 

Employment Standards Administration (ESA) ($334 million in FY 

1998) enforces and administers laws governing legally mandated wages 

and working conditions, including child labor, minimum wage, overtime, 

family and medical leave, equal employment opportunity in businesses 

with Federal contracts, and workers’ compensation for certain employees. 

ESA includes the Wage and Hour Division, the Office of Federal Contract 

Compliance, the Office of Workers’ Compensation Programs, and the 

Office of Labor Management Standards. Target population: All American 

workers. 

Occupational Safety And Health Administration (OSHA) ($337 

million in FY 1997), through over 200 offices nationwide, establishes 

protective standards, enforces those standards, and reaches out to 

employers and employees through technical assistance and consultation 

programs to save lives, prevent injuries and protect the health of America's 

workers. Target population: Approximately 100 million American 

workers. 

Mine Safety And Health Administration (MSHA) ($203 million in FY 

1998) administers the Federal Mine Safety and Health Act of 1977 and 

enforces compliance with safety and health standards to eliminate 

accidents, minimize health hazards, and promote improved mine safety. 

Target population: The nation’s 370,000 miners. 

Veterans Employment and Training Service (VETS) ($184 million in 

FY 1998) furthers employment and training opportunities for veterans. Its 

Homeless Veterans’ Reintegration Project just awarded grants to 22 State 

and local organizations to serve about 4,000 veterans. Target population: 

America’s 14 million working-age veterans. 

Women’s Bureau ($8 million in FY 1998) promotes working women’s 

interests and workplace rights. Its "Working Women Count Honor Roll" 

includes 1,300 businesses, nonprofits, and State and local governments 
that pledge to initiate policies to improve workplaces. Target population: 

Working women and their employers. 

Office of Small Business Programs ($500,000 in FY 1997) promotes 

opportunities for small businesses in the Department’s contract and grant 

activities. 

B. Current Activities in Children’s Health Outreach 

Because the Labor Department has not historically provided information 

about public health insurance programs for children, it has only just begun 

outreach activities in this area. 

Outreach at VETS Grantee Conference. At a May 12-13 VETS 

conference in Washington on homeless reintegration grants, information 

on CHIP and Medicaid was disseminated to attendees, who were asked to 

share it with the populations they serve. At a June conference after 

veterans’ training grants are awarded, grantees received CHIP materials 

and be asked to share them with those they serve. 

II. PROPOSED PLANS FOR CHILDREN’S HEALTH 

OUTREACH 

The Department of Labor could focus its outreach activities on its 17,000 

employees, as well as its extensive network of partners and stakeholders 

who actively help to implement DOL programs serving working 

Americans and their families. These include State and local governments, 

grantees, labor and business organizations, community colleges and other 

education providers, and community-based organizations. 

A. Educating Workers About CHIP and Medicaid 

Federal Workers 

1. Distribute letters to all employees about children’s health outreach.

The Secretary of Labor and the Assistant Secretaries could distribute a 

letter which describe CHIP and Medicaid outreach activities to all 17,000 

employees in the national and Regional offices in July 1998. 

2. Provide employees with updated information about children’s 

health outreach. Agencies could hold "Brief & Brunch" presentations on 

the importance of CHIP and Medicaid outreach for interested employees.

Information about CHIP and the importance of outreach would be made 

available in the Department’s employee newsletter, "The Labor Exchange" 

which is distributed to 18,000 people on a quarterly basis. It could also be 

included at the bottom of employees’ Earnings and Leave statements, with 
contact points for additional information when that information becomes 

available (Fall 1998). 

3. Establish coordinated information campaign. The Department could 

ask the Federal Executive Board to coordinate all DOL agencies in the 

Regions to keep Federal employees informed on an ongoing basis. 

State Workers

4. Send letters to State Unemployment Insurance offices. UI could send 

a General Administrative Letter (GAL) to all UI and Employment Service 

offices, asking State Employment Security Agencies (SESA’s) to include 

CHIP and Medicaid information in UI check mailings to claimants in July. 

Simultaneously, they could also be encouraged to disseminate promotional 

materials at local offices when those materials become available in 

September. 

5. Include outreach in conference of State Employment Security 

Agency Liaisons (U.S. Employment Service). In the Summer of 1998, a 

national training conference is being planned for the designated 

coordinators for each State and Federal region and representatives of 

participating agencies (e.g., Job Corps, vocational rehabilitation agencies, 

Food Stamp offices). A knowledgeable presenter could explain CHIP and 

Medicaid. 

Other Workers

6. Send notices to employment and training community. ETA could 

conduct outreach about CHIP and Medicaid through notices, bulletins, or 

other documents used to transmit information to the employment and 

training system. Specifically, ETA could target: 

• 113 Job Corps Centers: Distribute a "Job Corps Notice" about 

CHIP and Medicaid to all national office senior staff; Regional 

directors; Job Corps Center operators; training and support 

contractors; outreach, admissions and placement contractors; and 

other service providers in July of this year. Centers will be 

encouraged both to educate workers and to distribute information 

to families once those materials are made available in September. 

• 700 One-Stop Career Centers: Send information on CHIP and 

Medicaid to One-Stop State contacts through a Training 

Information Notice in July. Regional One-Stop contacts, which 

have been informed about this initiative, could be encouraged to 

discuss it when they meet with State contacts. Flyers could be 

distributed at a National One-Stop conference on July 28-30. 
• 106 Bureau of Apprenticeship and Training Field Offices:

Distribute a "BAT Notice" providing information on CHIP and 

Medicaid to the 184 Federal staff and State partners in all field and 

Regional offices in July. It could also ask partners -- the National 

Association of State and Territorial Apprenticeship Directors, in 

the National Apprenticeship System -- to disseminate information 

to the apprenticeship community, including employers. CHIP and 

Medicaid flyers could be distributed at all national apprenticeship 

functions. All field staff could be encouraged to distribute flyers to 

existing and potential apprenticeship sponsors by September. 

Because BAT recognizes child care specialists as apprenticeable, it 

could conduct special outreach to inform them about CHIP and 

Medicaid 

• Welfare-to-Work Grantees. Distribute CHIP information to 

Welfare-to-Work competitive grantees (the first round of awardees 

will be announced in May) and Welfare-to-Work stakeholders, 

including community-based organizations and religious 

institutions. Informational letters may be distributed to grantees as 

early as July with more specific materials such as brochures to 

follow in September. 

• Summer Works program. Distribute formal notices and bulletins 

about CHIP and Medicaid to State partners and stakeholders who 

administer the Summer Works in July. These State liaisons could 

be encourage to share this information with all 640 private industry 

councils. 

• School-to-Work (STW) grantees and partners. Distribute CHIP 

and Medicaid literature, posters, etc. to grant coordinators at 

periodic grantee meetings; share information with State STW 

Directors through mailings and at quarterly grantee meetings; share 

information with members of the STW Advisory Committee and 

Communications Task Force via fax, tele-conferences, and 

periodic meetings; and prepare a fact sheet to distribute to the 

STW community through the STW Learning and Information 

Center (via the STW Website, in STW information packages and 

at conferences where the STW Learning Center is an exhibitor). 

This mass dissemination will begin in September, with specific 

dates to follow as meetings, conferences, etc. are scheduled. 

• Economically Disadvantaged Adult Program, National Job 

Training Programs, and Demonstration Projects. Distribute 

formal notices and bulletins about CHIP and Medicaid to State and 

local partners in July. 

7. Educate "Honor Roll" members of the Women’s Bureau about 

outreach. The Women’s Bureau’s could send a letter to 1,300 Honor Roll 

members to ask them to share CHIP and Medicaid materials with their 

employees. The Women’s Bureau could also do a mailing targeted to 
advocacy organizations for low-wage workers, urging them to share CHIP 

information with their constituents. Both of these activities can take place 

in July. 

B. Educating Families About CHIP and Medicaid 

8. Encourage States to outstation eligibility workers at Job Corps 

Centers. The national office could send a letter encouraging Job Corps 

Centers to serve as a CHIP outstation agency for State CHIP workers, 

particularly in remote areas where some centers are. (Summer 1998) 

9. Include CHIP and Medicaid Information in Pension and Health 

Care Benefits Booklet. In late spring, the Pension Welfare and Benefits 

Administration (PWBA) will release and distribute 200,000 copies of 

"Pension and Health Care Benefits ... Questions and Answers for 

Dislocated Workers," a 32-page booklet outlining health and pension 

benefits coverage for dislocated workers and their families. It could 

include a general reference to low-cost or no-cost insurance coverage at 

the State level for children whose family income is temporarily reduced. 

In addition, PWBA’s Health Care Portability Team, which conducts 

educational efforts about the Health Insurance Portability and 

Accountability Act, could include information about children’s health in 

their presentations, and is drafting a fact sheet to be inserted in the booklet 

for distribution by team members. Brochures also could be distributed 

through 15 Regional and district PWBA offices, at seminars and meetings 

concerning health insurance, and through a targeted outreach campaign to 

State and local officials administering the Worker Adjustment and 

Retraining Notification Act (WARN) and Economic Dislocation and 

Worker Adjustment Act (EDWAA). 

10. Distribute information to people contacting the Employment 

Standards Administration. The Wage and Hour Division could include 

information on CHIP and Medicaid in its mailings on the Family and 

Medical Leave Act (FMLA) beginning in September. The Office of 

Federal Contract Compliance Programs (OFCCP) could distribute 

information on CHIP and Medicaid to its Regional and district offices, 

which, in turn, could provide copies to the public when they come to the 

offices for OFCCP business. 

11. Encourage OSHA offices to distribute information on children’s 

health. OSHA could make available information about CHIP at its 10 

Regional offices, 67 area offices, 6 district offices, and through its 25 State 

plan offices, which are the agency’s partners, as well as at its public 

meetings and seminars, beginning in September. In addition, OSHA could 

encourage its Consultation Program, visits about 25,000 businesses per 

year, to distribute information about CHIP. It also could provide booklets 
to the small business centers and new start-up businesses with which it 

works. 

12. Distribute information to miners through district offices and 

inspectors. The Mine Safety and Health Administration (MSHA) could 

reach uninsured children in the mining community by distributing CHIP 

and Medicaid flyers to district offices in selected regions of the country; 

encouraging inspectors to disseminate information to miners; and 

establishing a hot link on the MSHA Website. Website links can be 

operational in July, while distribution of materials can begin to take place 

in September. 

13. Distribute information through small employers. The Office of 

Small Business Programs could encourage 2,000 small businesses to 

distribute CHIP and Medicaid information to their employees in July for 

initial advisement, and later in September for distribution of flyers and 

other promotional materials. 

C. Coordination with Other Programs 

14. Create Internet and Intranet "Hot Buttons." Information on CHIP 

and Medicaid could be available via a "hot button," developed by the 

Office of the Assistant Secretary for Policy, that will link all of the 

Department’s Websites to CHIP PSA’s and the HHS CHIP Website. It 

could also be linked with internal DOL Websites. This information could 

reach Federal, State and other workers in intermediary organizations that 

connect with DOL Websites, as well as the general public. A hot button 

could be placed on the Website for America's Job Bank, ETA’s successful 

online database of 750,000 job listings, used by millions of job-seekers. 

Though the Departmental Website already has CHIP and Medicaid PSA’s, 

work could continue to link other sites and modify those that already exist 

(Summer 1998). 

15. Send mailings to DOL constituencies. Office of Congressional and 

Intergovernmental Affairs could include CHIP information as part of 

weekly mailings to trade associations, labor organizations, and 

Congressional Committee offices. 

 7. REPORT FROM THE COMMISSIONER OF SOCIAL 

SECURITY 

 

I. CURRENT PROGRAMS AND OUTREACH 

ACTIVITIES FOR CHILDREN 
The Social Security Administration (SSA) and other benefit programs 

have the same basic objectives: to keep individuals and families from 

destitution; to help them attain economic and personal independence; to 

keep families together; to give children the opportunity to grow up healthy 

and with some financial security. SSA has a network of 1,300 field offices 

which serve the local community. 

The outreach activities in this report outline SSA’s efforts to work with 

other Federal agencies to respond to President Clinton’s challenge to make 

every effort to enroll uninsured children in Medicaid or CHIP. 

A. Programs that Serve Middle to Low-Income Families 

Supplemental Security Income (SSI; $5.2 billion in FY 1997) is a 

Federal program, administered by SSA, which provides a floor of income 

to individuals and families who are aged, blind or disabled. Children are 

eligible if they are disabled and their income and resources are below 

specified amounts. Target population: Individuals who have limited 

income and resources. Currently there are just under one million children 

receiving SSI. 

Surviving Children (Approximately $6.6 billion in FY 1997). Title II of 

the Act provides for a variety of benefits, including payments to surviving 

children of deceased workers and is intended to protect against the loss of 

income due to the death of the worker. Target population: All children of 

workers covered under Title II who meet certain criteria (1,895,030 as of 

December 1997). Children must be under age 18 (or over 18 and disabled 

or a full-time student age 18-19 ); not married and have been dependent 

on the deceased worker. 

Children of Disabled Workers (Approximately $4.1 billion in FY 1997). 

Title II protects children against the loss of income due to the disability of 

the worker/parent. Benefits are paid to children of disabled workers based 

on the worker's earnings record and other eligibility criteria. Applications 

for children (auxiliary beneficiaries) are taken automatically at the time 

the workers' applications for benefits are filed. Target population: 

Dependent, unmarried children who are under 18 (or older and disabled 

or a full-time student age 18-19); not married and have been dependent on 

the deceased worker (1,442,540 as of December 1997). 

Children of Retired Workers (Approximately $1 billion in FY 1997). 

Title II protect children against the loss of income due to the retirement of 

a worker/parent. Target population: All children of insured workers who 

retire that are under age 18 (or disabled and over 18 or a full-time student 

age 18-19), not married and were dependent upon the worker. (441,210 as 

of December 1997). 
 

B. Current Activities in Children's Health Outreach 

SSA staff is participating in interagency implementation planning 

committees. 

SSA has been soliciting comments from field office staff on CHIP 

products. 

SSA sends notices to children who are redetermined under the Welfare 

Reform Bill to inform them of their continuing Medicaid eligibility under 

the Balanced Budget Act. 

SSA workers are informed about Medicaid eligibility and know the 

general rules for Medicaid in their respective States. 

 

II. PROPOSED PLANS FOR CHILDREN’S HEALTH 

OUTREACH 

A. Educating Workers about Medicaid and CHIP 

1. Send a Commissioner’s broadcast about the children’s health 

insurance initiative to all SSA and Disability Determination Service 

(DDS) employees. The Commissioner’s broadcast is an urgent, timely 

message which the Commissioner wants to get out to all employees as 

soon as possible. It is usually limited to one page and is received by more 

than 65,000 SSA and DDS employees. (June 1998) 

2. Publish an article in the summer issue of the OASIS magazine 

about CHIP and Medicaid outreach. The OASIS magazine is a 

quarterly Social Security publication that goes to more than 65,000 

employees and members of the SSA Alumni Association. This issue of the 

OASIS could be distributed in mid-to-late August 1998. 

3. Distribute information on children’s health outreach at 

conferences. SSA’s Office of Communications staff and the regional 

public affairs specialist participate in approximately 110 conferences, 

health fairs and other community activities annually. These conferences 

are sponsored by virtually every type of advocacy group/organization — 

business, children’s, disability, ethnic, women’s, religious, etc. Central 

office and regional office personnel perform a number of functions at 

conferences in addition to staffing exhibits to answer participants’ 

questions and pass out printed information on Social Security-related 
issues and concerns. They also conduct workshops and seminars, arrange 

for the Commissioner and other agency officials to speak at plenary 

sessions and serve on panels with private sector and other Government 

agency officials. Since these activities are ongoing, information about the 

Children’s Health Insurance Program could be incorporated in talking 

points or exhibit materials (when appropriate) as soon as the materials are 

finalized. (Fall 1998) 

4. Include children’s health insurance publications in our Teachers’ 

Kits when they are reprinted in early 1999. The SSA Teachers’ Kit is a 

self-instructional set of materials for teachers to use in high school 

classrooms. It includes five lesson plans, a teacher’s guide, a 24-minute 

video, fact sheets, and other handouts. The material are designed to 

provide a basic understanding of Social Security programs young people 

can use now and in the future. It is anticipated that 35,000 Teachers Kits 

will have been distributed during the period beginning September 1996 

and ending December 1998. SSA plans to print another 20,000 Teachers’ 

Kits in early 1999. 

B. Educating Families and Enrolling Children in Medicaid 

and CHIP 

5. Display children’s health insurance pamphlets and posters in SSA’s 

1,300 field office reception areas and distribute them at various publicity 

functions. SSA could provide HFCA a summary sheet, disk, and labels 

containing the field office addresses. The summary sheet could list the 

various classes (sizes) of field offices and the suggested numbers of flyers 

and posters that should be sent to each. This number of flyers and 

pamphlets includes a supply of these items to be stored in SSA's Public 

Information Distribution Center (PIDC) so local offices can reorder 

whenever necessary. (Fall 1998) 

6. Annotate field office referral screen with the national toll-free 

number for CHIP/Medicaid. The 800-number system contain’s pop-up 

screens of information on the most prevalent SSA issues/concerns. This 

system currently has a Medicaid screen and CHIP could be added to that 

screen. The staff could be informed about the CHIP outreach program via 

either e-mail or a Teleservice Center Guide. (Fall 1998) 

C. Coordination with Other Programs 

7. Link SSA’s website to DHHS children health website. SSA currently 

has a children’s webpage in addition to its main home page. Links could 

be established on SSA’s children’s page and on the main webpage to 

HCFA’s website. This would not require an interagency agreement and 
would be updated whenever HCFA made changes in the CHIP website. 

(Summer 1998) 

8. Provide HCFA a mailing list for an outreach letter about Medicaid 

and CHIP. HCFA or States could send an outreach letter to children 

denied SSI or who are receiving benefits on the basis of the death, 

disability, or retirement of the worker/parent. This kind of mailing list 

would be via a tape that SSA can produce in approximately four months. 

(Fall 1998) 

9. Send a message on children’s health outreach to community 

organizations. The Office of Communications will have a national 

community organization database in the summer of 1998. This database 

will contain 5,000 to 10,000 community organizations and it will be 

possible to identify those that serve families, children, and others who are 

interested in health issues. (Fall 1998) 

8. REPORT FROM THE SECRETARY OF TREASURY 

 

I. CURRENT PROGRAMS AND OUTREACH ACTIVITIES 

FOR CHILDREN 

A. Programs that Serve Middle to Low-Income Children 

As the Federal Government's financial agent, the Treasury Department not 

only interacts face-to-face with many families every year — including 

many families with children that are middle to low-income — but also 

works with a number of groups and organizations that serve this 

population. While these contacts occur primarily through the Internal 

Revenue Service (IRS) and its efforts to assist taxpayers, some will also 

arise as part of the Department's efforts to expand the use of electronic 

transfers of Federal benefit payments. 

Earned Income Tax Credit (E.I.T.C.) Compliance Initiative ($138 

million appropriation in FY 1998) is authorized under section 5702 of the 

Balanced Budget Act of 1997, P.L. 105-33. The E.I.T.C. is a refundable 

tax credit for working families with low and moderate income. It 

encourages families to move from welfare to work by making work pay, 

and helps ensure that parents who work full-time do not have to raise 

children in poverty and that families with modest means do not suffer 

from eroding incomes. Among other things, this appropriation supports 

expanded customer service, including increased community-based tax 

preparation sites and a coordinated marketing and educational effort to 

assist low-income taxpayers in determining their eligibility for the 
E.I.T.C.. Target population: Over 15 million low-income working families 

— generally those with one child and income below about $26,000 or 

those with more than one child and income below about $29,000 — are 

expected to claim the E.I.T.C. on their 1997 tax returns. 

IRS Walk-in Office Operations ($50 million appropriation in FY 1998) 

are funded through the Treasury Department Appropriations Act, P.L. 

105-61. This appropriation helps the IRS operate a network of over 400 

walk-in offices around the country, where taxpayers can go for answers to 

questions and to help resolve problems about Federal income taxes. While 

assistance is available at these offices year round, starting this year certain 

days during the tax season are focussed on helping taxpayers who are 

eligible for the E.I.T.C. fill out their returns and calculate their credit (with 

identifiable E.I.T.C.-related costs allocated to the E.I.T.C. Compliance 

Initiative). Target population: Taxpayers with questions or who are 

seeking to resolve problems related to Federal taxes, including those 

seeking assistance in determining their eligibility for the E.I.T.C.. 

Electronic Funds Transfer Initiative (EFT99) ($1.9 million 

appropriation in FY 1998) is authorized under the Debt Collection 

Improvement Act of 1996, P.L. 104-134. Under this appropriation, the 

Department's Financial Management Service (FMS) is actively pursuing 

measures to enhance the use of electronic fund transfers, which cost less 

and provide a more secure and reliable means of making payments to 

Federal beneficiaries. In the summer of 1998, FMS will begin an intensive 

year-long effort to encourage more beneficiaries to receive their payments 

electronically. As part of this process, FMS has developed an extensive 

list of community-based organizations around the country — most of 

which have constituents living in low-income communities — that will be 

contacted. Target population: Those who receive Federal benefits by 

check — many of whom are low-income — who are to be reached through 

community-based organizations which serve them. 

B. Current Activities in Children’s Health Outreach 

Because the Treasury Department has historically not played a role in 

disseminating information about health insurance options for children, it 

currently has no outreach activities in this area. 

 

II. PROPOSED PLANS FOR CHILDREN’S HEALTH 

OUTREACH 

A. Educating Workers about Medicaid and CHIP 
Federal Workers

1. Send memorandum from the Secretary to all Treasury employees.

Considering both the high priority attached to this initiative and the extent 

to which they work with low-income families, the Department would 

propose to educate its workers about Medicaid and CHIP by sending a 

memorandum from the Secretary to every Treasury employee — about 

158,000 in all. Incorporating language to be developed by HHS for use by 

other agencies, this memo would summarize the President's outreach 

initiative and the steps the Department plans to take as a result. It would 

also indicate that further guidance will be forthcoming for employees that 

would be affected by these proposed steps, and would refer both to the 

weblinks (see below) and to the Medicaid/CHIP toll-free information 

number that will be established as sources of more detailed and updated 

information about these programs. Implementation could take place soon 

after this report is approved by the President. Once the steps proposed in 

this report are implemented, options for updating employees about 

progress that has been made and for soliciting ideas about further possible 

steps would be explored. 

Other Workers

2. Help make information on Medicaid and CHIP available in 

conjunction with certain E.I.T.C. outreach efforts and events. The IRS 

is engaged in a wide range of activities as part of its marketing and 

educational campaign to assist low-income taxpayers in determining their 

eligibility for the E.I.T.C.. Though in some cases it would not appear 

possible to incorporate Medicaid and CHIP materials into these efforts 

without unduly complicating the process of disseminating information 

about the E.I.T.C. itself — information that is also very important for 

lower-income working families — in other cases the two outreach efforts 

could dovetail nicely. For example, E.I.T.C. outreach workers will be 

participating in 12 conventions held by relevant organizations (e.g., 

NAACP, La Raza, hotel/motel workers, tax practitioners) this fiscal year. 

The Department would propose to begin discussions with HHS at the 

earliest opportunity about the best way to provide information on 

Medicaid and CHIP though these contacts. The IRS also interacts 

regularly with the Center on Budget and Policy Priorities — which has 

sent its own E.I.T.C. mailing to over 25,000 groups and organizations in 

its database — and the American Association of Retired Persons (AARP), 

which has been active both in Medicaid outreach and taxpayer assistance; 

both groups could be encouraged through these channels to add or expand 

communications about Medicaid and CHIP and to contact HHS for 

outreach materials. 
B. Educating Families and Enrolling Children in Medicaid 

and CHIP 

3. Post basic materials on Medicaid and CHIP at IRS walk-in centers 

and provide them to Voluntary Income Tax Assistance (VITA) sites.

The Department would place in each of the 400 IRS walk-in centers a 

copy of outreach posters which highlight the availability of these health 

insurance programs for children, and urge potentially eligible families to 

call the toll-free Medicaid/ CHIP information number so that they can find 

out more about whether they are actually eligible and about how to apply. 

Pamphlets provided by HHS — or another item that families could take 

with them describing the programs and highlighting the toll-free number 

— could also be posted. In addition, there are about 8,600 VITA sites 

around the country where non-profit groups provide help to tax filers, 

most often those who are lower-income; here too the HHS posters and 

possibly other referral information could be provided with high impact. 

The Department would propose to begin discussions with HHS at the 

earliest opportunity about how best to reach these VITA sites (e.g., by 

providing HHS with a mailing list and collaborating on the text of a 

transmittal letter) and on the quantity and type of materials required. 

Contingent on the provision of these materials by HHS early in the next 

fiscal year — and on the successful implementation of the toll-free 

number to which they would refer — these steps could begin in FY 1999 

and be updated as appropriate in subsequent years. 

4. Invite State outreach workers to certain walk-in centers on 

E.I.T.C.-focussed days. Given the overlap between the E.I.T.C. and 

Medicaid/CHIP target populations, the days at certain walk-in centers that 

will be focussed on E.I.T.C. assistance provide a substantial opportunity to 

reach this audience. To take maximum advantage of this opportunity while 

absolutely minimizing the burden on the IRS workers at these centers 

during times of peak demand, the Department would propose having a 

Medicaid/CHIP outreach worker at appropriate walk-in center on those 

days. Because these centers are generally small and have very limited 

space available, and due to taxpayer privacy concerns, an extensive 

presence would not be feasible. Where space permits, this worker could be 

available in the waiting area to provide information materials and possibly 

mail-in application forms that are requested, and to answer the questions 

of walk-in center patrons. The Department would propose discussions 

with HHS to resolve any logistical and implementation issues surrounding 

this proposal. Based on these discussions, the Department would propose 

to have this invitation be coordinated through HHS, with Treasury 

providing a list of the centers and days involved to be passed on to the 

relevant State agencies. If practical, a notice could be posted at the 

designated walk-in centers in advance, announcing the dates that an 

outreach worker will be available on-site. Implementation of the steps 
outlined here could begin once the dates and locations of these E.I.T.C.-

focussed days have been established for FY 1999. 

C. Coordination with Other Programs 

5. Help provide information about Medicaid and CHIP to the 

community-based organizations being contacted through the EFT99 

initiative. Since the organizations being contacted through this initiative 

over the next year are likely to interact with many families that are eligible 

for Medicaid and CHIP, the list of them that has been developed — which 

includes a large number of local offices located in the communities of 

interest — constitutes a valuable database for outreach purposes. The 

Department would propose sharing this list with HHS at the earliest 

opportunity and coordinating about the most effective means of 

distributing materials such as posters and pamphlets to these 

organizations, once these materials are available. 

6. Add Medicaid/CHIP link to Treasury's websites. The Department 

could add a link to the CHIP/Medicaid webpage at HHS to its external 

website for the general public; to its internal website for Departmental 

employees; and to the E.I.T.C. home page maintained by the IRS. 

Implementation may depend on further development of this HHS 

webpage. (Fall 1998) 

 

 

 APPENDIX A: 

 EXECUTIVE MEMORANDUM, FEBRUARY 18, 1998 

 

 

MEMORANDUM 

FOR THE 

SECRETARY OF 

TREASURY 

THE SECRETARY 

OF AGRICULTURE 

THE SECRETARY 

OF THE INTERIOR 
THE SECRETARY 

OF LABOR 

THE SECRETARY 

OF HEALTH AND 

HUMAN SERVICES 

THE SECRETARY 

OF HOUSING AND 

URBAN 

DEVELOPMENT 

THE SECRETARY 

OF EDUCATION 

THE 

COMMISSIONER 

OF SOCIAL 

SECURITY 

SUBJECT: 

 Children’s 

Health Insurance 

Outreach 

 

 

Over 10 million of our Nation’s children are currently uninsured and, as a 

consequence, often cannot afford much-needed health care services such 

as doctor visits, prescription drugs or, hospital care. Last year, with 

bipartisan support, we took a major step toward solving this problem. The 

Balanced Budget Act that I signed into law enacted the largest single 

expansion of children’s health insurance in 30 years. The new Children’s 

Health Insurance Program (CHIP) provides $24 billion over 5 years for 

coverage of millions of uninsured children in working families. It builds 

on the Medicaid program, which currently covers nearly 20 million poor 

children across the country. 

We now face the serious task of enrolling uninsured children in both 

Medicaid and State-administered children’s health programs. We know 

that well over 3 million uninsured children are eligible but not enrolled in 

Medicaid. This is largely due to a lack of knowledge about Medicaid 

eligibility and the difficulty of the enrollment process. These same 
problems could limit the potential of CHIP to successfully enroll millions 

of uninsured children. 

To ensure that both Medicaid and CHIP fulfil their potential, I am calling 

for a nationwide children’s health outreach initiative involving both the 

private and public sectors. As illustrated by my announcement today, 

foundations, corporations, health care providers, consumer advocates and 

others in the private sector are already responding to our challenge to 

make every effort to enroll uninsured children in Medicaid or CHIP. In the 

public sector, my FY 1999 budget proposal includes policies to give States 

the flexibility and funding they need to conduct innovative outreach 

activities. The Health Care Financing Administration (HCFA) and Health 

Resources and Services Administration (HRSA) should continue their 

focused efforts to promote outreach through administrative actions. 

There is clearly more that the Federal Government can do to help the 

States and the private sector achieve our mutual goal of targeting and 

providing coverage to uninsured children. Many children who lack health 

insurance are the same children who benefit from the programs your 

agency now administers. Eligibility for Medicaid and CHIP is often 

similar to that for programs like WIC, Food Stamps, Head Start, tax 

programs, job training, welfare to work, Social Security , public housing, 

and homeless initiatives. Thus, a coordinated Federal interagency effort is 

critical to the success of the Administration and the States to provide 

health care coverage for children. 

Therefore, to increase enrollment of uninsured children in Medicaid and 

CHIP, I hereby direct you to take the following actions consistent with the 

mission of your agency. 

First, I direct you to identify all of the employees and grantees of your 

agency’s programs who work with low-income, uninsured children who 

may be eligible for Medicaid or CHIP. 

Second, I direct you to develop and implement an educational strategy 

aimed at ensuring that your agency’s employees and grantees are fully 

informed about the availability of Medicaid and CHIP to our Nation’s 

children. 

Third, I direct you to develop an agency-specific plan as part of our 

Administration-wide, intensive children’s health outreach plan. Your 

agency’s plan should include distributing information and educating 

families about their options; coordinating toll-free numbers and other 

sources of information on public programs; simplifying, coordinating, and, 

where possible, unifying the application process for related public 
programs; and working with State and local agencies on broadening the 

locations where families can apply for Medicaid and/or CHIP. 

Fourth, I direct you to identify any statutory or regulatory impediments in 

your programs to conducting children’s health insurance coverage 

outreach. 

Finally, I direct the Department of Health and Human Services to serve as 

the coordinating agency to assist in the development and integration of 

agency plans and to report back to me on each agency’s plan in 90 days 

with recommendations and a suggested implementation timetable. In so 

doing, I direct the Department to ensure that Federal interagency activities 

are complementary, aggressive, and consistent with the overall initiative to 

cover uninsured children. 

 APPENDIX B: 

 PRESIDENT CLINTON’S INITIATIVE FOR CHILDREN’S 

HEALTH 

Enacted Single Largest Investment in Children’s Health Care since 

1965. The Balanced Budget that President Clinton signed into law on 

August 5, 1997 included $24 billion for the Children’s Health Insurance 

Program (CHIP) -- the single largest investment in health care for children 

since the passage of Medicaid in 1965. CHIP will provide health care 

coverage to millions of currently uninsured children -- including 

prescription drugs, vision, hearing, and mental health services. 

Passed Meaningful Health Insurance Reform. The President signed the 

Health Insurance Portability and Accountability Act which limits 

exclusions for pre-existing conditions, makes coverage portable and helps 

individuals who lose jobs maintain coverage. This law helps millions of 

children keep their health care coverage when their parents lose or change 

jobs. 

Raised Immunization Rates to All Time High. 90 percent or more of 

America's toddlers in 1996 received the most critical doses of each of the 

routinely recommended vaccines -- a record high that surpasses the goal 

set by the President in 1993. 

Protected Children in Child Care Settings by Ensuring Proper 

Immunization. In July 1997, President Clinton proposed new child care 

regulations to ensure that children in child care receive the immunizations 

they need on time. The proposed rule would require that all children in 

Federally subsidized child care be immunized according to State public 
health agency standards. This will particularly help children in child care 

arrangements that are legal but exempt from State licensing. 

Ensured that Prescription Drugs Have Been Adequately Tested for 

Children. President Clinton announced an important Food and Drug 

Administration regulation requiring manufacturers to do studies on 

pediatric populations for new prescription drugs -- and those currently on 

the market -- to ensure that prescription drugs have been adequately tested 

for the unique needs of children. 

Established Protections for Mothers and Their Newborns. The 

President spearheaded legislation requiring insurance companies to cover 

at least 48 hour hospital stays following most normal deliveries and 96 

hours after a Caesarean section. This legislation ensures that mothers and 

babies do not leave the hospital before they and their doctors decide they 

are ready. 

Increased Research Funding at the National Institutes of Health. The 

President increased funding at the National Institutes of Health (NIH) by 

over $900 million, for a total of $13.6 billion for NIH in FY 1998. 

Between 1993 and 1998, NIH funding increased by $2.4 billion, or 35 

percent, benefitting critical research areas such as cancer, the Human 

Genome Project, and children’s health. 

Improved Children’s Health and Safety with Healthy Child Care 

America. In an effort to improve the health and safety of child care 

programs and to provide child health education to child care providers and 

parents, the Clinton Administration launched the Healthy Child Care 

America initiative. This effort has established partnerships between child 

care providers and health care services in 46 States, helping to ensure safe 

and healthy environments for children. 

 APPENDIX C: 

 TARGETING VULNERABLE GROUPS OF CHILDREN 

 

Some children eligible for Medicaid or CHIP are difficult to reach due to 

barriers to understanding or responding to outreach activities geared to a 

mainstream population. Special populations and minorities often face 

sociocultural and linguistic differences, low literacy levels, geographic 

isolation, homelessness, or transient living situations that make it difficult 

for them to enroll in health insurance. As a result, these groups tend to 

have higher rates of uninsured children. While general outreach strategies 

for CHIP and Medicaid enrollment may result in increased enrollment 
among these groups, a number of outreach activities have been proposed 

by Departments targeted specifically at reducing the unique barriers faced 

by minorities and special populations. 

Native American/Alaska Native Children 

American Indians are among the most disadvantaged minority in this 

country, particularly with respect to health. Approximately 38.3 percent of 

Native American children live in families below the Federal poverty level. 

Native American families may be hesitant to apply for or receive State 

health care or supportive services because of cultural differences. 

Although many Native Americans are eligible to receive a comprehensive 

range of health care services through the Indian Health Service (IHS), 

these services are often limited by budget constraints. In addition, State 

workers are often unfamiliar with tribal lifestyles, family values, and 

communication styles. The coordination of reservation based IHS services 

with the Medicaid and CHIP programs will be crucial in providing Native 

American children with access to health care services. Activities proposed 

to increase the enrolment of Native American/Alaska Native children 

include: 

Mapping Service Delivery Sites. Under the direction of the Department of 

the Interior, Federal agencies providing any reservation-based social, 

supportive, and health care programs or services will map all of their 

service delivery sites in order to efficiently coordinate outreach efforts to 

potentially eligible Native American children. 

Brochure Development. Because of the experience that many Native 

American families have had in dealing with IHS and with State programs, 

the Department of the Interior will develop a brochure explaining the 

Medicaid and CHIP programs, how they differ from IHS services, and 

how Native American families can work with the State to enroll their 

children. 

Targeted Mailings. The Department of Housing and Urban Development 

(HUD) could send information on CHIP and Medicaid to families who 

have purchased homes under the Department’s Section 184 Indian Home 

Loan Guarantee Program as the children in these families are likely to be 

eligible for health insurance programs. 

Hispanic Children 

Hispanic children have the highest rate of uninsured children of all major 

racial and ethnic minority groups: 29 percent were uninsured in 1996 

(U.S. Census Bureau, 1998). Seventy-three percent of Hispanic children 

live in families with incomes below 200 percent of the Federal poverty 
level and are potentially eligible for Medicaid or CHIP. Barriers to 

enrollment in health insurance programs for this population include lack of 

Spanish language outreach information and applications in some areas, the 

welfare stigma of health programs, and a fear that applying for a public 

program could cause problems with immigration officials for family 

members. The following activities have been proposed in an attempt to 

alleviate existing barriers to enrollment in health insurance programs for 

this population: 

Development of Bilingual Educational Materials. The Health Care 

Financing Administration (HCFA) could partner with Educational Video 

in Spanish, Inc. to develop public service announcements about the 

availability of Medicaid and CHIP. These advertisements could be aired 

on Spanish language television nationwide. 

Partner with Minority Advocacy Groups. HCFA could partner with La 

Raza and other organizations representing Hispanic populations to explore 

how they can assist State Medicaid and CHIP agencies in conducting 

outreach. 

Focus Groups. HCFA could conduct focus groups to identify outreach 

needs of newly arrived and well-established Hispanic immigrants and will 

share this information with States. The focus groups will identify 

perceived application barriers to enrollment, specific cultural barriers, and 

identify to what extent States target outreach activities to address the 

Hispanic population. 

African American Children 

Almost 19 percent of black children live in very poor neighborhoods, 

where over 40 percent of the residents are below the Federal poverty level. 

Sixty-eight percent of black children live in families with incomes below 

200 percent of the Federal poverty level and are potentially eligible for 

Medicaid or CHIP. Barriers to enrollment in health insurance programs for 

this population include a lack of culturally appropriate information about 

available programs and inaccessibility of sites for applications in some 

urban areas. The following activities have been proposed in an attempt to 

alleviate existing barriers to enrollment in health insurance programs for 

this population: 

Outreach Conference. The Health Resources and Services Administration 

and the Health Care Financing Administration are sponsoring a Children’s 

Health Insurance Program Outreach Conference for Historically Black 

Colleges and Universities (HBCUs) on August 13-14, 1998. The purpose 

of this conference is to provide HBCUs with information on the Federal 

framework for CHIP and State options for its implementation and 
administration, and to examine outreach strategies that HBCUs can 

employ to assist in enrolling children in Medicaid and CHIP. 

Partnership with Minority Advocacy Groups. HCFA could develop 

partnerships with the National Congress of Black Churches, Historically 

Black Colleges and Universities, and other organizations representing 

African Americans to explore how they can assist State Medicaid and 

CHIP agencies in conducting outreach. 

Training on Cultural Sensitivity and Cultural Competence. HCFA could 

develop educational outreach modules for training its Central and 

Regional Office outreach specialists on cultural sensitivity and cultural 

competence to minority populations, particularly African American 

children. This training will assist staff in providing technical assistance to 

States in developing culturally sensitive information specific to minority 

populations. 

Asian American/Pacific Islander Children 

Approximately 16.7 percent of Asian American children are part of 

families with incomes below the Federal poverty level. Barriers to 

enrollment in health insurance programs for this population include 

language barriers and the welfare stigma associated with public assistance 

programs. To address existing barriers to enrollment in health insurance 

programs for this population, ACF proposes the following activity: 

Provide Technical Assistance for Outreach. DHHS’ Administration for 

Children and Families (ACF) could, as part of a broader effort, 

supplement a technical assistance contract to include CHIP and Medicaid 

outreach activities to allow the to outreach to Pacific Islanders. 

Homeless and Transient Children 

Research has demonstrated a strong relationship between residential 

stability and the well-being of children. Young children are the most 

mobile of any child age group. In 1994, 22 percent of children under the 

age of five had changed residencies in the previous year. Estimates of 

homeless children range widely, based on seasonal and other variations. 

These children are at high risk for lacking insurance because of their 

transient life situations. The following activities have been proposed in an 

attempt to alleviate existing barriers to enrollment in health insurance 

programs for this population: 

Education of Health Care Providers to the Homeless. HUD has proposed 

to educate homeless providers about CHIP and Medicaid by having HUD 

Field Office staff speak about the programs in technical assistance 
meetings, satellite broadcasts, and conferences held to distribute HUD 

program information. 

Revision of Existing Educational Materials. Information on CHIP and 

Medicaid could also be added to existing HUD homeless program fact 

sheets, booklets, and question and answer documents, as well as the 

homeless assistance Notice of Funding Availability materials. 

Encourage Collaboration. Providers of services to the homeless could also 

be encouraged to establish relationships with local CHIP providers and 

make information on CHIP and Medicaid a standard part of their outreach, 

intake, and assessment processes. 

Migrant/Border Children 

These children are difficult to find and track because of migrant families’ 

transient lifestyles. Migrants often face communication barriers due to 

poor literacy and linguistic difficulties. Further, some immigrant migrants 

are apprehensive about enrolling their families in public assistance of any 

kind. The Department of Health and Human Services has a number of 

health programs targeted specifically for migrant and border populations. 

In addition, HRSA proposes the following activity to help alleviate 

existing barriers to enrollment in health insurance programs for this 

population: 

Expanding Site Visit Protocol. HRSA has proposed to expand the outreach 

worker site visits that presently take place through the Migrant Health 

Program and the Border Health Program to include dissemination of CHIP 

and Medicaid information. 

Children With Special Health Care Needs 

An estimated 16.9 percent of low income uninsured children had a special 

health care need in 1994. The primary reason for absence of coverage for 

this population is the high cost of health insurance. Without health 

insurance, low income children with disabilities experience substantial 

difficulties in accessing the health care services they need; these children 

are eight times more likely than insured children to be without a usual 

source of care. The following activity has been proposed to address 

barriers to enrollment in health insurance programs for this population: 

Targeting Children With Special Health Care Needs for Enrollment. 

HRSA’s Maternal and Child Health Bureau, through partnership with 

advocacy organizations such as Family Voices, could expand its efforts to 

identify and enroll children with special health care needs in Medicaid to 

include States’ new CHIP programs. DHHS’ Substance Abuse and Mental 
Health Services Administration will also set up a workgroup to identify 

these children’s unique access barriers and launch an effort to reducing 

them. 

Rural and Isolated Children 

Children in rural or isolated places often face communication and 

geographic barriers when attempting to enroll in health care insurance 

programs. The following activities have been proposed in an attempt to 

alleviate existing barriers to enrollment in health insurance programs for 

this population: 

Encourage State Outreach Plans to Consider Rural Communities. HRSA 

could send letters to its 221 grantees from the Office of Rural Health 

Policy informing them about Medicaid and CHIP and encouraging them to 

get involved in their State’s CHIP activities. 

Using Distance Based Learning. CDC uses several different types of 

distance based learning for training health professionals around the 

country. CDC will put information about CHIP and Medicaid enrollment 

on the television screens either before or after the educational sessions. 

CDC is also exploring the possibility of conducting a satellite training 

session on CHIP and Medicaid during the summer of 1998. These forms 

of communication can educate rural health providers who, in turn, see 

must sick, uninsured children in their area. 

 APPENDIX D: 

 COORDINATING ELIGIBILITY IN HEALTH AND NONHEALTH PROGRAMS 

 

As outlined in the Presidential memorandum, Federal agencies can help 

enroll children in health insurance programs in a number of ways. One of 

these ways is through coordination of program eligibility rules, 

applications, and enrollment processes. Because of their unique goals and 

histories, public assistance programs often have different rules for income 

and/or resource limits; how income is defined; who is considered a 

member of the family; what type of documents are required for 

enrollment; and how applications are processed. These differences can 

result in children being enrolled in programs like Head Start or the 

National School Lunch program but not being enrolled in Medicaid or 

CHIP even when eligible. 
Three major barriers can prevent coordination of Medicaid, CHIP and 

non-health programs. The first is the financial and non-financial eligibility 

rules. Different programs often have -- because of law, regulations, or 

State choice -- different definitions of family size, type of income counted 

toward eligibility, income disregards, upper income limits, and allowable 

resources. A second issue is the documentation required from the 

applicant. Families are usually required to bring proof of income, 

resources, birth certificates and other types of documentation -- even when 

a different agency might have already verified that information for their 

own program. Third, the application process itself may require multiple 

visits to different sites that may be geographically inaccessible or whose 

hours may be restricted. 

The goal of simplifying and integrating eligibility for multiple Federal 

programs is both important and long-standing. In 1991, at the request of 

Congress, a DHHS and USDA produced a joint application for seven 

Federal programs -- WIC, Title V, Head Start, Migrant and Community 

Health Centers, Health Care for the Homeless and Medicaid. In 1994, the 

Department of Health and Human Services and the Department of 

Agriculture developed a report to Congress outlining the differences in 

program rules under Food Stamps, AFDC and Medicaid. 

Most recently, DHHS sent a letter to States encouraging them to 

coordinate CHIP with Medicaid as they plan for their new programs 

(January 23,1998). It made specific suggestions on how to simplify 

Medicaid and integrate Medicaid and CHIP, including: using a simple, 

mail-in application; using a joint Medicaid-CHIP application; using joint 

processing of the Medicaid and CHIP applications; and taking advantage 

of new Medicaid options like presumptive eligibility and 12-month 

continuous eligibility for children. It also reiterated that there are few 

verification requirements under Federal Medicaid law. While it is 

important to maintain program integrity, excessive requirements for 

documentation can deter families from completing the application process. 

HCFA will continue to work with States on ways to simplify the Medicaid 

program. 

A simple, coordinated Medicaid-CHIP application process is not only 

important to integrating those two programs, but is essential to linking 

health and non-health programs, many of which target similar families. 

For example, Food Stamps (income below 130 percent of poverty), free or 

reduced-price lunch under the National School Lunch Program (income 

below 185 percent of poverty), Head Start (most participants are below 

100 percent of poverty) and subsidized child care all cover children who 

are probably also eligible for Medicaid or the new Children’s Health 

Insurance Program (CHIP). The simpler the health application process, the 

easier it is for formal or informal linkages across these programs. 
This appendix describes both examples and suggestions of how States may 

improve enrollment in Medicaid and CHIP through coordination with 

other programs. 

Same application for multiple programs. One of the best ways to ensure 

that a child eligible for two or more public programs gets enrolled in them 

is through the use of a single, joint application. By using a single 

application, the family fills out the application, provides necessary 

documentation and completes other necessary steps only once, improving 

the likelihood that the child is efficiently enrolled. This also can reduce 

State administrative costs associated with processing the same family 

multiple times. 

• Same application for WIC and Medicaid. Vermont has a joint 

application for the Special Supplemental Nutrition Program for 

Women, Infants and Children (WIC) and its Medicaid program 

called "Dr. Dynasaur." The family fills out the application and 

checks boxes corresponding to the benefits that they would like to 

receive. If the WIC office receives the application, it photocopies it 

and sends it to Medicaid. 

• Same application for welfare, Food Stamps and Medicaid. 

Most States (e.g., Illinois, Maryland, Michigan, Ohio) use joint 

applications for the various social services programs that are 

administered by the same agency. Similarly, Iowa uses a common 

application for Medicaid, Maternal and Child Health Services, 

WIC and Presumptive Medicaid Eligibility for Pregnant Women. 

When a joint application is filed at a different program site, 

Medicaid accepts this application date as the date Medicaid 

services can start. 

• Common Form for Referrals. In South Dakota, health and social 

services programs use separate intake forms, but use a common 

page for referral to other programs that gives information about 

how to contact programs listed, including Child and Adult Care 

Food Program, Child Care assistance, Children’s Special Health 

Services, Community/Migrant Homeless Health Centers, Family 

Planning, Head Start, Healthy Start, Medicaid/CHIP and WIC. 

In an example like South Dakota, where many programs’ applications are 

combined, there is often a need for follow-up questions on the application. 

However, it does not have to be a several-step process. In Vermont, once 

the application is completed, little additional information is needed from 

the family. States with a joint Food Stamps, welfare and Medicaid 

application frequently use the same agency to determine eligibility for 

these programs. This usually means that the joint application is sufficient, 

although some States have attached supplemental application pages for 

Medicaid. It is important to note that, in some instances, using a joint 
application may not achieve the goal of improving enrollment of children 

in health insurance. If the additional questions required by other programs 

are long and difficult, it could make families’ less likely to complete the 

application. 

"Adjunctive" eligibility. An alternative to using a joint application for 

several programs is allowing eligibility for one program to be used to fulfil 

some or all of the eligibility requirements for another. For example, a 

family that shows its eligibility card for one program can be deemed fully 

or income eligible for another without going through an extensive 

application process. This "adjunctive" eligibility can shorten the Medicaid 

and/or CHIP application and speed up eligibility determinations. 

• SSI eligibility automatically means Medicaid eligibility for 

most children. Children who are disabled and whose income and 

resources are below specified amounts are eligible for 

Supplemental Security Income. In most States, SSI children are not 

required to make a separate application to Medicaid, but are 

automatically eligible. 

• Medicaid eligibility automatically means WIC income 

eligibility. By law, all women, infants and children enrolled in 

Medicaid are income eligible for WIC. WIC applicants must meet 

other eligibility requirements (e.g., must be determined at 

nutritional risk). Although not required, it can work in the opposite 

direction in States where Medicaid income eligibility is higher than 

that of WIC. 

• School Lunch Program eligibility for CHIP. Florida’s Healthy 

Kids program makes children eligible for the free or reduced-price 

meals under the National School Lunch Program automatically 

eligible for its State health insurance program. School districts in 

Colorado are also helping determine a child’s eligibility for its 

State health program. 

States with non-Medicaid CHIP expansions can use adjunctive eligibility, 

since there are few CHIP eligibility rules. Given Medicaid’s flexibility on 

both State definition of income for children (e.g., 1902(r)(2)) and 

documentation requirements, States could also design an expansion where 

a child’s enrollment in a program like Head Start, subsidized child care, or 

free school lunch programs either reduces the length of the application or 

substitutes for the usual documentation requirements. 

Referral of families to Medicaid and/or CHIP. A third way that States 

may increase enrollment in health programs via other programs is to use a 

referral system. For example, the names of families screened or enrolled in 

one program could be sent to the Medicaid and/or CHIP agency for 

follow-up. 
• Food Stamp / Medicaid applicants match. To identify uninsured 

children eligible for its Medicaid expansion ("TennCare"), 

Tennessee compared the lists of families with children 

participating in Food Stamps and TennCare. The families 

participating in Food Stamps but not in TennCare were sent an 

information letter, a mail-in application with a pre-addressed, 

postage-paid envelope, and a toll-free number for questions. 

• Check-box on School Lunch Program application. Washington 

State includes a check-box on its School Lunch Program 

application for families interested in information on health 

insurance. This box plus a signature releases the name and address 

of the family to the State’s Healthy Kids program. Like in 

Tennessee, families then receive an information letter and a mail-in 

application with a pre-addressed, postage-paid envelope. 

In Tennessee, because the same State agency administers Food Stamps 

and Medicaid, the State may use the information from Food Stamps for 

Medicaid eligibility purposes. The information provided by families in the 

National School Lunch Program application may be shared with a number 

of Federal, State and local agencies. Federal law, however, specifically 

prohibits sharing the school lunch applicant information with Medicaid or 

CHIP agencies, without first receiving written permission from a student’s 

parent or guardian. Washington State’s approach is successfully structured 

within the statutory parameters, although not all families might check the 

box and not all Washington schools submit the names of interested 

families in a timely manner. 

Assisting families at other program’s eligibility offices. Finally, even if 

there is not a formal link in either the application itself or its processing, 

States have often outstationed eligibility workers at other program sites 

and/or trained other workers in the health application process so they can 

help families. 

• Outstationing eligibility workers in other program sites.

California is both expanding the number of sites where Medicaid 

eligibility workers will be outstationed and paying an "enrollment 

fee" to private contractors who successfully assist families in 

enrolling their children in the new Healthy Families program. 

• Using the new "presumptive eligibility" option: Some States 

(e.g., Indiana, Connecticut, Massachusetts) have filed State plan 

amendments to allow workers to give children "temporary" or 

"presumptive Medicaid eligibility." Under Medicaid, States now 

have the option of allowing health care providers and eligibility 

workers for Head Start, WIC and the Child Care Development 

Block Grant to grant presumptive eligibility for children. 
• Training Head Start eligibility workers to screen and assist in 

health insurance enrollment. Because children must have a 

health assessment and immunizations before enrolling in Head 

Start, people assisting in Head Start applications are in a good 

position to identify and help uninsured children. In Philadelphia, 

the school district’s Head Start health coordinator refers families 

with uninsured children to a local advocacy organization that 

assists them in completing Pennsylvania’s mail-in application over 

the phone. Louisiana contracts with Head Start staff and other 

community-based organizations (with Federal Medicaid 

administrative match) to assist families in completing Medicaid 

applications. 

These examples are not exhaustive. Other Federal programs and States are 

successfully using these as approaches to integrate children’s health and 

other programs. While a considerable amount of coordination can occur 

under current law, Federal agencies, States and advocates have identified 

some statutory barriers to coordination of programs (e.g., complexity of 

the Medicaid transition benefit; confidentiality rules that prevent programs 

from sharing names of potentially eligible families without parental 

permission). The Administration is committed to continuing to identify 

and remove such barriers, and DHHS has proposed a work group to 

accomplish this. 

NOTE: This section was developed in with input from the Eligibility 

Technical Assistance Group of the American Public Welfare Association 

and the Center on Budget and Policy Priorities. Although their opinions or 

recommendations are not represented here, their assistance is appreciated. 

 APPENDIX E: 

 TARGETING NATIVE AMERICAN / ALASKA NATIVE 

CHILDREN USING MAPS 

 

INTRODUCTION 

Children’s health insurance outreach presents a number of challenges in 

reservation-based and urban American Indian and Alaska Native 

communities. Through a comprehensive, coordinated Federal effort that 

supports localized integration of Medicaid/CHIP information 

dissemination, these barriers to children’s health outreach may be 

overcome. 
To coordinate children’s health outreach efforts to potentially eligible 

American Indian/Alaska Native children, Federal agencies providing any 

reservation-based social, supportive, and health care programs and 

services have mapped their service delivery sites. Federal and triballycontracted reservation-based programs under the Department of 

Agriculture, the Department of the Interior, the Department of Health and 

Human Services (including the Indian Health Service), and the 

Department of Housing and Urban Development were mapped on national 

and regional maps. 

MAPS 

The maps of Federal and tribally contracted service delivery sites allow 

for coordination of children’s health outreach implementation strategies on 

reservations. Federal agencies can collaborate about the development of 

appropriate outreach materials and strategies, but avoid duplication of 

effort in the information dissemination stage. Maps provide a visual 

depiction of data. Displaying color-coded symbols make data easier for 

users to identify. These maps will benefit all Federal and tribal service 

providers, as they allows users to integrate implementation strategies and 

divide responsibilities and activities. The overall benefit of the use of 

maps for the purposes of children’s health outreach include being able to 

quickly identify outstationed Medicaid/CHIP eligibility offices. 

This Appendix includes two sample Regional maps. The legend notes the 

symbols and color-coding of assorted reservation-based federal agency 

programs and service delivery sites. The Aberdeen Area office 

encompasses the three states of South Dakota, North Dakota, and 

Nebraska. The 15 Indian tribes in the Aberdeen Area boast a total of 10 

outstationed eligibility determination sites. The Portland Area office 

serves the states of Washington, Oregon, Idaho, and a portion of western 

Montana. The Indian tribes in the Portland Area, are highly concentrated 

in the northwest corner of Washington state. This area is enlarged on a 

separate Puget Sound detail map to allow the user a better view of the 18 

tribes located in the vicinity. A great variety of social, support, and health 

services are available to reservation-based Indian communities in the 

Portland Area. 

These maps, and any others that are developed, may be accessed on the 

internet at: 

http://gdsc.bia.gov/hs.htm. 

 

 
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