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Child Health Plus

Tanya Keys never noticed the four smiling babies dressed in furry angel wings. Yet these spokesbabies are part of a multi-million dollar advertising campaign out to enroll city kids into Child Health Plus, the state insurance program that offers coverage to all children under 18. The free or low cost program came as a total surprise to Keys, a mother of six. She did not learn about it until she went to the Riverside Child Health Clinic last year with her children.

"I didn't know about Child Health Plus or that we could even get health insurance," said Keys, revisiting the West 100th Street clinic for check-ups for Davon, 10, and Shanice, 7.

The word is not getting out about Child Health Plus. Although there are 735,000 New York City children currently enrolled in the insurance plan, an additional 370,000 kids remain uninsured. Many parents are equating the program with welfare and do not believe their children are entitled to coverage. Others, particularly immigrants and working parents, are afraid or ashamed of public programs.

The number of American children without health insurance has increased steadily in the last decade, totaling about 11 million in 1999, the latest date when statistics are available. In an effort to reduce these numbers, Congress passed the State Children's Health Insurance Program in 1997. Billions of dollars were made available to states for the sole purpose of insuring children.

With an annual budget of over $250 million, New York State launched Child Health Plus. Child Health Plus is actually a dual program that joins Children's Medicaid (now called Child Health Plus A) with the new Plan B, primarily for children from better off families; a family of four is eligible if it earns up to about $41,000 a year.

Child Health Plus has a lot going for it. Both plans offer emergency, preventive and routine physical and dental care, and prescription drugs, at no charge, or premiums of no more than $15 a month per child. Families with incomes above the cutoff can also buy into the program at slightly higher rates. And with life around the poverty line routinely accompanied by depression, substance abuse, and eating disorders, mental health is an important part of the program. Child Health Plus A, however, offers additional Medicaid benefits, while Child Health Plus B operates more like a private insurance program through a range of sponsoring insurance providers.

Against this backdrop of differences stands the program's single biggest barrier: lack of information. "A lot of parents know about Medicaid and that it pays for everything," said Ruth Santana, a social worker with the Morris Heights Health Center in the Bronx. "But very few working families that don't have insurance know that Child Health Plus is a good option for them."

According to a recent report, "Addressing the Barriers to Covering Kids", funded by the Robert Wood Johnson Foundation, the nation's largest health care foundation, many parents are like Tanya Keys and are unaware of Child Health Plus. "Because they work, earn a living, probably pay taxes, and equate government programs with welfare only, they tune out messages promoting State Child Health Insurance Programs," the report found.

A number of community roundtables sponsored by the New York Academy of Medicine found that children eligible for Child Health Plus aren't signing up because families aren't getting adequate information from sources they rely on. "The information is not out there, it's not in the places parents need to be," said one participant. Moreover, trusted messengers such as clinicians, schools and community groups are often just as confused as parents about the program and eligibility of children from working families.

According to the New York Academy of Medicine, this ignorance is creating a host of false impressions and unfounded fears. Medicaid still carries the stigma of dependency and charity, despite the de- linking of welfare from Medicaid in the 1996 federal welfare laws. And all too many parents think Child Health Plus is Medicaid. "My suspicion is they lump the two together and question its value," said Santana.

But behind the surplus of confusion and inconvenience, lies a sharp reality: most uninsured children come from families in which the parents are themselves uninsured. In New York City, more than 70 percent of the uninsured have an employed adult in the family but still have no coverage. "The fact that parents are delaying care for their uninsured kids because of financial worries is tragic," said Dr. Risa Lavizzo-Mourey of the Robert Wood Johnson Foundation. This fall Child Health Plus is scheduled to expand into Family Health Plus, and allow some parents to enroll with their children.

The city has started to address some of these barriers. Mayor Rudy Giuliani announced a back-to-school enrollment drive with the popular children's clothing stores Modells, Cookies and Sears. So far, 1,000 children have signed up for Child Health Plus through this partnership. Under a plan unveiled this spring by the mayor, schools that successfully enroll uninsured students will receive bonuses ranging from $25,000 to $50,000. Dr. Diane Stump from the Riverside Health Clinic said she has seen information about Child Health Plus on the new school enrollment forms. These initiatives are part of the larger HealthStat program, which targets uninsured New Yorkers who are eligible for Child Health Plus, Medicaid or Family Health Plus. HealthStat initiatives have enrolled more than 151,000 adults and children since it began in 2000.

But signing kids up for insurance does not necessarily guarantee they'll use it. There are a number of other obstacles, such as lengthy Medicaid interviews, Child Health Plus re-enrollment procedures, immigrant fears about deportation, limitations on providers and inconvenient office hours. Medical treatment for many children is limited to the school nurse or emergency room. In a study reported by the American Academy of Pediatrics, researchers found that, "Simply extending health insurance coverage to low-income children is not enough to ensure access to care."

"It's time we encourage eligible New Yorkers to take advantage of existing coverage programs," said Mark Green, the public advocate, in a August speech. "My proposal rests not on making a new bureaucracy, but instead on making the most of existing programs." Like Green, the other candidates have suggested building greater awareness through aggressive advertising, simplified enrollment and more extensive outreach with churches, and community groups in low-income neighborhoods. "It's the city's responsibility to guarantee access, remove barriers, and make the process family- friendly," said Judy Farrell, a policy analyst for Bronx Borough President Fernando Ferrer.

Peter Vallone, the City Council speaker, has proposed that the city pick up all premiums on Child Health Plus B, which would cost the city an additional $147 million. "It's a way to get to those for whom the premium would be a factor," said Vallone spokesman Mattis Goldman. Green, Ferrer and Alan G. Hevesi, the city comptroller, have been critical of this plan. "Why should the city pay if state and federal already pay for those who need it," said Farrell. Moreover, Ruth Santana, the Bronx social worker, said that many parents want to pay premiums. "Parents want insurance for their children," said Santana. "But they also want to maintain dignity."


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