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School Lunch Program Offers Promising Way To Reach Most Uninsured Children

Document date: January 04, 2000
Released online: January 04, 2000
Contact: Susan Brown (202) 261-5702

WASHINGTON, D.C., January 4, 2000—Three-quarters of low-income children and 60 percent of all children without health insurance live in families that participate in government programs serving low-income families, according to a new policy brief prepared for the Urban Institute's Assessing the New Federalism project.

The brief suggests that 4.7 million more uninsured children could be enrolled in Medicaid or the Children's Health Insurance Program (CHIP) by coordinating coverage with four programs-the National School Lunch Program, the Food Stamp program, the Special Supplemental Program for Women, Infants and Children (WIC), and the Unemployment Compensation Program. But the authors also note that formidable confidentiality and other administrative barriers must be overcome to meet this challenge.

"Most Uninsured Children Are In Families Served by Government Programs," by Urban Institute researchers Genevieve Kenney, Jennifer Haley, and Frank Ullman, documents the number of low-income uninsured children participating in these programs, analyzes their participation by age, race, and geographic origins, and identifies barriers to effectively coordinating program participation with enrollment in public health insurance programs.

The brief comes at a time when many states are seeking to increase the participation of eligible, low-income children in public programs that provide health coverage and services.

"If administrative and other obstacles to enrollment can be overcome, these programs will provide us with a promising outreach tool for extending Medicaid and CHIP coverage to large numbers of eligible uninsured children," said Kenney.

Program Variations
The researchers analyzed data from the 1997 National Survey of America's Families (NSAF), a large nationally representative survey that oversamples the low-income population. Among their findings:

Program Differences: The National School Lunch Program has the potential to reach 3.9 million low-income uninsured children while the WIC Program has the potential to reach 1.5 million low-income uninsured children. Both the Food Stamp program and the Unemployment Compensation program have the potential to reach over 600,000 low-income uninsured children.

Age Differences: The National School Lunch Program has the greatest potential to reach low-income uninsured school-age children. Fully three-quarters of low-income uninsured children aged 6 to 11 and 65 percent of low-income uninsured children aged 12 to 17 live in families participating in this program. By contrast, only 38 percent of low-income uninsured children under age 6 live in such families. The WIC program offers greater potential for reaching low-income, uninsured preschool children. About half of these children live in families participating in WIC.

Racial and Ethnic Differences: About 80 percent of both Hispanic and black low-income uninsured children live in families participating in at least one of the programs; only 66 percent of other, primarily white, non Hispanic low-income uninsured children could be reached this way. Overall, Hispanic children represent over one third of all low-income uninsured children with families participating in these programs. Foreign-born children represent a smaller proportion (13 percent) of such participants.

Geographic Differences: Relative to other regions, the Northeast has smaller percentages of low-income uninsured children in these programs. Among the 13 states oversampled in the NSAF, Massachusetts, Colorado and Washington had the lowest proportion (61 percent) of uninsured children participating in these programs, with Alabama, California and Mississippi revealing the highest (80 percent).

Enrollment Barriers
Over the last several years, federal and state governments have worked to overcome numerous administrative and other barriers to increasing health coverage of eligible uninsured children. The Interagency Task Force on Children's Health Insurance Outreach, for instance, helped a number of government agencies identify ways to use government programs to reach more uninsured children. But, until now, the information needed to best target such outreach efforts has been missing.

Many localities also have begun to build outreach efforts, particularly around the National School Lunch Program, sending informational flyers to parents and positioning trained volunteers at schools to answer questions and help complete applications.

Despite these efforts, the authors note that formidable obstacles remain. Among the most challenging: the need to protect the privacy of lunch program applicants; greater information requirements for Medicaid and CHIP program applications; widespread confusion over eligibility criteria; frustration with the enrollment process; negative images associated with a program closely linked to welfare; and concerns that enrollment might pose risk to immigration status.

Reaching Remaining Uninsured Children
Finally, while the analysis indicates that most children can be reached through these four programs, there are still over 1.5 million uninsured children living in low-income families that do not participate in these programs. Identifying and enrolling these children may pose an even greater challenge.

The project has received funding from the Robert Wood Johnson Foundation in support of the analysis of the Children's Health Insurance program. The Urban Institute is a nonprofit, nonpartisan policy research organization established in Washington, D.C., in 1968. Its objectives are to sharpen thinking about societal problems and efforts to solve them, improve government decisions and their implementation, and increase citizens awareness about important public choices. Assessing the New Federalism is a multi-year Urban Institute project designed to analyze the devolution of responsibility for social programs from the federal government to the states. The project analyzes changes in income support, social services, and health programs. Researchers monitor program changes and fiscal developments. Full copies of this report are available on the Institute's Web site.

Topics/Tags: | Children and Youth | Education | Health/Healthcare | Poverty, Assets and Safety Net

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