    [Public Papers of the Presidents of the United States: WILLIAM J. CLINTON (1999, Book II)]
    [October 12, 1999]
    [Pages 1755-1757]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Memorandum on School-Based Health Insurance Outreach for Children
    October 12, 1999

    Memorandum for the Secretary of Health and Human Services, the Secretary
    of Education, the Secretary of Agriculture

    Subject: School-Based Health Insurance Outreach for Children

        The lack of health insurance for millions of Americans remains one
    of the great challenges facing this Nation. To help address this issue,
    I worked with the bipartisan Congress to create the Children's Health
    Insurance Program (CHIP), the single largest expansion of children's
    health insurance in 30 years. The 1997 Balanced Budget Act allocated $24
    billion over 5 years to extend health care coverage to millions of
    uninsured children in working families. CHIP builds on the Medicaid
    program, which currently provides health coverage to most poor children,
    and together, these programs could cover most uninsured children.
        Yet too few uninsured children eligible for CHIP or Medicaid
    participate. Barriers to enrollment include parents' lack of knowledge

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    about the options; cultural and language barriers; complicated
    application and enrollment processes; and the ``stigma'' associated with
    so-called welfare programs. The Vice President and I have made removing
    these barriers to enrollment a high priority. In 1997, I launched a
    major public-private outreach campaign called ``Insure Kids Now.''
    Foundations, corporations, health care providers, consumer advocates,
    and others have participated through activities such as setting up
    enrollment booths at supermarkets and promoting the national toll-free
    number (1-877-KIDS NOW) on grocery bags, TV and radio ads, and posters.
    In addition, we created a Federal Interagency Task Force on Children's
    Health Insurance Outreach in February 1998, which has implemented over
    150 new activities to educate and train Federal workers and families
    nationwide about the availability of Medicaid and CHIP.
        Today I am directing the Secretaries of Health and Human Services,
    Education, and Agriculture to focus children's health insurance outreach
    on a place where we know we can find uninsured children: schools. State
    experience indicates that school systems are an ideal place to identify
    and enroll uninsured children in Medicaid or CHIP because schools are
    accepted by parents as a conduit for important information. In addition,
    health insurance promotes access to needed health care, which experts
    confirm contributes to academic success. We have learned that children
    without health insurance suffer more from asthma, ear infections, and
    vision problems--treatable conditions that frequently interfere with
    classroom participation; and children without health insurance are
    absent more frequently than their peers. As we strive for high standards
    in every school and classroom, it is essential that we help families
    ensure their children come to school ready to learn.
        Therefore, I hereby direct you, in consultation with State and local
    agencies, to report to me a set of recommendations on specific actions
    to encourage and integrate health insurance enrollment and outreach for
    children into schools, consistent with the mission of your agency. This
    report shall include:
        Specific short- and long-term recommendations on
                administrative and legislative actions for making school-
                based outreach to enroll children in Medicaid and CHIP an
                integral part of school business. These may include:
        Technical assistance and other support to school districts
                and schools engaged in outreach;
        Suggestions on how to effectively use the school lunch
                program application process to promote enrollment in health
                insurance programs;
        Lists of practices that have proven effective, such as
                integration of outreach and enrollment activities into
                school events such as registration, sports physicals, and
                vision and hearing testing; and
        Model State CHIP and Medicaid policies and plans for school-
                based outreach.
        A summary of key findings from the national and regional
                conferences scheduled for this fall on the topic of school-
                based outreach. These conferences will bring together
                national and State education officials, Medicaid and CHIP
                directors, public policy experts, and community-based
                organizations to examine the use of schools to facilitate
                the enrollment of children in Medicaid and CHIP; evaluation
                tools to monitor the effectiveness of current school-based
                outreach efforts; and best practices in school-based
                outreach and enrollment for children's health insurance.
        Recommendations on methods to evaluate CHIP and Medicaid
                outreach strategies in schools. Performance measures should
                be an integral part of school-based CHIP and Medicaid
                outreach strategies, as they can inform policy-makers on the
                effectiveness of these strategies, as well as help to
                identify areas of improvement.
        I direct the Department of Health and Human Services to serve as the
    coordinating agency to assist in the development and integration of
    recommendations and to report back to me in 6 months. The recommended
    actions should be consistent with Medicaid and CHIP rules for coverage
    of appropriate health- and outreach-related activities. They should be
    developed in collaboration with State and local officials as well as
    community leaders and should include recommendations on fostering
    effective partnerships between education and health agencies. These
    recommended activities should be complementary, aggressive, and
    consistent

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    with my Administration's overall initiative to cover uninsured children.

                                                          William J. Clinton