[Weekly Compilation of Presidential Documents Volume 35, Number 41 (Monday, October 18, 1999)]
[Pages 2013-2015]
[Online from the Government Publishing Office, www.gpo.gov]

<R04>
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 
about the options; cultural and language

[[Page 2014]]

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:
<bullet>    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:
<bullet>    Technical assistance and other support to school districts 
            and schools engaged in outreach;
<bullet>    Suggestions on how to effectively use the school lunch 
            program application process to promote enrollment in health 
            insurance programs;
<bullet>    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
<bullet>    Model State CHIP and Medicaid policies and plans for school-
            based outreach.
<bullet>    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.
<bullet>    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

[[Page 2015]]

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