US Mayor

Mayor's Initiative Identifies, Registers Children for Coverage 

Healthy Start is an effort led by Lynn Mayor Patrick J. McManus to provide health insurance for the more than 3,000 young people in his city who, at the beginning of 1998, were estimated not to have any form of health care coverage. The initiative involves an aggressive outreach program which works through the schools to identify families with uninsured children and help them take advantage of the year-old Children's Health Insurance Program (CHIP).

Authorized in the Balanced Budget Act of 1997, the CHIP program provides $24 billion over five years, through the states, for health care coverage for uninsured children. It is the federal government's most aggressive effort to insure children since the creation of Medicaid in 1965. Through the program, states may either cover children in families whose incomes are above the Medicaid eligibility threshold, but less than 200 percent of poverty, or within 50 percentage points over the state's current Medicaid income limit for children. States, upon federal approval of their applications, are able to use part of their federal funds for outreach to target and identify uninsured children.

Student Survey

Early in 1998, questionnaires designed to identify families with uninsured children were sent to the parents of the more than 14,200 students in the City. The surveys were printed in several languages and presented in a brief, easy-to-complete format. Because the information requested was personal and potentially sensitive in nature, the questionnaires simply asked parents or guardians their children's names and whether they had health care coverage. If they did not have coverage, they were asked if they would like to be contacted with information on the CHIP program.

Outreach -- To increase the number of responses to the survey, teachers and school nurses provided outreach assistance. Teachers made follow-up inquiries in the classrooms; nurses contacted parents by phone. The response rate for the survey was nearly 50 percent, considered quite successful, with more than 7,000 families completing and returning the questionnaires. The high volume of returned surveys spawned an overwhelming workload for Mass Health, as over 600 families were identified as needing assistance and were targeted to receive it. This volume of demand ordinarily would result in a six-month delay before the needs of the families could be met, but City officials worked with Mass Health to virtually eliminate delays in service.

Follow-up -- Mayor McManus's continued work with state offices on strategies to enhance the City's outreach efforts produced a $15,000 Enhanced School Health Grant from the Massachusetts Department of Public Health. This grant enabled school nurses in Lynn to follow up with the identified families during the summer. In a concentrated effort, the nurses completed the reviewing, evaluating and recording of all returned surveys during June. They also received training from Mass Health and the Children's Medical Security Plan on insurance guidelines and the application process.

Applications and Appointments

After the nurses help the families complete the application forms, a Mass Health outreach representative works with the nurses to ensure the applications are given priority status. City officials quickly began contacting families to schedule appointments at convenient times and locations -- e.g., neighborhood schools during summer school hours or the School Administration Building during evening hours. Additionally, home visits are being made on an as-needed basis.

The Lynn School Committee, which the Mayor chairs, now requires parents to file health insurance information forms for all new students, kindergarten through grade12, with the Parent Information Center during registration. Additionally, it is now a requirement to include health insurance information when completing student emergency forms. This initiative is intended to ensure that all qualified students receive health care throughout their years in the Lynn school system.

The Mayor is also working with the Superintendent of Schools on a program to link school nurses with parents of newborns. Through the program, nurses would help parents understand the importance of proper development in the first 18 months of life.

Recognizing Lynn's aggressive efforts to insure every child, Massachusetts Secretary of Health and Human Services William O'Leary commented recently that when state and local governments work together, "we can literally deliver assistance to the doorsteps of the Commonwealth's at-risk youth."

Lynn is the first city in Massachusetts to undertake an effort to insure every child. "Nothing will affect education in Lynn more than making sure every child has health insurance and medical care," said the Mayor. "This is an investment in our children's future and the future of our City."

Additional information on the Healthy Start program is available from Frank Meilinger, Office of the Mayor, at (781) 598-4000.

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The United States Conference of Mayors

J. Thomas Cochran, Executive Director
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