Giving every child a healthy start should be every parent’s goal. Getting enrolled in health coverage — and staying enrolled — should be simple and seamless. No parent should face barriers to enrolling their children in the health coverage they need to survive and take advantage of the educational opportunities required to succeed in our global economy.
Schools are in a unique position to identify and connect eligible but uninsured children to health insurance. Our goal in offering this toolkit is to provide school and community leaders and parents and child advocates with a framework to build community support for connecting children to health insurance through schools and to provide the practical steps schools need to take to implement a successful and sustainable campaign. This toolkit sets the stage for school districts to partner with community agencies to identify and enroll eligible students in health insurance through a proven strategy in a simple, routine and cost effective way. When we insure our children, we ensure our future. Asking this simple question, "Does your child have health insurance?" on important annual school forms, is central to ensuring all children in your school district are happy, healthy and ready to learn.
Our vision is a country where every child has access to comprehensive, affordable health insurance that is easy to get and easy to keep. Children must enter school healthy and ready to learn. The role schools play in student lives is complex and ever-expanding. To ensure students are ready and able to achieve academically, schools must be poised to meet the myriad health, emotional and social needs that can negatively impact student performance. Too many children are uninsured or underinsured, overweight and undernourished, or miss too many school days because of chronic illnesses like asthma. Far too many are victims of homelessness and other adverse childhood experiences. Children of color are disproportionately suspended from school, missing valuable learning time.
Brandon, a six-year-old in the Houston Independent School District in Houston, TX had two working parents until his father was laid off. Brandon lost his health insurance when his father lost his job. Brandon’s mother, employed by the school district, quickly scrambled to try to enroll her son who has asthma in new insurance, but met some obstacles and didn’t know where to turn. An outreach worker in Brandon’s school, stepped in and helped her find insurance for Brandon through the Children’s Health Insurance Program. With his new health insurance, doctors discovered Brandon also had high blood pressure and prescribed medication to control it. Now the school nurse monitors his blood pressure every day and Brandon is healthy and happy to be in school learning.4
These challenges are exacerbated by the growing number of children in public education from low- income families. Based on data from the National Center for Education Statistics, a study by the Southern Education Foundation revealed that for the first time, low-income children are the new majority in public schools. 2 Educators alone are not equipped to solve serious social and economic problems and cannot erase early trauma or challenges children may bring to school. But educators can help change schools. From the moment children cross the threshold, they are in a special place — a place where good things should happen not by chance, but by design.
Medicaid and the Children’s Health Insurance Program (CHIP) provide a safety net for low-income children in the school system by increasing their access to health care and reducing the financial burden of health care costs for their families.
Thanks in large part to Medicaid and CHIP, the number of uninsured children in the U.S. is at a historic low. While our country has made incredible progress expanding health insurance* for children, nearly 4.5 million children under age 18 (6 percent) remain uninsured — one in seventeen. School-aged children (ages 6-17) are more likely than younger children to be uninsured, and account for nearly three out of four uninsured children in the nation. That 2.8 million uninsured children are eligible for Medicaid or CHIP right now but not yet enrolled creates an opportunity for schools to help close the gap.3 The children who remain uninsured are often the hardest to reach because of various enrollment and retention barriers. They are also more likely to come from families with mixed immigration status, be homeless, or frequently left behind.
Whether you are an educator, parent or child advocate you have already know that teaching healthy children helps close achievement gaps. Schools are trusted entities in students’ daily lives and you take that trust seriously. No one has to tell you that sick children can’t learn. You bear witness to this every day in your classrooms and communities.
When children are well, they do better on all indicators of achievement: academic performance, attendance, grades, cognitive skills, attitudes and in-class behavior5. And the converse is true. Preventable health issues such as hunger, physical or emotional abuse and chronic illness can lead to poor performance in and increased absenteeism from school; and violence, physical inactivity, substance abuse and other risky health behaviors are all linked to consistent underachievement.6
How can schools ensure every child in the classroom is physically and emotionally healthy? A major determinant is having health insurance. Schools have an amazing advantage because the children are already in your care, and your vantage point offers a perspective that community agencies, parents, state and local officials, faith-based organizations and businesses value. The mission of public education has always been to help produce healthy, successful students who can build strong communities.
CDF and AASA suggest you approach this effort systemically from the start. Some of the small changes you will need to make will impact all students as soon as you make them. Even if outreach and enrollment efforts begin in targeted schools, many of the tools needed to identify, refer and assist families to enroll students in health insurance will already be in place when you expand to all schools in your district.
The urgent need for schools and health agencies to work together to benefit the health and education of all students was stressed in a January 2016 joint letter7 from the U.S. Secretary of Education and the U.S. Secretary of Health and Human Services to all Chief State School Officers and State Health Department Officials and copied to all governors. It encouraged schools and health agencies to work together to support quality education and quality health care for all children. The Departments released a toolkit8 of steps school districts and health agencies can take to strengthen their bond to benefit children. They call these steps “high impact opportunities.” The first high impact opportunity they highlight is the work of CDF and AASA. So get started now.
* For the purposes of this toolkit, “health insurance” is used to broadly define all types of health coverage for children, including Medicaid.