Washington state's Apple Health for Kids earned a federal performance bonus last week (announced Dec. 28) of $16.9 million for outstanding achievement. The U.S. Department of Health and Human Services has rewarded the program with generous bonuses three years in a row for insuring large numbers of children from low- and moderate-income families. The awards, won in competition with dozens of other applying states, have brought Washington a total of $42.4 million in federal dollars since 2009.
The legislature created Apple Health For Kids in 2007 to expand existing health care for children by making it affordable to all families. The 2011 award is particularly noteworthy when the number of uninsured Washington residents of all ages rose last year to a staggering total of 1 million individuals.
Also worth noting is the fact that Washington is one of only four states, and is the only one in the Western U.S., to win federal awards in 2011 for both early learning and children’s insurance programs (the other three are Maryland, North Carolina, and Ohio), said Jon Gould, deputy director of the advocacy group Children’s Alliance, which has advised the state on children’s health issues.
Clearly, despite what can seem like endless bad news from Olympia, Washington has made good progress for many of its youngest, most vulnerable citizens during hard times.
Between 2006 and 2010, nearly 165,000 of the state’s children lost the health coverage that had been included in insurance plans provided by their parents’ employers. Apple Health for Kids pushed hard against this swift, sad current to enroll 208,000 children since 2007. With unemployment having doubled since the start of the recession, Apple Health now covers almost half the children in the state, or 733,000 youngsters.
“Good things have happened to protect children’s health care from some of the most devastating effects of the recession,” said Gould. “Given how big it’s been and how long it’s endured, and how many factors such as foreclosures have impacted children’s well-being, the health of children has had a protective layer, thanks to Apple Health for Kids.”
The program achieved its success by streamlining the application process, now available to families via the Web, phone, or mail — a range of media that makes it easy for working parents to apply. Efficiency is further increased through using the same application form as the one used for Medicaid and the Children’s Health Insurance Program (CHIP). Coverage is for a full 12 months, ensuring coherence in medical care for each child while reducing the state’s administrative costs.
A child from a family of three making less than $36,320 is covered free of charge. Children who are from limited-income families that make more, or who are not federally qualified immigrants, pay monthly premiums. Parents who have the option of buying employer health insurance for their children but who can’t afford the payments may apply for financial aid.
Insuring children’s health is more than the right thing to do; it’s a wise investment. Fewer contagious illnesses make their way into public spaces. The state’s diminishing health-care dollars can be targeted more prudently instead of being expended on costly emergency treatment. Parents can be more productive in the workplace — taking less time off to care for sick youngsters, concentrating on their work instead of worrying about their kids’ health, and staying healthier themselves. Children do better in school — missing fewer classes, focusing on their studies untroubled by symptoms of illness, and thus becoming more likely to graduate, an essential for readiness to get a job or go to college.
The federal award will help Washington state continue to increase the number of insured children at a time when indicators of child well-being are at a troubling low, as summarized in Kids Count 2012, published by the liberal public policy organization Washington State Budget & Policy Center in partnership with Children's Alliance. According to statistics provided in the summary, parental unemployment has almost doubled since 2007, and the state has 100,000 children still uninsured.
The Budget & Policy Center and the Alliance are collaborating to develop strategies for improving various aspects of children's lives. Budget & Policy is doing necessary research, compiling data, and analyzing the results; the Alliance handles communication, said Gould. Together “we make sure policymakers have access to data when figuring out where funds should go and changes in policy” in a wide range of areas relevant to children, including health care.
Last year the state’s budget makers, including Governor Gregoire, preserved Apple Health for Kids funding because they realized that Washington “was on the trajectory to get this bonus,” said Gould. Anticipating the upcoming legislative session, he said that “it’s going to be a tough year. We need to work very hard to educate lawmakers about the multiple benefits of health for kids, and encourage them to keep the program off the list of cuts.”
One reason so many children remain uninsured in Washington is that the legislature defunded outreach programs in 2009, said Gould. Consequently, fewer parents in less populated areas know about Apple Health or get the help they need to navigate the system. “There are still high rates of uninsured kids in rural Washington. We’re still not reaching those kids,” he said.
Policymakers need to know that enrolling the 100,000 children not yet covered will put the state at a competitive advantage against others for federal fiscal bonuses in the coming years. “The performance bonus size is related to case load growth,” said Gould. “If legislators work on developing this, we stand a chance for bigger bonuses. They’re not based on the size of the state, but on how much you grow the case load.” For example, a small state, Alabama, received the largest federal bonus because they enrolled huge numbers of children whose health care coverage had been neglected in the past.
It's in the fiscal interest of Washington state, with its comparatively respectable history of attention to children’s health, to continue growing Apple Health for Kids. Serious federal money hangs on policymakers’ upcoming decisions, said Gould. “Let’s find the kids not yet covered.”
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