Uninsured Elementary Students

1. Uninsured Elementary Students Kali Beasley, Alexandra Derbawka, Erik Rammelsberg, Alexis Sanchez "This one is for the kids." -Gheorghe Muresan

2. Population Characteristics • According to U.S. Census 20101: • 48,858 children, ages 6-17 years, in Benton-Franklin Counties • 4,989 are uninsured (~10%) • Diverse population, but key informants consistently identified undocumented immigrant children as particularly at-risk • Therefore, we can expect the actual percent of uninsured children to be higher 1U.S. Census Bureau. (2010). Health insurance coverage status by sex and age: Benton County, Washington and Franklin County, Washington. Retrieved from http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml

3. Special Note About This Population • It has been a challenge to identify this population • WA State provides subsidized coverage to children up to 300% poverty level • Nearly all children are eligible once identified as uninsured

4. Reasons For Uninsured Status 1) Eligible, but opt out of public insurance programs 2) Ineligible due to income (>300% poverty level) and do not purchase private insurance 3) Assume ineligible due to income or legal status 4) Unaware of public insurance option or unsure how to enroll

5. Special Needs • Linking to Medicaid outreach workers • Need a safe place to access medical care without fear of being reported to INS • Limited access to care Mon-Fri, 8-5

6. Strengths • Self-sufficient • Resilient • Community support • Cultural • School • Religious/Spiritual support

7. Current Resources Available • Washinton's Apple Health • Almost all kids are eligible • Benton-Franklin Health District has outreach worker for application • Washington Health Plan • Hearing/Vision screening in school districts

8. Policy Gaps • Limited services for Washington Health Plan members • Eligible, undocumented families afraid to apply for Apple Health • Utilization of dental services • Dental offices generally open 4 or 5 days a week during working hours. • Accessible education about available services

9. Healthy People 2020 • Increase the proportion of persons with health insurance • Increase the proportion of persons who have a specific source of ongoing care • Reduce the proportion of individuals who are unable to obtain or delay in obtaining necessary medical care, dental care, or prescription medicines

10. Major Health Problems: Dental • Uninsured children and children on public insurance are much more likely to have an unmet dental need • Lack of dental care affects much more than just mouth • Screenings available in school, but treatment options are lacking • Missed school days • Future development of health problems • Dental is covered under Apple Health, but many families are not able to utilize dental services due to hours of operation

11. Major Health Problems: Mental Health • Undiagnosed & untreated mental health issues affect school performance • School staff report this as a widespread problem • Anxiety • Depression • Hyperactivity disorders • Grades, attendance, & other students' learning all suffer from this unmet need.

12. Policy Development: Family Outreach and Education • Host meeting at rural elementary school to educated parents about Apple Health Care • Gear towards parents of undocumented, uninsured kids • Family outreach workers identify and invite uninsured families • Capitalizes on already established trust

13. Policy Development: Family Outreach and Education Implementation • Key contributors • BFHD Medicaid Outreach Worker • BFHD PHN • Family Outreach Worker • Similar meeting structure was successful in Paterson School District • Principal support? • Available meeting facility? • BFHD participation?

14. Policy Development: Family Outreach and Education • BFHD PHN already in Paterson Elementary working on ESD123 grant addressing truancy • Working with school nurse to provide more comprehensive assessment • Family Outreach workers have identified families, helped establish nurse-family relationships • PHN can enlist cooperation of BFHD and Medicaid Outreach Worker

15. Assurance Family Outreach and Education • Expect to see increased rates of insurance among rural, undocumented children • Long-term reduction in absence rates • PHN and school nurse can review data and interview families to evaluate effectiveness

16. Policy Development Dental Care • Address the lack of utilization of dental services • Many dental offices in the area accept Apple Health • Offices could coordinate to allow extended hours for low-income families. • Late hours on weekdays and/or weekend hours • Educational materials would be provided to community schools/churches/public places.

17. Policy Development Dental Care Implementation • Coordinate with Benton-Franklin Oral Health Coalition • Communication between dental offices is key • Possible rotating schedule • Community Health Nurse role • Might include providing information about extended clinic hours to clients • Educating about the importance of dental care in childhood

18. Assurance Dental Care • Desired results: • Improved dental services utilization • Improved dental screening results in school districts • Decreased absenteeism in school • Passive surveillance • Dental clinics keep records and statistics about utilization during extended hours • School district health staff report data about dental screenings • Active surveillance • CHN assessments of elementary aged clients & their families

19. Questions?