April 2, 1999

The White House launched a nationwide outreach campaign in February to boost families' enrollment in the Children's Health Insurance Plan (CHIP).

About 5 million uninsured children qualify for CHIP but are not enrolled. An additional 5 million Medicaid-eligible children remain uninsured. This represents more than 90 percent of the total number of uninsured children in the United States.

To increase CHIP and Medicaid enrollment, the White House announced several publicity efforts in February including a toll-free number, (877) KIDS-NOW, a national public-service media campaign, and outreach efforts by federal agencies and private organizations, according to the press release. Moreover, President Bill Clinton has requested $1.2 billion in his Fiscal 2000 budget to assist states in children's health outreach activities.

The president's budget request is in addition to the $20 billion that was allocated to CHIP in 1997, when it was created under the Balanced Budget Act to help states insure more children age 5 and over, according to information from the Health Care Financing Administration (HCFA). However, states were not allowed to use more than 10 percent of their allotment for outreach. The President's request would give each state an additional 3 percent for outreach, according to Hilary Wilson, an associate director of APA's Division of Government Relations.

States will continue to expand and refine their initial CHIP plans this year, according to HCFA. In addition, "states are beginning to face implementation issues related to finding and enrolling children [and] ensuring that health plans and services are available to meet their needs and that the programs improve children's health status," according to HCFA.

Moreover, states choosing to offer non-Medicaid CHIP programs that include coverage of mental health services must comply with the Mental Health Parity Act regulations covering lifetime and annual dollar limits. States choosing to offer Medicaid CHIP plans must comply with parity regulations for Medicaid managed care plans on certain dollar limits for mental health benefits.

Forty-eight states, Puerto Rico, and the Virgin Islands have CHIP plans approved by HCFA. Two other territories, American Samoa and Guam, had submitted proposals at press time.

Medicaid expansions continue to be the primary mode of enrolling uninsured children (28 states), followed by separate state child health plans (14 states), and combined Medicaid expansion/state plans (11 states), according to HCFA. The Medicaid expansion will cover mental health and substance abuse services under its Early and Periodic Screening and Diagnostic Testing (EPSDT) program.

To assist APA members in evaluating the effectiveness of their local CHIP/Medicaid mental health programs, APA's Presidential Advisory Committee on Medicaid/CHIP Mental Health Managed Care is developing an educational tool kit. The Board of Trustees approved the tool kit proposal in 1997. Former APA president Mary Jane England, M.D., chairs the 12-member committee.

The draft tool kit outline covers four main areas: vision and principles for advocacy; methods and techniques for policy analysis and assessment of mental health policy and performance under managed care; policy strategies; and resources, contacts, and allies for advocacy and sound policy formation and implementation.

Committee consultant Robert Cole, Ph.D., told Psychiatric News that the committee hopes to present a final draft of the report to APA's Board at its meeting in May. If approved by the Board, the complete tool kit will be posted on APA's Web site.

The outline of the tool kit report and a list of committee members are posted at the committee's Web site at www.machipapa.org. A state update on CHIP/Medicaid plans is posted at HCFA's web site at www.hcfa.gov/init/children.htm.