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REMARKS BY:	DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES
PLACE:		Covering Kids National Conference, Washington, D.C.
DATE:		April 7, 2000

It seems that one beautiful April day, Charlie Brown and his friends were lying on a baseball mound, looking up at the sky, and describing what they saw in the clouds. Lucy said, "I see Madame Curie in her laboratory making a life-saving discovery." Then Linus added, "There's Aristotle contemplating the nature of the universe." And Schroeder remarked, "That's Beethoven penning the ninth symphony." Finally, they all looked at Charlie Brown. He muttered, "Well I was going to say a horsey and a doggie, but I've changed my mind."

One of the things that distinguishes Peanuts from all other cartoons about children is the complete absence of caring adults. But in the real world, children certainly can't take care of themselves. In the real world, children get sick and have accidents. And in the real world, children need adults to provide the healthy foundation for their dreams.

Providing a healthy foundation-that's exactly what insuring eligible children is all about. That's why the entire Clinton-Gore Administration has been working hard to find and enroll children in Medicaid, and in our newer program-the "State Children's Health Insurance Program"-or SCHIP. It's why we created a 500 million dollar Medicaid fund for states to conduct aggressive outreach. And it's why we partnered with the National Governors' Association, to launch a nationwide "Insure Kids Now" outreach campaign that includes a web site and a toll free number. To date, that number-1-877-KIDS-NOW-has received nearly 250,000 calls.250,000 requests for information.for help.for answers. We also formed a federal "Task Force on Children's Health Insurance Outreach" that's implemented over 150 innovative and successful activities.

But at HHS, we certainly didn't stop there. Last year, my Department teamed up with other federal agencies-and many of the organizations here today-to launch a major "back-to-school" campaign that enlisted over 1,500 schools to conduct local outreach activities. We created a paid radio campaign to reach parents and other caring adults. We've been training grantees; meeting with State Medicaid Directors; encouraging Head Start programs to become active in outreach; even enlisting the help of grandparents. And I'm happy to announce that the Health Resources and Services Administration is offering new grants to help states develop plans for providing even more families with access to affordable health insurance. Fifteen million dollars will be available to fund one-year studies in up to 10 states.

Thanks, in part, to all these efforts, nearly two million children- more than the combined population of Montana, Vermont and North Dakota-were enrolled in SCHIP as of last September. That's nearly double the estimate for December 1998, and it includes both children enrolled in new, state-designed, programs and in Medicaid expansion plans. Additionally, the number of states covering children up to 200 percent of poverty with SCHIP has increased seven-fold-from only four in 1997 to thirty today.

These are significant accomplishments.Accomplishments we can all be proud of...And accomplishments that never could have happened without the commitment, compassion-and leadership-of all of you who are in the trenches and on the frontlines in the campaign to insure eligible children. As part of the "Covering Kids" initiative, you've written enrollment success stories in every corner of our nation-from enlisting Naomi Judd as the spokesperson for KCHIP in Kentucky.to generating over 100 news stories that aired on 41 T.V. stations. Of course, none of your efforts would have been possible without the continued support of the Robert Wood Johnson Foundation. Today, I'm pleased to announce that the Foundation will be providing up to 26 million dollars more-26 million above their original 47 million dollar commitment-to "Covering Kids."

I've no doubt that these funds will help intensify efforts to aid uninsured children.and complement the work of the Clinton-Gore Administration.

But despite all of our efforts-to paraphrase Robert Frost-we still have miles to go if we want to reach the millions of uninsured children...If we want to give every child a healthy foundation for her dreams...And if we want every child's story to have a happy ending-an ending like the one I first heard about at a children's health event sponsored by the First Lady.

At the event, a father told the story of his young son-who had suffered repeated ear infections that left him hearing impaired. The father couldn't afford health insurance. He couldn't get the medical care his son required. And he didn't know that the boy was eligible for Medicaid. But thanks to the President's outreach efforts, the family learned the boy was eligible. At first, they were reluctant to apply...and they needed help with the enrollment process. But soon, the boy was enrolled and he received the surgery he needed. A short time afterward, the toddler was exploring his familiar yard, when he was struck by something decidedly unfamiliar-and he began to cry with fear. That little boy had never heard the wind before.he had never heard the wind. And as he comforted his son, I know the father would have agreed with Tennyson that "sweet is every sound." Because in that small cry, I'm sure the father also heard something very different- the sound of the opening of doors...doors to a world of beauty, opportunity and possibility that had previously been closed to his son.

I tell that story here-not because we're all unfamiliar with such cases-but because I believe it reflects five challenges...five challenges that government cannot meet alone.and five challenges that are also barriers to enrolling every eligible child.

Our first challenge is the challenge of awareness. Many states have already found innovative ways to spread the word about Medicaid and SCHIP. Utah placed a full-time outreach worker in its Primary Children's Hospital to target and enroll eligible children who visit the emergency room and clinics. Georgia hired people to distribute Medicaid flyers in pizza boxes, and on the weekend before public schools opened, outreach workers stationed in K-Mart stores completed applications for families to enroll in PeachCare.

It's up to all of us to support, enhance and further these efforts. After all, too many parents-like the father of that young boy-still don't realize that their children are eligible for SCHIP or Medicaid. Too many parents still don't know that Medicaid eligibility isn't linked to welfare-now known as TANF...and that their children can qualify for Medicaid, as well as SCHIP, even if the family earns too much to qualify for cash assistance. And too many parents still don't understand that working doesn't disqualify their children from Medicaid or SCHIP. Right now, the families of 4 million uninsured children probably don't know they're eligible for Medicaid coverage.

We must do more to educate low-income families-and their employers-about Medicaid availability for children outside the welfare system. And we must find new ways of reaching SCHIP and Medicaid eligible children. For example, we know that the uninsured rate for Hispanics was 35 percent in 1998-more than twice the national average. My department is continuing to look at ways to address this issue-but a first step would be to make sure that-where appropriate-our outreach efforts are culturally sensitive and language appropriate. After all, no one should be unable to complete the route to enrollment-simply because they can't read the signs along the way.

Above all-if we really want to reach these children-we must go where their families live, work, learn, pray and play. That's why, six months ago, the President instructed HHS, and the Departments of Agriculture and Education, to prepare a comprehensive report on school based outreach. That report will be released later this year-and it will tell us what we can do to make school-based outreach an integral part of regular school business.

Of course, if we really want to maximize our outreach efforts, then we must simultaneously address our second challenge: the challenge of perception. For too many people, a stigma surrounds Medicaid-and even SCHIP. This stigma may partially stem from Medicaid's historic ties to welfare-and the negative public image sometimes associated with cash assistance. Also, not everyone understands that public health is really like public education-it's every child's right and a benefit for our entire society. Nebraska has the right idea. It organized focus groups that found that a colorful, positive, upbeat image for the state's Medicaid expansion plan-known as Kids Connection-would reduce any stigma associated with the program.

No family-like the one in my story-should be reluctant to enroll.and open the door to a better life for their children. We all need to spread the message that these programs are not hand-outs-but a helping hand. And they're an important work support for parents who are struggling to be both good workers and good caretakers for their children.

Our third challenge is the challenge of simplification. We know that many families-again, like the one in my story-find the enrollment process difficult. And we know that in some states enrolling in SCHIP is much easier than enrolling in Medicaid.

Fortunately, many other states have already started efforts to make the application and enrollment process for both programs as user-friendly as possible. Ohio has just reduced verification requirements for both Medicaid and SCHIP. And Nebraska developed a one-page Kids Connection/Medicaid application that's available in Spanish, Russian, Arabic and Vietnamese.

These are important accomplishments-but we need to do even more. Today, we're taking further steps to explain and clarify the enrollment process for Medicaid families moving on and off cash assistance- because we all know that the delinkage of cash assistance and Medicaid eligibility has meant both new opportunities and new challenges for states. We're asking all states to review their computer systems and eligibility processes-in order to ensure that all families that are eligible to keep their Medicaid benefits really do keep them. We're asking states to review their own records-and to be sure that no one who was entitled to keep Medicaid after leaving cash assistance lost out. And we're asking then to reinstate anyone who was improperly terminated from Medicaid.

Of course, we're partners in this with the states, so we'll match all costs for reinstatement. And we'll offer to match any state dollars used to reimburse families for medical bills that would have been paid by Medicaid during the time these families were terminated from the program. We'll also continue to work with all the states to simplify application and enrollment procedures-and in the summer, we'll be holding a "best practices" conference to share our success stories. Additionally, the President's Fiscal Year 2001 budget would require states to make their Medicaid and SCHIP enrollment equally simple. And it would also allow states to determine presumptive eligibility for Medicaid, as well as SCHIP, at more sites-such as child care centers, homeless shelters, and schools.

But as we simplify the process, we also need to improve coordination. That's our fourth challenge. A recent study by the Urban Institute found that approximately 60 percent-almost 4 million-of America's uninsured children are enrolled in school lunch programs. But federal law prohibits these programs from sharing enrollment information with Medicaid.

The President's Fiscal Year 2001 Budget would allow school lunch programs to share application information with Medicaid-and to use enrollment in school lunch programs as the basis for presumptive eligibility for both Medicaid and SCHIP. Sharing information should become common practice because it makes common sense. After all, health insurance promotes access to health care-which promotes academic success. That means-just like the school lunch program-health insurance prepares children to learn.

Our fifth, and final challenge, is the challenge of expansion. As you may be aware, the President has proposed creating a new "FamilyCare" program. Under this initiative, parents of SCHIP and Medicaid eligible children would be covered by the same health plan as their children. Additionally, states would have the option of covering young people ages 19 and 20-the age group with the highest uninsured rate in the country-through SCHIP and Medicaid.

Now I do realize that the mission of "Covering Kids" is to find and enroll children that are currently eligible. But we know that family enrollment promotes both the enrollment-and the use of medical services-by children. And after all, isn't that really our ultimate goal?

Our children will be the architects of society in this new millennium. The future is very much in their hands. But right now, their future is very much in our hands. That's why we must work together to meet all of our five challenges...To endow each child with a healthy foundation...To enable every child to open the door to a world of opportunity, beauty and possibility.And to convince everyone that providing our children with health insurance isn't only good for them...it's good for us. After all, healthy children- today-means a healthier...more productive...more prosperous nation, tomorrow. So just like Charlie Brown-who never gave up trying to kick that football-let's never give up fighting for our children.