Tools for Schools and Communities: An Online Toolbox for Enhancing SCHIP Outreach and Awareness

Introduction

Nationally, 8.1 million children—one in 9—are estimated uninsured (U.S. Census Bureau, 2008). With the struggling economy and sweeping unemployment, this statistic is on the rise. It is estimated that the majority of uninsured children qualify for public health insurance like Medicaid and the State Children's Health Insurance Program (SCHIP) yet remain without coverage (Dubay, Holahan, & Cook, 2006).

Covering Kids & Families-Wisconsin (CKF), a statewide coalition, leads initiatives to encourage access to public coverage among the uninsured yet eligible. Originally begun as Wisconsin's Robert Wood Johnson initiative of the same name, CKF has a 7-year history of promoting participation in Wisconsin's Medicaid and SCHIP program, BadgerCare Plus, through:

• Direct outreach


• Training for those who assist with applications


• Broader educational campaigns for policymakers and general public

The online toolbox resource developed by CKF and discussed here aims to support communities, including Extension, in assisting individuals to access public coverage. While the toolbox is geared specifically to Wisconsin's programs, Extension personnel in other states will likely find it of benefit for their communities.

Community Assistance for the Uninsured

The ever-changing rules and processes of Medicaid and SCHIP can be confounding to anyone not directly and regularly involved with them. CKF works to simplify how these programs are presented so that more eligible persons apply. While this can involve providing technical education to those who routinely guide families through the application process, CKF primarily produces materials for an audience simply in need of basic information on eligibility and application:

• Individuals seeking coverage for themselves


• Individuals working to assist those seeking coverage

While state or county agency workers are trained to be knowledgeable of Medicaid and SCHIP policy, they may not be easily accessible to persons seeking help due to distance and workload issues. Further, when confronting an issue like uninsurance, individuals may prefer to look to those in their communities with whom they are familiar and feel they can trust:

• Public school staff


• Spiritual advisors


• Librarians


• Health care workers


• Employer-based human resources professionals

However, these "community contacts" tend to lack the background, materials, and confidence to help their uninsured clientele take first steps.

Toolbox

As part of its mission, CKF engages community contacts—and the Extension personnel who serve them—to develop their capacity to assist with Medicaid and SCHIP eligibility and application processes. To support their needs, CKF has developed an online toolbox available at <http://www.ckfwi.org/toolsyoucanuse.htm>. "Toolboxes" have widely been used to pass along tested systems of knowledge and methods for those working with communities and are a familiar resource for Extension professionals (Barta & Woods, 2002; Bixler, Crites, & Kock, 2006; Skelly, 2005)

The content of the CKF toolbox is organized into four main "drawers":

• Outreach


• BadgerCare Plus


• County Tools


• Research and Data

Outreach

The first drawer contains resources and plans for conducting outreach. It offers materials for Extension professionals who wish to actively engage potentially Medicaid/SCHIP-eligible individuals. It includes information about hosting single-occasion events as well as materials for larger scale initiatives as developed under the CHILD project.

CKF's CHILD (Connecting Health Insurance to Lunch Data) project works collaboratively with public schools to efficiently identify and provide assistance to eligible children and their families. The CHILD method establishes relationships, identifies administrative processes, and forms an outreach plan that may be replicated year-to-year and even institution-to-institution. As school districts and community partners use CHILD resources in the field, they continually assess their effectiveness and refine them. The resulting materials are adaptable according to both school district capacity and the needs of the communities they serve.

Materials include:

• Sample outreach plans


• A guide to organizing initial meetings


• A PowerPoint presentation about the project


• Numerous examples of outreach materials (flyers, bookmarks, etc.)


• Template data collection and outreach tracking forms, as well as data sharing agreements to guide evaluation

CHILD materials are flexible for use with other institutions or organizations. For organizations and individuals not interested in implementing the complete project, individual materials can be selected to use for their endeavors.

BadgerCare Plus

Information found in the second drawer presents the fundamentals of BadgerCare Plus, including up-to-date eligibility rules, benefit packages, and application procedures in language that is easily understandable.

County Tools

The third drawer provides county-specific resources including Benefits Brochures (Figure 1) and MAP publications (Figure 2). Benefits Brochures present county-specific contact information for BadgerCare Plus as well as other public programs for food, financial, energy, and child-care assistance. Available in English and Spanish, the brochures give examples of income eligibility and the link for online applications.

Figure 1.
Benefits Brochure

Figure 2.
MAP Publication

MAP, or Making-A-Plan, is a resource for identifying communities of individuals most likely at risk for being uninsured and qualifying for public coverage. It is tricky to estimate this population. MAP offers the next best solution using color maps shaded comparing counties, school districts, and census tracts in terms of poverty rates, enrollment in school lunch programs (a proxy for SCHIP eligibility), and uninsurance.

Research and Data

The fourth drawer offers a library of resources where visitors will find statistics, links to media coverage and advocacy organizations, and academic research for both Wisconsin and the nation at large.

Recommendations

By making these tools available on the Web, we aim to improve and increase public health insurance outreach efforts across Wisconsin. Beyond our state's borders, the toolbox can be adapted by Extension professionals to build capacity within their states' communities to help the uninsured. There is little doubt that community organizations serve as initial resource points for uninsured individuals trying to navigate the often complex public coverage system.

CKF views the toolbox as a dynamic set of resources. As we continue with our educational and outreach efforts, we also improve the materials available. Further, the toolbox offers opportunities for visitors to suggest additional resources and share their experiences with using the materials provided.

References

Barta, S., & Woods, M.D. (2002) The community economic development toolkit. Journal of Extension [On-line], 40(5) Article 5TOT5. Available at: http://www.joe.org/joe/2002october/tt5.php

Bixler, M., Crites, A. M., & Kock, J. A. (2006) Anger management toolbox for parents. Journal of Extension [On-line]. 44(6) Article 6TOT4. Available at: http://www.joe.org/joe/2006december/tt4.php

Dubay, L., Holahan, J., & Cook, A. (2006) The uninsured and the affordability of health insurance coverage. Health Affairs. 26(1), w22-w30. Retrieved August 25, 2009, from: http://content.healthaffairs.org/cgi/reprint/26/1/w22

Skelly, J. (2005) Social marketing: Meeting the outreach challenges of today. Journal of Extension [On-line]. 43(1) Article 1IAW1. Available at: http://www.joe.org/joe/2005february/iw1.php

U.S. Census Bureau. (2008). Income, poverty, and health insurance coverage in the United States: 2007. Washington, DC: U.S. Government Printing Office. Retrieved May 18, 2009, from: http://www.census.gov/prod/2008pubs/p60-235.pdf