Partnering for Kid’s Coverage – It’s Never too Late

By Carla Plaza

July 2013

Over the last couple of years, we’ve heard and learned much about states’ efforts to implement the Affordable Care Act (ACA). However, we have heard less about the continuing efforts and successes of states in covering more children. NASHP’s Children in the Vanguard project, supported by The Atlantic Philanthropies, brought together a diverse group of states—California, Colorado, Maryland, Mississippi, New Jersey, North Carolina, Ohio, Oklahoma, and Oregon—to focus on children’s coverage during this incredibly busy time. Participating state teams of state officials and advocates developed complementary strategies and engaged in peer learning opportunities to improve the enrollment of children in health insurance coverage and to address the needs of children and youth in implementing the ACA.

A recent example of the value of partnerships between states and advocates comes from New Jersey.  State officials and child health advocates worked together to make the state’s express lane eligibility (ELE) process more effective. In the state, all school districts are required to collect information about their students’ health insurance status. New Jersey’s ELE process matches this data for children identified as not having insurance with data on a student’s participation in the school’s free, reduced or full pay lunch program. School districts then share this matched data with the Division of Medical Assistance and Health Services (DMAHS), which runs NJ FamilyCare, the state’s CHIP program. DMAHS sends out a shorter “express lane” application to the families of identified uninsured children that includes an indicator of their participation in the school’s free or reduced lunch program, a proxy for income used to make an initial eligibility determination.


However, not all school districts shared their data with DMAHS. Recognizing the effort of the state to get children covered, Advocates for Children of New Jersey sent letters to the superintendents of non-participating school districts to underscore the importance of getting the data to DMAHS. This and other efforts by the state and its partners resulted in more schools sending in their data. Through New Jersey’s School Lunch ELE program and these targeted efforts, at least 5,000 additional low-income children obtained health insurance coverage.


State officials and child health advocates in Ohio also have forged a strong partnership, but that was not always the case. Both parties acknowledge that prior to participating in Children in the Vanguard, they did not have a close relationship. With the support and neutral space provided by the network, in less than two years, a collaborative relationship was firmly established. Through this partnership, the state worked with Voices for Ohio’s Children and the Children’s Defense Fund-Ohio to identify sites for its pilot and subsequent statewide roll-out of presumptive eligibility for children and pregnant women. The state team also facilitated the transition of approximately 37,000 children with special health care needs from Medicaid fee for service to Medicaid managed care. They jointly developed a letter to affected families to explain the change in coverage in laypersons’ terms and identified ways to make it easier for families to get needed assistance from the state during the transition. Medicaid officials and child health advocates in the Buckeye state now meet bimonthly to discuss children’s coverage issues.


These are just two of many examples of state officials and children’s advocates coming together on behalf of children’s coverage as the country’s new health coverage infrastructure is being built. NASHP will continue to work with state and federal policymakers, as well as other interested stakeholders to ensure that children’s coverage remains strong now and into the future. NASHP’s recently released report, Health Care Reform and Children: Planning and Design Considerations for Policymakers, explains some of the policy challenges and opportunities for making health care reform work for kids. In addition, theAdvancing Children’s Coverage through Health Reform Implementation Toolboxoffers numerous resources to assist states in considering policy actions to advance children’s coverage.  If you have “tools” you would like us to add to the toolbox, please send an email to and include “children’s coverage toolbox” in the subject line.


Especially since the creation of the Children’s Health Insurance Program, children have been in the vanguard of state and federal efforts to reduce the country’s uninsured rate, resulting in nearly 93 percent of children having health insurance coverage even before ACA’s major provisions kick in. With continued focus and partnerships with key stakeholders, states can build on the work they have done on children’s coverage and maximize the opportunities that lie ahead to achieve coverage for all children. The goal is in our reach!


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