With federal funding for the Children’s Health Insurance Program (CHIP) assured through 2027, states can consider using a portion of their CHIP dollars to improve the health of low-income children through innovative Health Services Initiative (HSI). HSIs provide states with a mechanism to use CHIP administrative dollars to fund a range of activities beyond just health insurance.
To date, states have used HSIs to provide preventive services and interventions, such as school health or youth violence prevention programs, and more direct services like lead testing and poison control programs. States are also using HSIs to address emerging health issues. Recently, New York used an HSI to train school officials to administer naloxone to reverse opioid overdoses and Michigan expanded lead abatement activities through an HSI in response to the water crisis in Flint.
While HSIs offer states a unique way to fund new programs or support existing services for children, some states may debate whether to implement a long-term versus short-term HSI because of upcoming changes in the federal CHIP match rate. The most recent federal funding package that extended CHIP includes a phasing down of the 23 percent increase to the enhanced CHIP match rate – known as the 23 percent “bump”— that was initially included in the Affordable Care Act and available through FFY 2019. Despite this future phase-down, a number of states are still pursuing HSIs, and more than 15 have already implemented them.
For an example of a creative way to use an HSI for a short-term project, read NASHP’s report, Oklahoma Uses Focus Groups to Identify Strategies to Better Serve Foster Care Youth, to learn how one state used an HSI to study antipsychotic use among foster care youth.
Arkansas and Delaware provide two additional examples of states that are using HSI funding for unique projects to improve the health of low-income children.
Arkansas: Intensive Home and Community-Based Family and Child/Youth Support
Similar to Oklahoma, Arkansas implemented an HSI in 2017 to improve the quality of care provided to foster care youth. Under the HSI, the state uses a small portion of its CHIP funds to provide intensive home- and community-based family and support services for children with serious mental health issues who are involved in the Arkansas welfare system. The goal is to provide behavior management and wrap-around services to children and foster families to allow children to move out of a psychiatric or behavioral health treatment facility and into a home/community setting.
This transition is often a period of significant adjustment and can cause stress on both the child and family. To support children and families during this process, Arkansas’ HSI provides services to prepare and help families navigate the transition, and to help families safely manage the child’s behavioral health issues after discharge. These services are provided in conjunction with a state care coordination program and are outcome-oriented, trauma-informed, and individualized based on the child’s behaviors.
In addition to providing wrap-around services, this HSI also has the long-term goal of reducing the number of children in the state’s welfare system who are living in psychiatric residential treatment facilities by helping move them into family homes.
Delaware: Vision to Learn
Beginning in January 2017, Delaware used an HSI to launch a school-based initiative to increase access to vision services and eyeglasses for under- or uninsured children. The state CHIP program partners with Vision to Learn, a nonprofit Medicaid provider that administers eye exams and provides glasses on-site at schools through a mobile eye clinic. Although Vision to Learn has been operating in Delaware since 2014, this HSI provides additional public funds through CHIP to enable the program to reach more children in need.
In order to connect these services with low-income children, the HSI specifically targets Title I schools where at least 51 percent of the student body receives free or reduced price meals. In addition to providing vision services, Delaware uses this initiative to perform outreach to children not currently enrolled in Medicaid or CHIP by supplying the mobile clinics with brochures and information about enrollment in these programs.
HSIs offer states the flexibility to use a portion of their CHIP funding to implement a wide range of activities to improve children’s health. The projects in Arkansas and Delaware offer two recent examples, however, many states have used HSIs or are considering them as a unique option to fund vital new programs or support existing services for low-income children.