California County Focuses on Health Care for Schoolchildren

Sep. 11–Two weeks into summer vacation, Markham Elementary School is quiet except for the kindergarten classroom where Maria Rios is holed up with her laptop computer and her appointment book.

Rios isn’t a teacher or an administrator, but she plays a key role in the lives of the school’s 700 students. Her job is making sure every child has health insurance. She meets with parents at the school three times a week to determine what health coverage their children qualify for and then gets the application process moving.

Thanks to Rios’ help, 97 percent of the students at Markham had medical coverage last year. That’s up from 70 percent two years earlier and is significantly higher than most schools in low-income areas in California and nationwide.

Rios is one of five school-based outreach workers of the Solano Coalition for Better Health, a group that aims to improve access to health care for the 500,000 residents of Solano County.

The county is a burgeoning rural and suburban area near Napa Valley, about 50 miles east of San Francisco. Focusing mainly on getting residents into existing government health programs, the coalition has helped cut Solano County’s rate of uninsured residents from 15 percent to 7 percent.

“We’re a poor area here, and the parents need help,” said Rios, who typically speaks Spanish to parents who call or visit her at the school.

The coalition takes an aggressive approach to getting kids signed up either for Medicaid, the State Children’s Health Insurance Program (in California, it’s called Healthy Families), as well as a low-income program offered by giant HMO Kaiser Permanente.

Overcoming early objections about privacy, the coalition has worked to get most schools in this county to ask parents about their kids’ health insurance status. The question is posed to all parents when they fill out an emergency contact card at the beginning of each school year.

Parents who lack medical insurance are sent information about available insurance options, and they get a telephone call from outreach workers such as Rios. They are asked to meet with an outreach worker so they can get assistance filling out insurance forms. Later Rios and other workers check with parents to be sure they and their children are enrolled in health care plans.

Parents say the hands-on help from the outreach workers makes all the difference in getting them through the sometimes cumbersome process of signing up.

“Maria helped me fill out all the papers and told me everything I needed to know,” said Ashwan Gill, who now has health coverage for her 7-year-old son, Maheswari.

The Gills had been without health insurance for two years after Ashwan’s husband lost a job as a cook. Now, under the State Children’s Health Insurance Program, the Gills pay just $5 when Maheswari goes to the doctor.

Last year, 29 Solano County schools had at least 99 percent of students with health insurance, and seven schools hit 100 percent of students, said Jacque McLoughlin, who heads the Solano Kids Insurance Program for the coalition. The school initiative, heading into its fourth year, has helped enroll 13,000 previously uninsured students.

“This is not a passive strategy,” McLoughlin said. “We don’t wait for the family to come to us before we go to them.”

The Solano Coalition for Better Health gives awards to schools for getting 100 percent of their students enrolled in health plans and gets local publicity for the schools’ accomplishment — and schools are engaged in an informal competition to get all students medical benefits.

In contrast to Solano’s aggressive approach, most school districts in the United States, including Palm Beach County’s, usually put up posters in schools about health insurance plans and send a note home with students telling parents about insurance options. Few schools follow up with phone calls or set up meetings with parents to help them enroll their children in medical plans.

Palm Beach County school officials, who have worked with the county health care district to inform parents about health insurance plans for children, say they have no idea how many students have gotten coverage through assistance from the school district. Schools don’t call parents regarding health care because they say they don’t have the staffing.

Solano County’s extensive outreach effort in schools, which costs about $250,000 a year, is considered to pay for itself through improved student health and in turn improved school attendance. In California, as in most states, government money for schools goes up with attendance rates.

The coalition’s outreach work has helped increase health coverage among Principal MaBella Gonzales’ 550 students at Widenmann Elementary School to 100 percent from 70 percent three years ago. Attendance rates rose from 90 percent to 94 percent during that time.

“You can’t teach kids when they’re not healthy and if they don’t feel good,” she said. “When they are in good health you can teach them and they become better members of society.”

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