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As states face increasing fiscal pressures, many are considering proposals to cut eligibility levels, eliminate outreach, and retract simplified enrollment procedures for children and families eligible for Medicaid and the State Children's Health Insurance Program (SCHIP). This paper presents evidence on the importance of maintaining gains made in the number of children and families enrolled in these programs and of building further on improvements in Medicaid and SCHIP coverage. Following an executive summary are introductory remarks detailing the phased-in eligibility expansions for Medicaid and the enactment of SCHIP, the increased program participation, and the potential risk to coverage gains due to proposed state actions. The paper is then organized in two major parts. Part 1 examines research evidence on how public health insurance coverage enhances access to care, health, family finances, and quality of life. Part 2 examines evidence on Medicaid and SCHIP's importance to communities, focusing on economic, health, and social consequences of public health insurance coverage beyond the target population. Among the key findings presented are that previously uninsured children enrolled in Medicaid have fewer unmet needs and fewer delays in getting needed care. Medicaid reduces emergency room use and the rate of preventable hospitalizations. Medicaid expansions are related to reduced infant mortality. Low-income families of children enrolled in Medicaid spend considerably less out-of-pocket than families of uninsured Medicaid-eligible children. Medicaid brings federal matching funds into states, thereby promoting community economic development through job creation and income growth. Public coverage reduces uncompensated care burdens on providers and localities, thereby strengthening local providers capacity to serve all people; and provides access to care for low-income children and parents at risk of communicable disease, thereby reducing burdens on public health departments to provide medical services to the uninsured. The paper concludes by pointing out that research findings provide an objective foundation for state policymakers to evaluate the potential consequences of their choices. (Contains 70 references.) (KB)

The Southern Regional Initiative on Child Care (established by the Southern Institute on Children and Families) is guided by the Southern Regional Task Force on Child Care including representatives from 16 southern states and the District of Columbia. The initial charge from the Task Force was to develop a southern regional action plan to improve access to child care assistance for low-income families and to develop and implement a similar plan to improve child care quality. This report provides information on the two action plans and describes activities and reports produced as the initiative moved to the implementation stage. Chapter 1 of the report describes the development of the child care initiative and its initial activities. Chapter 2 summarizes findings from state surveys on implementing the 10-goal action plan to improve access to child care assistance for low-income southern families. Chapter 3 reports on the Southern Regional Forum on Child Care Financial Aid Issues held in February 2002. Chapter 4 describes the 7-goal quality action plan developed by the Task Force in 2002. Chapter 5 describes the Second Annual Southern Regional Forum on Child Care, the setting for the release of an action plan to improve the quality of early care and education, and incorporates dialogue on implementing the action plan to improve access to child care assistance. Chapter 6 details collaboration initiatives across Head Start, the Child Care Development Fund subsidy program, and Pre-Kindergarten, including barriers to creating coordinated policies, areas of collaboration, and policy and practice issues. Chapter 7 outlines future activities of the Southern Regional Initiative on Child Care. The report's five appendices include the action plans, a list of state contacts, and presentations on child care funding policy and crime and violence prevention through investments in child care. (Contains 15 endnotes.) (KB)

This study examined the type of collaboration occurring among child care, Head Start, and prekindergarten programs in eight southern states.The telephone survey was follow-up to a written survey of child care administrators in 15 southern states and the District of Columbia. Participating in the telephone survey were seven child care administrators and eight Head Start state collaboration directors from eight states. Participants had an opportunity to review questions prior to their interview and were allowed to submit responses in writing. Traditional areas of collaboration were identified, including professional development, extension of Head Start and prekindergarten for working parents, state planning committees to improve school readiness indicators, and development of parent education materials. Emerging areas of collaboration were also identified, including universal prekindergarten, early literacy, mental health, and comprehensive family support services. Each survey participant described up to three collaborative projects. Respondents generally agreed that policies were not a barrier to collaboration, but a few state child care policies were cited as burdensome by Head Start providers because they required that programs operate differently. Federal and state policies restricting funding to 4-year-olds were cited as problematic. Federal health policies restricting how states could use funds were also cited as a problem. Five states reported problems at some point with early childhood practice issues based in different program cultures or philosophies as obstacles to collaboration. States generally reported being open to technical assistance. Survey participants identified lessons learned from their collaborative projects, and their advice for federal officials was solicited. (Two appendices contain a list of the individuals interviewed for this report and the telephone survey instrument used.) (KB)

This booklet presents the action plan developed by the Southern Regional Task Force on Child Care for improving the quality of early care and education (ECE) in southern states. Also included in the booklet are tables that represent data collected from 16 participating states and the District of Columbia on state child care quality standards and initiatives, including licensing standards. The survey findings were used as a key references in developing the 7 goals and 39 action steps of the action plan addressing child care for children from birth through age 12. The goals of the plan are as follows: (1) all children and families will have the benefit of a quality, comprehensive, and coordinated ECE system; (2) rigorous licensing requirements and/or regulatory processes will be enacted to ensure that children are adequately protected in all ECE settings; (3) states will support development of quality ECE programs; (4) staff in ECE settings will be appropriately credentialed and adequately compensated; (5) families will have the information to make well-informed decisions about the quality of their child's care and education, to be actively involved in their childs care and education; (6) quality ECE programs will be financially accessible to all children; (7) states will ensure that accountability is built into all systems, programs, and activities undertaken to achieve the goals of this action plan. For each of the goals, relevant action steps are listed. (KB)

In the year 2000, the Southern Regional Task Force on Child Care was formed with representatives from 16 southern states and the District of Columbia as well as appointments from the Southern Institute on Children and Families and the Southern Growth Policies Board to collaborate in developing an action plan to improve access to child care assistance for low-income families in the southern region of the United States. This report details the work of that Task Force since its inception, including the receipt of testimony from professionals and others, the conduct of state surveys related to subsidy system policies and procedures and plan implementation, identification of barriers to child care financial assistance, development and implementation of the Action Plan, state site visits, and a regional forum. Chapter 1 serves as an introduction, summarizing the Task Force's areas of activity. Chapter 2 outlines the state site visit activities and discusses identified issues. Chapter 3 presents findings of a survey to identify the extent to which participating states have implemented the Action Plan and includes a table delineating implementation for each action step for each state. Chapter 4 highlights information presented at the Southern Regional Invitational Forum on Child Care related to the child care initiatives in participating states, barriers to implementation of the Action Plan, and opportunities for replication. Chapter 5 describes the Task Force's initial work in the area of child care program quality, and chapter 6 outlines plans to address child care quality improvements, as well as other activities planned by the Southern Regional Initiative on Child Care during 2002. The report's four appendices include: the text of the Action Plan To Improve Access to Child Care Assistance for Low-Income Families in the South; a summary chart of an analysis of legal issues; state survey contacts; and participant contacts for the regional forum. (KB)

This report presents findings of a survey study examining the efforts of southern states and the District of Columbia to implement the goals and action steps of the Action Plan to Improve Access to Child Care Assistance for Low-Income Families in the South. Surveys were sent to the members of the Southern Regional Task Force on Child Care, appointed by the governors of 16 southern states and the mayor of the District of Columbia. Florida's response was not received in time for publication; Delaware did not participate in the survey because their position to the Task Force was vacant; and Virginia declined to participate. The report includes a copy of the survey introduction and instruction as well as a chart displaying the results of state implementation. The findings are reported as "action step completed,""action taken toward goal," or "no action reported." The goals relate to: (1) funding for direct child care assistance; (2) broadening child care eligibility and subsidy policies; (3) aggressively implementing outreach initiatives; (4) maintaining uncomplicated and family friendly child care application and redetermination processes; (5) establishing a coordinated, seamless eligibility system; (6) establishing customer service outcome goals and setting standards to ensure respectful treatment for families; (7) designing the subsidy system; (8) creating partnerships with employers; (9) providing child care assistance through federal and state tax laws; and (10) having an effective, coordinated system to guide policy decisions and direct use of resources. The bulk of the report presents the survey feedback for each state and the District of Columbia. Information provided for each state includes the name and contact information for the individual completing the survey. (KB)

In 1999, the Southern Regional Task Force on Child Care, comprised of appointees from 16 southern states including Oklahoma and the mayor of the District of Columbia, with additional appointees from the other agencies, was formed with the charge of developing a plan to improve access to child care assistance for low-income families in the southern region. The task force received testimony from professionals, families, and representatives of the business communities, identified barriers that impede access to child care assistance for low-income families, and developed an action plan to improve access to financial aid for families needing and seeking assistance. This report presents the plan, along with supporting information. Chapter 1 describes the work of the task force. Chapter 2 discusses the reasons priority attention must be given to making quality child care more accessible and affordable for low-income families, including the positive effect child care can have on workforce capacity, the advantages availability of such care can bring to the welfare reform effort, and the financial support it can provide for early learning opportunities for children in low-income families. Chapter 3 presents an action plan setting forth 10 goals and 52 action steps to improve access to child care assistance. This chapter also includes descriptions of initiatives representing progress made by various states in addressing the goals. Chapter 4 describes planned activities for 2001 and beyond to promote implementation of the action plan goals and to address additional issues associated with improving access to quality child care. The report's appendix presents results of a survey detailing the state/federal subsidy system policies and procedures in each of 17 participating states. (Contains 56 endnotes.) (KB)

The report details an action plan developed by the Southern Regional Task Force on Child Care, comprised of appointees from 16 southern states including Oklahoma and the mayor of the District of Columbia, with additional appointees from the other agencies. The charge to the task force was to develop a plan to improve access to child care assistance for low-income families in the southern region. The task force received testimony from professionals, families, and representatives of the business communities; identified barriers that impede access to child care assistance for low-income families; and developed an action plan to improve access to financial aid for families needing and seeking assistance. This report presents the 10 goals and 52 action steps of the plan and calls on public and private sector leaders to support specific initiatives, including significant increases in child care resources, eligibility simplification, improved customer services, implementation of tax strategies, and creation of employer partnerships. Appended are survey data and other information supporting the goals and action steps. (KB)

The Southern Institute on Children and Families is an independent, nonprofit public policy organization founded in 1990 to improve opportunities for children and families in the South with a focus on disadvantaged children. This annual report presents the accomplishments and activities of the organization for 2000. The report begins with introductory letters from the chairman and from the president discussing the organization's mission. Background information is provided, including a timeline of the organization's major accomplishments over the 10 years since its inception. The report continues with information on the background and progress of the following initiatives: (1) "Covering Kids," a health access initiative for low-income uninsured children; (2) the "Southern Regional Initiative on Child Care," improving access to affordable child care; and (3) "Supporting Families After Welfare Reform," improving access to Medicaid, state health insurance programs, and food stamps. Also described are new initiatives for improving transportation services in rural areas, improving the environment of local service eligibility offices, and enlisting the support of business partners for their mission. The report also includes a list of 2000 publications of the Southern Institute. The report concludes with a list of the board of directors and Institute staff. The report's appendix summarizes the institute's accomplishments over the past 10 years. (KB)

The Southern Institute on Children and Families is an independent, nonprofit public policy organization founded in 1990 to improve opportunities for children and families in the South with a focus on disadvantaged children. This annual report presents the accomplishments and activities of the organization for 1999. The introductory letter from the president and chairman notes that the major thrust during 1999 was to continue efforts to reduce the number of children lacking health insurance. The report presents information on the progress of the following initiatives: (1) an expansion of the "Covering Kids" health access initiative for low-income uninsured children; (2) the "Southern Regional Initiative on Child Care"; (3) "Supporting Families After Welfare Reform," improving access to Medicaid, state health insurance programs, and food stamps; and (4) a site visit to Mayersville, Mississippi to develop strategies for addressing challenges faced by rural families related to transportation, child care, child health coverage, and health care. The report also includes a list of 1999 publications of the Southern Institute. Plans for the year 2000 are delineated related to improving access to children's health insurance and to child care assistance, supporting families who no longer receive welfare assistance, and pursuing solutions to problems common to small, rural communities. The report concludes with a list of the Institute's board of directors and staff. (KB)

To assist states in easing the burden of Medicaid application procedures and verification requirements for families, the Southern Institute on Children and Families conducted a regional meeting to discuss child health coverage verification issues in September, 1998. Participating in the dialogue were Medicaid and state child health insurance programs (CHIP) officials from 15 southern states. The Department of Education is working with teachers, principals, researchers, and others to notify families with low to moderate incomes about the Children's Health Insurance Program (CHIP), as well as regional and central office Health Care Financing Administration (HCFA) representatives. This report presents knowledge attained as a result of this discussion. In addition, prior to the meeting, a poll of 17 southern states and the District of Columbia was conducted to identify verification questions states wanted to pose to HCFA; this report includes information from HCFA responses, specifically: verification requirements at application and verification requirements at redetermination. Additional issues covered in the report include: (1) Medicaid versus CHIP benefits; (2) random verification checks; (3) insurance verification; (4) alien status of CHIP applicants; (5) continuous eligibility; (6) regulation clarification; (7) paternity establishment; (8) social security number; (9) immigration status; (10) quality control concerns; (11) confidentiality; (12) remote eligibility determination; and (13) applying for children. The report includes information on the interpretation of federal rules related to verification of income, age, citizenship, resources and family composition both at application and redetermination. The need for clarification on verification and other eligibility issues is discussed, as is the importance of state initiatives to reduce the verification burden on families while maintaining the integrity of the eligibility process. (JPB)

With the passage of welfare reform, the consolidation of child care programs, the attainment of more state options under Medicaid, and the enactment of the State Children's Health Insurance Program, states are now able to significantly change fundamental health and social policies related to children. This project of the Southern Institute on Children and Families, funded by the Robert Wood Johnson Foundation, was designed to help southern states identify ways to improve access to benefits by low-income working families with children. Specific activities of the project included: the development of outreach information brochures and videotapes for use in southern states; site visits in 17 southern states and the District of Columbia to identify policies and procedures that present access barriers for low-income families and identify strategies being used to improve access to benefits; and a conference to promote dialogue on interagency and interdepartmental issues affecting low income families. This report outlines actions states are taking and can take to improve access to benefits, including issues related to the affordability of health coverage and child care in relation to family income, the categorical structure of benefit programs, counterproductive eligibility rules, inadequate transportation services, and the need for aggressive outreach. State strategies are summarized and state-by-state data are presented where available. Presentations from the Southern Regional Forum on Improving Access to Benefits for Families with Children are summarized. Six appendices include sample outreach brochures, state data on Aid to Families with Dependent Children application denials, and state contacts in fourteen states for Head Start collaboration. (KB)

During 1997, in cooperation with 17 southern states and the District of Columbia, the Southern Institute on Children and Families held site visits to identify ways to uncomplicate the delivery of health coverage, child care and other benefits to assist low wage families. This report presents key findings and recommended actions states can take to remove barriers that families face in accessing benefits, as well as descriptions of other Institute activities during 1997. Key issues discussed include information outreach to dispel confusion about government benefits, child health coverage, child care assistance, transportation, and earned income tax credit. The report briefly describes the Institute's efforts at website development, the Southern Regional Forum, and the program Covering Kids: A National Health Access Initiative for Low-Income, Uninsured Children. (This document is relevant to the field of education in that the U.S. Department of Education is working with teachers, providers, and others to notify families with low to moderate income about children's insurance programs.) (JPB)

The Georgia Information Outreach to Reduce Welfare Dependency Project began in January 1996. The Georgia Department of Human Resources, Division of Family and Children Services (DFCS), commissioned the Southern Institute on Children and Families to conduct the project. Phase 1 of the project focused on the development of three information outreach brochures for use with welfare families, community organizations, and employers. (Appendices to this report contain black and white copies of the brochures and results from nine focus groups with whom the brochures were tested.) Phase 2 was launched in September 1996 with three briefing sessions sponsored by the state DFCS to preview the three information outreach brochures for major user groups prior to statewide dissemination. Following the state-level briefings, 30 presentations on the brochures were held in 10 Georgia counties at events hosted by county DFCS offices. In December 1996, a statewide training session on the information outreach brochures was held for DFCS staff. The information outreach brochures were extremely well received by community organizations and employers who attended the briefing sessions. County DFCS directors were enthusiastic about the brochures, and reaction from county DFCS staff was positive overall. County staff stressed the need to have enough brochures for widespread dissemination throughout the community and for internal use. To enhance the chances that the positive results attained in the project are realized statewide, the Southern Institute recommends that the state DFCS take several actions, including assigning responsibility to a specific office, directing that brochures be distributed and reviewed at welfare application and redetermination interviews, developing cross-training opportunities with other public agencies, and requesting that county DFCS offices that were not part of the project hold community briefing sessions on the brochures. (EV)

Medicaid continues to be viewed as a primary funding mechanism for providing health coverage for children in poor and low-income families. In order to make informed decisions about health coverage for children, states need data on uninsured children and the potential role Medicaid can play in reducing the number of children who are without coverage. The Southern Institute on Children and Families released the first report on uninsured children in the south in November 1992. The report provided estimates of uninsured children by state, with age and income breakouts related to Medicaid. This is the second such report and covers the states of Alabama, Arkansas, Delaware, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia, and the District of Columbia. The source of the estimates of uninsured children is the Current Population Survey (CPS). A major finding is that, of the 9.4 uninsured children in the United States in 1993, a total of 4.1 million (43%) resided in the south. Only 36% of all children lived in these 17 southern states. The report includes recommendations on actions states can take to reduce the number of uninsured children, and an appendix contains Medicaid amendments expanding eligibility for children. (EV)