To reach uninsured children in the nation's rural and frontier areas, aggressive outreach that addresses cultural issues is critical. While there are no one-size-fits-all approaches to increasing access to healthcare services in rural communities, outreach efforts that address key misperceptions about CHIP (Children's Health Insurance Program) will have a higher rate of success, says Linda Rouse, government affairs special assistant for the National Rural Health Association in Washington, D.C.
One of the primary obstacles is the absence of rural mandates for states in administering the $4.8 billion that they receive annually to provide healthcare outreach. Other social barriers include:
- CHIP being perceived as a "welfare handout," particularly in states where CHIP is administered through its Medicaid program.
- Immigrant families being fearful that their residency will be questioned if they pursue insurance for their children.
For perspective, there are 22 million Americans living in the 802 counties designated as Health Professional Shortage Areas, according to NRHA. While there are no statistics available on the number of uninsured children in rural areas, 22.4 percent of rural children are in poverty and at high risk for being uninsured.
To put a dint in the problem in one state, California earlier this month awarded Blue Cross of California a $1.5 million grant to increase access to healthcare coverage for children in rural areas. The grant will target children of seasonal and migrant farm workers and Native Americans. California has 600,000 uninsured children - 50% are in the Los Angeles area with the rest spread throughout the state.
The funds were awarded by the Managed Risk Medical Insurance Board, the state agency that administers the Healthy Families Program, which provides low-cost healthcare coverage to children of medium-income working families. The grant will fund 20 rural projects.
Here, BCC relies on at least 45 outreach specialists to be the eyes and ears of the state's rural communities and to do "whatever it takes to get the job done," says Christopher Champlin, BCC's director of health education and sales promotion. These specialists do "county sweeps" in 28 rural areas, educating small business owners, community centers, health officials and schools about BCC's Healthy Families program. What works best is comparing the cost of the health coverage to the cost of a McDonald's extra value meal - about $4 a month, says Champlin.
The "handout" issue and illegal immigrant concerns are prevalent for rural families in California, particularly in farming communities where being self-sufficient is a strong value. This is why the McDonald's analogy is so important in addition to positioning Healthy Families as a non-Medi-Cal healthcare service, says Champlin. Medi-Cal is the state's Medicaid program.
(NRHA, Linda Rouse, 202/232-6200; BCC, Chris Champlin, 805/384-3614)