Communities play key role in extending public health insurance to children.

Nearly all low-income children are now eligible for public health insurance coverage through Medicaid or the State Children's Health Insurance Program (SCHIP), but millions of eligible children still lack coverage. Increasingly, states have turned to local communities to assist with SCHIP outreach. The Center for Studying Health System Change's (HSC) recent site visits to 12 nationally representative communities found many organizations not traditionally involved in public health insurance activities--such as schools, employers and religious and community groups--playing important outreach roles. Local social service agencies, health departments and providers also are helping children gain coverage. For policy makers seeking to increase enrollment, these community efforts offer a valuable road map. Local SCHIP outreach generally is considered successful but is costly. And, state budget shortfalls and reduced federal SCHIP funding could threaten outreach efforts.

Local innovations provide managed care for the uninsured.

A number of communities in the United States are adopting a managed care approach to caring for low-income uninsured individuals. This Issue Brief focuses on such programs in five of the 12 communities that the Center for Studying Health System Change (HSC) is tracking intensively. It describes the local market factors that motivated the creation and varying design of these initiatives, all of which seek to increase access to primary and preventive care while managing the use of more costly inpatient and emergency care. The Issue Brief also discusses the long-term viability of these programs as they attempt to simultaneously expand access to services and contain costs for this growing population.