Over 45 percent of uninsured eligible for Medicaid/CHIP and 24 percent of low-income uninsured eligible for tax credits live in families with at least one school-age child. In addition, significant shares of the remaining uninsured live in a household with a child receiving free or reduced-price lunches through the public schools. This makes public school–based strategies to educate the uninsured and assist them in enrolling in coverage an attractive approach, although such strategies face significant challenges.
Some schools already collect information on the health insurance coverage of children at the beginning of each school year, allowing them to quickly identify uninsured students. And as noted, a child’s eligibility for free and reduced-price lunches is significantly correlated with eligibility. Enrollment assisters could work directly with schools, extracurricular programs, and parent-teacher associations to boost enrollment. Enrollment assisters could be colocated in schools for certain periods, and school communications with parents could provide information on the benefits of insurance, the availability of low-cost options, and the availability of enrollment assistance.
Challenges in relying upon schools’ involvement include the fact that school districts are administered in a decentralized manner, so there is no single state agency to approve involvement. In addition, children who are undocumented can qualify for the subsidized lunches, whereas those children are not eligible for Medicaid. Plus, income misreporting means that not all families with children receiving subsidized school lunches will be eligible for these programs. In addition, school staff themselves tend to be under-resourced, so relying on the schools’ own staff for enrollment assistance is more than can likely be expected.
However, schools are viewed by many as a trusted setting, and providing information to parents through schools, giving parents an easy option to have assisters contact them directly, and placing enrollment assisters at schools and school-related functions may be effective at boosting participation. Further, middle school and high school health classes could incorporate information on the importance of having insurance coverage and the programs available to provide financial assistance to those without it and provide focused teaching to improve health insurance literacy. Activities for high school seniors could remind them of the need for insurance coverage and how to obtain assistance.