1. U NINSURED E LEMENTARY S TUDENTS Kali Beasley, Alexandra Derbawka, Erik Rammelsberg, Alexis Sanchez "This one is for the kids." -Gheorghe Muresan

2. P OPULATION C HARACTERISTICS According to U.S. Census 2010 1 : 48,858 children, ages 6-17 years, in Benton- Franklin Counties 4,989 are uninsured (~10%) Diverse population, but key informants consistently identified undocumented immigrant children as particularly at-risk Therefore, we can expect the actual percent of uninsured children to be higher 1 U.S. Census Bureau. (2010). Health insurance coverage status by sex and age: Benton County, Washington and Franklin County, Washington. Retrieved from http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml

3. S PECIAL N OTE A BOUT T HIS P OPULATION It has been a challenge to identify this population WA State provides subsidized coverage to children up to 300% poverty level Nearly all children are eligible once identified as uninsured

4. R EASONS F OR U NINSURED S TATUS 1) Eligible, but opt out of public insurance programs 2) Ineligible due to income (>300% poverty level) and do not purchase private insurance 3) Assume ineligible due to income or legal status 4) Unaware of public insurance option or unsure how to enroll

5. S PECIAL N EEDS Linking to Medicaid outreach workers Need a safe place to access medical care without fear of being reported to INS Limited access to care Mon-Fri, 8-5

6. S TRENGTHS Self-sufficient Resilient Community support Cultural School Religious/Spiritual support

7. C URRENT R ESOURCES A VAILABLE Washinton's Apple Health Almost all kids are eligible Benton-Franklin Health District has outreach worker for application Washington Health Plan Hearing/Vision screening in school districts

8. P OLICY G APS Limited services for Washington Health Plan members Eligible, undocumented families afraid to apply for Apple Health Utilization of dental services Dental offices generally open 4 or 5 days a week during working hours Accessible education about available services

9. H EALTHY P EOPLE 2020 Increase the proportion of persons with health insurance Increase the proportion of persons who have a specific source of ongoing care Reduce the proportion of individuals who are unable to obtain or are delayed in obtaining necessary medical care, dental care, or prescription medicines

10. M AJOR H EALTH P ROBLEMS : D ENTAL Uninsured children and children on public insurance are much more likely to have an unmet dental need Lack of dental care affects much more than just mouth Screenings available in school, but treatment options are lacking Missed school days Future development of health problems Dental is covered under Apple Health, but many families are not able to utilize dental services due to hours of operation

11. M AJOR H EALTH P ROBLEMS : M ENTAL H EALTH Undiagnosed & untreated mental health issues affect school performance School staff report this as a widespread problem Anxiety Depression Hyperactivity disorders Grades, attendance, & other students' learning all suffer from this unmet need

12. P OLICY D EVELOPMENT : F AMILY O UTREACH AND E DUCATION Host meeting at rural elementary school to educate parents about Apple Health Care Gear towards parents of undocumented, uninsured kids Family outreach workers identify and invite uninsured families Capitalizes on already established trust

13. P OLICY D EVELOPMENT : F AMILY O UTREACH AND E DUCATION Implementation Key components BFHD Medicaid Outreach Worker Family Outreach Worker/Advocate Contribute to success Principal/School support Available meeting facility

14. P OLICY D EVELOPMENT : F AMILY O UTREACH AND E DUCATION BFHD in Rural Areas to address Access to Care Issues Working with school nurse to provide more comprehensive assessment Family Advocates/ Outreach workers have identified families, helped establish nurse-family relationships BFHD can enlist cooperation of Medicaid Outreach Worker

15. A SSURANCE F AMILY O UTREACH AND E DUCATION Expect to see increased rates of insurance among rural, undocumented children Long-term reduction in absence rates PHN and school nurse can review data and interview families to evaluate effectiveness

16. P OLICY D EVELOPMENT D ENTAL C ARE Address the lack of utilization of dental services Many dental offices in the area accept Apple Health Offices could coordinate to allow extended hours for low-income families. Late hours on weekdays and/or weekend hours Educational materials would be provided to community schools/churches/public places

17. P OLICY D EVELOPMENT D ENTAL C ARE Implementation Coordinate with Benton-Franklin Oral Health Coalition Communication between dental offices is key  Possible rotating schedule Community Health Nurse role Might include providing information about extended clinic hours to clients Educating about the importance of dental care in childhood

18. A SSURANCE D ENTAL C ARE Desired results: Improved dental services utilization Improved dental screening results in school districts Decreased absenteeism in school Passive surveillance Dental clinics keep records and statistics about utilization during extended hours School district health staff report data about dental screenings Active surveillance CHN assessments of elementary aged clients & their families

19. Q UESTIONS ?