Using Results Count Skills to Expand Health Care Coverage for Kids in Georgia

Posted July 12, 2021, By the Annie E. Casey Foundation

Erica Fener Sitkoff (far right)

Photo courtesy of the David and Lucile Packard Foundation.

Erica Fener Sitkoff (far right) with other members of the Children’s Health Leadership Network.

When Gov. Bri­an Kemp signed a mea­sure into law in May 2021 to expand health care cov­er­age to approx­i­mate­ly 70,000 unin­sured kids in Geor­gia, it marked the real­iza­tion of a pol­i­cy goal Eri­ca Fen­er Sitkoff had defined near­ly five years before as a mem­ber of the first cohort of the Children’s Health Lead­er­ship Net­work (CHLN).

Spon­sored by the Annie E. Casey Foun­da­tion in col­lab­o­ra­tion with the David and Lucile Packard Foun­da­tion and the Atlantic Phil­an­thropies, CHLN is an inten­sive 17-month lead­er­ship devel­op­ment pro­gram based on Results Count®, Casey’s unique approach to equip­ping social-sec­tor exec­u­tives with the skills and con­fi­dence to achieve bet­ter out­comes for all kids and fam­i­lies. Sitkoff, exec­u­tive direc­tor of Voic­es for Georgia’s Chil­dren, says that her pro­fi­cien­cy in lever­ag­ing data, along with her deep immer­sion in the areas of part­ner­ships, per­son­al pow­er and orga­ni­za­tion­al author­i­ty accel­er­at­ed” her effec­tive­ness as a pol­i­cy advocate.

First Steps

As in every Results Count ini­tia­tive, CHLN par­tic­i­pants select an over­ar­ch­ing result that guides their work toward spe­cif­ic, mea­sur­able improve­ments for large num­bers of young peo­ple and fam­i­lies. Sitkoff’s result: All chil­dren in Geor­gia who are eli­gi­ble for pub­lic health insur­ance — through Med­ic­aid and Georgia’s Peach­Care for Kids health pro­gram — will be enrolled and receive the ben­e­fit.

With­out health care cov­er­age, unin­sured chil­dren are more like­ly to have unmet med­ical needs and less like­ly to have a reg­u­lar source of care, which are devel­op­men­tal risks for chil­dren. If you don’t have health insur­ance,” says Sitkoff, you are not proac­tive­ly going to the doc­tor, you are wait­ing longer to go to the doc­tor when some­thing is wrong and you are boxed out of many activ­i­ties. For exam­ple, many schools won’t allow you to go on field trips or par­tic­i­pate in cer­tain sports activ­i­ties with­out health insurance.”

With near­ly 200,000 unin­sured chil­dren under the age of 19, Geor­gia had the nation’s fourth largest unin­sured child­hood pop­u­la­tion in 2019, accord­ing to the Foundation’s lat­est KIDS COUNT® Data Book. Sitkoff’s deep dive into cov­er­age data revealed sig­nif­i­cant racial, eth­nic and geo­graph­ic dis­par­i­ties. Lati­no chil­dren in Geor­gia were unin­sured at near­ly three times the rate of their white peers and twice the rate of their Black coun­ter­parts. In some rur­al coun­ties, more than half of all chil­dren lacked health insurance.

To bet­ter under­stand the real-life expe­ri­ences behind the data, Sitkoff and her col­leagues talked to peo­ple in com­mu­ni­ties across the state. They found that bar­ri­ers to obtain­ing pub­lic health insur­ance includ­ed the intim­i­dat­ing 30-page appli­ca­tion form and the lim­it­ed capa­bil­i­ties and hours of the Geor­gia Gate­way, the online sys­tem for deter­min­ing fam­i­lies’ eli­gi­bil­i­ty for var­i­ous fed­er­al and state ben­e­fit pro­grams. Geor­gia Gate­way shut down dai­ly at 4 p.m. and com­plete­ly on weekends. 

Fam­i­lies would take sev­er­al hours to fill out the appli­ca­tion and hit sub­mit’,” says Sitkoff. The appli­ca­tion would go out into the ether and nev­er be received.” An urgent pri­or­i­ty for Voic­es for Georgia’s Chil­dren and its part­ners was advo­cat­ing for sys­tem improve­ments to make enroll­ment eas­i­er for fam­i­lies. Geor­gia Gate­way is now avail­able to fam­i­lies at all times.

The Express Lane

A key step toward achiev­ing Sitkoff’s CHLN result was advo­cat­ing for Express Lane Eli­gi­bil­i­ty, a fed­er­al pol­i­cy option avail­able to states that makes fam­i­lies who are eli­gi­ble for the Sup­ple­men­tal Nutri­tion Assis­tance Pro­gram (SNAP) auto­mat­i­cal­ly eli­gi­ble for Med­ic­aid. The fed­er­al government’s rea­son­ing for this option: fam­i­ly income and oth­er require­ments for SNAP are more strin­gent than Medicaid’s. In essence,” says Sitkoff, Express Lane Eli­gi­bil­i­ty means that par­ents just have to fill out one application.”

Voic­es for Georgia’s Chil­dren pro­vid­ed law­mak­ers with exam­ples of Express Lane Eli­gi­bil­i­ty in oth­er states and with the most recent cov­er­age data in Geor­gia: 85,000 chil­dren in the state were enrolled in SNAP but not cov­ered by pub­lic health insur­ance. In Jan­u­ary 2021, Rep. Sharon Coop­er intro­duced House Bill 163, which direct­ed state agen­cies to seek fed­er­al approval of a plan allow­ing fam­i­lies who apply for SNAP assis­tance to simul­ta­ne­ous­ly apply for Medicaid.

The state agen­cies that would imple­ment the bill were an essen­tial audi­ence for Sitkoff’s advo­ca­cy. Pol­i­cy lives and dies with its imple­men­ta­tion,” she says. A key cham­pi­on for Express Lane Eli­gi­bil­i­ty was Tom C. Rawl­ings, direc­tor of Georgia’s Divi­sion of Fam­i­ly and Chil­dren Ser­vices. His agency esti­mat­ed that stream­lin­ing enroll­ment would not only result in 70,000 unin­sured chil­dren obtain­ing health insur­ance but also reduce the agency’s admin­is­tra­tive costs for col­lect­ing and review­ing pre­vi­ous­ly ver­i­fied data.

A broad coali­tion of part­ners has been vital to Voic­es for Georgia’s Children’s pol­i­cy advo­ca­cy. The orga­ni­za­tion and the Geor­gia Chap­ter of the Amer­i­can Acad­e­my of Pedi­atrics co-found­ed the Child and Ado­les­cent Health Coali­tion, com­prised of advo­cates, ser­vice providers, uni­ver­si­ties and state agency leaders. 

The Long Game

Sitkoff sees this pol­i­cy win for chil­dren as a cat­a­lyst for fur­ther stream­lin­ing the way fam­i­lies access crit­i­cal sources of sup­port. For exam­ple, Geor­gia is cur­rent­ly con­sid­er­ing the inclu­sion of the fed­er­al Tem­po­rary Assis­tance for Needy Fam­i­lies pro­gram in its Express Lane Eli­gi­bil­i­ty ini­tia­tive. The state is also test­ing a short­er health insur­ance appli­ca­tion that is acces­si­ble to fam­i­lies with lim­it­ed Eng­lish pro­fi­cien­cy, dif­fer­ent read­ing lev­els and dif­fer­ent time con­straints and inter­net availability.

Pol­i­cy change is a long game,” Sitkoff says. But it is an impor­tant game and a game that can be won. It just may not hap­pen overnight.”

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