May 21, 2001


BOARD MEMBERS:                                             LEGISLATIVE BOARD MEMBERS:

Eldon Huston, Chair                                                 Senator Johnie Hammond

Terri Vaughan, Vice-Chair                                     Senator Kenneth Veenstra

Edward Schor, MD (for Stephen Gleason)          Representative Brad Hansen (absent)

Brenda Oas (for Ted Stilwill)                                  Representative Bob Osterhaus (absent)

Susie Poulton (absent)

Diane Briest

Barry Cleaveland



Dennis Headlee                                                      Marne Woods

Anita Smith

Shellie Goldman

Anna Ruggle


GUESTS:                                                             AFFILIATION

Wendy DeWitt                                                      Iowa Health Solutions

Jule Reynolds                                                       ASK Family Resource Center

Patti Walden Allen                                                Marketing Works

Susi Lyon                                                             Iowa Department of Public Health

Sonni Vierling                                                      Iowa Department of Public Health Ė Covering Kids

Diane Ellis                                                           Community Health, Marion County

Alice Benge                                                         SIEDA HAWK-I Outreach Worker

Frann Otte                                                            Wellmark

Angela Rubino                                                     Des Moines University Clinics

Leila Carlson                                                         National Association of Social Workers

Tawanna                                                                Black Polk County HAWK-I

Kelly Harvey                                                          Trinity Regional Hospital

Ed Conlow                                                             House Democratic Staff

Nancy Palm                                                           Healthy Linn Care Network

Tomi Johnson                                                       Minority Health Coalition

Jim Donoghue                                                      Broadlawns Hospital

Denise Hill                                                            Iowa Medical Society

Chris McCarthy                                                    Iowa Methodist, Lutheran and Blank Hospitals

Mary L. Madison                                                  Healthy Polk 2010

Barbara Fox-Goldizen                                         MAXIMUS

Sam Leto                                                               Legislative Fiscal Bureau

Mary OíBrien                                                         Visiting Nurses

Cindy Groene                                                       John Deere Health

Marie Glancy                                                       John Deere Health

Bob Harpster                                                       Iowa Dental Association


The Healthy and Well Kids in Iowa (HAWK-I) Board met on Monday, May 21, 2001, in the Oak Room, Des Moines Botanical Center, 909 E. River Drive, Des Moines, Iowa. Eldon Huston, Chair, called the meeting to order at 12:30 p.m.

Anita Smith took the roll call, a quorum was present. Audience members introduced themselves. Mr. Huston informed the guests that there would be an opportunity for public comment later in the agenda and if someone would like to address the Board, they should notify him.


Ed Schor made a motion to approve the April 16, 2001, minutes as written. Brenda Oas seconded the motion. Unanimous approval was made by Barry Cleaveland, Diane Briest, Ed Schor, Brenda Oas, and Eldon Huston.


Anita Smith reviewed the correspondence.

Terri Vaughan arrived at the meeting at this time.


Ms. Smith said she recently received a report indicating the Medicaid roles are growing and it is believed to be a result of HAWK-I outreach. Since July of 2000, 19,500 people have been added to Medicaid. Since December, a net total of 5,891 children. For the period from July to December, 2,782 kids were added. After the elimination of monthly reporting, that number doubled. In the poverty level groups since July 8,600 kids have been added. Ms. Smith said these numbers are not necessarily reflected in the Medicaid expansion report the Board receives every month.


Ms. Smith said that staff is receiving a lot of questions about the status of the budget and many rumors are circulating, such as that no new applications will be taken after July 1, that the program is going to end. Ms. Smith said staff is doing their best to stop these rumors as they hear them.

The monthly CHIP budget report shows FY 01 expenditures of $5.6 million. This does not include what has been spent for the media campaign or health plan expenditures. Ms. Smith said that it was brought to her attention that some payments to the health plans may have been missed during the transition between MAXIMUS and ESI and staff is in the process of investigating. Total expenditures for CHIP for FY 01 are estimated to be $7.8 million, leaving a carryover of approximately $800,000. Interest earned on the HAWK-I trust fund totals approximately $350,000 and would serve to draw down about $1.2 million in federal funding.

Ms. Smith presented a budget comparison between FY 01 and FY 02 budgets. In FY 01 the total budget in state funds was $11.6 million. As it stands now, the FY 02 budget will be $12.4 million; $8.4 million from the General Fund, $3.8 million from the Trust Fund; and $200,000 in tobacco funding. Ms. Smith said that the original projection for FY 02 was for $13 million in state funding. However, the budget was recalculated based on experience with enrollment and claims in the Medicaid population and was adjusted accordingly.

Senator Hammond arrived at the meeting at this time.

Ms. Smith explained that the biggest difference in cost is for Medicaid enrollees. Between FY 99 and FY 00 there was a 37% increase in Medicaid expenditures for the HAWK-I expansion kids. The original budget was for 6,100 kids at an average monthly cost per child of $248.23. Based on actual claims data, the average monthly cost is now believed to be $201.00. The new projection is for 8,300 kids. Total Medicaid expansion component is projected at $20 million.

The total cost for infants has increased in the revised budget projection. The original projection was for 154 infants, but has doubled to 309. The cost, however, is lower than originally projected based on claims data.

The original projection was that 40% of enrollment would be in the indemnity plan and 60% in managed care plans. With the elimination of Wellmarkís Unity Choice managed care plan this will change.

Ms. Smith said the original projection indicated there could be a $622,000 deficit and the program would have to go to waiting lists. The revised projection shows a $600,000 surplus in the HAWK-I trust fund. Ms. Smith cautioned that there are a lot of variables. If enrollment continues at its current pace and the assumptions used to determine the health plan split (indemnity vs. managed care) remain the same, then the budget will be on target. However, if there is a large increase in enrollment there may be a budget shortfall. Costs will vary based on whether kids go into Medicaid or the HAWK-I indemnity plan, or the HAWK-I managed care plans. Projections show that a total of 17,305 kids can be enrolled in HAWK-I before going to a waiting list (assuming Medicaid projections are correct). The average HAWK-I cost per month ($117.96) used in the projections is a blended rate of the managed care and indemnity cost.

Mr. Huston asked if there was a budget shortfall would there be an opportunity to request a supplemental appropriation. Ms. Smith said yes, that was a possibility.

Enrollment & Statistics

Ms. Smith reported that for the first time, HAWK-I enrollment has exceeded the Medicaid expansion enrollment. There were 706 children added to HAWK-I bringing total enrollment to 10,286. As of April 30th there were 10,025 in the Medicaid expansion.

The daily activity report from MAXIMUS shows a steady increase in the number of applications received since the beginning of the media campaign. At the beginning of March an average of 43 applications were received per day. That number increased to as high as 75 per day during the campaign. The reports also indicated a higher number of applications are being referred to Medicaid. More and more of the applications are from individuals who have never been on public assistance of any kind. Ms. Smith said this supports the belief that the media campaign would reach individuals that have not been reached before through other grassroots efforts.

Of the applications referred to Medicaid in April 60% were approved. This is up from the 25% approval rate in October when the simplification process was introduced.

The "Application and Referral Report by County" identifies what is checked on the application as to how they heard about the program. As anticipated, the April report shows an increase in television and radio. Mr. Huston wanted to know if the radio advertising period was completed. Ms. Smith said there still may be a few ads airing. Several local outreach efforts requested tapes of the ads and have made arrangements for air time.

The "HAWK-I Applicants not Enrolled by Reason" report reflects the larger number of applications being referred to Medicaid. In April, 166 were referred to Medicaid or were denied eligibility because they were either already on Medicaid or were referred to Medicaid and subsequently approved.

The April disenrollment report indicates the top three reasons for disenrollment were: 1) 209 were identified as being on Medicaid; 2) 93 failed to pay the monthly premium; and 3) 83 simply did not follow through with the renewal process. It is not known whether the 93 that failed to pay the premium no longer wanted the program or if it was due to a financial issue.

The "How you Heard about HAWK-I" report shows more and more insurance agents are making referrals to HAWK-I and it is believed that this may be due to the increased awareness of HAWK-I through the St. Ambrose College seminars currently being conducted.

Legislative Update:

Ms. Smith reported that although House File 382, the "HAWK-I technical bill", made it through the second funnel, it went no further. The bill will be included as part of the Department of Human Serviceís legislative package for 2002. The recommendations made by the Clinical Advisory Committee did not make it through the legislative process either. The recommendations were added as an amendment to HF 382, but were subsequently withdrawn.

Mr. Huston suggested that staff notify the Clinical Advisory Committee that their recommendations were not acted upon and find out if they want to make any changes. Mr. Huston said these recommendations need to be given to the Department of Human Services quickly enough so they can be included in the Departmentís legislative package for the upcoming legislative session.

Senator Hammond suggested it might be helpful if Mr. Huston would visit with the chairs of the committees to which the bill drafts are assigned prior to the session. Ms. Smith said that when the HAWK-I technical amendments were going through the process she did not receive any feedback to amend it in any way other than to add additional items. No one seemed to have any issues with the recommendations, but it was a vehicle to use to try to get some other things through as well.

Ms. Smith shared the Departmentís analysis of the Departmentís appropriation bill with the Board. Section 9, lines 28-32, requires DHS to submit a report to the General Assembly and the HAWK-I Board "identifying the insurers reported actual costs of providing coverage to children enrolled in the CHIP program". The Department has recommended that this section be vetoed because this information is not currently collected from the health plans. Ms. Smith said that encounter data is different than the insurerís actual costs so while the bill requires the Department to submit a report, it does not require the insurers to provide the information.

The Department is also recommending a veto of Section 9, lines 1-8, which state the Department shall seek a waiver from the Health Care Financing Administration regarding the choice issue. Ms. Smith said that the Department is not opposed to seeking a waiver and is being pro-active in trying to get approval from HCFA. However, no funds were appropriated for additional staff for the development of the waiver should it be allowed. Ms. Smith said that if the Departmentís waiver request is approved, next yearís legislative package would request the funding it would take to develop the waiver and monitor it. Last year there was sufficient funding in the trust fund to pursue the waiver if it appeared that HCFA would consider it. However, that is not the case this year since most of the funds remaining in the trust fund at the end of FY 2001 will be re-allocated for other purposes. That is why the veto is being recommended this year and was not last year.

HCFA Site Visit:

Ms. Smith reported that the HCFA site visit went extremely well. Mr. Huston was present for the entrance and exit conferences. The review team only cited three potential findings at the exit conference. There were too many telephone numbers on one notice, additional outreach with the Native American population along the Nebraska border was recommended, and that the state should consider an automatic assignment of health plans when the family does not choose a plan rather than denying the application.

The review team was given a tour of MAXIMUS and had an opportunity to listen in on the customer service center. They witnessed someone being referred to the AT&T translator line, they heard people being assisted with primary care physician selection, and they heard an individual being referred to the Healthy Families hotline. Ms. Smith said she believed the visit was a very positive experience and the draft written report should be released in approximately 90 days.

Mr. Huston said he was surprised at the number of officials on the review team representing a variety of areas such as HRSA and civil rights. The term "best practices" was used almost all the time. The review team said that Iowa is ahead of the curve and they found some things they felt could be very useful in other programs. Mr. Huston said he was impressed that the review team was so complimentary. They were very complimentary to the program and what is being done in the State of Iowa.

Ms. Smith said the review team appeared to be impressed with the infrastructure that has been developed and were impressed with all of the data reports that can produced. One reviewer indicated that many states have worked so fast and furious to get their programs started and their enrollment up that now they are going back and trying to recreate some of the data that wasnít originally collected. HCFA was also very positive with the quality measures being developed as well as those that are in place.

Mr. Headlee said he would like to commend Anita and the staff at MAXIMUS for doing such a good job this past year of getting the program up to speed and establishing some of those best practices. Mr. Headlee said he was very impressed and pleased with the results of the site visit and the Department has received continuing feedback from the regional office on the review and how they are using this to help other states.

Termination of the Unity Choice Contract:

The Department was notified in an April 27, 2001, letter from Peter Roberts, President of Wellmark Health Plan of Iowa, Inc. that they would not be renewing their contract with the HAWK-I program for their Unity Choice product. They will continue participating with their Classic Blue indemnity product. Ms. Smith told the Board that the process has begun to notify enrollees of the change and shared copies of the letters that were sent to Unity Choice members. Health plan options depend upon the county of residence so some enrollees will have a choice of two health plans while others will need to enroll with either Iowa Health Solutions or John Deere. For some, the only option will be to go to the indemnity product. For families that have a choice of two health plans, if they have not made a choice by a certain date a plan will be selected for them. Ms. Smith said that the current policy is that if there is a choice of health plans and a family does not affirmatively select a health plan then they are denied eligibility. There are a fairly high number of denials due to failure to select a plan, and this is one area that HCFA commented on during the site visit. Staff is in the process of amending the administrative rules so that in the future if a family fails to choose a plan, one will automatically be assigned. The administrative rule amendment will be brought to the Board next month for consideration.

Mr. Huston asked Ms. Smith to monitor this process closely because changing plans and possibly providers will be confusing to a lot of people and he wants to make sure families are assisted in every way possible through the transition.


Patti Allen, a marketing consultant from Des Moines, was introduced to the Board. Ms. Allen told the Board that she has more than 20 years of marketing, strategic planning, training, and publication management experience; a career in both the "for profit" and "not-for-profit" communities.

Ms. Allen said that several months ago she was asked to serve on a panel that was established to review grant proposals for HAWK-I outreach. Ms. Allen said she was interested in doing so because she was one of a large group of people who had submitted marketing proposals for HAWK-I at the time the original outreach activity was initiated three years ago. Ms. Allen said that the proposals she helped review had a nice scheme of work for what is currently being done with regard to outreach. However, the measurability and evaluation components and specific goal-setting elements that would have enabled her to say yes, this is an investment of money that will pay off in additional HAWK-I enrollments, just was not there. Ms. Allen said this was what peaked her curiosity enough to call Ms. Smith and ask for the opportunity to discuss specific services that she might be able to provide. Ms. Allen told the Board that she would secure the necessary funding and the only charge for this work would be her hourly fee.

Ms. Allen said she was amazed at the amount of infrastructure and learning that has taken place in the three years since HAWK-Iís inception and proposes four succinct activities that would provide a framework for the next phase.

  1. Goalsetting
  2. Assessment
  3. Contractor Development
  4. Planning
  1. Goalsetting. Update the uninsured kids estimates by county to reflect most current census data, current DHS outreach funding, and HAWK-I enrollees. Management could look at relative value and relative investment by county and be sure decisions reflect priorities.
  2. Assessment. Review quarterly outreach project reports to evaluate and report relative effectiveness of activities and correlation with accepted social marketing processes. There is great value in the reports, not just from the providing feedback to individual contractors, but also in looking for things that are working that might be shared among reporting entities so that everybody in each outreach project is not having to reinvent the wheel. Ms. Allen proposes to develop a standard feedback mechanism to produce a response report to each report submitted by the contractors.
  3. Contractor Development. Develop a communication plan for interaction with county project liaisons in a manner that ensures optimum identification and exchange of best practices information and encourages enthusiasm among staff. HAWK-I outreach is not the only priority served by many of the people, so the HAWK-I message needs to be "top of mind" and be communicated in the most effective way possible. A consistent training plan needs to be developed.
  4. Planning. Develop a statewide marketing plan that integrates goals, strategies and objectives for all five components of the marketing mix Ė outreach, advertising, public relations, direct mail, and special event management Ė with current outreach activity.

Ms. Allen said a number of organizations have expressed interest and spent money in Iowa on HAWK-I outreach and she is in the process of contacting those organizations to see if they are interested in funding the proposal.

Ms. Smith said she thinks that what Ms. Allen is proposing is exactly what needs to be done, but existing staff has not had the time. Although there was a statewide outreach coordinator, the position was so busy getting the nuts and bolts in place and working on brochures and other materials, there was no time for the analysis piece. Ms. Smith said that it would help tremendously if Ms. Allenís proposals were put in place for the next statewide outreach coordinator and hopes the Board supports the plan.

Ms. Vaughan said she feels this is exactly what the HAWK-I program needs. The media campaign seems to be making progress and this proposal ties everything together and makes a lot of sense. Ms. Vaughan said that since the funding would be provided from a source other than state or federal funds, she was all for it and sees no reason to hold back.

Dr. Schor said that this is a good plan, provided a funding source can be found. Dr. Schor suggested that since the activities would be representing the HAWK-I program, a formal structure be in place to provide accountability, checkoffs on activities, and so forth.

Mr. Huston asked if it was possible that a document be prepared that makes it clear what the Board has reviewed, how the Board envisions the proposal, and making it clear that the financing comes from someplace other than state or federal funds. Marne Woods said yes, such a document would be prepared and would identify all the variables, such as the funding source.

Senator Veenstra asked for clarification on Ms. Allenís hourly fee and whether that would come from the grant and whether or not this would replace the outreach coordinatorís role. Ms. Allen said her fee would be what the grants would fund, there would be no other expenses associated with her work. Ms. Smith said that Ms. Allen would get the infrastructure built so that a future outreach coordinator can follow through and would be able to do the job more efficiently. Ms. Smith said that since the outreach coordinator position has been vacant and other staff has been trying to fill in, she is more convinced than ever that at least one person is needed to adequately coordinate outreach activities. Ms. Smith said that by having the four components proposed by Ms. Allen in place, it would be of tremendous help and give an outreach coordinator the tools they need to do the job.

Mr. Huston asked that Ms. Allen and staff work together and provide a progress report for the June Board meeting.


Tomi Johnson, President of the Minority Health Coalition of Healthy Polk 2010, spoke to the Board. Ms. Johnson said that the Coalition decides health indicators for Polk County and their goal for HAWK-I is to increase minority and vulnerable children enrollment by 5% by 2005 and to advocate against disenrollment of this particular population. Ms. Johnson said that vulnerable children are defined as low socio-economic or immigrant and different-culture populations.

Ms. Johnson said that the Coalitionís first involvement with HAWK-I was with the "HAWK-I Takes Flight" outreach effort. Assistance was provided from the Department of Health to have trainers, school nurses, and volunteers to assist people in filling out the application. Ms. Johnson said they tried to do a one-time, mass saturation of Polk County in the very low socio-economic neighborhoods. Experience has since shown that outreach works best when and where families naturally congregate and the Coalition has been very successful at the Hispanic Educational Resource Center where evening health care and educational programs are held.

Ms. Johnson said another thing that needs to be taken into consideration is that working families exist in survival mode. From crisis to crisis -- whether the rent gets paid or whether something else gets paid. Health care becomes a luxury and the families that HAWK-I hopes to serve usually seek care when an illness has become critical enough that it can no longer be denied. The families usually have jobs where they do not have sick leave. Some may have health insurance, but it has been given to them in a language that they donít understand and donít know how to interpret. Ms. Johnson said she knows that the Board has wondered why there is a high refusal of Medicaid among applicants and it is because there is still a stigma around Medicaid and being labeled poor. Ms. Johnson said a lack of respect can be witnessed at the grocery store when behind a mother with food stamps or by going into a local welfare office and seeing how people are told to sit and be quiet and there is never a smile. Ms. Johnson said that applying for Medicaid is not something these families want to do.

Ms. Johnson told the Board that since the 1990 census Polk County has had a 6.6% increase in the Latino population and the number of Latino children 0 to 17 years of age quadrupled. Therefore, a lot of the new HAWK-I recipients will be Latino whose parents may have poor use of the English language. Ms. Johnson said parents cannot simply pick up an application and fill it out because of language barriers. Ms. Johnson gave the examples of the terms "lawful admitted alien", and "unearned income". Additionally these families tend to be transient so donít always have the proper documentation as it has become lost when moving.

Ms. Johnson shared several concerns regarding the application with the Board.

  1. Section 1 of the application asks for the head of the household. In some cultures the head of the household is the eldest person in the family so the question may not be answered the way it was intended, with the name of the parent, guardian, or caretaker.
  2. The listing of citizenship is awkward, the space is not adequate.
  3. Why is the nationality of a child who is not applying for the program important when the Department is really most concerned with who is a citizen? Ms. Johnson said that anything that causes suspicion in an immigrant family will make them hesitant to apply.
  4. Section 3 asks for the names of other people living in the household. This question scares families. If they donít admit to other people living in the household, then they have created fraud and if there is any intent to commit fraud by an immigrant that is immediate grounds to return to the home of residence. Ms. Johnson suggested asking for parents, spouses, step-parents and siblings who are 19 and under because many immigrant families have other relatives living with them. Because of the immigration process usually the people who have been here longer help those who come after them. Ms. Johnson said asking for the names of all the people living in the household may make other people vulnerable and they have nothing to do with the child who is seeking HAWK-I.
  5. Section 4 asks for the householdís 12 month sustained income. Working families sometimes have serial jobs and may work several months at one job and several months at another. Some get jobs through an employment agency and are suppose to be available by phone at certain times, but never know when they will get called. Ms. Johnson asked if there could be some kind of flexibility in the application process as to how the family is actually living. This ties into section 5, insurance history of the child.
  6. Ms. Johnson said sometimes the child has health insurance and the parents just donít know it. They may have signed papers through an employer and been given a health care package that they could not read.
  7. Section 6, question 3, asks if any child listed in section 2 is in an institution. The question is not clear and needs clarification. Does it mean juvenile detention, adolescent shelter, or foster home?
  8. Ms. Johnson said that she is bothered by Section 7, whether the applicant wants the application passed on for a Medicaid review. Ms. Johnson said that since it is the law that the application be reviewed, why give the applicant the choice of answering the question? Ms. Johnson said she believes the only purpose that question serves is to eliminate, and that the application should be an invitation.
  9. The brochure should contain information about the appeal process.
  10. The application should include a place for the applicant to authorize someone as their agent to assist with processing the application. Many times the applicant doesnít have the language skills or thorough understanding of the process.

In addition to the recommendations for the HAWK-I brochure/application Ms. Johnson outlined several other recommendations:

Ms. Johnson concluded by saying that she believes the application as currently written does need an advocate in order for people to complete it successfully. Ms. Johnson encouraged the Board to "think out of the box" and gave the example that other states have a prorated annual fee for the first year. Ms. Johnson said that families are used to letting bills slide to make payment on another and if there was a prorated fee for the first six months or a year it might be easier for the families to keep the children enrolled. Ms. Johnson said the Minority Health Coalition of Polk County would like to be involved because they do believe that HAWK-I is important.

Mr. Huston told Ms. Johnson that the Board was aware of the comments about the Spanish brochure. Ms. Smith explained that originally the Spanish brochure was translated by an individual that was under contract with the Department. About a year ago staff met with Latino Affairs to enlist their help with outreach. Latino Affairs staff pointed out what they believed were errors in the Spanish brochures and offered to retranslate. Ms. Smith said the process took quite awhile, but as soon as the retranslation was received the brochures were reprinted and distributed. Shortly after that the Department received several angry letters pointing out that there were over 106 errors in the brochure. Since that time the Department has been working very hard to get it retranslated again to make sure that it is correct. Ms. Smith said she takes issue with the comments that the Spanish language brochure is disrespectful of the Latino community because HAWK-I staff has worked very hard to get a corrected brochure and worked with outside individuals who were believed to be experts at translation.

Ms. Vaughan asked if during the translation process if any of the cultural issues mentioned by Ms. Johnson were being reviewed: i.e., the term head of household; names of other people living at the address. Ms. Smith said that the application has gone through several changes since it was originally designed. The application itself is legislatively mandated not to exceed two pages so it is hard to give more explanation about unearned income, to provide more space, or to do a lot of the things that have been suggested. The HAWK-I application was reviewed and critiqued by the Childrensí Defense Fund as well as a national advocacy group who reviewed applications from all the states and provided feedback and recommended changes. Ms. Smith said that Section 7, the referral to Medicaid statement, was added to the application because of advocates. They wanted to make sure that people knew their application would be referred to Medicaid and what would happen if they checked no, because some people thought there was a choice between Medicaid and HAWK-I. Ms. Smith said that the Board has always been very receptive to any input and staff is compiling a list for the next revision. The brochure probably wonít be reprinted for another six months or so.

Mr. Huston said that the Board has gone over the application numerous times and Senator Hammond has probably been the most vocal about making it as succinct and understandable as possible. Mr. Huston told Ms. Johnson that he appreciated the thoroughness of her comments and would like to have a copy of her presentation. Mr. Huston suggested that representatives from Latino Affairs, Minority Health Coalition of Healthy Polk 2010, and HAWK-I staff meet and to seek a satisfactory resolution. Mr. Huston assured Ms. Johnson that the Board agrees with her that the application needs to be as simple as possible so as many kids as possible are enrolled in the program.


Dennis Hill told the Board that the Covering Kids Now Task Force last met in April. In March the task force issued their winter report and Ms. Hill provided copies to the Board.

The Covering Kids Now Task Force has four legislative recommendations for Medicaid and HAWK-I.

  1. Design a statewide presumptive eligibility pilot project. Ms. Hill said that the task force has revisited the presumptive eligibility issue several times. Most recently there has been concern about the impact on quality so the group wanted a further study. Therefore, the task force recommended a pilot project by provider type and suggested that MAXIMUS, as the HAWK-I third party administrator, perhaps could fill that role.
  2. Require schools to ask about childrenís insurance status at registration and forward that information, with parental consent, to DHS for eligibility purposes. This requirement would help target outreach efforts to areas with higher rates of uninsured children. Ms. Hill said representatives are hoping to meet with the Department of Education to see if there is a way to do this without legislation.
  3. Consider continuous eligibility in relation to the impact of the elimination of monthly reporting.
  4. Continue to study expansion of HAWK-I coverage to parents.

Ms. Hill added that the task force continues to support the request to HCFA that families be allowed to choose between HAWK-I and Medicaid. Task force members have also been working with medical students from the University of Iowa on ways they can help with outreach. A study in Florida found that people are twice as likely to follow up and actually enroll if a physician tells them to.

Ms. Hill said that in July the task force will be discussing Medicaid managed care and in particular communicating changes in participating providers or plans. The task force will also be focusing on stigma.

Mr. Huston said he understands that the Covering Kids Now Task Force does not lobby, but many of the members are from organizations that do. Mr. Huston asked if any of those organizations are planning to lobby for the task forceís legislative recommendations. Ms. Hill said she believes several did. Representative Osterhaus submitted many of the recommendations in the form of study bills and amendments, however, there was such a need to protect the technical clean up bill that the amendments were withdrawn.

Dr. Schor asked which, if any, of the recommendations the Department of Human Services might include in their legislative package. Mr. Headlee said the Department has looked at a number of the recommendations and there are varying degrees of cost for each, some very significant such as presumptive eligibility. Mr. Headlee said it would be helpful if there was an analysis on what the return on investment would be or how the task force would prioritize the recommendations. Mr. Headlee said the Department supports trying to move in this direction if there is ever an opportunity.

Ms. Hill said she believes the recommendations are listed in priority order, with 1 and 2 being very closely linked in terms of priority. As for cost estimates the task force wanted to leave it to the legislature as to what the appropriate provider type might be for the presumptive eligibility pilot project. The cost would vary based on type of provider.

Ms. Smith said that states are looking at buying into employer plans for people on CHIP as a way to expand coverage to parents. At a recent meeting in Washington D.C. she learned it is very likely that funding will be made available to states next year for coverage of parents. However, before parents could be covered under HAWK-I, parents would have to be covered under the Medicaid program first.

Mr. Huston asked that the June agenda include a discussion of legislative recommendations and include the clean-up bill, the Clinical Advisory Committee recommendations, and any other recommendations that have been discussed this past year.


Sonni Vierling remarked that it was exciting to hear the comments presented at the last several Board meetings by Latino Affairs and the Minority Health Coalition. Ms. Vierling said she sees great opportunities for HAWK-I and Covering Kids would like to continue to help with these efforts and to really dialogue with other members of the community.

Ms. Vierling reported that the School Nurse Workshop held on April 26th was a great success. Speakers were able to share not only with school nurses, but with counselors and other school staff, community based agencies, and DHS outreach workers. Ms. Vierling said she will take into consideration Ms. Johnsonís idea of a training component and expand that mailing list.

Ms. Vierling said a new School Nurse HAWK-I handbook was designed this year. It is done in a binder format so they can be kept up-to-date. The table of contents was designed to reflect some of the things that the school nurses and other people working with famlies could use. There is a tab for "Local and State Resources" and includes safety net providers for families that may not quality for HAWK-I, a list of Title 5 clinics, free clinics, and a list of interpreters provided by Latino Affairs. Another section contains HAWK-I program information and includes materials to use with families, how to select a health plan, the difference between Medicaid and HAWK-I, and outreach material to use. These notebooks are available not only to school nurses, but to anyone else who is interested.

Ms. Vierling also reported that 288 responses were received to the School Nurse Outreach Survey and provided the results to the Board. The survey was designed to get feedback from the school nurses on what was being done with HAWK-I outreach, what would be more supportive of their activities, and what are the prominent health issues in their school. Mental health was the number one issue identified, followed by substance abuse, then health insurance. The nurses indicated that even though they identified lack of health insurance as a prominent issue, it doesnít necessarily mean that they have time to work on outreach events. This is why coordination with HAWK-I outreach workers is so critical. Counselors, principles, secretaries, and assistants have been identified as effective allies for outreach. The most effective outreach strategy identified was linking HAWK-I with free and reduced lunch applications, followed by a newsletter about HAWK-I for the schools to disseminate to parents. Ms. Vierling said in response, Covering Kids has developed a newsletter they are sending to school nurses as a follow up. The nurses were asked to identify their county on the survey so that the information can be provided to the appropriate HAWK-I outreach worker in that area.

Ms. Vierling told the Board that Covering Kids is funded through a Robert Wood Johnson Foundation grant. The grant has been extended for another four years and will include what Covering Kids has been doing with enrollments, outreach efforts, and policy issues, but now will include as a major focus retention issues. A portion of the grant applies to 19 states that are working through waivers and other means to increase and improve the system of covering families. Iowa is not on that list at this point in time but this is something Covering Kids would like to pursue in the future. Ms. Vierling said the grant application is due February 1, 2002, so she wanted the Board to be aware that the Department of Public Health is again interested in taking the lead as an extension of their current activities.

Ms. Vierling said that the advertising agency that created the commercials used for HAWK-Iís media campaign, (Greer, Margolis, Mitchell, and Burns) also created the back-to-school campaign. The back-to-school kits will be included in the follow-up packet for school nurses and will also be sent to outreach coordinators, Covering Kids Coalition members, and any other interested parties. The packet contains a template of press releases, media guides, and contains a video that talks about the outreach campaign. Ms. Vierling aired the video for the Board members and the audience.

Mr. Huston inquired about the school nurse survey and whether the choices were already laid out as part of the survey. Ms. Vierling said they were already laid out, but also included "other". Ms. Vierling said there was a long list of other things the nurses thought were important and she could provide that. Mr. Huston said he would like to see the list. Mr. Huston added that the schools are one of the most important contacts for HAWK-I so he is glad to see the material that is available and that the nurses are taking an active role.


Ms. Smith reported that staff is continuing to struggle to fill in for all of the activities that Ms. Van Den Berghe provided as state outreach coordinator. HAWK-I will be participating at the Iowa State Fair again this year, as well as participating in several health fairs and other events. Ms. Smith said hopefully she will be able to fill the outreach coordinator position so there wonít be a lapse in any of those activities. Both Mr. Huston and Senator Hammond asked the status of the position and were informed that it was a contract position and the Department does not have sufficient funding to fill contract positions.

Free and Reduced Lunch Effort:

Ms. Smith told the Board that she and Shellie Goldman have been working with the Department of Education on coordination with the free and reduced lunch program. Ms. Goldman said that the USDA has developed a prototype format for schools to give to parents to apply for free and reduced lunches. Ms. Goldman said that language has been submitted to the Department of Education to include a box for the parents to check if they do not want information on the health care coverage program. Due to stricter confidentiality guidelines, the USDA has mandated that the forms be sent to one specific entity as a representative of the Department. Therefore, all the forms will be submitted to MAXIMUS and MAXIMUS will be sending out the letters and applications once the information is received from the schools. Ms. Smith added that families will be asked if they are already on Medicaid or HAWK-I or if they have health insurance. That will avoid a duplication of effort and avoid having to perform data matches.

Outreach Contracts:

Anna Ruggle reported that the Department of Revenue and Finance requires a new procedure for contracts over $5,000. Since many of the outreach contracts fall into that category, a grant-type application was developed. The new application has been provided to DHS area and regional administrators. Those administrators will contact the outreach people in their communities and have them complete the application and describe how they are going to meet the outreach plan. If the funding is under $5,000, a letter of agreement can be signed and the funding will be issued.

Ms. Smith said that in the past local communities developed their outreach plan and it had to meet certain criteria. Funds could not be used to supplement funding for existing staff or to buy incentives for people to enroll. For FY 02 two new provisions will be added to the outreach contracts. One is that all locally produced outreach materials must be approved. There have been instances where materials developed at a local level have not been correct. The other new provision is a mandate that all outreach coordinators attend a one-day training session. The session will most likely be held in September or October. In addition to a "nuts and bolts" of eligibility program, the training will discuss the role of the outreach worker, their relationships with MAXIMUS, the health plans, and the Department, and introduce them to MAXIMUS staff.

Senator Veenstra asked if those contracts include empowerment boards as providers and if so, would they be allowed to contract. Ms. Smith said that yes, in some cases there are empowerment boards that are considered a lead agency or administrator of the contract.

Mr. Huston asked if there was an appropriation for continued contracting for outreach. Ms. Smith said yes, the budget still includes $300,000 for community outreach and the communities will get the same amount of funding that they received last year. The main difference is that in the past the communities have developed their outreach plan and designated a lead agency to carry it out. Based on the new guidelines, instead of just designating a lead agency, the community outreach plan is developed jointly and anyone interested in being the lead agency has to apply and describe how they would carry out the plan, then there is a selection process at the local level.

Mr. Huston asked if there was an appropriation for the Department of Human Rights to continue their outreach program. Ms. Smith said that unless something changed since she last spoke with Bill Brand, no money was appropriated.

St. Ambrose CEU Presentations:

Ms. Smith reported that she has been traveling around the state doing the presentations on HAWK-I for the insurance agent continuing education classes with St. Ambrose College. Mike Baldwin from DHS is presenting the Medicaid portion. Ms. Smith said the local area outreach workers have been invited to attend these sessions as well.

Ms. Vaughan said that when the HAWK-I program was initiated the independent insurance agents were asked to put something in their newsletter about HAWK-I. Ms. Vaughan suggested this might be a good time to do so again.

Ms. Smith said that Drake University has contacted her about doing a continuing education class for insurance agents this fall. Ms. Smith said she has also been working with Scott Kinney of the Insurance Division about doing outreach to the Latino community in follow-up to the last Board meeting. Mr. Kinney is going to work with several leaders in the community to find out what he can do to help educate families about insurance and HAWK-I. Ms. Smith said she will update the Board when more details are available.


There was no new business to present before the Board.

The Boardís June meeting has been rescheduled and will be held on Wednesday June 20, 2001, at 12:30 in the Willow Room at the Des Moines Botanical Center.

The meeting was adjourned at 3:40 p.m.