MEMORANDUM OF SUPPORT
S5197 (Montgomery)

AN ACT to amend the social services law, in relation to Medicaid eligibility for independent foster care adolescents

The Campaign for Healthy Children, a joint project of Statewide Youth Advocacy, Inc. and the American Academy of Pediatrics, District II, is committed to working with policy makers to improve the health and well being of all infants, children and adolescents. In this role the Campaign supports this legislation, which provides automatic Medicaid eligibility to independent foster care adolescents who are under 21 and were in foster care on their 18th birthday.

The Foster Care Independence Act of 1999 established a new optional Medicaid eligibility group for children who are in foster care under the responsibility of the State on their 18th birthday. It is past time for New York to take action on behalf of the thousands of young people who are losing their health care coverage at the time they are discharged from foster care.

Young people leaving foster care need considerable support to help ensure that they make a successful transition from care to independence.  Whether youngsters are continuing their educations or entering the job market, they need access to health care.  Compared with other adolescents their age, children in foster care are more likely to quit school, to be unemployed, to be on welfare, to have mental health problems, to be parents outside marriage, to be arrested, to be homeless, and to be the victims of violence and other crimes.

Extending Medicaid coverage to these young people would at a minimum enable them to access health care when they need it and avoid their use of emergency rooms for non-emergency care.  In addition, an appropriate relationship with a health care provider could also help these at-risk youngsters remain healthy and even help them avoid high-risk behaviors as they navigate the adult world.

Rarely have states seen an opportunity as simple and sensible as the optional Medicaid expansion for these young people who are aging out of foster care. 

The Campaign for Health Children enthusiastically supports this legislation because it will provide needed medical coverage to some of the most vulnerable young people in our state.

MEMORANDUM OF SUPPORT
S. 4861-A (Meier)         A. 8709 (Green)

AN ACT to amend the social services law, in relation to child day care during certain periods and child care assistance for eligible families

The Campaign for Healthy Children, a joint project of Statewide Youth Advocacy, Inc. and the American Academy of Pediatrics, District II, is committed to working with policy makers to improve the health and well being of all infants, children and adolescents. In this role the Campaign supports this legislation because it will assist families who are working toward self sufficiency by ensuring that day care is continued during short breaks in activities.

The enactment of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, provided states with great flexibility in designing their child care systems. The work requirements in the Act have increased the demand for child care assistance among current and former welfare families. Many individuals working toward independence experience short breaks in their work or educational activities and may, during these breaks, lose their precious day care slot.

Since current law does not provide any continuing child care for those individuals who have employment or education breaks families must struggle to maintain current arrangements or make new arrangements when the parent returns to school or work. For many parents finding child care that is convenient, affordable and of the quality that they desire can be very time consuming. Maintain the existing relationship is better for the family and the child and the caregivers.

Education is the key to a good job or advancement up the job ladder. When a parent is pursuing their education, local districts should be assisting them with child care. This legislation would allow counties the option to provide child care assistance while the parent is at school.

The best child care is unattainable if it is unaffordable. This legislation would limit the families child care contribution to 10% of the families income and would not be assessed on families whose income is at or below the state income standard.

The Campaign support this legislation because it recognizes that families are guaranteed transitional assistance as they move to independence, that child care must be affordable and that parents should not be required to reapply or experience a break in the childcare assistance that they rely on to maintain their employment.

MEMORANDUM OF SUPPORT
June 4, 2001
S. 5381 (Marchi        A. 4506 (Luster
 -On Rules)                - On Insurance)

AN ACT to amend the insurance law and the executive law, in relation to enacting the "fair insurance treatment act of 2001"

The Campaign for Healthy Children, a joint project of the American Academy of Pediatrics, District II and Statewide Youth Advocacy, is committed to working with policy makers to improve the health and well being of all infants, children and adolescents. In this role the Campaign supports the Fair Insurance Treatment Act of 2001, which ensures that mental health and chemical dependency coverage is provided by insurers and health maintenance organizations and is provided on terms comparable to other health care and medical services.

The mental health needs of children and adolescents are increasing, while access to behavioral health, mental health, and substance abuse services are decreasing. Such services include preventive interventions, early identification, assessment and diagnosis, case management, outpatient treatment, hospitalization, home-based treatment, comprehensive drug and alcohol treatment, and residential and hospital psychiatric treatment. In the past 20 years, the rate of psychosocial problems identified in children in primary care settings has increased from 7% to 18%.

Pediatricians are currently reporting increases in the number of children who desperately need mental health or substance abuse services. Yet, despite the increased need, the availability of mental health and substance abuse services for children and adolescents continues to shrink. Due to health care cost containment measures, benefits packages often provide limited mental health services or carve out plans, in which behavioral health care may be carved out (not included) or contracted for separately, making mental health services more difficult to obtain. Limiting access to mental health services is occurring despite evidence of the effectiveness of specific mental health and substance abuse services.

Although specific long-term economic benefits are difficult to calculate, children and adolescents who receive early intervention and care may avoid needing costly treatment in the future. In economic terms, immediate improvements in the mental health of children and adolescents are reflected in better outcomes for children both socially, medically and educationally. They also produce increased parent work productivity, less parent absenteeism, and less use of general medical services.

More importantly, in the long-term, preventive efforts and early treatment of behavioral problems and mental disorders in childhood result not only in positive changes in behavior but also in physiological changes in the brain. The potential impact of early intervention on instances of violence and on the number of incarcerated juveniles and young adults is significant. Even a modest reduction in negative outcomes for youth will more than compensate for any limited increase in health care costs.

Action must be taken now to curb the ever-shrinking access to mental health and substance abuse services.

Managed care and behavioral health organizations should be required to provide adequate panels of culturally competent clinicians who are qualified to address child and adolescent mental and behavioral health and substance abuse needs. The number of qualified child mental health and substance abuse clinicians should be increased through support for training programs, better recruitment into these programs, and job incentives.

The Campaign for Healthy Children supports this legislation because enacting the Fair Insurance Treatment Act of 2001 will have a positive impact not only on the health and well-being of children and adolescents but on society as well.

MEMORANDUM OF SUPPORT
A. 7909 (Gottfried)

AN ACT to amend the public health law and the social services law, in relation to eligibility under the child health insurance plan

The Campaign for Healthy Children supports most of the provisions in A. 7909. But we have very strong concerns about several components of the legislation as proposed.

New York still has more than 600,000 children without health care coverage. Increasing eligibility, reducing barriers to enrollment, and implementing pro-active strategies to help families maintain their coverage should contribute to bringing and keeping more eligible children under the coverage options of Child Health Plus A or Child Health Plus B.

We enthusiastically endorse expanding eligibility for both Child Health Plus A & B. Increasing Child Health Plus eligibility to 133% of poverty reduces the complexity of the current program. Once this goal is reached, New York will only have two levels of coverage for children. One for infants from birth until their first birthday, at 250% of poverty. And a second for all other children up to 133% of poverty. Expanding Child Health Plus B eligibility to include children in families up to 250% of the poverty level will help more working families afford quality health care for their children. Creating additional subsidized, and therefore, affordable, health care coverage options for children in New York is to be applauded.

We also endorse increasing coverage for pregnant women in the PCAP program to 250% of poverty and the expansion to 250% for eligibility for family planning services in Medicaid,

We also support instituting presumptive eligibility for Child Health Plus A, the children's Medicaid program. It is important that children do not have wait for weeks, or even months, to get their health care coverage. If a child is eligible for health care coverage, then the parent should be able to take that child to the doctor once the application is signed. A form of presumptive eligibility exists in the Child Health Plus B program, but this statute defines an insurer's pro-active responsibility to provide coverage from the day the child's application is received, if the family appears eligible.

However, we are troubled by the fact that it remains the insurer who decides Child Health Plus B eligible. Our question would be how would the insurer let the family know that the applying child is presumptively eligible for services. If the insurer must send a letter, or a card, we would ask, exactly how fast could they do that?? And if they could do that fast, why couldn't they just offer the full coverage fast?

We would prefer to have true presumptive eligibility for both Child Health Plus A & B in a simple, streamlined approach. A tear off form would be at the bottom of each application. When the adult completes the application, either with a facilitated enroller, specially trained Medicaid enrollment worker, provider, insurance marketer, or even at their own kitchen table, they would chose their child's insurer, they would chose their child's doctor and write both on the tear off, along with their signature and the date the application was mailed or completed. That receipt would allow the family to access health care services for the presumptively eligible child until such time as the child's coverage card(s) appear.

A.7909 supports implementation of true presumptive eligibility in both Child Health Plus A & B by providing simplified movement of children between the programs, through automatic enrollment and methods of pro-rating coverage periods that may be less than one month. This would permit families' immediate access to health care, with the state having a fail-safe method of assuring both insurers and providers that they would be reimbursed for children who accessed services when they appeared eligible for one program, but actually belonged in the other program.

We endorse the removal of any requirement for a personal interview as part of the application process for Child Health Plus A (Children's Medicaid). And we support the availability of mail in applications for the Medicaid program.

We are also pleased with the simplified renewal process described in the legislation for both Child Health Plus A & B. We would encourage the commissioner to assure that the renewal processes for both programs are the same.

We support "express lane eligibility" to expedite eligibility determinations.

We are however, deeply troubled by the emphasis throughout the legislation on social security numbers and documentation requirements. We are also concerned about references to "resources".

The Child Health Plus A & B programs have worked hard to simplify the process of families applying for health insurance for their children. There are sections of this legislation that would actually take the children's programs backwards, making it almost impossible for some families to meet the documentation requirements. For instance, Section 3 of this legislation would add to the existing Public Health Law, the requirement for a Social Security number, in order for a family to self-attestation their income. Currently, families can self-attest to document their income if they have no other method of proving their income. There is no requirement that they submit social security numbers to support their self-attestation. By requiring a social security number of support self- attestation, this legislation creates additional obstacles and barriers, especially for immigrant families and persons working outside the mainstream economy. We oppose this provision because it creates additional and for some insurmountable barriers to accessing health care for children.

We are also concerned about the interpretation/definition of family members for the children's health insurance programs. Children's advocates have worked very hard over the last several years to develop the broadest and most flexible interpretation of family composition to assure that no child would be disadvantaged in the eligibility determination process and to assure that both Child Health Plus A & B eligibility determinations were as similar as possible. This legislation requires that "all adults who are members of the household and whose income is available to the child" be listed with their social security numbers. This is a more rigid interpretation that the one currently in place. We oppose this provision because it will create obstacles to coverage.

The Campaign for Healthy Children supports all the eligibility expansions in A.7909, the implementation of true presumptive eligibility for Child Health Plus A & B, and all the provisions which offer simplification of the application and renewal process. But we remain concerned about the possibility that certain provisions of the bill would actually make applying for health insurance for children more complicated and more arduous than it is today.

MEMORANDUM IN OPPOSITION
A.4999 (Ortiz)    S.1988 (Libous)
On Health

AN ACT to amend the public health law, in relation to unlawful possession of tobacco with intent to use by persons under the age of eighteen years

The Campaign for Healthy Children, a joint project of Statewide Youth Advocacy, Inc. and the American Academy of Pediatrics, District II, New York State is committed to working with policy makers to improve the health and well being of all infants, children and adolescents. In this role the Campaign opposes this legislation because it unfairly punishes children who are responding to the tobacco industry’s aggressive marketing.

According to the American Academy of Pediatrics, "Despite the ban on television advertising of cigarettes, the prominent display of logos, billboards, and banners in televised sports events makes cigarette advertising on American television more prominent than ever before. In two recent studies, one-third of 3-year-old children and nearly all children older than age 6 were able to recognize the Old Joe Camel logo. By age 6 the Camel logo is as familiar to children as Mickey Mouse. Advertising for Camel cigarettes was more effective among children and adolescents than among adults. Camel's share of the illegal children's cigarette market represents sales of $476 million per year--one-third of all cigarette sales to minors."

Cigarette companies market their fatal products to children to create demand to continue their existence. Smoking is a pediatric disease because almost no one starts smoking once they reach 24 years of age. Big tobacco companies persist in marketing tobacco to children because they must perpetuate a consumer base. The Campaign for Healthy Children supports enforcement efforts that are focused on preventing youth access to tobacco products, not on shifting the blame for smoking to the victim.

The Campaign for Healthy Children vigorously opposes this legislation and urges its defeat because it inappropriately shifts the enforcement focus away from reducing youth access to tobacco to penalizing children for responding to multi-million dollar tobacco advertising campaigns.

MEMORANDUM OF SUPPORT
A.228-A (Grannis)

AN ACT to amend the public health law, in relation to clean indoor air.

The Campaign for Healthy Children, a joint project of Statewide Youth Advocacy, Inc. and the American Academy of Pediatrics, District II, New York State is committed to working with policy makers to improve the health and well being of all infants, children and adolescents. The Campaign supports this legislation because it would prohibit smoking in bar areas in food service establishments, by imposing standards for separation. The legislation would also require food service establishments without bars to be smoke-free.

Exposure to environmental tobacco smoke has been linked to increased rates of various cancers, cardiovascular and cerebrovascular diseases, respiratory disease, and reproductive and developmental effects. Environmental tobacco smoke is a known human carcinogen. Exposure to environmental tobacco smoke dramatically increases the risk of heart disease and heart attacks by increasing a person's risk of developing blood clots. Other dangers from inhaling second-hand smoke include: increased risk of lung and other cancers, breathing difficulties, including asthma attacks, increased strain on the heart during exercise, aggravated conditions in those with chronic heart and lung disease, and health risks to infants and unborn babies like damaging lung tissue.

Environmental tobacco smoke includes the following chemicals: acetone, ammonia, arsenic, benzene, cadmium, cyanide, formaldehyde, lead, mercury, nickel, phenol, styrene, and toluene. Children and teenagers are most seriously affected by exposure to second-hand smoke since their developing tissues are more likely to be damaged by these chemicals.

Children exposed to smoke-filled environments are more likely to: need emergency care for breathing problems, be hospitalized for respiratory illnesses, be absent from school due to illness caused by inhaling second-hand smoke, make frequent trips to the doctor for more serious illnesses like: bronchitis, pneumonia, asthma, and ear infections, and, they start smoking themselves.

Even when smoking is limited to a specific space, the harmful elements are dispersed throughout the entire area. Many of the highly dangerous chemicals in second-hand smoke are in the form of gases that are not removed by existing ventilation systems.

The only effective way for children and teenagers to avoid the negative effects of second-hand smoke is to be in smoke-free environments. While adults can choose to avoid being in smoky areas, children and infants are especially vulnerable because they often are not free to choose areas that are smoke-free.

The Campaign for Healthy Children strongly supports this legislation because it will provide protections for infants, children and teenagers from the harmful effects of second-hand smoke.

MEMORANDUM OF SUPPORT
A. 1057 (Luster)

AN ACT to amend the public health law, in relation to the availability of tobacco products and herbal cigarettes.

The Campaign for Healthy Children, a joint project of Statewide Youth Advocacy, Inc. and the American Academy of Pediatrics, District II, New York State is committed to working with policy makers to improve the health and well being of all infants, children and adolescents. The Campaign for Healthy Children strongly supports A. 1057, which will further restrict minor’s access to tobacco products.

This legislation will restrict minor’s access to tobacco products by requiring sellers of tobacco products to keep these products behind the counter. The legislation also requires a sign that clearly states the law regarding the minimum requirement of 18 years to purchase tobacco products. Sellers would be require to ask all individuals who do not reasonably appear to be at least 25 years of age to provide a photographic identification card.

Smoking has been classified as a "Pediatric Disease" because the vast majority of smokers begin using tobacco products before they are 18 years old. This legislation would make it much more difficult for those under the age of 18 to purchase tobacco products and to initiate smoking. These measures would also make it much more difficult for minors to shoplift tobacco products by decreasing accessibility to the products.

Numerous studies have shown that the health risks associated with cigarette smoking include higher rates of lung cancer, asthma and heart disease. These health risks are particularly pertinent and dangerous for minors because of the destructive effect of tobacco on a growing body. Also, the younger the age that a person starts smoking, the more likely the person will develop a stronger addiction to nicotine.

Tobacco products are addicting and that there use can lead to multiple health care problems in people of all ages. The Campaign for Healthy Children supports this legislation because it will help to reduce access to tobacco products for children and young teens.

MEMORANDUM OF SUPPORT
June 5, 2001
A.7934 (Paulin - On Health)

AN ACT to amend the public health law, in relation to prohibiting smoking in dormitories, residence halls, and other group residential facilities of public and private colleges, universities, and other educational and vocational institutions.

The Campaign for Healthy Children, a joint project of Statewide Youth Advocacy, Inc. and the American Academy of Pediatrics, District II, is committed to working with policy makers to improve the health and well being of all infants, children and adolescents. In this role the Campaign supports this legislation which prohibits smoking in dormitories, residence halls and other residential facilities of public and private colleges, universities and other educational and vocational institutions unless they are separately ventilated.

Exposure to environmental tobacco smoke (ETS) is a proven cause of disease and death in exposed nonsmokers and is estimated to be the fifth leading cause of death in the United States. Exposure to environmental tobacco smoke has been linked to increased rates of various cancers, cardiovascular and cerebrovascular diseases, respiratory disease, and reproductive and developmental effects. Environmental tobacco smoke is a known human carcinogen.

Exposure to environmental tobacco smoke dramatically increases the risk of heart disease and heart attacks by increasing a person's risk of developing blood clots. Other dangers from inhaling second-hand smoke include: increased risk of lung and other cancers, breathing difficulties, including asthma attacks, increased strain on the heart during exercise, aggravated conditions in those with chronic heart and lung disease, and health risks to infants and unborn babies like damaging lung tissue.

The Campaign for Healthy Children supports this legislation because it will restricting smoking to separately ventilated smoking rooms will eliminate the adverse health effects of second-hand smoke on nonsmokers, mitigate the risk of fire and reduce the number of college students that become regular smokers.

MEMORANDUM OF SUPPORT
March 15, 2001
S. 3341 (Hannon)    A.1644 (Kaufman)

AN ACT to amend the public health law and the state finance law, in relation to the statewide planning and research cooperative system

The Campaign for Healthy Children, a joint project of Statewide Youth Advocacy, Inc. and the American Academy of Pediatrics, District II, is committed to working with policy makers to improve the health and well being of all infants, children and adolescents. In this role the Campaign supports this legislation because it codifies in the Public Health Law the Statewide Planning and Research Cooperative System (SPARCS) data collection requirements for hospitalizations and ambulatory surgery procedures. This bill would also require that information on emergency room procedures be reported in SPARCS.

The existing SPARCS system for reporting and tracking hospital discharges in New York State provides needed data for planning, research, public information and is vital in identifying ways to improve the delivery of health care services. The inclusion of emergency room data in the SPARCS reporting system will enhance the quality of public information available to plan and develop policies designed to reduce illness and injury among New Yorkers.

Unfortunately far too many children and adults do not have access a Medical Home and therefore find that the only way they can access medical care is through the emergency room. Collecting data on emergency department encounters will contribute significantly to efforts to discover more about the current the asthma epidemic. Currently asthma accounts for one in six pediatric emergency room visits and is leading cause of school absenteeism for a chronic illness. Collecting emergency room data will enable researchers and health care providers to track treatment of medical emergencies, identify usage trends.

The Campaign for Healthy Children supports this legislation because it provides access to information which can lead to better health care services for children in New York State.

The Campaign for Healthy Children, a joint project of Statewide Youth Advocacy, Inc. and the American Academy of Pediatrics, District II, is committed to working with policymakers to improve the health and well-being of all infants, children and adolescents.

In this role, the Campaign supports this legislation because it prohibits children from riding in the cargo areas of trucks, which is extremely hazardous and potentially fatal.

Motor vehicle trauma remains a leading cause of death of children. Occupants in pickup trucks should receive the same level of protection provided in other vehicles. According to the American Academy of Pediatrics, the safety issues relevant for pickup trucks include the following: prohibition of cargo area travel; age-appropriate restraint use; appropriate seat location in the cab; appropriate use of rear seating positions in various models of extended cab vehicles; and risk of air bag-related injuries.

Pickup trucks have become increasingly popular vehicles for passenger transportation. Travel in the cargo area of the pickup truck is a major occupant protection issue that disproportionately involves youth. Because the cargo area is not intended for passenger use, it is neither required nor designed to meet occupant safety standards applicable to passenger locations. Nevertheless, the cargo area is used for transporting passengers. In 1997, 161 deaths of occupants riding in the cargo area were reported; 77 (48%) were children and adolescents younger than 20 years. Of these occupants, 7 (9%) were younger than 5 years; 15 (19%) were 5 through 9 years of age; 14 (18%) were 10 through 14 years of age; and 41 (53%) were 15 through 19 years of age.

Persons who are injured when traveling in cargo areas of pickup trucks are more likely to sustain multiple injuries and injuries of greater severity and have a greater likelihood of death than do occupants in the cab. The most significant hazard of travel in the cargo area of a pickup truck is ejection of a passenger in a crash or noncrash event (e.g., sudden stop, turn, swerve, or loss of balance, as well as intentional or unintentional jumps and falls). Studies have demonstrated that the proportion of occupants ejected from the cargo area markedly exceeds the proportion ejected from the cab.

In a recent study of fatalities in pickup trucks from 1987 through 1996, nearly one-third of the deaths among occupants of the cargo area were a result of noncrash events. Of the deaths that occurred as a result of cargo area occupants being ejected, 40% were children and adolescents 17 years or younger. Cargo area passengers were 3 times more likely to die than were occupants in the cab. Compared with restrained cab occupants, the risk of death for those in the cargo area is 8 times higher.

The Campaign for Healthy Children supports this legislation because it is unsafe for children to travel in the cargo areas of trucks.

The Campaign for Healthy Children supports this legislation because mandating that children under 7 ride in the back seat will protect them from air bag injury and because it is the safest place for children to ride.

The Campaign for Healthy Children, a joint project of Statewide Youth Advocacy, Inc. and the American Academy of Pediatrics, District II, is committed to working with policymakers to improve the health and well-being of all infants, children and adolescents.

In this role, the Campaign supports this legislation because it will educate the public about the compatibility of child safety seats, the benefits of seat belt use, and of the potential dangers of air bags to children.

Despite the existence of laws in all 50 states requiring the use of car safety seats or child restraint devices for young children, many children continue to be killed each year while riding in motor vehicles. Many parents require assistance to know which car safety seat is best for their child. Parents often look to their pediatricians for up-to-date, accurate information on selecting and using car safety seats.

Assisting parents in gaining this knowledge helps parents assure that their children are transported as safely as possible. The message parents need to learn is this: When children out-grow forward facing convertible seats, they need to be restrained in belt-positioning booster seats until they are big enough to fit properly in an adult seat belt.

The Campaign for Healthy Children supports this bill because if requires the development and implementation of a public outreach campaign to inform the general public of the need to properly use and correctly install child safety seats, the benefits of using seat belts, and of the potential dangers of air bags and how to properly protect children from risks associated with air bags.

The Campaign for Healthy Children – a joint project of Statewide Youth Advocacy, Inc. and the American Academy of Pediatrics, District II, New York State – is committed to working with policy-makers to improve the health and well-being of all infants, children and adolescents. The Campaign supports this legislation because it will reduce the number of children killed or injured in motor vehicle crashes.

In 1999, motor vehicle crashes killed 1,135 child occupants aged 0-10 years in the United States and injured approximately 182,000 children. This represents approximately 3 deaths and 500 injuries to U.S. children every day. While the fatality rate has gone down steadily, the total number of child occupant deaths has not dropped as rapidly, due to concurrent increases in the U.S. child population and a near doubling of the number of miles Americans travel.

According to the National Highway Traffic Safety Administration, about 70 percent of children 3 and younger are properly restrained but that number drops to as low as 20 percent for children 4 to 9. Booster seats provide effective restraint during car crashes and minimize injury, if used appropriately.

Booster seats should be used when the child has outgrown a convertible safety seat but is too small to fit properly in the vehicle's shoulder belt. Shoulder belts can tangle around a child's neck and the lap portion of the belt rides up over the abdomen. Children who weigh less then 80 pounds and use automobile seat belts are nearly four times more likely to receive serious injury in a collision than kids in safety or booster seat.

The Campaign for Healthy Children supports this legislation because children who don't fit the seat belt properly can hit their heads on their knees, jerk forward and damage their spines, or slide out of the belt altogether.

Defibrillator mandate carries $15.7 million cost (04/22/02)
Bill requires all schools to be equipped, but provides no money

A bill just passed by the Legislature amends state law to require cardiac emergency equipment called automatic external defibrillators (AEDs) to be maintained in every public instructional facility in New York State. NYSSBA estimates the cost of the unfunded mandate in A.10577/S.6851 to be at least $15.7 million.

NYSSBAs estimate does not include the cost of purchasing multiple AEDs for junior and senior high school buildings to accommodate multiple activities simultaneously or the cost of training staff and paying them to be available after school hours.

Nor does the estimate include the cost of any litigation related to the use of AEDs.  While we do not anticipate dramatic litigation regarding these devices, the standard of liability protection in the statute would still require districts to go to court to prove that the device was not used with gross negligence, said David Little, NYSSBAs director of governmental relations.

Early in the legislative session, both houses quickly passed a bill (A.8779-a) that would require certain schools to maintain on-site AEDs and to train and have available staff to use them in the event of an emergency at school-related functions.

NYSSBA is opposed to the bill due to the unfunded mandate imposed on local districts and its endorsement of a one-size-fits-all regulatory policy. Under the legislation, all instructional school buildings that are publicly funded would be required to maintain AEDs in the quantity and of the type(s) specified by the commissioner of education in consultation with the commissioner of health in order to ensure ready and appropriate access for use during emergencies. 

AEDs would be required for any school-related curricular or extracurricular activity that takes place at a school facility and for any school-sponsored athletic contest regardless of location.  If the athletic contest is to take place at a location other than a school, the school administrator must ensure the presence of an AED on site.

This mandate is unnecessary, said Little. Districts are already permitted to obtain AEDs and train staff under Chapter 552 of the Laws of 1998, the Public Access Defibrillator (PAD) program.  This program is voluntary for districts and the Departments of Health and Education have established guidelines to help districts establish policies regarding the maintenance and use of AEDs in schools.

In fact, a number of districts have already established PAD programs.  As of March 2002 approximately 64 schools and/or districts were already registered with the Emergency Medical Services unit of the Department of Health to participate in these programs.  The benefit of this voluntary approach is that districts can weigh the cost and benefits of this program against other educational and community needs. In addition, the district gets to develop its own policy for the use of these devices.

NYSSBA has urged Gov. George E. Pataki to veto this legislation.  Members are urged to write to James McGuire, the governors counsel, requesting that the governor veto this legislation. Letters should be addressed as follows:

The Honorable James M. McGuire
Counsel to the Governor
Executive Chamber, The Capitol
Albany, New York 12224

Thank you Chairman Gottfried, for providing the Campaign for Healthy Children with the opportunity to comment on Disaster Relief Medicaid.  We will direct our remarks to how New York can apply what it has learned from implementing Disaster Relief Medicaid to improving the process of enrollment in subsidized health insurance for all New Yorkers.

Today presenting testimony on behalf of the Campaign for Healthy Children are Dr. Danielle Laraque, the President of New York Chapter 3, of the American Academy of Pediatrics, and myself, Elie Ward the Executive Director of Statewide Youth Advocacy, and the Co-chair of the Campaign.

The Campaign for Healthy Children is a partnership between the American Academy of Pediatrics, District II, New York State and Statewide Youth Advocacy.  The Campaign’s organizational members, who come from every part of the health care system and from every part of the state, are committed to working with policy makers to improve the health and well being of all infants, children and adolescents in New York.

The events of September 11th were tragic and horrifying for all of us, but they also demonstrated that when we are faced with disaster and overwhelming tragedy our federal, state and city governments can and do come together to do their best to make things better for the children, families and communities impacted by disaster.  Here in New York City, the implementation of Disaster Relief Medicaid is an example of that effort.  With the HRA computer system and networks directly affected by the World Trade Center tragedy, a decision was made to waive all the usual requirements for application and to offer New York City resident’s access to Medicaid coverage without an onerous application and documentation process.  In this case, necessity was the mother of invention.  And the low-income families were the beneficiaries.

Prior to the events of September 11th, the Campaign for Healthy Children convened representatives from the insurance industry, health care providers, and children’s health advocates and the New York State Department of Health to discuss extending children’s Child Health Plus A renewal period.  The impetus for the meeting was an impending crisis caused by a systems issue in the New York City Medicaid computer system.  New York City’s Welfare Management System, WMS, was about to send letters to hundreds of thousands of children telling their parents that they would have to come to an HRA office to keep their children's health insurance coverage.

Chapter 2 of the laws of 1998, creating the Facilitated Enrollment program, authorized the "outstationing of persons who are authorized to provide assistance to families in completing the enrollment application process including the personal interviews required upon re-certification."  While the legislature clearly intended for families to have the option to renew their children’s coverage with the same trusted community based enrollers who facilitated their initial enrollment, the City’s Medicaid notification system was never programmed to allow for community based renewals.  Families, who were told by enrollers that the could renew their children’s coverage with them in community based settings, instead received letters from the Welfare Management System, stating that they needed to go to an HRA office to keep their children's coverage.

During our discussions with Department of Health representatives, we suggested that the State automatically extend the renewal periods of all children in New York City who would be directly affected by the computer system problem, until such time as we could all work out a solution to the problem.  We were informed that it was impossible to automatically extend children’s renewal periods.  However, after September 11^th, the impossible, became possible.  Children residing in New York City in the Child Health Plus A program, with a renewal date between September 2001 and January 2002 are automatically re-certified for an additional year.  Children enrolled in Child Health Plus B, whose health plan is located in New York City, regardless of where they reside in the state, are automatically renewed for one year.

The Campaign endorses this action and supports its continuation, so that all children enrolled in Child Health Plus A or B will be enrolled for 24 months.

The Campaign members have also advocated for immediate true Presumptive Eligibility for children enrolling in Child Health Plus A and B.  We proposed designing a tear off Temporary Enrollment Card that could be part of the Growing Up Healthy application.  Since virtually every child in New York is eligible for either Child Health Plus A or B, families could meet with an community based enroller who would screen the families' income and assess the children's eligibility for Child Health Plus A & B.  The completed application would then be forward to the appropriate office.  The family would leave with a Temporary Enrollment Card they could use to access services until their final eligibility and permanent card was issued.

During our discussions with representatives from the New York State Department of Health we were informed that providers would not accept "a piece of paper" as proof of coverage.  We argued that our information indicated that indeed they would, if the "piece of paper" indicated coverage.  Today, in New York City, individuals applying for Disaster Relief Medicaid receive a simple piece of paper, that is part of the Disaster Relief Medicaid application that providers are accepting as proof of coverage.

Again, the Campaign would support keeping true Presumptive Eligibility and a Tear Off Temporary Card as a permanent part of the Children health enrollment process.

A number of recent studies have indicated that the lack of information about health insurance programs, confusion about eligibility, and problems associated with the enrollment process reduce children's participation in health care programs (Cohen-Ross and Cox 2000; Kaiser Commission 2000; Stuber et al. 2000).  The Urban Institute’s 2001 report "Why Aren't More Uninsured Children Enrolled in Medicaid or SCHIP?" found that 38% of parents did not inquire or apply for Medicaid or Child Health Plus because they did not want to deal with administrative hassles.  According to a recent Washington Post article which reinforces these studies "New York has demonstrated that radical simplification could overcome one of the more vexing problems in health insurance: the millions of poor people who remain uninsured even though they are eligible for Medicaid."  A full copy of this article is attached to our testimony.

Recent experience indicates that over 75,000 New Yorkers filled out applications for Disaster Relief Medicaid as of November. The overwhelmingly positive response to the Disaster Medicaid program seems to indicate that the "stigma" associated with Medicaid is not with the product, but is with the process.  The simple one page application, along with the elimination of documentation requirements, which characterize the Disaster Relief Medicaid program, demonstrates that people will apply for public health insurance programs when they know how and where to apply, when the application process is simple and when they are treated with respect.  When asked what the main obstacle families face enrolling their children in Child Health Plus A or B, Facilitated Enrollers, regardless of where the are in the state, report that getting their hands on all of the necessary documentation is the primary barrier.

The simple one page application for Disaster Medicaid means that families are not being forced to take time away from their jobs, children and other family and community responsibilities documenting their home address, with a legibly postmarked non window envelope, or searching to find their last four consecutive pay stubs to substantiate their income.  In addition to the time savings for families, the Disaster Relief Medicaid program eliminates costly and unnecessary administrative time.  Social Service staff are not spending time working with families to complete the eight page complicated long green form, nor are they working income, asset and depreciation formulae that would make any accountant's head spin. Instead families can go to one of the out-stationed sites, complete the one page form, show their ID, attest to their income and address and leave with health coverage.  Unfortunately, for these families, once their four months of coverage ends, they will have to reapply, without the benefit of a notice that their coverage has expired.

We urge our state leaders to carefully explore the inherent wisdom in simplifying the health insurance application process for all New York families.  Recent experience with Disaster Relief Medicaid indicates that families will access coverage if the process is simple and they are treated with respect.

The Campaign wishes to commend the Governor and the Department of Health for their wisdom in creating a single door enrollment system for children to access health coverage during these troubling times.  Facilitated Enrollers in New York City forward every Child Health Plus application, regardless of the eligibility screen, to health plans that enroll the children.  The appropriate payer is determined later and then charged for the coverage.  This structure allows children to attain and maintain coverage beyond the four months provided via Disaster Relief Medicaid.  It also helps to ensure continuity of coverage because the Facilitated Enroller working with the family has knowledge of the children’s coverage renewal dates.

The following are some additional recommendations from the Campaign for Healthy Children for permanent program changes similar to those currently in place in the Disaster Relief Medicaid program, designed to move New York State closer to a high quality, easily accessible and seamless health insurance system for all eligible children.

New York State can increase children’s access to health care services and create a seamless health care system by:

• implementing true presumptive eligibility for both Child Health Plus A & B by developing a tear-off temporary enrollment card as part of the Growing Up Healthy application

• removing the 50% Medicaid Managed Care penetration requirement for Child Health Plus A presumptive eligibility

On September 5th the U.S. Department of Health and Human Services approved New York State’s waiver to expand health insurance coverage to about 71,000 low-income children.  New York State should implement the Child Health Plus A (Medicaid) expansion to 133% immediately for all children outside of New York City and should implement the expansion for children in New York City in February.  Implementation of the expansion will mean that children who celebrate their sixth birthday will not have to lose their Child Health Plus A coverage, will be able to maintain their provider relationships and will be afforded the same eligibility criteria as their parents enrolling in Family Health Plus.

New York State can simplify the enrollment, transfer, and renewal process by reviewing all State imposed documentation requirements against Federal requirements and eliminating unnecessary State requirements, including proof of address, birth certificates and income.

The Campaign for Healthy Children and its many public and private partners across the state, including many in this room today, have been working for many years to simplify children’s access to health care.  We believe the implementation of Disaster Relief Medicaid in New York City opened a door to improved access to health care coverage for all New York families.  We urge our state leaders to keep that door open and make the best aspects of the Disaster Relief Medicaid enrollment process permanent for Child Health Plus A& B, Family Health Plus and Medicaid statewide.

Thank you for the opportunity to present testimony on the ways New York State can implement the positive aspects of the Disaster Relief Medicaid program to enable more needy children and families to access health coverage.