BuildingonourSuccess:

MovingfromHealthCareCoverageto ImprovedAccessandComprehensiveWellBeing forIllinoisChildrenandYouth

September2007
MidAmericaInstituteonPovertyofHeartlandAlliance 1

Acknowledgements

WegratefullyacknowledgetheIllinoisChildrensHealthcareFoundationfortheirgenerous supportofthisreport.

Wealsothankthefollowingadvisorsfortheirvaluableinputandfeedbackonvariousdraftsofthis report:
StephanieAltman,Health&DisabilityAdvocates KarenBerg,IllinoisMaternal&ChildHealthCoalition LisaBilbrey,IFLOSSCoalition JohnBouman,SargentShriverNationalCenteronPovertyLaw DianeDoherty,IllinoisHungerCoalition BlairHarvey,IllinoisMaternal&ChildHealthCoalitionandIllinoisCoalitionforSchoolHealthCenters GinaGuillemette,HeartlandAllianceforHumanNeeds&HumanRights JulieJanssen,IllinoisDepartmentofPublicHealth,DivisionofOralHealth,OfficeofHealthPromotion PatrickKeenanDevlin,SargentShriverNationalCenteronPovertyLaw MadeleineLevin,FoodResearchandActionCenter MeganMeagher,IllinoisCampaignforBetterHealthCare DawnMelchiorre,VoicesforIllinoisChildren SandraMills,NationalAssociationofSocialWorkersIllinoisChapter JulieParente,VoicesforIllinoisChildren JoelRubin,NationalAssociationofSocialWorkersIllinoisChapter MonaVanKanegan,HeartlandHealthOutreach KarenYarbrough,OunceofPreventionFund AmyZimmerman,Health&DisabilityAdvocates

September2007 Writing:AmyTerpstra,MidAmericaInstituteonPovertyofHeartlandAlliance Editing:AmyRynell,MidAmericaInstituteonPovertyofHeartlandAlliance Maps:HelenEdwards,MidAmericaInstituteonPovertyofHeartlandAlliance Printing:GraphixProducts,Inc. Suggestedcitation:MidAmericaInstituteonPovertyofHeartlandAlliance.(2007,September). BuildingonourSuccess:MovingfromHealthCareCoveragetoImprovedAccessand ComprehensiveWellBeingforIllinoisChildrenandYouth.Chicago:Author. This report can be downloaded from http://www.heartlandalliance.org/maip 2007HeartlandAllianceforHumanNeeds&HumanRights

BuildingonourSuccess

TableofContents

RealizingaVisionofChildandYouthWellBeinginIllinois TheRelationshipBetweenChildPovertyandHealth ExistingGaps&TargetedSolutions PhysicalHealth MentalHealth OralHealth ProperNutrition Insurance BuildingonourSuccess:WheretogofromHere Endnotes

2 4 5 6 8 10 12 14 16 17

ThePovertyMeasure
Income poverty is defined by the federalgovernmentusingfoodcostasa basis.Each year, amonetarythreshold commonlycalledthefederalpoverty line(FPL)isset,andfamiliesaswell as the individuals who comprise those families are considered poor if their family income falls below the threshold for their family size. In 2007, a family of four is considered poor if their gross annual income falls below $20,650. Income poverty is also discussed in terms of percentage of the FPL. Extreme poverty is defined as half the povertyline,or50%FPLlowincomeis defined as twice the poverty line, or 200%FPL.

RealizingaVisionofChildandYouth Well-BeinginIllinois
Childhoodisanimportanttimeofemotional,physical,cognitive,andsocialdevelopment,andeach playsanimportantroleinhelpingchildrengrowintohealthy,productiveadults.Illinoishasmade initialinvestmentsinthehealthanddevelopmentofchildren.Mostnotably,Illinoishas takenimportantstepstoensurepublichealthinsurancecoverageforallchildrenregardlessof incomeandstatus.
th Asrecentlyas2003,Illinoisstatechildrenshealthinsuranceprogram,KidCare,ranked39 inthe nationwithonly18percentofeligiblechildrenenrolled.Duetoconcertedoutreachefforts,Illinois th rankimprovedto18 bythefollowingyearwith35percentofeligiblechildrenenrolledthe 1 secondlargestincreaseofallstates. InJulyof2006,IllinoisimplementedtheAllKidsprogram, whichabsorbedchildrensMedicaidandKidCareandoffershealthinsurancecoverageonasliding feescaleforeverychildinIllinois.AllKidsestablishedIllinoisasaleaderinextendingcoverageto children,andasofApril2007,50,000previouslyineligible,uninsuredchildrenhadcoverage 2 throughtheprogram,withatotalof1.3millionIllinoischildrencovered.

Additionally,Illinoiswasthefirststateinthenationtoofferhealthinsurancecoveragetothe parentsofchildrenwhoareeligibleforthestateschildhealthinsuranceprogram.Throughthe 3 creationofFamilyCare,parentalcoverageincreasedby227percent. Thiscoverageincreaseis significantinlightofresearchthatshowsthatlowincomeuninsuredparentsarethreetimesas 4 likelytohaveuninsuredchildrenasinsuredparents. Researchalsoshowsthatparentenrollment inMedicaidincreasesenrollmentofchildren,andthatwhenparentsareinsuredtheirchildrengain 5 betteraccesstocare. Alongwiththeseexpansionsofpublichealthinsurancecoverageareeffortstomovetowarda medicalhomemodelofcarethatemphasizesprimaryandpreventivecareforbothchildrenand adultswithpublichealthinsurancecoverage.6 Thismodel,calledIllinoisHealthConnect,aimsto achievebetterpatientoutcomesandincreasethecosteffectivenessofhealthcareservices. Whiletheseeffortsarevitalfirststepsinhelpingchildrenandyouthrealizehealthylives,theyare indeedonlyfirststeps.TheeffectsofpovertyexperiencedbymanyIllinoisfamilies translateintoahigherriskfornegativechildhealthoutcomesandmoredifficulty accessingthehealthcarechildrenneedtothrive.Childrenfrompoorfamiliesarestillless likelytobeinsured,andBlackandHispanicIllinoischildrenare2.5timeslesslikelytohavepublic 7 healthinsurancecoverageasWhitechildren. Lackofhealthinsurancecoveragegreatly contributestounfavorablehealthoutcomesformanypoorandminoritychildrenandyouthand diminishestheabilityofpoorfamiliestoadequatelyrespondtotheirchildrenshealthneeds.Illinois mustcontinuewitheffortstoenrollpoorandminoritychildrenintheAllKidsprogramasafirst stepinhelpingimprovehealthoutcomes. Forthosewithcoverage,manypoorandlowincomefamiliesfaceagapbetweenhavinginsurance andaccessingthecaretheirchildrenneedtobecomeandstayhealthy.Thenumberofdoctors, dentists,andmentalhealthprofessionalswhoacceptpatientswithpublicinsurancefallsfarshort ofmeetingthedemand,andinmanyplacesinthestatethereisaseverelackofproviderswho acceptpublicinsurancewithinareasonabledistancefromwherefamilieslive.Fillingthisgap requiresconcertedeffortstoexpandthenumberandgeographicdispersionofhealthcare professionalsacrossthehealthspectrumwhoacceptpublicinsuranceandisacriticalstepin ensuringchildrenandyouthcanleadhealthylives.

BuildingonourSuccess

FamiliesinIllinoisnotonlyexperiencedifficultyfindinghealthcareprofessionalsthatacceptpublic insurancefortheirchildren,buttheyalsohavetroubleobtainingregularandpreventivephysical healthcare,gettingmentalhealthneedsmet,accessingoralhealthservices,obtainingnutritious food,andforolderyouth,acquiringinsurance. Helpingchildrenandyouthbecomeandstayhealthyrequiresaholisticapproachinwhichallthe componentsofhealthareaddressed.Healthismorethantheabsenceofdiseaseitencompasses completephysical,mental,andsocialwellbeing.Inordertorealizecomprehensivechildandyouth wellbeing,thefollowingcomponentsneedtobeinplace: Affordablehealthinsurancecoverageforthosewhoneeditthatcoversprevention,early diagnosis,andtreatment Acoordinatedandstreamlinedhealthsystemthatminimizesbarrierstoaccessingcoverageand care Healthcareprofessionalswhoacceptpublicinsurancewithofficesincloseproximitytowhere peoplewiththatinsurancelive Medicalhomesforallchildreninwhichthedoctorknowsthechildsmedicalhistoryandwhere parentsknowtheycantaketheirchildrenforneededcheckupsandtreatment Preventivecareandtreatmentforphysical,mental,andoralhealth Nutritionalsupporttopromotehealthydevelopment Appropriateinsurancecoverageandcareforparentssotheycanmaintainhealthylivestocare fortheirchildren Whatfollowsinthisreportisadescriptionofaccesschallengesintheareasofphysicalhealth, mentalhealth,oralhealth,propernutrition,andinsurancecoverageforolderyouth.Inaddition tothecriticalstepofenrollingadditionaldoctors,dentists,andmentalhealth professionalsinMedicaid,Illinoiscanimplementthefollowingconcrete recommendationsinordertoachievethecomponentsofcomprehensivechildandyouth wellbeingoutlinedabove.Theserecommendationsarerealisticnextstepsthatcanbe implementedinthenearfuturetohelpIllinoisenhanceitsstatusasaleaderinthefieldofchild health.

BuildingonourSuccess:WheretogofromHere
Expandexistingschoolhealthcenters,andestablishnewcentersincommunities ofneed. EngageinoutreacheffortstoenrollLicensedClinicalSocialWorkersas MedicaidprovidersandeducationeffortsaimedtowardfamilieswithMedicaid enrolledchildren. Expanddentalsealantprogramstoreachmorelowincomechildrenand increaseMedicaidreimbursementratesforrestorativeprocedures. Implementuniversalschoolbreakfastindistrictswithhighpercentagesoflow incomestudents. ExtendeligibilityofAllKidstoincludeyouththroughage24.

MidAmericaInstituteonPovertyofHeartlandAlliance 3

TheRelationshipBetweenChild PovertyandHealth
Alone,povertyorhealthproblemscanhaveseriousconsequencesforachild.Butthe realityisthatpovertyandhealthintersectinachildslifepovertyisexacerbatedby healthproblemsandhealthproblemsareintensifiedbypoverty.Theeffectsof povertyexperiencedbymanyIllinoisfamiliestranslateintoahigherriskfornegative childhealthoutcomesandmoredifficultyaccessingthehealthcarechildrenneedto thrive. Growingupinpovertyhasadverseeffectsonchildrensphysical,cognitive,and emotionalhealth.Comparedtotheirnonpoorcounterparts,poorchildrenare: Morelikelytobelowbirthweightandhaveagreaterriskofinfant 8 mortality. 9 Twiceaslikelytobeinpoorhealth. 10 Threetofourtimesaslikelytosufferleadpoisoning. 11 Morelikelytohaveunmetmedicalanddentalneeds. 12 Morelikelytoexperienceinjuriesfromaccidents. Morelikelytoexperiencedevelopmentaldelaysandlearning 13 disabilities. 14 Atgreaterriskforsufferingfrombehavioraloremotionalproblems. Theintersectionofpovertyandhealthinachildslifeisfurthercompoundedbythefact thatpovertyoftenlimitsoptionsandopportunitiesforadequatelyaddressinghealth issues.Poorfamiliesarelesslikelytohaveemergencyfundsavailabletorespondto healthcrises,andpoorchildrenarelesslikelytohaveamedicalhome,morelikelyto relyonemergencyroomsforroutinecare,anddespiterecentinvestments,areless 15 likelytohavehealthinsurancecoverage.

ChildandYouthPovertyinIllinois
16 Overhalfamillionchildrenliveinpoverty. 17 1in5childrenliveinlowincomeworkingfamilies. Childrenaredisproportionatelyaffectedbypoverty, makingup25%ofIllinoispopulation,but35%of 18 thoseinpoverty. 19 1in5youthages18to24liveinpoverty. 15%ofyouthages18to24arenotenrolledin school,arenotworking,andhavenodegreebeyond 20 highschool.

BuildingonourSuccess

ExistingGapsandTargetedSolutions

Thefollowingpageslookatchildrensphysical,mental,andoralhealth,aswellasnutritionissues andinsurancecoverage.Ineachofthefollowingsections,thesetwoquestionsareposed:

Whatarethebarrierstoachievingahealthylifeforpoorandlowincomechildrenand youthinthisarea? Whatcanwedotoensureallchildrenandyouthhaveaccesstothecaretheyneedto becomehealthy,productiveadults?

Theanswerstothefirstquestionilluminategapsincareandaccessproblemsformanychildren andyouthinIllinois.Thesecondquestionelicitsrecommendationsfortargetedsolutionsthatcan beeffectiveinbuildinguponIllinoissuccessfulinsuranceexpansionsinordertorealizeavisionof expandedaccesstocareandcompletewellbeingforallchildrenandyouth.

MidAmericaInstituteonPovertyofHeartlandAlliance 5

PhysicalHealth

Q:

Whatarethebarrierstoachievingahealthylifeforpoorandlowincome childrenandyouthintheareaofphysicalhealth?

A:

ThephysicalhealthofpoorIllinoischildrenandyouthis compromisedbylimitedaccesstoregularcare,lackofpreventive care,anddisparitiesamongracialandethnicgroups.

ManyIllinoischildrenandyouthlackpreventivecare,personaldoctors,andmedical homesinwhichthedoctorknowsthechildsmedicalhistoryandwhereparentsknowtheycan taketheirchildrenforneededcheckupsandtreatment.

21 20%ofIllinoischildrendidnothaveapreventivemedicalcarevisitinthepreviousyear. 52%ofIllinoischildrendonothaveapersonaldoctorornursewhoknowsthechild,andto 22 whomparentstaketheirchildrentowhentheyneedcheckupsandtreatment.

LowerincomeIllinois childrenarelesslikelyto beinexcellentorvery goodhealththantheir higherincome 23 counterparts. Thereareanumberof healthoutcomesandrisk behaviorsthatemergeas childrengetolderthat highlighttheimportance ofprevention:

ParentsReportingtheirChild'sHealthtoBeExcellentor VeryGood,byIncome
93.2% 89.7% 79.0%

100.0% 90.0% 80.0% 70.0% 60.0% 65.3%

50.0% 31%ofIllinoischildren 099%FPL 100199%FPL 200399%FPL 400%FPLand andteensfromage10to over 24 17areobese. 52%ofIllinoischildren 25 andteensdonotexerciseregularly. 26 Youthages10to19constitutenearly40%ofIllinoisChlamydiaandGonorrheacases. Inthepastmonth,ofallIllinoisyouthages12to17:141,000haveusedtobacco,190,000 27 haveusedalcohol,147,000haveusedmarijuana,and50,000haveusedotherillicitdrugs.

MinoritychildrenandyouthinIllinoisoftenhaveworsehealthoutcomes andmoredifficultyaccessingneededhealthservices. 67%ofHispanicchildrenand59%ofBlackchildrendonothaveamedicalhomecomparedto 28 46%ofWhitechildren. 26%ofHispanicchildrendidnotreceivepreventivemedicalcarevisitsintheprevious12 29 monthscomparedto19%ofbothWhiteandBlackchildren. 66%ofHispanicparentsand79%ofBlackparentsdescribetheirchildshealthexcellentor 30 verygood,comparedto91%ofWhiteparents.

BuildingonourSuccess

PhysicalHealth

Q:

Whatcanwedotoensureallchildrenandyouthhaveaccesstothecarethey needtobecomehealthy,productiveadults?

A:

Expandexistingschoolhealthcenters,andestablishnewcentersin communitiesofneed.

Schoolhealthcenters(SHCs)provideprimarycare,mentalhealth,oralhealth,and preventivehealthcareservicestostudentsandarelocatedonschoolgroundsornearby. Thesecentersofferaffordable,comprehensive,andageappropriatehealthservicestochildrenand youthandsignificantlyincreasestudentsaccesstocare,particularlyamonglowincomestudents whomayotherwisehaveadifficulttimeaccessingcomprehensivemedicaltreatment.Research showsmanyhealthbenefitsofSHCs: SHCshavedemonstratedthattheyattracthardertoreachpopulations,especiallyminorities andmales,andthattheydoabetterjobthancommunityhealthcentersorHMOsatgetting 31,32 themcrucialservicessuchasmentalhealthcareandhighriskbehaviorscreens. Therecanbesignificantincreasesinhealthcareusebystudentswhouseschoolhealthcenters 33 comparedtothosewhodonothaveaccesstoaSHC. SHCmedicalservicescanhelpdecreaseabsencesby50%amongstudentswiththreeormore 34 absencesina6weekperiod. StudentswhoreceivementalhealthservicesfromSHCscanexperiencedramaticdeclinesin 35 schooldisciplinereferrals. Schoolhealthcenterscanreduceinappropriateemergencyroomuseamongregularusersof 36,37 schoolhealthcenters. Elementaryschoolhealthcentershaveshownareductioninhospitalizationandanincreasein 38,39 schoolattendanceamonginnercityschoolchildrenwithasthma. 40 SHCscanreduceMedicaidexpendituresrelatedtoinpatient,drug,andemergencyroomuse. FiftytwoschoolhealthcentersoperateinIllinois,andthereare10morecentersintheplanning stage.Inthe20042005schoolyear,*38SHCsreportedenrollingover82,000studentsand providingover102,600healthcarevisits.Thecostislessthan$39.00perstudenteachyear.
41 EachyearinIllinoisSHCssaveanestimated: $233,000to$342,000byreducingasthmahospitalizations $1.77millionbyprovidingimmunizations $2.50millionbyreducingemergencyroomvisits

Schoolhealthcentersareaviablestrategyforensuringchildrenandyouthhavea regularplaceofcareforbothtreatmentandpreventivecare,andforaddressingrisk behaviors.

*Thisisthemostrecentyearforwhichdataareavailable.

MidAmericaInstituteonPovertyofHeartlandAlliance 7

MentalHealth

Q:

Whatarethebarrierstoachievingahealthylifeforpoorandlowincome childrenandyouthintheareaofmentalhealth?

A:

ManyIllinoischildrenandyouthdonothaveaccesstoneededmental healthservices.

Mentalhealthisacriticalcomponentto overallchildandyouthwellbeing. Mentalhealthproblemsinchildrencan manifestaspoorweightgain,slowgrowth, delayedcognitiveandphysicaldevelopment, aggressiveorimpulsivebehavior,sleep problems,andinconsolablecrying.Anyof thesecanleadtoanumberofnegative outcomesincludingpersistentfearand stress,schoolfailure,teenagechildbearing, 42 unstableemployment,andviolence. ManyIllinoischildrendonothave accesstomentalhealthtreatment,yet withoutearlyintervention,manymay facemuchmoreseverementalhealth 43 problemslaterinlife. 37%ofIllinoischildrenwithcurrent emotional,developmental,orbehavioral problemsdidnotreceiveanytypeof mentalhealthcareintheprevious 44 year. 1in10Illinoischildrensuffersfroma mentalillnessthatissevereenoughto needtreatment,butinanygivenyear, onlyabout20%ofthemreceivemental 45 healthservices. HispanicIllinoischildrenarelesslikelyto receiveneededmentalhealthservices: 71%didnotreceiveneededservices 46 comparedto33%ofwhitechildren. Illinoishasashortageofmentalhealth serviceprovidersforpeoplewithpublic insurance.Only16percentof psychiatristsandpsychologistsin 47 Illinoisacceptpublicinsurance.

NumberofPsychologistsandPsychiatrists AcceptingMedicaidbyCounty,2006

0MedicaidAccepting PsychiatristsorPsychologists 19MedicaidAccepting PsychiatristsorPsychologists 10ormoreMedicaidAccepting PsychiatristsorPsychologists

BuildingonourSuccess

MentalHealth

Q:

Whatcanwedotoensureallchildrenandyouthhaveaccesstothecarethey needtobecomehealthy,productiveadults?

A:

EngageinoutreacheffortstoenrollLicensedClinicalSocialWorkers asMedicaidprovidersandeducationeffortsaimedtowardfamilies withMedicaidenrolledchildren.

Childrenandyouthneedbroaderaccesstomentalhealthservicesinordertosucceedin schoolandhavehealthyrelationshipswiththeirfamiliesandpeers.Halfofalllifetime 48 casesofmentalillnessbeginbytheageof14. Delaysindiagnosingandtreatingmentalillness canleadtoamoresevere,moredifficulttotreatillness,andtothedevelopmentofadditional mentalillnesses.InvestingadditionalresourcesinthementalhealthofIllinoischildrenandyouth todaywillsubstantiallyreducefuturespendingonmorecomplexproblemswhentheybecome adults. Therearenearly9,000LicensedClinicalSocialWorkers(LCSWs)inIllinoiswhoarelicensedto 49 providementalhealthservices. Mentalhealthisthespecialtyofapproximately37percentof 50 LCSWs. LCSWsholdmasterdegrees,areprofessionallytrainedtooperateunderacodeofethics, arelicensedandregulatedbythestateofIllinois,andhaveaprofessionalcommitmenttoserving underservedpopulations.UnderfederallawandrecentlyunderIllinoisstatelaw,LCSWscanbe directlyreimbursedbyMedicaidfortheirservices. TherecentchangeinIllinoistoallowLCSWstobedirectlyreimbursedfortheservicestheyare licensedtoprovidewillsignificantlyincreasethenumberofmentalhealthprofessionalsavailableto childrenandyouthwithpublicinsuranceandwillexpandtheserviceproviderandservicesetting optionsfortheirfamilies.Implementingthispolicychangeholdsparticularpromiseinareaswhere thereareshortagesofmentalhealthproviderswhoacceptpublicinsurance. However,achangeinlawissimplythefirststepinexpandingaccesstomentalhealthcare.This effortssuccessdependsontheextenttowhichLCSWsareawareoftheirexpandedoptionsfor billingandfamiliesareawarethattheycanaccessmentalhealthservicesfortheirchildrenin additionalsettings.Increasingaccesstomentalhealthservicesforchildrenandyouth mustincludeoutreacheffortstoenrollLCSWsasMedicaidprovidersandeducation effortsaimedtowardfamilieswithMedicaidenrolledchildren.Sucheffortswillfacilitate greateraccesstothementalhealthcarelowincomechildrenandyouthneedtodevelopinto healthyadults.

MidAmericaInstituteonPovertyofHeartlandAlliance 9

OralHealth

Q:

Whatarethebarrierstoachievingahealthylifeforpoorandlowincome childrenandyouthintheareaoforalhealth?

A:

ManyIllinoischildrenhaveuntreatedoralhealthneedsandlack preventivecare.

Achildcannotbe completelyhealthywithout havingsoundoralhealth. Untreatedoraldiseasesand conditionscanhavea significantimpactonachilds qualityoflife.Thepain associatedwithmanyoral diseasesandconditionscan renderconcentrationdifficult, leadingtodiminishedschool performanceandincreased daysabsent.Additionally,oral diseasecanpresentbarriersto speaking,chewing,swallowing, cancontributetolossofself esteem,andcanultimately leadtoworseoralhealth 51 problemsasadults.

PercentofIllinoisChildrenwithTeethinFairorPoorCondition, byIncome
25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 099%FPL 100199%FPL 200399%FPL 400%FPLand over 5.9% 3.7% 21.0% 14.2%

Cavitiesarethemostcommonchronicchildhooddisease,occurringfivetoeighttimesas 52 frequentlyasasthma,thenextmostcommonchronicchildhooddisease. 53 55%ofIllinoisthirdgradershavesufferedfromthedamagingeffectsoftoothdecay. 54 30%ofIllinoisthirdgradershaveuntreatedcavities.

PercentofIllinoisChildrenNotReceivingallNeededDentalCare, byIncom e 14.4% 12.1% 3.3% 4.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0%

099%FPL 100199%FPL 200399%FPL 400%FPLandover 0.0%

Preventionisthesurest measureinthefightagainst childhoodoraldisease,yet28 percentofIllinoischildrendid notseeadentistforroutine preventivecareinthepast12 months.Researchhasshown thatchildrenwhoarepoor andminoritychildrenare morelikelytohaveteeththat areinfairorpoorcondition andarelessabletoaccess thecaretheyneedto maintainhealthyteethand 55 mouths.

10

BuildingonourSuccess

OralHealth

Q:

Whatcanwedotoensureallchildrenandyouthhaveaccesstothecarethey needtobecomehealthy,productiveadults?

A:

Expanddentalsealantprogramstoreachmorelowincomechildren andincreaseMedicaidreimbursementratesforrestorative procedures.

Toothdecay,aninfectiveandsometimespainfulcondition,canlargelybepreventedbyproviding allchildrenandyouthwithaccesstotimelyexamsanddirectinterventionsthatincludeeducation topreventdecay,appropriateamountsoffluoridesupplementation,anddentalsealants.Dental sealantsconsistofathinplasticcoatingappliedtothechewingsurfacesofmolarstopreventtooth decayandareaprovencavitypreventioneffort.Furthermore,dentalsealantsarecosteffective: 56 onaverage,adentalsealantcostsoverthreetimeslessthanafilling. Therateofschoolagechildrenreceivingdentalsealantshasrisenoverthepastseveral 57 decadeshowever,therehasbeennoincreaseforchildrenfromlowincomefamilies. 58 Only27%ofIllinoisthirdgradershavedentalsealants. TheIllinoisDepartmentofPublicHealthoperatesaDentalSealantGrantProgram,whichprovides grantstolocalcommunitiestoimplementdentalsealantprogramstoservelowincomechildren. Thedentalsealantprogramoperatedin44ofIllinois102countiesinthefiscalyear2007,reaching 50,953childrenandapplying53,019sealants.Increasingavailablefundstosupportthedental sealantprogramwillhelpmaintainandbuildneededinfrastructuretoreachmorechildren. Manychildrenhaveoralhealthneedsthatarewellbeyondthatofdentalsealants.Childrenwith existingdecayneedrestorativetherapies,suchasfillingsandothermorecomplexprocedures.The currentlowrateofMedicaidreimbursementdoesnotcomeclosetothecostofprovidingsuchcare anddiscouragesdentistsfromacceptingpatientswithpublichealthinsurance.Consequently, childrenandyouthwhoneedtheseproceduresoftenfacealargegapinongoingoralhealthcare. ExpandingtheDentalSealantGrantProgramandincreasingtheMedicaidreimbursement rateforrestorativeprocedures,coupledwitheffortstoincreasethenumberofdentists inallareasofthestatewhoacceptpublicinsurance,willresultinmorelowincome childrenreceivingtheproperoralhealthassessment,treatment,andpreventiveoral healthcaretheyneed.

MidAmericaInstituteonPovertyofHeartlandAlliance 11

ProperNutrition

Q:

Whatarethebarrierstoachievingahealthylifeforpoorandlowincome childrenandyouthintheareaofpropernutrition?

A:

Providingpropernutritionisdifficultforlowincomefamilieson limitedbudgets.

Propernutritionisavitalcomponentofhealthyliving forchildrenandyouth.Yetwhenfamilieshavelow incomes,itcanbeastruggletopurchase enoughfoodforthefamily,letalonethemore costlynutritiousfoodthatchildrenandyouth needforproperdevelopmentandrobust immunesystems.Over12percentofIllinois householdsexperiencefoodinsecurityor 59 hunger. Familiesareincreasinglyrelyingon supportstoensurethattheirchildrendo notgohungry: Nearly820,000Illinoischildrenreceived FoodStampsin2006makingupnearly 60 halfofallIllinoisFoodStamprecipients. 46%ofIllinoisstudentsreceivedschool lunchesin2006throughtheNational SchoolLunchProgram,afederally assistedmealprogramoperatingin schoolsforlowincomechildrenupfrom 61 42%in2001. Familieswhoarestrugglingtogetbyare oftenforcedtotakemeasurestomakefood lastlonger.Thismaymeanskippingbreakfast beforeschooloronlyeatingbreakfast sporadically.Missingbreakfastand experiencinghungerleadtoavarietyof negativehealthandeducational outcomes: Childrenexperiencinghungerhavelower mathscoresandaremorelikelytohave 62 torepeatagrade. Behavioral,emotional,andacademic problemsaremoreprevalentamongchildren 63 experiencinghunger. Youthwhodonoteatbreakfasttendtohave ahigherbodymassindex,anindicationof 64 beingoverweightorobese.

PercentofChildrenReceiving FoodStamps,2006

6.0%19.9%ofchildrenreceiving FoodStamps 20.0%34.9%ofchildrenreceiving FoodStamps 35.0%ormorechildrenreceiving FoodStamps

12

BuildingonourSuccess

ProperNutrition

Q:

Whatcanwedotoensureallchildrenandyouthhaveaccesstothecarethey needtobecomehealthy,productiveadults?

A:

Implementuniversalschoolbreakfastindistrictswithhigh percentagesoflowincomestudents.

TheSchoolBreakfastProgramreduceshungeramonglowincomechildrenwhile improvingtheirhealthandnutrition.Childrenandyouthwhoeatbreakfasthaveincreased schoolattendance,aremoreattentive,havehigheracademicachievement,fewerschoolnurse visits,fewerclassroomdisciplineproblems,andarefarlesslikelytobeoverweightsinceskipping 65 breakfastisassociatedwithobesity. TheNationalSchoolLunchProgramandtheSchoolBreakfastProgramareimportanttoolsin guaranteeingthatlowincomechildrenhavenutritiousfoodintheirstomachstogetthemthrough theschooldayandmaximizetheirlearningpotential.InIllinois,theChildhoodHungerReliefAct mandatesthatschoolswithover40percentofstudentseligiblefortheLunchProgramalsooffer eligiblestudentstheoptionofbreakfast.Despitethismandateandthewelldocumentedbenefitsof ahealthybreakfasttostartachildsdayoffright: LessthanonethirdofIllinoislowincome(i.e.freeandreducedpriceeligible)studentswho 66 receiveSchoolLunchonanaveragedayalsoparticipateintheSchoolBreakfastProgram. Betweenthe20042005andthe20052006schoolyear,thenumberofIllinoislowincome studentsintheSchoolBreakfastProgramgrewbyover13%,yetIllinoisstillhasthesecond 67 lowestpercentageoflowincomestudentsparticipatingintheprograminthecountry. IntheChicagoPublicSchoolsystem,only29%oflowincomeSchoolLunchstudentsparticipate 68 intheBreakfastProgram. Implementingauniversalbreakfastprogram,ratherthananoptionalprogram,inIllinois districtswithahighpercentageoflowincomestudentscansignificantlyincreaselow incomestudentparticipationintheprogramsinceitreducesstigmaandeliminatesfee barriersformanylowincomefamilies.Schooldistrictsthatofferbreakfastfreetoallstudents aremoresuccessfulinenrollinglowincomechildrenwhoaremostlikelytoneedbreakfast.Low incomestudentparticipationrisesevenmoreindistrictsthatmakebreakfastpartoftheschoolday 69 byservingbreakfastintheclassroom. RaisingparticipationintheSchoolBreakfastProgramwillalsoincreasefederaldollarsgoinginto schooldistricts.Forexample,iftheChicagoPublicSchooldistrictraisedparticipationintheSchool BreakfastProgramto70percentoftheLunchProgramarealisticachievementifuniversal breakfastwereimplementedthedistrictwouldreceiveanadditional$25.3millioninfederal fundingandwouldserveaneedednutritionalbreakfastto116,080additionallowincome 70 students.

MidAmericaInstituteonPovertyofHeartlandAlliance 13

Insurance

Q:

Whatcanwedotoensureallchildrenandyouthhaveaccesstothecarethey needtobecomehealthy,productiveadults?

A:

ManyolderyouthinIllinoislackhealthinsurancecoveragewhich limitstheirabilitytoaccesshealthcare.

Inrecentyears,Illinoishasprioritized insuringchildrenages0through18, yetyouththroughtheageof24 arenoteligibleforpublichealth insurancecoverage.Manyofthese youthdonothaveaccesstohealth insurancebecauseiftheyarenot enrolledinschool,theycannot typicallybeontheirparents insurance.Additionally,youthwhodo nothavechildrenoftheirownordo nothaveadisability,aretypicallynot eligibleforpublicinsurance.Manyof theseyouthareworkinginlowwage orentryleveljobsthatdonotoffer healthbenefitsorthatrequirethemto paysubstantialportionsofthecosts whichtheycannotaffordtodo. 19to24yearoldIllinoisans havethehighestrateof uninsuranceofanyage group.Whiletheseyouth compriseonly9percentofthe Illinoispopulation,theyrepresent 17percentofIllinoisuninsured population.Youthwithlow incomesaresignificantlymore likelytobeuninsuredthan 71 higherincomeyouth.

RatesofUninsuredIllinoisansbyAge,2006

0to18 19to24 25to39 40to64 65andover 0.0% 1.6% 5.0% 10.0%

10.4% 26.0% 19.7% 13.4%

15.0%

20.0%

25.0%

30.0%

UninsuredIllinoisYouthAges19to24,2006, byIncome
50.0% 40.0% 30.0% 20.0% 47.2% 41.6% 27.9% 18.6% 13.0%

Whileconstitutingarelatively 10.0% healthygroup: Therateofinjuryfor18to24 0.0% yearoldsis19%higherthan 099%FPL 100% 200% 300% 400%FPL thatof0to17yearolds, 199%FPL 299%FPL 399%FPL andover 32%higherthanthatof25to 44yearolds,and102% higherthanthatof45to64 72 yearolds. Uninsuredpeoplewhoexperienceaccidentalinjuryarelesslikelytoreceiveanymedicalcare 73 andiftheydo,theyaretwiceaslikelytonotreceiveneededfollowupcare. 18to24yearoldsaretheleastlikelyofanyagegrouptohaveausualplacetogoformedical 74 care. 14
BuildingonourSuccess

Insurance

Q:

Whatcanwedotoensureallchildrenandyouthhaveaccesstothecarethey needtobecomehealthy,productiveadults?

A:

ExtendeligibilityofAllKidstoincludeyouththroughage24.

Theagerangeof19to24yearsisacriticaltimeinthelivesofmanyyouththatincludesa transitionfromschooltoworkwithnewindependenceandfreedom.Nothavinghealthinsurance duringthisjuncturepresentsaseriousthreattothesafetyandstabilityofIllinoisyouthandcan resultinserioushealthandfinancialcoststhatfollowthemwellintothefuture.

75 Havinghealthinsurancecanleadtoimprovedhealthoutcomesandbetteraccesstocare. ExpandingthefullpackageofAllKidscoveragetoyouththroughage24willhelplowincome Illinoisyouthreceivepreventivecare,addressproblemsbeforetheygrowintomoreseriousissues, andensuretheydonotincurdevastatingfinancialconsequencesthatforcethemtostartadulthood withsignificantmedicaldebt.Moreover,havingaccesstomedicalcareatthisagecanhelpyouth formarelationshipwithhealthcareprofessionalsthatcarrieswellintoadulthood.Researchhas establishedalinkbetweenpoorhealthanddecreasedannualearnings,whichisproblematicnot onlyforanindividual,butalsoforthestate,whichfeelstheeffectsofreducedlaborforce 76 participationandworkeffortthroughfewertaxrevenues.

Illinoiscannotaffordtonotinsuretheseyouthwhoarethefuturebackboneofthestates 77 workforce.Infact,youngadultsaretheleastexpensiveagegrouptoinsure. Bylaunching youthintoadulthoodwiththisnecessarysafeguardtoaddresshealthissuesasthey ariseratherthanlettingthemmanifestintomoredifficultproblems,andtoheadoffthe physical,emotional,andfinancialconsequencesofunexpectedaccidentsorhealth events,thestatecanmakeaninvestmentthatwillreapsolidhealthandeconomic returns.

MidAmericaInstituteonPovertyofHeartlandAlliance 15

BuildingonourSuccess: Wheretogofrom Here

Illinoishasbeenagroundbreakingleaderinofferinghealthcarecoverageforallchildren,andwe mustbuilduponthisfoundationtoimprovehealthcareaccessandavailabilityandaddressallof thecomponentsofhealthandwellbeingforIllinoischildrenandyouth.Thisrequiresconcerted effortstoexpandthenumberandgeographicdispersionofhealthcareprofessionalsacrossthe healthspectrumwhoacceptpublicinsuranceandcontinuedworktoenrollpoorandminority childrenintheAllKidsprogram.Inaddition,thehighlightedsuggestionsinthisreportoffer concreteideasonhowtofurtherpromotehealthandwellbeingsoallIllinoischildrenandyouth canthrive: Expandexistingschoolhealthcenters,andestablishnewcentersincommunitiesofneed. EngageinoutreacheffortstoenrollLicensedClinicalSocialWorkersasMedicaid providersandeducationeffortsaimedtowardfamilieswithMedicaidenrolledchildren. Expanddentalsealantprogramstoreachmorelowincomechildrenandincrease Medicaidreimbursementratesforrestorativeprocedures. Implementuniversalschoolbreakfastindistrictswithhighpercentagesoflowincome students. ExtendeligibilityofAllKidstoincludeyouththroughage24. IncorporatingthesesuggestionsareimportantstepsinbuildingonIllinoisinvestmentsinhealth carecoveragetobecomethenationalleaderinensuringcomprehensivechildandyouthwellbeing.

TheMid-AmericaInstituteonPoverty (MAIP)isthepolicyandresearcharmof
HeartlandAllianceforHumanNeeds&HumanRights.MAIPprovidesasourceofreliable informationanddatatoelectedofficials,governmentagencies,media,nonprofits, communitygroups,andotheradvocatestopromoteeffectivepolicies,programs,and systemschange.

HeartlandAllianceforHumanNeeds&HumanRights championsthe
humanrightsandimprovesthelivesofmen,women,andchildrenwhoarethreatenedby povertyordanger.Formorethan100years,Heartlandhasbeenprovidingsolutions throughservicesandpolicythatmoveindividualsfromcrisistostabilityandonto success.Heartlandsworkinhousing,healthcare,legalprotections,andeconomicsecurity servesmorethan100,000peopleannually,helpingthembuildbetterlives.

16

BuildingonourSuccess

Endnotes

Rich,R.F.,&Elkins,C.L.(n.d.).ChildrenshealthcareinIllinois:Whereareweandwherearewegoing?InC.Herring(Ed.), ThestateofthestateofIllinois,2006 (pp.7088).Chicago:Instituteof GovernmentandPublicAffairs,UniversityofIllinois. 2 Coughlin,T.A.,&Cohen,M.(2007,August). Aracetothetop:IllinoissAllKidsInitiative.WashingtonDC:UrbanInstitute&KaiserCommissiononMedicaidandtheUninsured. 3 Rich,R.F.,&Elkins,C.L.(n.d.).ChildrenshealthcareinIllinois:Whereareweandwherearewegoing?InC.Herring(Ed.), ThestateofthestateofIllinois,2006 (pp.7088).Chicago:Instituteof GovernmentandPublicAffairs,UniversityofIllinois. 4 Schwartz,K.(2007,June). Spotlightonuninsuredparents:Howa lackofcoverageaffectsparentsandtheirfamilies.KaiserLowIncomeCoverageandAccessSurvey.WashingtonDC:KaiserCommission onMedicaidandtheUninsured. 5 KaiserCommissiononMedicaidandtheUninsured.(2007,February). Healthcoverageforlowincomeparents.KeyFacts.WashingtonDC:Author. 6 Bouman,J.,Cohen,F.H.,Chizewer,D.J.,Altman,S.,&Yates,T.(2007,MayJune).Litigationtoimproveaccesstohealthcareforchildren:LessonsfromMemisovskiv.Maram. ClearinghouseReview, JournalofPovertyLawandPolicy,41,129. 7 U.S.CensusBureau,CurrentPopulationSurveyAnnualSocialandEconomicSupplement20052007,calculationconductedbytheMidAmericaInstituteonPovertyofHeartlandAlliance. 8 Gershoff,E.T.,Aber,J.L.,&Raver,C.C.(2003).ChildpovertyintheU.S.:Anevidencebasedconceptualframeworkforprogramsandpolicies.InR.M.Lerner,F.Jacobs,&D.Wertlieb(Eds.),Promoting positivechild,adolescent,andfamilydevelopment:Ahandbookofprogramandpolicyinnovations (pp.81136).ThousandOaks,California:SagePublications. 9 Ibid. 10 Ibid. 11 Ibid. 12 Ibid. 13 Duncan,G.J.,BrooksGunn,J.,&Klebanov,P.K.(1994).Economicdeprivationandearlychildhooddevelopment. ChildhoodDevelopment,65,296318. 14 Ibid andKalil,A.K.,&ZiolGuest,K.M.(2006,May8). Lifetimeincomelevel,stability,andgrowth:Linkstochildrensbehavior,achievement,andhealth.Chicago:CenterforHumanPotentialandPublic Policy,TheHarrisSchoolofPublicPolicyStudies,UniversityofChicago. 15 U.S.CensusBureau,CurrentPopulationSurveyAnnualSocialandEconomicSupplement20052007,calculationconductedbytheMidAmericaInstituteonPovertyofHeartlandAlliance. 16 U.S.CensusBureau,AmericanCommunitySurvey2006, calculationconductedbytheMidAmericaInstituteonPovertyofHeartlandAlliance. 17 AnnieE.CaseyFoundation.(2006). Kidscountstateleveldataonline. RetrievedMay2,2007,fromhttp://www.kidscount.org 18 U.S.CensusBureau,AmericanCommunitySurvey2006,calculationconductedbytheMidAmericaInstituteonPovertyofHeartlandAlliance. 19 Ibid. 20 AnnieE.CaseyFoundation.(2006). Kidscountstateleveldataonline. RetrievedAugust7,2007,fromhttp://www.kidscount.org 21 NationalSurveyofChildrensHealth. (2003).IllinoisStateProfile.RetrievedMay31,2007,fromhttp://nschdata.org/DataQuery/ 22 Ibid. 23 Ibid. 24 AnnieE.CaseyFoundation.(2003). Kidscountstateleveldataonline. RetrievedMay31,2007,fromhttp://www.kidscount.org 25 Ibid. 26 IllinoisDepartmentofPublicHealth.(2007,April).Adolescentsatrisk:StatisticsonHIV/AIDS,STDs,andunintendedpregnancy. RetrievedAugust10,2007,from http://www.idph.state.il.us/aids/materials/adol_hiv_fs.htm 27 U.S.DepartmentofHealth&HumanServices,SubstanceAbuseandMentalHealthServicesAdministration,OfficeofAppliedStudies.(2007,April). NationalSurveyonDrugUseandHealth,2004and 2005.RetrievedAugust10,2007,fromhttp://www.oas.samhsa.gov/geography.htm 28 NationalSurveyofChildrensHealth. (2003).DataQuery. RetrievedMay31,2007,fromhttp://nschdata.org/DataQuery/ 29 Ibid. 30 NationalSurveyofChildrensHealth. (2003).DataQuery. RetrievedMay31,2007,fromhttp://nschdata.org/DataQuery/,calculationconductedbytheMidAmericaInstituteonPovertyofHeartland Alliance. 31 Juszczak,L.,Melinkovich,P.,Kaplan,D.(2003).Useofhealthandmentalhealthservicesbyadolescentsacrossmultipledeliverysites. JournalofAdolescentHealth,32S,108118. 32 Kaplan,D.W.,Calonge,B.N.,Guernsey,B.P.,Hanrahan,M.B.(1998).ManagedcareandSBHCs.Useofhealthservices.ArchivesofPediatricandAdolescentMedicine,152(1),2533. 33 Kisker,E.E.,&Brown,R.S.(2002).DoSBHCsimproveadolescentsaccesstohealthcare,healthstatus,andrisktakingbehavior?JournalofAdolescentHealth,18,335343. 34 Hall,L.S.(2001).FinalReport YouthandFamilyCentersProgram20002001 (REIS011722).Dallas:DallasIndependentSchoolsDistrict,YouthandFamilyCentersProgram. 35 Ibid. 36 Key,J.D.,Washington,E.C.,Hulsey,T.C.(2002).ReducedemergencydepartmentutilizationassociatedwithSBHCenrollment. JournalofAdolescentHealth,30,273278. 37 Santelli,J.,Kouzis,A.,etal.(1996).SBHCsandadolescentuse ofprimarycareandhospitalcare.JournalofAdolescentHealth,19,267275. 38 Webber,M.P.,Carpiniello,K.E.,Oruwariye,T.,Yungtai,L.,Burton,W.B.,&Appel,D.K.(2003).Burdenofasthmainelementaryschoolchildren:DoSBHCsmakeadifference?ArchivesofPediatricand AdolescentMedicine,157,125129. 39 Lurie,N.,Bauer,E.J.,Brady,C.(2001).AsthmaoutcomesinaninnercitySBHC.JournalofSchoolHealth,71(9),916. 40 Adams,E.K.,Johnson,V.(2000).AnelementarySBHC:canitreduceMedicaidcosts?Pediatrics,105(4Pt1),780788. 41 IllinoisCoalitionforSchoolHealthCenters.(n.d.). Reducingcosts,improvinghealth costsandbenefitsofIllinoisschoolhealthcenters. Chicago:IllinoisMaternalandChildHealthCoalition. 42 Melchiorre, D.(2006,November). Childrensmentalhealth.SpecialReport.Chicago:VoicesforIllinoisChildren. 43 Ibid. 44 NationalSurveyofChildrensHealth. (2003).IllinoisStateProfile.RetrievedMay31,2007,fromhttp://nschdata.org/Content/StatePrevalence.aspx?geo=Illinois 45 VanLandeghem,K.(2003,April). Childrensmentalhealth:AnurgentpriorityforIllinois.FinalReport.Chicago:IllinoisChildrensMentalHealthTaskForce. 46 NationalSurveyofChildrensHealth. (2003).DataQuery. RetrievedMay31,2007,fromhttp://nschdata.org/DataQuery/ 47 VoicesforIllinoisChildren.(2007). Illinoiskidscount2007:Thestateofchildrenshealth.Chicago:Author. 48 NationalInstituteofMentalHealth.(2005,June6). Mentalillnessexactsheavytoll,beginninginyouth.PressRelease.RetrievedAugust20,2007,fromhttp://www.nimh.nih.gov/press/mentalhealthstats.cfm 49 IllinoisDepartmentofFinancialandProfessionalRegulation.(2007,June22). RosterofLicensedClinicalSocialWorkersinIllinois.Onfile withauthor. 50 Whitaker,T.,Weismiller,T.,&Clark,E.(2006). Assuringthesufficiencyofafrontlineworkforce:Anationalstudyoflicensedsocialworkers. Executivesummary.WashingtonDC:NationalAssociationof SocialWorkers. 51 nd U.S.Departmentof HealthandHumanServices.(2000,November).HealthyPeople2010.2 ed.WashingtonDC:U.S.GovernmentPrintingOffice. 52 Ibid. 53 IFLOSS.(2007,Spring). OralhealthcareinIllinois:Comprehensivecareforchildren&families.TheIllinoisOralHealthPlanII.Springfield,IL:IllinoisDepartmentofPublicHealth. 54 Ibid. 55 NationalSurveyofChildrensHealth.(2003).DataQuery. RetrievedJune15,2007,fromhttp://nschdata.org/DataQuery/ 56 IFLOSS.(2007,Spring). OralhealthcareinIllinois:Comprehensivecareforchildren&families.TheIllinoisOralHealthPlanII.Springfield,IL:IllinoisDepartmentofPublicHealth. 57 nd U.S.DepartmentofHealthandHumanServices.(2000,November).HealthyPeople2010.2 ed.WashingtonDC:U.S.GovernmentPrintingOffice. 58 IFLOSS.(2007,Spring). OralhealthcareinIllinois:Comprehensivecareforchildren&families.TheIllinoisOralHealthPlanII.Springfield,IL:IllinoisDepartmentofPublicHealth. 59 Nord,M.,Andrews,M.,&Carlson,S.(2006,November). HouseholdfoodsecurityintheUnitedStates,2005.EconomicResearchReportNumber29.WashingtonDC:U.S.DepartmentofAgriculture EconomicResearchService. 60 IllinoisDepartmentofHumanServices,BureauofResearch&Analysis(2007,June). Countof personsreceivingFoodStampsduringcalendaryear2006.Onfilewithauthor. 61 IllinoisStateBoardofEducation.(n.d.). Nutritionprograms,FreeandReducedPriceMealeligibilitydata.RetrievedDecember6,2006,from http://www.isbe.state.il.us/nutrition/htmls/eligibility_listings.htm,calculationconductedbytheMidAmericaInstituteonPovertyofHeartlandAlliance. 62 FoodResearchandActionCenter.(n.d.). Breakfastforlearning.ChildNutritionFactSheet.WashingtonDC:Author. 63 Ibid. 64 Ibid. 65 Levin,M.(2007,August). SchoolbreakfastinAmericasbigcities.WashingtonDC:FoodResearchandActionCenter. 66 Cooper,R.,Levin,M.,Adach,J.,Parker,L.,&Weill,J.(2006,December). Schoolbreakfastscorecard2006.WashingtonDC:FoodResearchandActionCenter. 67 Ibid. 68 Levin,M.(2007,August). SchoolbreakfastinAmericasbigcities.WashingtonDC:FoodResearchandActionCenter. 69 Ibid. 70 Ibid. 71 U.S.CensusBureau,CurrentPopulationSurvey20052007AnnualSocialandEconomicSupplement,Microdata,calculationconductedbytheMidAmericaInstituteonPovertyofHeartlandAlliance. 72 CenterforDiseaseControlandPrevention,NationalCenterforHealthStatistics,HealthDataforAllAges.(2007). Healthcareaccessanduse,Injuryvisitstotheemergencydeptbyintentandmechanism, allages:U.S.,20022004.RetrievedJune11,2007,fromhttp://209.217.72.34/hdaa/ReportFolders/ReportFolders.aspx 73 Hadley,J.(2007,March).Insurancecoverage,medicalcareuse,andshorttermhealth changesfollowinganunintentionalinjuryortheonsetofachroniccondition. JournalofAmericanMedicalAssociation, 297(10),10731084. 74 CenterforDiseaseControlandPrevention,NationalCenterforHealthStatistics(2007,June). Earlyreleaseofselectedestimatesbasedondatafromthe2006NationalHealthInterviewSurvey Usualplace togoformedicalcare.Hyattsville,MD:Author. 75 Hadley,J.(2002,May).Sickerandpoorer:Theconsequencesofbeinguninsured.WashingtonDC:KaiserCommission onMedicaidandtheUninsured. 76 Ibid. 77 Dorn,S.(2004,September). Towardsincrementalprogress:Keyfactsaboutgroupsofuninsured.WashingtonDC:EconomicandSocialResearchInstitute.

MidAmericaInstituteonPovertyofHeartlandAlliance 17

MidAmericaInstituteonPovertyof HeartlandAllianceforHumanNeeds&HumanRights 4411NorthRavenswoodAvenue Chicago,Illinois60640 Ph773.336.6075 Fx773.506.6649 maip@heartlandalliance.org www.heartlandalliance.org/maip/