MEMBERS: Paul J. Noto (Co-Chair), Amy Paulin, Lois Bronz

STAFF: Dolores Heredia

GUEST(S): Dr. Harold Adel (Commissioner, Dept. of Health), Patsy Yang-Lewis (Deputy Commissioner), Bill Randolph.

The meeting commenced at 12:05 AM. The first item for discussion was the minutes of March 10, 1998. Mrs. Paulin moved to approve, seconded by Leg. Bronz. All in favor [3-0].

Next Leg. Noto welcomed the guests. Leg. Noto stated that the Task Force is contemplating embarking on a new project which is to identify the number of children who presently lack any kind of health insurance and discuss this vis-à-vis Child Health Plus. Leg. Noto stated that he assumes poor children are covered by Medicaid but there is a middle group which is uncovered. Leg. Noto asked Dr. Adel to educate the Task Force on Child Health Plus. Dr. Adel first discussed Medicaid. He noted Medicaid does not necessarily reach every family even if they are below the income level. He noted that people who fear for their immigration status do not apply for Medicaid. In addition, because of pride they do no wish to accept it. Leg. Noto inquired how the Department of Health reaches these people. Dr. Adel explained how they distribute thousands of publications and brochures calling attention to their services. In addition, they reach into communities for

other reasons (for example community outreach). Next Dr. Adel explained that the current plan is to have Child Health Plus access only after Medicaid eligibility is determined. However, those that are not inclined to go to Medicaid will be blocked from access. Leg. Noto inquired as to whether there was any documents which stated this requirement. Ms. Yang-Lewis stated that this has never been codified. Leg. Noto inquired as to what was Child Health Plus. Dr. Adel stated that Child Health Plus is a modified insurance program which pays the provider for the services. A provider can be any approved Managed Health Care. Leg. Noto inquired into the procedural aspects of Child Health Plus. Dr. Adel stated that they are not sure yet what the procedures will be. Ms. Yang stated that if you want to make sure that children are enrolled it has to be user-friendly (this means it has to be in schools and day-care centers rather than big local providers). In addition, the guests stated that Child Health Plus should be enforced through an arm of government to make sure that services will be distributed and it is not used as a marketing tool. Local government could see that not only are the children enrolled but that they are getting the local care. Leg. Noto asked what is the number of uninsured children in the County. Dr. Adel stated that the number is 23,000, however, it is not accurate. Leg. Noto asked how do they know there is a problem. Dr. Adel stated that pediatric centers have questionnaires which inquire into income and insurance and many of the clients do not have insurance or Medicaid. Leg. Noto inquired as to what percentage are immigrants. Dr. Adel stated that that question is not asked.

Next Mrs. Paulin stated three concerns: (1) the accuracy of the number; (2) health source being the only provided and no community choice; where is the County for the other four plans; and (3) the problems with individual risk. Ms. Yang Lewis stated that anyway

you try to guess at the number of uninsured you are undercounting. There is census data that is extrapolated every ten years. According to the last census, in Westchester County there are approximately 190 thousand children under 19 who would be eligible. The last time the census bureau did a survey, on county level, was on 1995 data and overall total population of Westchester was 12% uninsured. Therefore if you divide 12% with the 190 thousand kids you get the number of 22,800. With regards to Mrs. Paulin’s second concern, Dr. Adel stated that they have an interest in expanding Child Health Plus to the four other providers. He anticipates that all of the HMO’s will participate when the money starts to flow.

Leg. Bronz inquired whether it would make sense for any the Task Force to talk to someone at the state level. Dr. Adel stated that they are in the process of lobbying the New York State Department of Health. Ms. Yang-Lewis briefly discussed the recent welfare reform bill. As of 1996, under the law, immigrants even if they come into the country legally they cannot access federal programs such as food stamps and Medicaid for the first 5 years. Illegal immigrants get nothing. So if a child is born here they are a citizen but the law says that if they parents seek assistance there is a clause that they must be turned into INS. She noted that if the child health plus is not implemented in a way that removes barriers there will remain untapped federal dollars and care for children remains a local charged

Mrs. Paulin discussed Paula Roberts and the child support databases. Mrs. Paulin explained that there is a pool of approximately 37,000 cases in which a large number are poor and in the computer is whether these kids have insurance or don’t. Mrs. Paulin stated that the head of Child Support and Enforcement in New York State and

they will be doing a letter to these families telling them of their eligibility. Mrs. Paulin felt that a letter is not proactive enough since this pool does exist. Dr. Adel stated that there multiple ways in which they interface with the community, however he noted that the access to health care cannot be exclusively left to the client

Leg. Noto thanked the guests for their time. Next the Task Force canceled it meeting on the Tuesday, March 24, 1998. The next Task Force meeting will be held on Thursday, April 2, 1998. The Task Force will invite Georganne Chapin, of Health Source, as well as, Mark Rappaport on this date. The upcoming Task Force meeting will be held on April 6th at 11:00 AM and April 15th at 11 AM.

The meeting adjourned at 1:20 PM.