One of the most shameful failures of our public safety net system is when structural harm goes unaddressed. The lead crisis in Flint, Michigan remains a painful reminder of when blind commitment to cost savings results in irreversible harm for an entire generation of children and families. The city of Flint is a low-income, majority black community—and it does not go unnoticed that this low-income, majority community of color, is the recipient of cost cutting efforts. The lead crisis in Flint – a crisis that is ongoing and will be for years to come—highlights the importance of public health and equitable infrastructure investment as a clear path to improving health outcomes and advancing health equity. Despite the high profile reporting on Flint, over 4 million children in the U.S.  live in homes with high levels of lead. This is heartbreaking – and unacceptable. States and communities are not without tools to demand and require lead exposure prevention programs and abatement in homes, in schools and in our water systems to ensure healthy living conditions for low-income children and families.

Cindy Mann, the former head of Medicaid at the Centers for Medicare and Medicaid Services, and her colleagues at Manatt recently highlighted a key tool in this battle: the Children’s Health Insurance Program (CHIP). Within the CHIP program, there is an opportunity for states to use a portion of their CHIP funds for a Health Services Initiative (HIS). As outlined in Manatt’s brief, it does not require a CMS waiver, it does not need to be a statewide effort and it does not require that only Medicaid- and CHIP- enrolled children benefit from the initiative. It does require a state to demonstrate need, meet program requirements that communicate how it will meet the needs of the targeted group and the program must have a clear timeline. Mann and her colleagues note that a majority of states have not yet taken up this opportunity—and have room in their CHIP budgets to do so.

Thanks to the Affordable Care Act (ACA), states are able to draw down a CHIP enhanced match through September 2019. While access to this enhanced match remains unclear beyond September (CHIP needs to be refunded by September 2017), there is opportunity now for states to address the needs of low-income communities. Advocates can play an important role in highlighting this opportunity for key decision makers and communities.  

We know that children’s health and wellness requires more than access to health insurance coverage. Children’s health is shaped by their surrounding environment—clean drinking water, stable and safe housing, nutritious foods and nurturing caregivers and community. All of these basic needs when knit together, blanket children with health opportunity. We know that for many children, this is not their reality and that the systems that serve them continue to struggle to identify needed resources, coordinate their work and reach the most vulnerable families. CHIP remains a key tool in helping states not just increase access to coverage and care but also create a healthier environment.