1. Hawaii: Update on SB2655 SD 2 Relating to Health It requires insurers to cover medically necessary services but defines "medical necessity" according to adult standards. Child health advocates point out that standards for "medical necessity" for children would be different because prevention and early intervention services, which are critically important for children, would have to be included. There is a fear that private insurers would not be constrained to cover the services that are necessary for children. That would be a problem for everybody but advocates are concerned that if private insurers don't cover preventive services, parents will prefer to enroll their childre in State CHIP even when they might otherwise have private coverage. For more information, contact Leolinda Parlin of Family Voices at parlin@gte.net or Cal Sia, MD at calsia@pol.net. 2. At The Federal Level: The Immigrant Children's Health Improvement Act Families USA and other health and immigrant groups are working hard to restore benefits to legal immigrants whose Medicaid and CHIP eligibility were unfairly eliminated by the 1996 welfare reform law. We are trying to gather broad support for bipartisan legislation that would allow states to cover lawfully present pregnant women through Medicaid, and children through Medicaid and CHIP. The name of the Senate bill is the Immigrant Children's Health Improvement Act, S.1227. Senate sponsors include Chafee (R-RI), McCain (R-AZ), Graham (D-FL), Mack (R-FL), Moynihan (D-NY), and Jeffords (R-VT). We are expecting similar legislation to be introduced in the House shortly. Currently there is a 5-year bar on serving legal immigrants who enter the country after August 22, 1996. Not only does this bar arbitrarily discriminate against legal immigrants based on their date of entry, it has also caused serious confusion in the immigrant community about who is eligible for what. Studies have shown a serious decline in eligible immigrants signing up for Medicaid and other benefits they are entitled to. We believe passage of the Immigrant Children's Health Improvement Act is critical to ensure that efforts to enroll eligible children in Medicaid and CHIP succeed. And the time to pass it is now, with elections looming and Members of Congress feeling vulnerable. There are other pieces of legislation that restore a range of benefits including Medicaid, SSI, Food Stamps etc, which we are also supporting. We would like to present a strong show of support from the health community for S.1227 as it has bipartisan support and, most believe, the strongest likelihood of passage this year. It will still be an uphill fight as there are many Members of Congress who still harbor very strong anti-immigrant sentiments. 3. Poverty in Isles Takes Stronger Grip on Kids by Alice Keesing, Honolulu Advertiser, 16 March 2000 Hawaii's children are dealing with increasing poverty, child abuse and teen arrest rates. But tipping the scale in their favor are better infant health, fewer teen pregnancies and better high school graduation rates. The trends affecting the well-being of the state's children were released yesterday in the 1999 Hawaii Kids Count report. One in five Hawaii children live in poverty, according to the report. The number of poor children increased dramatically during the past decade, rising 78 percent between 1990 and 1997. The increase in poverty has hit all areas of the state, but Hawaii County fared worst: Its poverty rate is nearly double that of other areas. Marcia Hartsock, project director of Hawaii's Kids Count at the University of Hawaii Center on the Family, said she is worried that climbing poverty may be responsible for an increase in child abuse and neglect. Between 1990 and 1997, there was a 66 percent increase in the rate of abuse and neglect of children ages 6-11. Again, Hawaii county had the highest increase. Its numbers jumped 355 percent. Hawaii's ailing economy also may be responsible for fewer poor children participating in the Head Start preschool program and the A-Plus after-school program, Hartsock said. Preschool programs can help prevent future special education needs and school dropouts, and can reduce the likelihood of teen pregnancies, criminal activity and welfare dependency, according to the report. But despite rising poverty, Hawaii has seen improvements in more areas than there have been declines. Services to special needs children have improved, and the state has one of the lowest high school dropout rates in the country. The state has fared particularly well in health-related areas, Hartsock said, with gains in early prenatal care and immunizations and a recent drop in low birth-weight babies. A decline in teen pregnancies also is particularly good news, Hartsock said. Between 1990 and 1997, there was a 22 percent drop in the pregnancy rate among women ages 15-19. Still, every day in Hawaii, three girls ages 17 or younger discover they are pregnant. "The message is getting out," said Candice Calhoun, a planner in the Department of Health's community adolescent program. "In the schools, they are talking about sexually transmitted diseases and HIV, and people may be more cautious and abstaining." The Kids Count report is sponsored by the Baltimore-based Annie E. Casey Foundation and has been reporting on the condition of America's youth since1985. A national report showing how Hawaii compares with the rest of the country will be released in May. Here are some highlights of the report, comparing key indicators from 1990 to 1997: * Children in poverty: up 78 percent. * Teen birth rate (birth per 1,000 females ages 15-17): down 23 percent. * Children in single parent families: down 13 percent. * Low birth-weight babies (less than 5.5 pounds): up 22 percent. * Infant mortality rate: down 7 percent. * Child death rate (deaths per 100,000 children ages 1-14): down 27 percent. * Public school elementary students in special education: up 33 percent. * Rate of child abuse and neglect (per 1,000 children ages 6-11): up 66 percent. * Teens not attending school and not working (ages 16-19): down 29 percent. * Teen pregnancy rate (per 1,000 women ages 15-19): down 22 percent. * Teen homicides, suicides and accidents in children ages 15-19: down 18 percent. * Juvenile violent crime arrest rate (arrests per 100,000 youths ages 10-17): up 38 percent.