More than 5,000 kids 18 and younger are uninsured in Chatham County, putting them at risk for preventable diseases, burdening families with financial distress resulting from medical bills and increasing costs to our hospitals (and taxpayers) for emergency room visits for routine care. A new initiative aims to change that.
A National League of Cities grant, just announced, will fund the Mayor’s Campaign for Healthy Children and Families to reduce by 50% the number of uninsured children in our county. Savannah is one of eight cities in the U.S. awarded these innovative grants that set 18-month goals to boost the numbers of eligible children and families enrolled in Medicaid and PeachCare.
Step Up, with its partner, Chatham County Safety Net Planning Council, the county’s healthcare collaborative, and City of Savannah staff produced the successful proposal. Key city departments such as the Public Information Office, the Citizen’s Office 311 service, plus enrollment and outreach partners will work hand-in-hand with community-based organizations, health clinics and hospitals to accomplish the ambitious enrollment gains.
Strategic points where kids and parents regularly intersect such as schools, health clinics, even public events will have information and direct families to trained enrollment assistance staff.
Georgia lags behind other states in terms of health insurance coverage for children and families. Eleven percent of Georgia’s children are uninsured, representing 4.3% of the nation’s total population of uninsured children. Additionally, 23% of Georgia adults with dependent children are uninsured; 78% of Georgia’s uninsured children are eligible, but not enrolled in Medicaid or PeachCare.
Access to health insurance is a critical piece of the poverty puzzle — medical debt causes undue hardship, particularly on low-income families, and in most cases is avoidable by signing up for existing public health insurance programs. The National League of Cities grant funds raise the possibility of fostering real change and getting more eligible families signed up in our county.
About the author: Suzanne Donovan is executive director of Step Up Savannah, the City of Savannah’s poverty reduction initiative.
Supreme Court cases are usually known for what they hold. Harris v. Quinn will forever be known for what it did not hold. The Court did not overrule Abood v. Detroit Board of Education, a 35-year old precedent that is a cornerstone of public sector collective bargaining. But it certainly foreshadowed its demise.
In Harris v. Quinn the Supreme Court held 5-4 that the First Amendment prohibits the collection of an agency fee from home health care providers who do not wish to join or support a union.
Medicaid recipients who would otherwise be institutionalized may hire personal assistants. In Illinois, the Medicaid recipient is the employer and is responsible for almost all aspects of the employment relationship. But the personal assistant is a state employee for collective bargaining purposes. A number of personal assistants did not want to join the union or pay it dues.
In 1977 in Abood v. Detroit Board of Education the Court held that state and local government employees who don’t join the union may still be compelled to pay an agency fee (fair share) to cover the cost of union work related to collective bargaining. The Court refused to extend Abood to personal assistants who aren’t “full-fledged” public employees. What justifies an agency fee is that unions must promote the interests of members and nonmembers alike, meaning they cannot negotiate higher pay for members or only represent members in grievances. This justification has little force where a union cannot negotiate pay or represent nonmembers (or members) in grievances.
While the Court was highly critical of Abood, it did not overrule it, which many predicted the Court might do. But, this case is still a significant blow to public sector organizing. It has been widely reported that numerous states have recognized Medicaid personal assistants as state employees for collective bargaining purposes. As a result of this decision, none of these employees will have to pay fair share if they don’t join the union.
About the author: Lisa Soronen is the Executive Director of the State and Local Legal Center and a regular contributor to CitiesSpeak.
This is a guest post by Cheryl Townsend, Cover Jacksonville Project Director. Jacksonville is one of eight cities NLC has awarded funding to reduce the number of uninsured children.
There are over 25,000 uninsured children in Duval County (Jacksonville, FL). Many of these children qualify for insurance through Medicaid or Florida Healthy Kids (Florida KidCare), but most of their parents are simply not aware. And, while efforts have been made in the community to increase enrollment, ongoing challenges have created barriers to its success. Some of Jacksonville’s challenges have historically been a lack of strategic focus on community health, a very large five-county geographic service delivery area, and insufficient funding for educational outreach to get to all areas. Therefore, Jacksonville is extremely excited to begin implementation of the Cover Jacksonville campaign as a result of receiving the Cities Expanding Health Access to Children and Families grant from the National League of Cities.
Cover Jacksonville is a health campaign that builds on existing enrollment efforts and leverages community resources in order to reduce the number of uninsured Duval County children by 20% by December 2015. Led by the City of Jacksonville and the Jacksonville Children’s Commission, the campaign’s key partners include the Mayor’s appointment of Jacksonville’s first-ever Commissioner of Health, THE PLAYERS Center for Child Health at Wolfson Children’s Hospital, United Way of Northeast Florida, the Health Planning Council of Northeast Florida and Duval County Public Schools. Cover Jacksonville will focus on four outreach and enrollment strategies:
- Building Capacity: Understanding and tackling obstacles through training and education of community stakeholders, parents, and elected officials.
- Raising Awareness: Promoting a culture of health and education about insurance options, using phone banks and on-the-ground enrollment events, and online at http://www.coverjax.org (coming soon!).
- Establishing a Single Point of Access: Streamlining the consumer information-gathering process by directing consumers to United Way of Northeast Florida’s 2-1-1 hotline, where parents will be able to schedule appointments with Community Enrollment Assisters at various sites located throughout the city.
- Identifying Uninsured Children through Public Schools: Establishing a pilot program at three schools (Bartram Springs Elementary, Twin Lakes Middle School, and Atlantic Coast High School) to identify uninsured children through school enrollment questionnaires and using trained school officials, who will work to get these children coverage.
After analyzing secondary data and input from community leaders and parents, Cover Jacksonville will target working poor families with uninsured children. Previous community enrollment efforts utilized Health Zone designations to identify targeted areas, which left out families from pockets of poverty that fell outside the city’s urban core. By targeting working poor families throughout the county, however, Cover Jacksonville ensures these families will no longer be overlooked.
The Cover Jacksonville campaign will govern itself using a shared governance model, emphasizing: collaboration, shared decision making, and accountability to improve the quality of care, safety, and enhance work life. This includes the creation of the Cover Jacksonville Advisory Board, led by the Commissioner of Health, and the Cover Jacksonville Action Committee, led by the Project Director.
During the planning process, participation and invaluable input from the city’s top leadership provided a vision for what would eventually become Cover Jacksonville. These leaders included Jacksonville Mayor Alvin Brown; The Honorable Mia L. Jones, Florida House of Representatives and Special Assistant to the Mayor; Dr. Nikolai Vitti, Superintendent, Duval County Public Schools; The Honorable Kimberly Daniels, City of Jacksonville Public Health and Safety Committee Chair and City Council liaison to the Children’s Commission Board of Directors; The Honorable Ray Holt, Jacksonville City Council; Michael Aubin, Hospital President, Wolfson Children’s Hospital; Dr. Kelli Wells, Director, Duval County Health Department; Dawn Emerick, Principal/Owner, Impact Partners (formerly President & CEO, The Health Planning Council of Northeast Florida); Connie Hodges, CEO of United Way of Northeast Florida (ret.); and Jon Heymann, CEO of the Jacksonville Children’s Commission.
From January to April 2014, key partners held three additional meetings, in which they reviewed data, developed key messages, inventoried assets, developed a process map for the referral system, and established campaign performance measures. In parallel to the community leadership meetings, five consumer focus groups were also conducted. The initial campaign strategy was to target child and family health insurance enrollment, however, the consumer focus groups and key partners unanimously indicated a strong need to combine those outreach efforts and messaging with the Federal Health Insurance Marketplace’s existing adult enrollment efforts. As a result of this significant finding during the market analysis, the business plan reflects noteworthy collaborative efforts between the child and adult efforts such as a new consolidated brand, Cover Jacksonville.
In July of 2014, as we move into the implementation phase of Cover Jacksonville, we will continue to share our lessons with the hope that more stakeholders will understand the needs in our community and become more direct with their priorities for our children. And through collaboration and alignment of existing efforts and resources, the outcomes we expect to emerge not only include a decrease in the number of uninsured children, but a community-wide approach to sustaining a culture of health and wellness in Jacksonville, Florida.
For more information on how participate in the campaign, contact Cheryl Townsend at email@example.com or (904) 630-6405.
In a unanimous opinion in McCullen v. Coakley the Supreme Court held that a Massachusetts statute making it a crime to stand on a public road or sidewalk within 35 feet of an abortion clinic violates the First Amendment.
Massachusetts adopted this statute because protesters routinely violated a previous statute. Petitioners were “sidewalk counselors” who claimed the buffer zones prevented them from having personal interactions with those entering the clinics which they viewed as essential to their “sidewalk counseling.”
The State and Local Legal Center’s (SLLC) amicus brief, which NLC joined, points out that cities frequently use buffer zones in numerous contexts. For example, prior to McCullen, lower courts upheld buffer zones to prevent congestion at special events and places that regularly draw crowds and near funerals to protect vulnerable mourners.
McCullen begs an obvious question: will any buffer zone statutes and ordinances survive constitutional scrutiny now?
While only time will tell how lower courts will interpret McCullen, the opinion provides a detailed analysis lower courts are likely to apply to future buffer zone cases.
Almost all buffer zones are created in response to a specific problem (circus buffer zones: think animal rights protesters). This may not mean that lower courts will consider such buffer zones content-based. In McCullen, the Court concluded that Massachusetts’ buffer-zone law was content-neutral despite the fact that Massachusetts regulated speech only outside abortion clinics and not outside every building that might host an event that could attract protesters. The Massachusetts legislature identified a problem only at abortion clinics and reasonably decided to regulate speech only at abortion clinics.
Massachusetts lost in McCullen because the Court concluded its buffer zone law wasn’t “narrowly tailored to serve a significant government interest.” Lower courts are likely to look at all of the reasons the Court relied on when determining if a buffer zone in another context is constitutional.
First, McCullen wasn’t a protester, she was a “sidewalk counselor” who could only work effectively if she could have close, personal conversations with women. More traditional protesters wielding signs and megaphones may not have as persuasive of an argument that they need to get really close to their audience.
Second, the Chief Justice recommended that Massachusetts try to solve its public safety problems at abortion clinics by harassment and obstruction statutes and ordinances which are more targeted than buffer zones. A related reason the Court thought the buffer zones were overkill was that only one clinic in the state had problems on Saturday mornings only. So, when evaluating whether a buffer zone is narrowly tailored a lower court is likely going to look at whether effective options not so burdensome to free speech were available.
Finally, the Court didn’t buy Massachusetts’ argument that it tried other laws already on the book to solve the problems caused by protesters at abortion clinics but they did not work. Massachusetts could not cite to a single prosecution in 17 years and their last injunction dated to the 1990s. In short, cities that adopted buffer zone laws because “everything else failed” are going to have to prove it.
About the author: Lisa Soronen is the Executive Director of the State and Local Legal Center and a regular contributor to CitiesSpeak.
As usual, on the last day of the Supreme Court’s term it released its opinion in the biggest case of the term: Burwell v. Hobby Lobby. The Court held 5-4 that the Affordable Care Act’s birth control mandate violates the Religious Freedom Restoration Act (RFRA), as applied to closely held corporations.
Though not obvious, this case may have a significant impact on land use regulation. For this reason, the State and Local Legal Center (SLLC) filed an amicus brief, which Justice Ginsburg quoted in her dissenting opinion.
RFRA provides that the federal government “shall not substantially burden a person’s exercise of religion.” The Religious Land Use and Institutionalized Persons Act (RLUIPA) bars state and local governments from enforcing land use regulations that substantially burden “the religious exercise of a person.”
So, FRFA and RLUIPA are related statutes. But FRFA only applies to the federal government, and RLUIPA only applies in the land use and institutionalized persons’ context. Both apply to “persons.”
If for-profit corporations are “persons” under RFRA they are also likely “persons” under RLUIPA. As Justice Ginsburg points out in her opinion quoting the SLLC’s amicus brief, this will have negative consequences for state and local government: “[I]t is passing strange to attribute to RLUIPA any purpose to cover entities other than ‘religious assembl[ies] or institution[s].’ That law applies to land-use regulation. To permit commercial enterprises to challenge zoning and other land-use regulations under RLUIPA would ‘dramatically expand the statute’s reach’ and deeply intrude on local prerogatives, contrary to Congress’ intent. Brief for National League of Cities et al. as Amici Curiae 26.”
The SLLC’s amicus brief focused exclusively on how “person” should be defined in RLUIPA. It discussed at the practical difficulties that will arise for state and local governments if corporations are “persons” under RLUIPA. “Interpreting RLUIPA to protect for-profit, secular corporations would dramatically expand the statute’s reach. For-profit corporations could avail themselves of RLUIPA’s broad definition of religious exercise to characterize secular commercial activity as religious in nature. They would have an incentive to do so to gain a competitive advantage in the marketplace. The likely result would be a dramatic increase in the number of for-profit corporations claiming to engage in ‘religious exercise,’ with a concomitant increased burden on local governments administering land use regulations.”
The National League of Cities, the National Association of Counties, the International City/County Management Association, the United States Conference of Mayors, and the International Municipal Lawyers Association signed onto the SLLC’s brief.
About the author: Lisa Soronen is the Executive Director of the State and Local Legal Center and a regular contributor to CitiesSpeak.
This is the fourth post in NLC’s 90th Anniversary series.
The “get tough on crime” movement, emerging in the late 1960s and early 1970s led to enormous increases in drug arrests, longer prison sentences with mandatory minimums, more punitive juvenile justice sentencing and greater incarceration of juveniles, low-income individuals and people of color.
According to the Bureau of Justice Statistics (BJS), about 6.98 million people were under some form of adult correctional supervision in the U.S. at yearend, 2011. This is the equivalent of about 1 in 34 adults – or about 2.9 percent of the adult population – in prison or jail, or on probation or parole.
By the end of 2012, there were around 1.35 million people incarcerated in state prisons, 217,800 in federal prisons and 744,500 in local jails. From 1998 to 2009, the state cost of mass incarceration of criminals increased from $12 billion to $52 billion per year.
Today, there is movement to reform the criminal justice system and reverse the trend of mass incarceration of nonviolent and drug related offenders. Federal, state and local leaders are looking for innovative ways to reduce the costs of criminal justice and corrections by keeping low-risk, nonviolent, drug involved offenders out of prison or jail, while still holding them accountable and ensuring the safety of our communities.
The Administration, Congress and many states are enacting new policies to slow the growth of prison populations and even downsizing corrections systems to save hundreds of millions of dollars.
Impact of Reform on Cities
As federal and state sentencing reforms begin to take shape, cities and towns will most likely see a considerable rise in the number of former nonviolent criminals returning back home.
According to the Office of National Drug Control Policy over 9 million ex-offenders cycle through local jails and nearly 700,000 ex-offenders are released from state and federal prisons every year back into their local communities. This number is expected to go up dramatically as sentencing reform takes place. Without sufficient federal and state support for local programs aimed at transitioning ex-offenders back into the community, cities may see a rise in crime levels which will lead to an increase in recidivism rates.
The BJS estimated two-thirds (68 percent) of the 405,000 prisoners released in 30 states in 2005 were arrested for a new crime within three years of release from prison, and three-quarters (77 percent) were arrested within five years. More than a third (37 percent) of prisoners who were arrested within five years of release were arrested within the first six months after release, with more than half (57 percent) arrested by the end of the first year.
Support to Prevent Recidivism
While experts agree that sentencing reform is needed for nonviolent, drug related and juvenile delinquent crimes, there is also a need to increase the level of funding and support for programs to prevent recidivism.
The Second Chance Act (SCA), signed into law on April 9, 2008, was designed to improve outcomes for people returning to communities after incarceration. The legislation authorizes federal grants to local governments and nonprofit organizations to provide support and services to reduce recidivism.
In accordance with the SCA, in 2013, the Department of Justice awarded $62 million in competitive and supplemental grants to 112 state, tribal and local governments and non-profit organizations to reduce recidivism, provide reentry services, conduct research and evaluate the impact of reentry programs.
Grant programs authorized by SCA could get additional funding to support local government efforts to reduce recidivism, but only if the federal government does not divert the money saved from reducing prison populations to deficit reduction or other efforts.
Role of Local Elected Officials
There are a number of barriers that prevent young nonviolent ex-offenders from becoming productive members in their communities, including drug and alcohol addiction, mental illness, unemployment and homelessness. Once in the criminal justice system, many of these young people will have criminal records that will last for decades, if not the rest of their lives.
When they are released from prison, many of them have difficulty finding a job and a place to live, and most return to a life of crime because of the lack of opportunities. Thus, the cycle of recidivism continues, creating challenges and missed opportunities not only for themselves and their families but for the cities in which the live.
Mayors and council members across the country are looking at ways to support local programs that help ex-offenders re-enter into society. One of the key challenges is to create an equitable and sustainable system that will provide opportunities for nonviolent ex-offenders to find jobs and affordable housing. More than 60 cities and 12 states across the country have instituted policies that would ban the box on employment applications asking individuals about their conviction history.
Municipal officials play a vital role in reintegrating ex-offenders back in society. They manage key functions of local government that are essential to breaking the cycle of recidivism, including law enforcement, jails, health and human services, housing authorities, workforce development boards, after school programs, and community development programs. They also play a vital role in bringing together key stakeholders, community leaders, and faith-based organizations that provide many of the social services that are needed by ex-offenders.
The Urban Institute put together the Elected Official’s Toolkit for Reentry (2011) to help local elected officials develop successful reentry programs for ex-offenders. In addition, The Annie E. Casey Foundation, U.S. Department of Justice and the U.S. Department of Labor published the Council of State Governments White Paper titled the Integrated Reentry and Employment Strategies: Reducing Recidivism and Promoting Job Readiness.
Need for Federal Action
There is movement in Congress to pass legislation that will allow a pathway to sealing criminal records of adult nonviolent ex-offenders and sealing and expunging juvenile records to make it easier for ex-offenders to apply for employment. Citing the need to embrace bipartisan solutions that lessen the taxpayers’ burden and increase public safety, U.S. Sens. Cory Booker (D-NJ) and Rand Paul (R-KY) introduced S. 2567, The REDEEM Act (Record Expungement Designed to Enhance Employment).
Additional policy changes are being considered by federal, state and local leaders that would lift the ban on certain benefits for low level drug offenders who may need medical and substance abuse treatments and examine policies that may prevent these ex-offenders from finding affordable housing.
On January 2011, Attorney General Eric Holder also convened the Federal Interagency Reentry Council with the purpose of removing federal barriers to successful reentry, so that ex-offenders who have served their time and paid their debts are able to compete for a job, attain stable housing, support their families, and contribute to their communities.
NLC continues to work closely with other local and state government organizations to support federal policies such as the Second Chance Act to help municipalities develop successful and sustainable programs aimed at reducing recidivism and reintegrating ex-offenders back into the community.
About the Author: Yucel (u-jel) Ors is NLC’s Program Director of Public Safety and Crime Prevention. Through Federal Advocacy, he lobbies on behalf of cities around crime prevention, corrections, substance abuse, municipal fire policy, juvenile justice, disaster preparedness and relief, homeland security, domestic terrorism, court systems and gun control. Follow Yucel on Twitter at @nlcpscp.
After working with 12 cities for the last six months as they developed outreach and enrollment campaigns to increase enrollment in Medicaid and CHIP, we are excited to announce that we have selected 8 cities to continue on to the third and final implementation phase of our Cities Expanding Health Access for Children and Families initiative.
With support from the Atlantic Philanthropies, NLC will award each city up to $260,000 as well as provide technical assistance over the next 18 months as they implement outreach and enrollment campaigns developed during the six-month planning phase of this initiative.
While each community is unique, each is dealing with a common challenge: children and families who are eligible for, but not enrolled in, Medicaid and CHIP. Recognizing the important role that city leaders have and the valuable steps they can take to increase enrollment in these programs, selected cities have crafted comprehensive campaigns involving key city leaders in partnerships with community organizations, schools and health care providers.
The campaigns aim to reach populations that have been the most difficult to enroll and increase their enrollment in and utilization of Medicaid and CHIP. With all of the attention from the Affordable Care Act on marketplace enrollment and deadlines, it is important to remember that there is no deadline for enrollment in Medicaid and CHIP; enrollment is available 365 days a year!
As city teams that were part of the planning phase assessed the barriers in their communities for families to access the health coverage they need and deserve, they learned that with greater knowledge about community needs and the existing gaps in service, they can custom design outreach and enrollment campaigns that have a significant impact on increasing health care access for children and families in their communities.
Dallas, Texas: Healthy Children in a Healthy Environment
Coordinated by the city’s Housing and Community Services Department, Dallas’ campaign focuses on training staff to become enrollment assistors and coordinating and consolidating existing enrollment efforts in order to increase effectiveness.
Garden City, Michigan: Healthy Kids-Healthy Families
The city’s Community Resource Department will coordinate the Healthy Kids-Healthy Families campaign to increase awareness and understanding of Healthy Michigan – the state’s Medicaid and CHIP program – and to provide assistance with enrollment, utilization, and re-enrollment. The department will become the entity for enrollment and re-enrollment assistance in the community. City staff and community partners will provide increased enrollment assistance throughout the community and will utilize a social medial campaign and trusted community members to spread their message about the importance of coverage.
Hattiesburg, Mississippi: E3: Educate, Enroll, Empower Health Initiative
Implemented through the mayor’s office who will work in partnership with community partners and agencies to help promote a healthy lifestyle, the E3 (Educate, Enroll, Empower) Health Initiative focuses on three main strategies to reduce the number of uninsured families and to increase retention rates. Plans include: educating families about opportunities for obtaining and retaining coverage; enrolling and recertifying families and children into Medicaid or CHIP; and empowering families to re-enroll on their own.
Jacksonville, Florida: Cover Jacksonville
The city’s first ever mayor-appointed Health Commissioner working in partnership with the Jacksonville Children’s Commission and community partners will lead the Cover Jacksonville campaign. The campaign will focus on: building the community’s capacity by providing training and increasing enrollment assistance; raising awareness about public insurance options and promoting a culture of health; establishing a single point of access for enrollment information and assistance; and identifying and assisting uninsured children through a partnership with Duval County Public Schools.
New Bedford, Massachusetts: Health Access Kids New Bedford
The New Bedford Health Department will lead the Health Access Kids New Bedford campaign in partnership with New Bedford Public Schools (NBPS) and community partners. In addition to reducing the number of eligible but unenrolled children and families, the campaign aims to establish a sustained culture of health quality, literacy, and advocacy in the city. Identifying as the target population NBPS students and their families with low levels of health literacy, the campaign will implement an outreach and marketing campaign to build awareness, and utilizes Community Health Workers to provide individual enrollment assistors and serve as Health Access Specialist navigators.
Pittsburgh, Pennsylvania: Healthy Together
The Healthy Together enrollment campaign complements Mayor Peduto’s Live Well Pittsburgh initiative which aims to achieve 100% coverage for Pittsburgh’s youth. The campaign will utilize three main strategies: embedding enrollment efforts into the core strategy of the Mayor’s administration; implementing outreach strategies led by the Mayor’s office and in partnership with community organizations; and establishing a referral system between schools and enrollment assistance agencies. Recognizing the role of mayors and city leaders in spreading the message of coverage and health access, Healthy Together incorporates a clear role for city leaders and trusted community members in the planned outreach and enrollment events.
Providence, Rhode Island: Healthy Providence
Having identified the existing barriers to enrollment for their city’s residents, the Healthy Providence campaign – led by the mayor’s Healthy Communities Office – focuses on new outreach strategies to reach their eligible but unenrolled population, with plans to serve as an enrollment facilitator for those identified. The campaign strategies include: institutionalizing health coverage assessment and enrollment with school-based outreach; partnering with youth-based organizations to create peer-led outreach efforts; fortifying effective community-based outreach and enrollment efforts with trusted community members and organizations; and improving the enrollment infrastructure through statewide policy initiative support.
Savannah, Georgia: The Mayor’s Campaign for Healthy Children and Families
Emanating from the mayor’s office and including partnerships with Step Up Savannah, the city’s poverty reduction initiative, and other community partners, The Mayor’s Campaign for Healthy Children and Families seeks to increase enrollment in Georgia’s public health insurance programs – Right from the Start Medicaid (RSM) or PeachCare for Kids (PCK) – by enhancing and expanding enrollment assistance services and outreach activities. The plan includes utilizing the city’s 3-1-1 system as a central clearinghouse to link individuals with enrollment assistance, undertaking a broad social media marketing campaign to increase awareness of enrollment and renewals, and also a focus on policy advocacy and systems change.
We’re excited to share a sample of what the cities have in store, and we’ll be sharing more from each city in the coming days and weeks. We hope you’ll follow our progress as we move forward in this implementation phase and find strategies and ideas that you can mirror in your own cities!
About the Author: Dawn Schluckebier is an Associate for Family Economic Success in NLC’s Institute for Youth, Education, and Families.