House Joint Resolution (HJR) 191 of the 1994 Session requested the Joint Commission on Health Care to study the feasibility of implementing a school-based health insurance program.

Approximately 900,000 Virginians, or 15 percent of Virginia's population, are uninsured. About one-quarter of Virginia's uninsured population is between the ages of 0-17 years. Research indicates that, compared to children with insurance, children without insurance are less likely to have a usual source of care and more likely to have hospitalizations which could have been avoided.

School-based health insurance is a relatively new initiative designed to provide coverage for school children with no other means of insurance. In these programs, uninsured children who are enrolled in school and not eligible for Medicaid can purchase comprehensive health insurance through the school-based program. The school systems play a key role in providing administrative support and in-kind services to the program.

New Hampshire and Florida have implemented school-based insurance programs. Florida is the only state which has enrolled children. In Florida, premium subsidies are provided for children based on family income. Florida's experience indicates that without subsidies, few children are likely to enroll. As such, subsidies are a critical element to the success of such a program.

Based on Florida's experience, the success of a school-based health insurance program in Virginia would depend on stable, long-term funding sources to provide premium subsidies. Funding alternatives include general fund appropriations, private donations, local government funding, and federal grant money. In addition, the success of such a program would depend on the level of administrative support provided by local school divisions.

The study offers two policy options for consideration. Option I would maintain the status quo. Option II would direct the Department of Education, in cooperation with the Bureau of Insurance and the Department of Medical Assistance Services to conduct further analysis to determine the level of interest among school divisions and families of uninsured school children, develop potential benefit designs and costs, and identify potential premium subsidies.