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Funding public health services through Health Services Initiatives (HSI)


Under Title XXI, Children’s Health Insurance Program (CHIP), states can design Health Services Initiatives (HSI) to improve the health of low-income children through both direct services and public health initiatives.

An HSI must directly improve the health of low-income children who are eligible for CHIP and/or Medicaid, but may serve children regardless of income. To the extent possible, the state should use an HSI to enroll eligible but unenrolled children in Medicaid or CHIP. An HSI can have an impact beyond the scope of a particular initiative to expand the state’s Medicaid/CHIP population and serve non-Medicaid children.

There are over 30 HSIs in more than 20 states to fund public health programs such as:

  • Immunizations
  • Lead testing and prevention
  • Newborn home visiting
  • Health screening 
  • COVID-19 and other communicable disease screening, diagnosis, and contact tracing

HSIs can be used to fund any public health initiative, as long as that initiative correlates to the improved health of at-risk children.

Examples of HSI funding

Targeted application
CMS approved an HSI for abatement activities following the lead exposure crisis in Flint, Michigan. The HSI provides coordinated and targeted lead abatement services for eligible homes of Medicaid- and CHIP-eligible children. Services funded through the HSI include the removal, enclosure, or encapsulation of lead-based paint and lead dust hazards; the removal and replacement of surfaces or fixtures, which can include water service lines and other fixtures identified during an environmental investigation as lead hazards; the removal or covering of soil lead hazards, and training to ensure there is a sufficient number of qualified workforce to complete the lead abatement activities.

It should be noted that HSIs are subjected to CHIP’s 10% administrative cap—a state cannot spend more than 10% of its CHIP program costs on administrative and HSI costs.  

Screening, diagnosing, and education for broad public health issues
Some HSIs are broad and can provide a public health agency with flexibility to address a wide variety of public health issues.

Public health agencies provide health-related services to children under the age of 19 in a wide variety of settings, including health department facilities, schools, preschools, day care centers, churches, community centers, homes and other settings. This type of HSI will cover services designed to improve the health of children under the age of 19, and/or increase the capacity of health services to children, regardless of the location where those services are provided. 

Eligible services include, but are not limited to: 

  • Health-related services including health education, screenings, maintenance of health records, basic nursing services, and referrals to other health providers
  • COVID-19 and other communicable disease screening, diagnosis, education, testing, and treatment
  • Opioid education and services conducted at the health department, other facilities, and schools
  • Injury prevention services, including review and education of services like car seat installation, use of bike helmets, fire safety, carbon monoxide detection, child locks, gun locks, and other activities to help prevent injuries 
  • Nutrition education and support, including but not limited to proper or good nutritional habits and food support programs
  • First aid classes
  • Education and support on emergency preparedness
  • Safe babysitter certification 
  • Inspection of tobacco and vaping licenses
  • Inspections of cafeterias
  • Communicable disease case investigation 
  • Communicable disease services, including, but not limited to:
    • Investigations
    • Screening
    • Education
    • Case management activities and support
    • Medicaid enrollment support
    • Contact tracing
    • Notification of parents/guardians, childcare providers, school health staff, and healthcare providers of the problem
    • Appropriate preventive measures
    • Exclusion of infected children and/or staff
    • Interviews of parents/guardians and staff regarding onset date and type of symptoms
    • Collection and analysis of specimens
    • Administration of antibiotics, vaccine, or immune globulin
    • Review of cleaning, sanitizing, disinfecting, and handwashing procedures
    • Review of food preparation or storage procedures

BerryDunn’s public health consultants can help to develop and implement an HSI that will allow you to use CHIP funds to pay for important public health services, including services to address the COVID-19 public health emergency.

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