Anticipated Changes To Agency Customer Base

The number of resident births in Virginia has grown over the past five years from 98,531 in 2001 to 105,822 (provisional data) in 2006 representing a 7.4% increase.

Teenage pregnancy rates for females overall (ages 10-19) are mirroring the national trend and have declined 26.8% from 36.2 to 26.5 per 1,000 females over the past ten years (1996 to 2005). The greatest decreases have occurred in rates for those under age 15 (47.4% decrease) and 15 to 17 year olds (46.6% decrease). Among 18 to 19 year olds, however, the rate declined over the same time period, but only by 6.5%. Rates for 18 to 19 year old White (Non-Hispanic) and Black (Non-Hispanic) females decreased by 29.3 and 19.4 percents, respectively. Among Hispanic (Any Race) females ages 18 to 19 the rates increased, however, by 51.6% during the ten-year time period. Rates for Hispanic teens (all age groups) are higher than for Black (Non-Hispanic) and White (Non-Hispanic) teens. The customer base for teenage pregnancy prevention is therefore becoming more narrowly defined.

The economic outlook for children and families is mixed: the percent of children (under age 19) in Virginia living at or below 200% federal poverty level seems relatively stable based on three year averages (29.4% for 2002-04 and 2003-05) however for 2005 alone the percentage was 31.8%. The rate of children receiving Temporary Assistance to Needy Families (TANF) funds has stabilized at 27 per 1,000 children since major drops in the late 1990s following welfare reform, and the proportion of children receiving a free or reduced lunch has been stable at 33% for the past four years. Unemployment across the state has declined over the last three years to 3.0% in 2006 and ranges from 1.9% to 8.5% among localities. These statistics indicate that the number of children and families in need of assistance with health care access and financing is likely to stay stable or potentially increase if poverty levels (200% federal poverty level) stay at current levels or increase.
The number of eligible children enrolled in public health insurance programs increased significantly between 2001 and July 2006 with a net increase of 159,000 enrollees. However, since new federal requirements requiring documentation of citizenship under the Deficit Reduction Act have been implemented, the number of children enrolled in FAMIS Plus (formerly Medicaid for children) has decreased by 11,000. It is estimated that the majority of children are in fact U.S. citizens and two-thirds were born in Virginia. Obtaining documentation, most notably for those born out of state, has caused delays in obtaining or renewing coverage. These administrative changes have impacted health care access with four out of ten children forgoing needed care and 18% having to use the emergency room for care during application delays. It is estimated that 8.8% of children in Virginia lack health coverage and that 96,000 could qualify for a publicly funded health insurance program. While the state has made considerable progress in reducing uninsurance among children, these developing factors are putting additional burdens on safety net services for children and government agencies with resulting delays in care. There continue to be issues with retaining enrollees, and concerns that families do not understand their insurance plans. The highest proportion of uninsured individuals in the Commonwealth (24%) is the group aged 19 – 24, which is a primary child bearing group. Hispanics and African Americans are more likely to be uninsured than Whites (39% and 20%, respectively for all persons under 65 years of age) and both have higher birth rates than Whites. The growing number of temporary and seasonal workers also contributes to the pool of uninsured parents. There will continue to be a need for safety net services for children’s health, as well as assistance with obtaining and understanding insurance benefits, and finding and using an effective medical home (a source of coordinated, ongoing, comprehensive, family-centered care from a health professional or team). In general, cultural and racial health disparities will continue to be a significant issue.

Only a little more than half of Virginia’s children with special health care needs (CSHCN) age 0 – 17 have an effective medical home. As CSHCN live longer, more productive lives, the need for adult health care services appropriate to their medical conditions becomes more significant, and more complex; assisting with transition to adulthood for these youth becomes a higher priority.

As of December 2005, local school divisions provided special education services to over 175,000 children with various disabilities. The number of CSHCN in schools is expected to continue to increase, with greater expectations for clinically skilled responsiveness by teachers, administrators, and school nurses.

The number of children being cared for outside the home is growing rapidly; the number of childcare slots in licensed day centers increased from 181/1000 in 2000 to 256/1000 in 2004. However, the younger the child, the less likely a slot is available; fewer than 50% of licensed child care facilities accepted children under two years of age in 2004. This does not account for unregulated childcare, licensed family day homes, and homes that are approved locally. Over sixty percent of children under the age of six are in circumstances where all of their parents (biological, by remarriage) are working. The need for assuring healthy and safe environments for out-of-home care is therefore increasing, with more customers in childcare settings.