The Texas Department of Insurance recently finalized rules that require “navigators” to register with the state and take additional training. CPPP chronicled the changes made in the final rule and questions moving forward in a new policy page.
Navigators under the Affordable Care Act are organizations and individuals who are trained, certified, and funded by the federal government to help people enroll in coverage options through the Health Insurance Marketplace, including private insurance, Medicaid and CHIP. Insurance is difficult to understand, especially for people who haven’t had it before. Navigators provide in-person help—answering questions, deciphering plan options, and helping people enroll. Their help is crucial in a place like Texas, with more than 6 million uninsured individuals.
Changes in the Final Rule
The proposed rules for navigators proved contentious. Advocates raised concerns that the proposal would be expensive and prevent navigators from helping consumers compare the benefits of different plans in the Health Insurance Marketplace. The Texas Department of Insurance (TDI) held two public hearings on the rules and sifted through nearly 300 pages of comments. In the end, the final rule was much improved, but the aggressive timelines in the final rule present challenges for navigators and TDI alike. TDI removed the prohibition related to comparing benefits, took steps to reduce the cost of training, and clarified limits on the use of the term “navigator” (people who serve as patient navigators or cancer navigators will still be able to use the word “navigator” in their job titles without running afoul of the law).
The rule, which took effect on February 10, requires many organizations and individuals who help consumers apply for or enroll in coverage through the Marketplace to:
- Complete registration with the Texas Department of Insurance by March 1. Navigators will undergo fingerprinting and a background check as part of registration.
- Take 20 hours of state mandated training by May 1, 2014. This extra state training is required on top of the 20-30 hours of federal training provided to federally grant-funded navigators
Certified Application Counselors are exempt from the new rule, as are organizations and individuals who are performing application assistance under state law or federal law, other than the Affordable Care Act. The flowchart on page 6 of our report can help organizations and individuals who provide application and enrollment assistance determine whether and how they are subject to the new rule.
Update on Registration
Both navigators and the Texas Department of Insurance have been working diligently to ensure navigators come into compliance according to the rule’s very tight timeline. Some navigators reported initial challenges accessing the state’s electronic fingerprinting process. But leading up to March 1, all federally grant-funded navigator organizations report having submitted their organization’s registration materials and registration materials for most or all individual navigators as well. TDI reports quick turnaround times when processing complete applications, and TDI staff worked over the weekend of March 1-2, to help ensure applications submitted near the deadline were not held up.
TDI’s rule leaves it up to private vendors or navigators themselves to create, get certified through TDI, and deliver training to navigators statewide. The next challenge will be ensuring that training is available to and completed by navigators across the state by May 1, 2014.
Written by Stacey Pogue, Center for Public Policy Priorities. Cross-posted from Better Texas blog.
Do you want to help spread the word about the March 31st deadline enrollment? Below are resources, images, in Spanish and English, and sample tweets you can share with your networks. With only a few weeks left before the enrollment deadline, all hands on deck are needed to help connect Texans with their new health care options, and your help is appreciated and necessary. Thank you!
A list of helpful tools consumers can use to help guide them through the process of enrolling in coverage:
- Enroll America has a Get Covered Calculator, which is free, easy to use, and provides realistic cost estimates for new coverage. If you’d prefer free, in-person application assistance, you can use the Get Covered Locator tool to find enrollment sites within 25 miles of your zip code.
- On our website, we have a guide with helpful tips on how to protect yourself from health insurance scammers and identity thieves. Most people will not encounter any fraudulent activity, but it’s is important to be informed of the risk and of ways you can protect yourself.
- A new resource, Financial Help for Health, features stories of people who have enrolled through the Marketplace and are saving hundreds of dollars on their monthly insurance premiums through tax credits. The website has a tool that explains the tax credit and how to use it.
- Visit Healthcare.gov or call 1-800-318-2596 for help with the enrollment process.
Sample Tweets (Copy and paste tweets as they are, or feel free to modify them however you’d like.)
You may be eligible to receive financial assistance to pay for health coverage! Find out here: www.healthcare.gov #LetsEnrollTX
The enrollment deadline is March 31st. Connect with affordable health care options here: www.healthcare.gov #LetsEnrollTX
El 31 de Marzo es el ultimo dia para comprar un seguro medico en el nuevo Mercado. Vaya a www.cuidadodesalud.gov
Enrollment Deadline Images (Right click and save the images to your computer to share on social media and elsewhere.)
In a short month’s time, the number of Texans who have selected a healthcare insurance plan through the Marketplace has increased by 57% — from 118,532 Texans in January to 207,546 enrolled in February, according to a new study released this month by the Department of Health & Human Services.
This increase in enrollment was accompanied by a notable increase in the proportion of young adults (ages 18-34) who have selected a Marketplace plan. The percentage rose from 24% to 27% over the last month. Along with the age group of ages 55-64, young adults now have the highest percentage of Marketplace enrollees. According to the Department of Health & Human Services, this growth has been consistent with expectations.
Other notable characteristics of Texans who have selected a Marketplace plan included:
- 56% Female
- 44% Male
- Plan Selections
- 62% Silver
- 21% Bronze
- 11% Gold
- 4% Platinum
- 1% Catastrophic
- Young adults (18-34) were the largest age group selecting this plan
- Financial Assistance (subsidies)
- 51% of Texans eligible to use Marketplace are also eligible for financial assistance
- 79% of Marketplace-enrolled Texans received financial assistance
- Increase from 74% in January
- 21% purchased plans without any assistance
- Medicaid/CHIP eligibility
- 80,368 determined eligible by Marketplace
Despite increases in Texans receiving healthcare, these 207,546 Texans who have selected a health plan through Marketplace are only 35% of the 586,342 Texans who applied and were found eligible to enroll. We can only conclude there is still work to be done, much of which will begin with educating Texans about the options available to them with the Marketplace.
Fortunately, Texans have mobilized across the state, advocating for healthcare expansion and educating the public about options currently available to them. Organizers like Enroll America and partners of the Texas Well and Healthy campaign have made it their mission to help Texans find coverage and to answer questions about finding local Marketplace navigation assistance. With the number of Texans selecting Marketplace health plans increasing exponentially each month, we are optimistic that the number of insured Texans will continue to grow.
Marketplace open enrollment for 2014 is nearing its end on March 31, 2014, but passionate Texans will continue to push for education and awareness of the opportunities available through the Marketplace. When Marketplace enrollment opens again on Nov. 15, 2014, even more Texans will be ready to select a Marketplace health plan for their families.
The recent reforms to the healthcare system have allowed millions of previously uninsured Americans access to affordable healthcare. Unfortunately, changes to any system can result in a lot of confusion, which scammers and identity thieves can use to their advantage. While most people will not encounter any fraudulent activity, it is important to be informed of the risk and of ways you can protect yourself.
How to protect yourself
- Be informed. People who are unaware of basic elements of the new Health Insurance Marketplace can easily become victims of fraud. Check out these websites for information about health coverage and for guides to the Marketplace:
- Make sure websites are true and secure. Scammers can set up fake websites that may look like real health insurance websites or marketplaces that they can use to collect your personal information from you. You should always be sure to check that any website in which you enter personal information is true and secure. You can do this by checking to see that there is a locked padlock sign to the left of the site’s web address in the address bar. You can also check the security of the page by checking to see that the beginning of the web address is https:// rather than http://. You should also check that the insurance company you are buying from is trustworthy and licensed in Texas by using the Company Lookup feature on the Texas Department of Insurance website: https://apps.tdi.state.tx.us/pcci/pcci_search.jsp.
- Never give personal information to anyone you don’t know or aren’t certain you can trust. Insurance companies do not usually come to you so be cautious of any one that does. Never give your personal information (social security number, etc.) to anyone that you did not contact yourself first.
- Verify that calls from the Marketplace are authentic. Sometimes a representative from the Marketplace may call you asking for additional information for your application. If they do, write down their full name and agent ID and make sure that the number that called you is one of these:
- Health Insurance MP
Marketplace representatives will not ask you for personal financial information (bank names and account numbers) or about personal health information. If you do not feel comfortable answering any of their questions over the phone, ask the representative to mail you their inquiries instead.
- Don’t fall for tricks and double check fishy information or requests. Scammers may try to convince you that you owe them money for their help, that you must pay a tax penalty, that you must have an insurance card, or that being without health insurance is a crime for which you can go to jail. None of these things are true. Official Marketplace assistants provide their services free of charge and will not call or bill you for a tax penalty. Similarly, you will not go to jail for not having health insurance and you are not required to have an insurance card.
- Take your time. Always take your time when making a decision and ask questions when you don’t understand something and take notes.
- Stand up to pressure. Scammers may pressure you to purchase their insurance plans even if you already have one. If you already have comprehensive health coverage then there is no need for you to change plans if you do not want to. Be cautious of anyone who insists that you do.
- Collect important information. Write down names and contact information of the people you talk to.
- Always read what you are signing before you sign it. And make sure that you fully understand what you are signing as well.
Who should you listen to?
Applying for health coverage can be very confusing. Luckily, there are people out there who can help. Navigators and Certified Application Counselors are certified by the federal government and registered insurance agents and brokers who have been licensed through the Texas Department of Insurance are trained to protect your personal information and to help guide you through the insurance marketplace free of cost. You can trust them to provide accurate information about the process. You can verify whether a health insurance agent or broker is licensed in Texas using the Texas Department of Insurance’s Agent and Agency Search feature: https://txapps.texas.gov/NASApp/tdi/TdiARManager.
What to do if you suspect you have been a victim of fraud
If you are contacted by a suspicious person or suspect any fraudulent activity, you can call any of these numbers:
Texas Department of Insurance Helpline: 1-800-252-3439
The Health Insurance Marketplace: 1-800-318-2596
Or your local police department: 9-1-1
Additionally, you can file a complaint online at any of these websites:
TDI Fraud Unit: http://www.tdi.texas.gov/fraud/
FTC Complaint Assistant: https://www.ftccomplaintassistant.gov
Written by Catherine Samuel, Children’s Defense Fund-TX.
This commentary by Texans Care for Children staff appeared in the Austin American-Statesman on February 2, 2014.
As the deadline to enroll in the new Health Insurance Marketplace gets closer, many are asking whether the youngest consumers will opt for coverage. People between the ages of 18 and 26 are some of the most likely to go uninsured. They also are the group most likely to suffer an injury or death at the wheel and are likely to experience mental health concerns, addiction, violence and STDs.
In other words, young people need to see a doctor as much as any of us do. What stands in their way, especially in Texas, is opportunity.
Undeniably, there is a lot of buzz right now around the new health care law. Here are some key points we keep hearing:
- If you’re between the ages of 19 – 64 and don’t have health insurance, visit Healthcare.gov to find competitively priced coverage options that meet your needs and budget;
- The open enrollment period ends March 31, 2014. Don’t delay;
- Most people qualify for financial assistance to help lower their cost.
Knowing how and when you may qualify for affordable health coverage is important information. There is one crucial point not listed above, though, that we want to highlight for families:
For Texas families with children under age 19 who earn between 138% – 200% of the federal poverty level, (i.e. a family of four earning between about $32,500 – $47,100), the March 31st enrollment deadline does not apply to their children. Stated another way, children who qualify for health care coverage through CHIP or Children’s Medicaid may apply any time throughout the year, and they can do it here. [Note: Parents of children deemed eligible for CHIP must still apply for coverage for themselves through the Marketplace by March 31.]
Helping families understand and navigate the often challenging, confusing process of getting health care, especially for their kids, is important work. And, it takes a community to make an impact. One great example of community players working together to make a real difference is the 15-year partnership between the organization CDF Texas and the Texas grocery chain Fiesta Mart Inc. Together, they raise awareness and increase enrollment in CHIP and Children’s Medicaid through outreach at Fiesta supermarkets. Meeting families where they live, learn, work, and in this case, shop for food, has proven to be quite an effective strategy in reaching eligible uninsured children and connecting them to coverage.
The partnership between CDF Texas and Fiesta, which has enrolled tens of thousands of our state’s uninsured children in Medicaid and CHIP, and has been recognized as a national best practice, is the featured subject of this new short video by the Centers for Medicare and Medicaid Services.
The video speaks to the important role businesses can have in building up not only the economic prosperity of a community, but in lifting up the health and wellbeing of children and families, too.
“We were shopping for beans and rice and came out with health insurance!” is a really great line. But, don’t take our word for it, watch for yourself, and share it on Facebook or Twitter to spread the word about an effective solution to getting more children and families covered.
Written by: Anat Kelman Shaw, Communications Director, Children’s Defense Fund-Texas
Editor’s note: Clayton Travis is a volunteer with Insure Central Texas, assisting Texans with enrollment in the new Affordable Care Act Health Insurance Marketplace.
Ava’s* second visit to the Foundation Communities’ Insure Central Texas enrollment site was when she started to really understand the opportunity of health coverage. Speaking only Spanish, she said she was there for her pre-scheduled appointment. The week before, Ava had come in curious about her health insurance options under Obamacare. While on that first visit she had been eager to create her own personalized account and compare plans, the early glitches on the federal Healthcare.gov site had prevented her from doing so.
This time she worked directly with the volunteer staff at Insure Central Texas who answered her questions and helped her estimate what subsidies she and her husband might receive for insurance in the Health Insurance Marketplace. Healthcare.gov worked intermittently, but Ava remained resolved and pledged to come back once the site was fully functioning. She – like many Texans – realizes the importance of health coverage for her whole family. It took a third visit, but eventually Ava was able to get covered.
The Affordable Care Act’s rollout of the Health Insurance Marketplace was marred by early technical glitches that impeded many Texans in accessing the federally facilitated portal. However, states that had opted to set up their own programs had fewer challenges. In California and New York, states that set up state-based Marketplaces, tens of thousands of residents completed insurance applications in just the first week of operation.
Texas could have been one of these examples. Instead, Governor Perry made it clear Texas would not participate in the creation of its own Marketplace, defaulting to the federally facilitated marketplace. Ava and hundreds of thousands of uninsured Texans and millions across the nation wound up all needing to use the same federal site at once as a result. An entire country’s pent-up demand for health coverage was pretty overwhelming, but the site is working today and the open enrollment period continues through March.
What has become clear is that uninsured Texans, eager to find care, remain undeterred by these challenges. The release of this month’s Health Insurance Marketplace data shows nearly half a million Texans have applied for coverage in the ACA Marketplace – 118,532 of whom have selected a plan and will have coverage starting February 1st. 74 percent of those who selected a plan received financial assistance to lower the cost of their monthly premiums. Furthermore, 47,000 Texans who applied through the new Marketplace have been determined eligible to enroll in the state’s existing Medicaid or CHIP plans.
During this critical window of opportunity, there are a few things uninsured Texans and those offering them assistance should know:
1) The last day of open enrollment for 2014 is March 31st with coverage beginning in April. If you sign up before March 31st and in the first half of the month (1st – 15th) your coverage will begin the first day of the following month. If you enroll in the end of the month (16th – end of month) your coverage will kick in the first day of the following month.
2) The website isn’t the only way to gain health coverage under the Affordable Care Act. The Healthcare.gov call center can help, too, and wait times are low. Families can go through the entire process of creating an account, comparing plans, and enrolling in health coverage by calling Call 1-800-318-2596.
3) If you do use the website, allow time to compare and shop. Once you set up an account, identify the area you live in, and determine what type of coverage you are looking for, plans will be outlined by price. Then you can see various price reductions available, due to subsidies and varying coverage levels. Like Ava, you might opt to go to talk someone in your area to help walk you through the ins and outs of various plans in your price range and get you ready to purchase through the Marketplace.
Health insurance plans have never before been so clearly laid out in one place. Families can discover coverage options that will fit their needs and at an affordable price – safeguarding them against medical bankruptcy and providing financial stability and reassurance. Ava and countless Texas families know this peace of mind was worth the wait.
*Names have been changed.
Written by Clayton Travis, Hogg Foundation Mental Health Policy Fellow for Texans Care for Children.
Last week, the Texas Department of Insurance released proposed rules on “navigators”—community organizations like the United Way that help uninsured people apply for health insurance. As proposed, the rules could prevent or delay the important work of navigators. Fort Worth Star Telegram editors agree, noting that the rules will impede insurance enrollment and hinder progress on reducing Texas’ worst-in-the nation uninsured rate.
But, there are many good provisions in the rules as well. They could work as intended—to increase consumer protections without hindering the vital work of trained and certified navigators—if the department modifies the proposed rules to address the key concerns listed below.
The rule could prevent a navigator from helping consumers understand and compare the benefits so that consumers can make an informed insurance choice. Explaining and comparing the features of different health plans (the premium, deductible, provider network, covered medications, etc.) is NOT the same thing as recommending a consumer buy a specific plan. Navigators need to be able to help consumers compare and understand insurance options, without recommending which plan to purchase.
The rule could shut down navigator services as of March 1, when demand will spike in the final month of open enrollment. As proposed, navigators must comply with the rule by March 1, 2014. Once the rule is final, navigators could have just a month (or less) to jump through many hoops. This timeline is too short for navigators to accomplish at least two time-consuming, bureaucratic necessities that are completely outside of navigators’ control:
1. obtaining advance federal permission to deviate from the navigator’s grant budget finalized back in August (processing takes 30-60 days), and
2. getting through TDI’s registration system (processing could take 2-3 weeks).
When you combine these steps with the other hurdles navigators have to clear to come into compliance, the full process could take three months. The rules should ensure that navigators can continue to provide their vital services while they work in good faith toward compliance.
Nonprofit navigators will have to pay excessive and unnecessary fees for the privilege of providing free application assistance to the poor and uninsured. TDI estimated some of the various costs imposed for compliance could add up to to $900 per individual navigator, on top of an additional $1,400 per navigator organization. A navigator organization that oversees 30 navigators could incur about $30,000 in costs in the first year—possibly about enough to support a full-time navigator. Every dollar diverted from enrollment assistance leaves fewer resources to serve Texas’ 6.4 million uninsured.
The 40-hour state training requirement (on top of the 20-30 hour federal training requirement already fulfilled by Texas navigators) is excessive and unjustified. TDI’s rules require 60-70 hours of total training for ACA navigators, and the agency says extra state training will cost navigators $200-$800 per person. ACA navigators will be held to a much different standard than HHSC Medicaid/CHIP navigators and other community-based enrollment assistors, who perform very similar services. For example, it takes about four hours to complete the free HHSC navigator training that prepares community groups to help people enroll in Medicaid, CHIP and other programs through the Community Partner Program. Community Medicare counselors in HICAP (also certified by TDI) receive 25 hours of free training.
The rule applies well beyond navigator grantees under the Affordable Care Act. For example, the proposed rule would require a mother helping her young adult son with an application for insurance to first complete an expensive and time-consuming registration with the state. The rule would also prevent organizations and individuals who provide basic information on health coverage programs (including the ACA, Medicaid, or CHIP) from using the term “navigator” as a job title if they do not go through the state registration process. Many health care-related organizations use the term “navigator” today (like patient navigators and cancer navigators) to describe the individuals who help patients understand and connect with health care and coverage.
We have created a flowchart to help organization and individuals determine if TDI’s proposed rules will affect them, and we plan to release additional resources related to the proposed navigator rule over the next few weeks. Make sure to check our website for these updates.
TDI is accepting public comments on the proposed rule through January 6, 2014. Written comments submitted via email must be sent to both email@example.com and NavigatorRegistration@tdi.texas.gov. Or you can provide written or oral testimony at either of the two hearings TDI is holding on these rules in Austin on December 20 and January 6.
Written by Stacey Pogue, Center for Public Policy Priorities. Cross-posted from Better Texas blog.
Earlier this year, the Texas Legislature passed a bill to wind down the Texas Health Insurance Pool. The Texas Health Insurance Pool, or “high risk pool,” was created to provide coverage for Texans who were denied coverage due to pre-existing conditions. It has been a lifeline for thousands of Texans for more than a decade, but it has never been an affordable for most because state law sets the premiums twice as high as comparable private market coverage.
As we’ve explained previously, the high risk pool will no longer be needed in 2014, when for the first time, the Affordable Care Act prevent people from being denied coverage or charged more due to pre-existing conditions. Texans whose only option is pricey risk pool coverage today will be able to choose from any plan offered by any insurer in Texas for coverage effective January 1, 2014, and they won’t pay more because of their pre-existing condition.
Some risk pool enrollees have already secured coverage for 2014. Cancer survivor Bob Flood and his family paid $3,000 each month for coverage in the risk pool and have enrolled in alternate coverage for 2014 that costs less than $1,000 to cover the family. But not all of the 23,000 risk pool enrollees have enrolled in other coverage. The technology issues with healthcare.gov have kept many people, including risk pool enrollees, from being able to apply for subsidies and coverage in the Marketplace.
The Texas legislation closing the risk pool contains a contingency allowing the Texas Commissioner of Insurance to keep the risk pool open if Marketplace operations are delayed. The Department of Insurance announced on Friday that the pool coverage will be extended until March 31, 2014. This aligns the end of risk pool coverage with the last day for open enrollment in the Marketplace, and gives risk pool enrollees an additional 3 months to get other insurance in place and avoid any gaps in coverage.
Extending pool coverage through March 2014 will provide current enrollees with needed time to get detailed information on their coverage options, make informed choices, and to enroll through the Marketplace. Individuals can also enroll in plans outside of the Marketplace, which do not rely on a functional healthcare.gov website, but the only way low- and middle-income enrollees can secure premiums subsidies is through the Marketplace website or phone line.
Unfortunately, there could be some tradeoffs for enrollees with extended risk pool coverage. Risk pool coverage has high deductibles. The most popular risk pool plan has a $5,000 deductible (for an individual, not a family). Risk pool deductibles re-start each year in January. If an enrollee remains in the risk pool for the month of January, for example, they would face a full year’s risk pool deductible for January, and then start over with a whole new deductible if they select an new plan in February. Meeting two deductibles within one year could prove financially difficult for many enrollees, especially moderate-income ones.
Another issue is premium increases. While most of us are used to once-a-year hikes, premiums historically have increased twice a year in the risk pool so costs remain twice that of regular coverage. It is possible that risk pool rates could increase between now and the end of March.
CPPP and the National MS Society sent a letter to the department last week that outlines the affordability issues related to an extension of risk pool coverage and potential fixes. The board of the Texas Health Insurance Pool will likely meet soon to determine if and how to address these issues. The risk pool has been conscientious about communicating changing information to enrollees, providing accurate and timely updates to its members. I’m certain the risk pool board will thoroughly examine how to make the extension and ultimate transition of coverage work well for risk pool enrollees.
Written by Stacey Pogue, Center for Public Policy Priorities. Cross-posted from Better Texas blog.
A Georgetown University Center for Children and Families report released today found some surprising news for Texas children. Even though the state continues to have the most uninsured children in the nation, the Lonestar State has made real progress in covering kids, with about a quarter of a million fewer uninsured children than it had four years ago. In fact, no state has seen as large of a positive swing in the number of children with health insurance.
“This is good news for children and the state of Texas since health insurance coverage greatly improves the economic security of families who are faced with tough budget decisions on a daily basis,” said Laura Guerra-Cardus with the Children’s Defense Fund – Texas. “Investing in our children’s health today helps create a strong workforce tomorrow since kids with coverage show up to school ready to learn and stay in school longer.”
Between 2009 and 2012, the number of uninsured children in Texas dropped by about 4 percentage points, with an estimated 256,000 children gaining coverage, according to data from the Georgetown University research center. A new report on improvements between 2010 and 2012 attributes the gains to the success of Medicaid and the Children’s Health Insurance Program (CHIP) in reaching uninsured children.
“Medicaid and CHIP are examples of federal-state partnership programs that work,” said Joan Alker, author of the Georgetown University CCF report. “Together they are improving health insurance coverage for children and are a testament to what states can accomplish when they lean in and work with the federal government to meet the needs of their residents.”
The Georgetown University CCF report found that in the state of Texas, about 84 percent of children had coverage, which is not as high as the 98 percent coverage rate for seniors, but better than the coverage rate for adults ages 18-64 in 2012. About two-thirds of working-aged adults have health insurance. Many of these adults fall into the so-called coverage gap, which means they would be eligible for Medicaid coverage if and when Texas accepts federal funds to improve that vital federal-state partnership.
A national survey released along with the Georgetown University CCF report found that getting all children covered is important to Americans. Almost nine out of ten (88%) surveyed said they wanted all children in their state to get covered.
“The truth is, as of this fall, nearly every Texas family can find health coverage for their children that fits with the family budget, now that new options are opening up in the Health Insurance Marketplace,” said Clayton Travis with Texans Care for Children. “That’s good news for everyone, as more kids will be able to stay healthy, show up for school and get ahead in life when they have the coverage they need.”
Families interested in finding out if their children qualify for Medicaid, CHIP or financial support with a new health plan in the marketplace should visit HealthCare.gov or call (800) 318-2596.
For earlier data from 2009 and 2011, read the Georgetown University Center for Children and Families prior report here.
Written by: Christine Sinatra, Texans Care for Children. Cross-posted at State of the Children blog.