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Bar Journal - Spring 2007

KEEPING CHILDREN HEALTHY: The HNH Foundation Promotes Health Coverage and Healthy Lifestyles


I. Introduction

The HNH Foundation, celebrating its 10th Anniversary in 2007, has set a broad and ambitious agenda for addressing the health and well being of New Hampshire’s children in the coming years. While enjoying recent public attention for launching the Childhood Obesity Project — and funding enhanced activity and nutritional education at 28 New Hampshire elementary schools — the HNH Foundation has been a fairly quiet organization during its first decade. Quiet does not mean ineffectual, however, as the Foundation has been instrumental in bringing health coverage to children throughout New Hampshire.

The Beginning...
The HNH Foundation was formed as the result of the merger of Matthew Thornton Health Plan with Blue Cross/Blue Shield of New Hampshire. Incorporated in October of 1997, with assets of $11.8 million, the primary mission at inception was to promote access to health insurance for the citizens of New Hampshire, a goal that quickly became focused on children with the passage of federal legislation creating the State Children’s Health Insurance Program (SCHIP).

II. The SCHIP opportunity

The purpose of this federal funding was to provide a means for states to initiate and expand health coverage for uninsured children. Participating states had the opportunity to claim an enhanced federal reimbursement match rate of 65 percent. States were required to fund the remaining 35 percent.

HNH Foundation directors recognized the program as an opportunity to accelerate the impact of the Healthy Kids Program — already enrolling uninsured children throughout the state — and help fulfill the Foundation’s primary purpose.

But matching funds were required before New Hampshire could receive federal monies, and the state looked to the HNH Foundation to get the program underway. There was much debate about this request at the time. Would the state assume there would be a steady and dependable stream of funding from the Foundation in the future? Would the new Foundation be seen by the stakeholder community as using private charitable funds to meet a public funding responsibility?

The potential impact of establishing a New Hampshire SCHIP, and the fact that an effective enrollment platform was already in place (the Healthy Kids Corporation), persuaded the HNH Foundation board to fund the program. This decision impacted the next several years of the young Foundation’s grantmaking activity.

The Price of Success
The initial HNH Foundation grant of $350,000 to the New Hampshire Department of Health and Human Services leveraged $650,000 in federal funds, and a New Hampshire SCHIP was established. The program took off like wildfire.

In June of 1999, only 1,295 children were enrolled in SCHIP. By December 31 of that same year 6,488 children were enrolled! With this growth and success, came a new realization: the HNH Foundation could not continue to fully fund the state match and continue to exist. In 2,000 the Foundation committed approximately $950,000 to continue SCHIP, significantly dipping into core resources. This put the Foundation in a precarious position.

While the HNH Foundation was not willing to let the State Children’s Health Insurance Program fail, it was clear that the Foundation could no longer afford — by itself – to support the program if it was to survive.

During the 2001 legislative session, funding for the majority of the state match was appropriated by the Legislature. The HNH Foundation has continued to fund a portion of the non-federal match for New Hampshire SCHIP, but in an amount that is within the grantmaking budget. The HNH Foundation grant to the state remains, however, the single largest grant it makes each year ($250,000 in 2006).

The Work Involved in Covering All Children
The creation of the State Children’s Health Insurance Program was an extraordinary achievement, culminating in New Hampshire’s ranking of third in the nation for covering children (2003 Census Bureau Data). Today, there are approximately 70,020 children enrolled in the Healthy Kids Program (7,420 in SCHIP and 62,750 in Medicaid).

The Foundation has learned, particularly in recent years, that the remaining uninsured New Hampshire children — estimated at 17,000 — are very difficult to reach.

The Foundation’s support to the White Mountain Community Health Center in Carroll County, for example, was triggered by the 2000 census, which revealed this part of our state as having the highest rate of uninsured children in New Hampshire: 12.8 percent. The HNH Foundation made a multi-year funding commitment to help bring this number down to 5 percent over three years.

The HNH Foundation has also been working more closely with community-based health organizations in urban parts of the state to bring more minority children into the health care system. At Child Health Services in Manchester, for example, this support helped leverage national funding from the Robert Wood Johnson Foundation’s “Covering Kids and Families Initiative.”

III. Promoting healthy lifestyles: The HNH Foundation Childhood Obesity Project

When Foundation resources were no longer wholly committed to providing the non-federal match for SCHIP, new grantmaking activity became possible. But with new possibilities there were new challenges as well.

While eager to begin making a wider range of grants that supported the Foundation’s mission, purpose, and priorities, it became clear that Foundation funds remained comparatively small given the many issues and problems in our current health care system.

The Foundation Board of Directors made a commitment in early 2004 to focus on one or two strategically targeted health issues in setting grantmaking priorities, with the goal of benefiting the most people, and having a measurable impact. Reducing childhood obesity became the focus that same year.

The Foundation’s Childhood Obesity Project was initially motivated by emerging New Hampshire research, which indicated that an alarming rate of New Hampshire children were overweight or obese.

Soon after the announcement of the Foundation’s Childhood Obesity Project, the initiative received considerable media attention. Articles appeared in state and regional newspapers, and the story was also circulated by the Associated Press, which brought national attention to the Project and inquiries from organizations across the country.

Taking the lead
From 2004 through 2006, the HNH Foundation made grants to 28 New Hampshire elementary schools that had submitted proposals to implement a variety of programs to address student activity level, nutritional education, and healthy food choices. Individual grants, between $2,000 and $5,000 have been used to purchase pedometers (in conjunction with a walking program), purchase snowshoes to introduce snowshoeing as a healthy lifestyle activity, hold community nutritional fairs and parent education events, consult with registered dieticians, purchase salad bars for the cafeteria, purchase books and other educational materials to integrate nutritional education into the academic curriculum, and many other types of equipment, activities, and programs.

The Foundation also developed a formal evaluation process. The evaluation will ultimately enable the Foundation to determine the best models for addressing the issue of childhood obesity at the elementary school level, and inform program structure and implementation in future years.

Looking ahead
While the HNH Foundation will continue its commitment to expand health coverage for New Hampshire’s children, the organization is also increasing attention on the hard-to-reach children in our state who qualify for coverage under existing programs. The HNH Foundation is working with Governor John Lynch’s Citizens Health Initiative, which seeks to not only expand health coverage for children, but also to “tame the cost-drivers” that impact all New Hampshire residents.

Work is also underway to support a wider range of initiatives that address the Foundation’s childhood obesity project including convening partners to support the planning and implementation of a statewide healthy eating/active living action plan, promoting a public education campaign on the causes of obesity, developing a website to communicate information and make resources available to New Hampshire citizens and professionals interested in healthy lifestyles, and continue to educate the media on the impact of childhood obesity epidemic.

The HNH Foundation believes that promoting healthy lifestyles and access to health care for all New Hampshire’s children is not only a laudable goal, but also an achievable one. It is a goal within reach, and has an important impact on our social, economic, and cultural future.

For more information about the HNH Foundation, visit or call 603-229-3260.

If you are in doubt about the status of any meeting, please call the Bar Center at 603-224-6942 before you head out.

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