Linda Boyer, Acting Commissioner, OCSE

May is Mental Health Awareness Month, and I know this past year has been challenging for all of us. Personally, many of our families have experienced economic hardship and personal heartache. Professionally, states and tribes are still struggling from effects on their programs, including lower paternity establishment performance, limited access to courts, and technology challenges.

Yet amid these ongoing struggles, I’m heartened by the resilience of the child support program and how we’ve helped struggling families during the pandemic. States and tribes adapted to unforeseeable changes to keep providing services. Many moved to virtual meetings and court hearings, provided outdoor genetic testing, and enhanced online services to safely work with our customers.

Not only did our programs have to shift, but so did we. We quickly had to balance home and work life, and many parents had to become teachers overnight. This naturally caused stress and mental health challenges for many Americans. According to the Kaiser Family Foundation , over 41% of adults reported symptoms of anxiety and depressive disorder at the beginning of 2020, up from 10% in 2019. Stress from this pandemic has also caused Americans to have difficulty sleeping (36%), trouble eating (32%), and increased alcohol use and substance abuse (12%).

Mental health resources

You may have heard flight attendants advise passengers, “In the event of a change in cabin pressure, put on your own oxygen mask before helping others.” In order to be capable of helping others, we must ensure we are taking care of ourselves first. It’s important to acknowledge the stress we’re all under and to know when we need help. Here are several resources to consider when seeking mental health aid:

• National Institute of Mental Health : Find free mental health resources, including how to cope with the stress of COVID-19.
• Substance Abuse and Mental Health Services Administration : Find information on treatment centers and mental health services. You can search by location, language, youth treatment services, payment options, and more.
• National Suicide Prevention Lifeline : If you or someone you know is struggling with depression or thoughts of suicide, call 1-800-273-TALK (1-800-273-8255) to speak with a professional 24/7 and learn about free mental health resources.

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Centers for Medicare & Medicaid Services

From school closures to limited social interaction, children have experienced unexpected changes to their daily lives during the public health emergency, impacting their well-being and mental health. The Connecting Kids to Coverage National Campaign wants to remind you that kids and teens up to age 19 can receive free or low-cost health insurance through Medicaid and the Children’s Health Insurance Program (CHIP). These programs cover vital mental and behavioral health services , including access to counseling services, prescriptions, and substance abuse programs.

Mental health and COVID-19

Mental health disorders can first arise in childhood , causing serious changes in the way children typically learn, behave, or handle their emotions. This can lead to distress and problems getting through the day. Prior to the public health emergency, as many as 1 in 6 U.S. children between the ages of 6 and 17 had a treatable mental health disorder. With additional stressors such as lack of a routine, there has been a surge of anxiety and depression in young people since the start of the pandemic. Despite this surge, mental health services declined sharply among children age 18 and under  (PDF). Although telehealth visits have helped increase mental health services, these services have rebounded less than primary and preventive care services among Medicaid and CHIP beneficiaries.

Medicaid and CHIP help support children through early intervention and access to essential mental health services, both in person and virtually. As the public health emergency continues, it’s important to make sure children take advantage of these resources.

How to enroll in Medicaid and CHIP

Medicaid and CHIP enrollment is open year-round, allowing parents and caretakers to immediately sign-up and access benefits; coverage must be renewed annually. Eligibility varies by state and is based on household size and income, but professionals working with children can direct families to learn more through the “Find Coverage for Your Family” map on InsureKidsNow.gov or by calling 1-877-KIDS-NOW (1-877-543-7669). The website has shareable materials like social media posts, graphics, and short informational videos for parents and caregivers. You can also access helpful resources like FAQs, print materials, and toolkits to share information about the programs across different channels.

When children with mental health disorders get the support they need, they are better able to reach important developmental and emotional milestones. Together, we can promote enrollment in Medicaid and CHIP and encourage eligible families to take advantage of the mental and behavioral health coverage available to kids.  

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Awendela Dana, Program Coordinator, Penobscot Nation Child Support Agency, and Patricia Graffam, Program Coordinator/Advocate, Penobscot Nation Domestic Violence & Sexual Assault Advocacy Center

Did you know that more than 4 out of 5 Native women experience violence in their lifetimes? The murder rate for Native women is 10 times higher than the national average, according to a U.S. Department of Justice study. These disturbing statistics highlight the importance of the National Day of Awareness for Missing and Murdered Indigenous Women (MMIW) to bring a call for action that continues year-round.

Raising awareness in the Penobscot Nation

In Maine, the Penobscot Nation recognizes MMIW every year through a community walk to raise awareness about this issue and honor victims. Our Tribal Child Support Agency supports and participates in this walk organized by our Domestic Violence Advocacy Center. The domestic violence team meets regularly to plan the walk, secure funding from the Office of Violence Against Women, and coordinate marketing. They promote the event through social media, posters, and word of mouth.

Each May, approximately 30 to 50 people show up for the walk and help elevate this important issue. Everyone wears red, the official color of MMIW, and a local artist makes red dress earrings for attendees to wear. The event begins with a prayer, traditional drumming, and reading the names of missing and murdered Indigenous women. We are fortunate to not have any names from our tribe on the list, but we read names from other tribes to stand in solidarity with other communities. Then, step by step, we start our two-mile community walk around the reservation with banners to educate our neighbors.

In May 2020, social distancing and health guidelines prevented a community walk, but this did not stop our efforts. We turned the walk into a community caravan and continued to raise awareness.

Advocates call for better data collection

While the statistics are alarming, we unfortunately still do not know the full magnitude of the problem. Advocates say underreporting of missing and murdered Indigenous women is likely due to varied data collection at the state and federal level, poor recordkeeping, and racial misclassification. The Wabanaki Women’s Coalition, a group of advocates from all five Native tribes in Maine, leverage the energy from MMIW and travel to the Maine State House to raise awareness. The coalition hopes new laws will better coordinate data collection and information sharing between law enforcement agencies to protect Indigenous women.

These conversations and efforts at the tribal and state level are helping to elevate this issue in the national conversation. Through continued efforts, we are working to ensure our communities are safe for all Indigenous women.

For more information on this topic, visit the Coalition to Stop Violence Against Native Women .  

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Alice P. Jacobsohn, Esq., Government Relations, American Payroll Association

Child support agencies send the National Medical Support Notice (NMSN) to employers to order health insurance coverage for an employee’s children when it’s available and ordered by a court. Soon, OCSE will launch the electronic NMSN (e-NMSN) to allow states and employers to transmit these current paper forms electronically. Like the e-IWO, the e-NMSN will create efficiencies to support children and families.

The COVID-19 health and safety stay-at-home orders have made electronic communication critical for state child support agencies and employers. The “new normal” will not reverse the virtual communication trend; if anything, it will make virtual communication even more vital.

Cost, security, and efficiency benefits

Development efforts and priorities may impact states’ abilities to implement the e‑NMSN, but the reduction in administration, printing, and postage will help offset these costs. The standard NMSN is generally 10 full pages. With copies included, a state easily spends $0.70 to $1.00 to mail a single NMSN. Sending those same 10 pages electronically would provide considerable savings.

Using e-NMSNs will also bring an additional level of security. States and employers will no longer have to send personally identifiable information via mail. The e-NMSN allows for secure two-way communication between child support agencies and employers.

And perhaps the most important benefit to using the e-NMSN is the speed in processing these official forms. Being able to receive and respond to the form electronically is an efficiency not only for states and employers but also for families waiting for the medical support to be implemented. This means that eligible children will be enrolled in employer-sponsored health plans sooner.

Please keep an eye out for news about the launch of the e-NMSN in the coming months. For more information, contact OCSE’s Employer Services team at employerservices@acf.hhs.gov.

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