Twice in two years, Ohio has been rewarded for its continuing efforts to provide health coverage and better care for low-income children. The Department of Health and Human Services awarded the state a $21 million performance bonus last month. Ohio, one of 23 states to share in $296 million of federal money, was similarly applauded with a $12 million bonus in 2010. The awards acknowledge the effectiveness of Ohio's practices. As important, it is a recognition of the foresight demonstrated by state leadership in striving to ensure that poor children receive a healthy start -- even in difficult economic times.Thousands of Ohio children who qualify to participate in Healthy Start, the state's Medicaid program for children up to age 19, are not enrolled. Some of that failure stems from parents' lack of awareness. Still, studies indicate factors such as eligibility rules and a cumbersome application process pose significant barriers to enrollment.Early in 2010, when Kathleen Sebelius, the secretary of health and human services, issued a nationwide challenge to increase access to health care for children, then Gov. Ted Strickland began simplifying the enrollment process. Children receive coverage for a full year to prevent being dropped from the program if the family's income changes during the year. Hospitals and community clinics also are able to decide eligibility, reducing delays in access to care. The state no longer requires separate face-to-face interviews.John Kasich has sustained the effort, the new bonus reflecting continued leadership in enhancing access to health care for low-income children.