1. Updated Hawaii Data
Our Evaluation Task Force revised the Hawaii Covering Kids home page using data calculated by the Hawaii Uninsured Project based on the 2005 Current Population Survey:
* approximately 5% of our children and youth are uninsured statewide...
* that means over 16,000 children and youth do not have health insurance...
* and 9,000 of those who are uninsured may be eligible for free public health insurance.
Mahalo for your hard work which has helped more children and youth enroll in health insurance programs!
2. Number of Uninsured Kids Grows in Minnesota
The number of Minnesota children without health insurance has grown by at least 8,000 in the past few years. The figures, collected by the Minnesota Department of Health, are included in a new report by the Children's Defense Fund Minnesota. The Children's Defense Fund says the trend is troubling because access to health care coverage is a key indicator of child well-being. The group says without insurance, kids are more likely to develop long-term health problems.
St. Paul, Minn. — Sixty-eight thousand Minnesota children were without health insurance in 2004. That compares to 60,000 uninsured kids in 2001, the last time the Department of Health collected the data. Jim Koppel, the executive director of the Children's Defense Fund Minnesota, says the spike in uninsured kids is most noticeable in the youngest age group. "There has been an increase of 11,000 children under the age of 5. The very youngest children in Minnesota have seen the most dramatic rise of all children," Koppel said. Koppel attributes some of the growth in this group to changes in state eligibility rules. Before 2003, he says newborns were automatically enrolled in Medical Assistance until age 2, if their mothers qualified for the program when they were pregnant. Medical Assistance is Minnesota's version of the federal Medicaid program. Koppel says lawmakers decided to cut off automatic enrollment at age 1, as a way to help balance the state budget in 2003. As a result, 3,800 kids were kicked off the program.
Koppel says many of those kids still qualified for the state's other subsidized health insurance program, MinnesotaCare, but he says many didn't realize it--in part because lawmakers cut the budget to promote MinnesotaCare. The number of enrollment forms to be filled out has tripled, and families now have to re-enroll every six months, rather than every year. "That's how you get rid of kids in coverage. That's how you cut participation. Just make it complicated," Koppel said.
Of the 68,000 uninsured kids in Minnesota, it's believed that more than three-fourths are eligible for public health insurance programs. Department of Human Services Commissioner Kevin Goodno says many of the eligibility changes were prompted by a desire to make the program more accountable. "What we want to do is make sure we're covering the kids that are uninsured, and not covering kids that already have good insurance in the private sector, by taking away some of those elements that were preventing the erosion from the private sector," Goodno said.
Goodno is referring to parents who decline their employer-sponsored health insurance to buy cheaper state-subsidized insurance. The state has a rule that if a family has access to employer-based insurance where the employer pays at least 50 percent of the premium, the family cannot use MinnesotaCare. On the complexity issue, Goodno agrees that enrollment paperwork can be daunting. He says the state is working on a project right now that would streamline the eligibility process by helping parents get connected with the right programs. But he says there's only so much the state can do.
"Parents do have to take responsibility for...coming into the counties or coming into our agency, and asking how they can cover their kids for health insurance. So there is some personal responsibility involved in all this as well," he said. Goodno says while he does think it's a serious problem that so many children are uninsured in the state, he points out that Minnesota is doing well compared to other states. He says the state has one of the lowest overall uninsured rates in the country. He says it's also one of the healthiest states.
But that doesn't satisfy the Children's Defense Fund's Jim Koppel. He says other states are showing more progress when it comes to kids. "Forty states in this same time period we're talking about, 40 states, decreased the number of uninsured children in their state," he said.
Koppel says three other states--Massachusetts, Illinois, and Maine--have recently passed legislation that makes sure that all of their children have health insurance. Legislative proposals to do the same thing in Minnesota have not gone anywhere. [by Lorna Benson, Minnesota Public Radio, April 19, 2006]
3. Sarasota Families Hurt by KidCare Decisions
Plummeting enrollment numbers demonstrate that Florida lawmakers who proudly tout their efforts to protect school-age children have deliberately undermined one of the most successful programs ever devised to provide low-cost health insurance for students. In spring 2004, more than 363,000 public school students throughout the state--including almost 6,000 in Sarasota County--received Florida KidCare coverage through three federally sponsored insurance programs that require an annual state contribution.
Cost-cutting legislative decisions have reduced the current statewide total to about 220,000, dropped the number of county participants down to less than 3,600 and closed many of the public outreach offices that helped enroll families. "When funding was cut, many communities decided not to do outreach," said Virginia Brockman, a Sarasota County public health employee who attempts to fill the void by fielding calls from Charlotte County, Manatee County and St. Petersburg on a part-time basis.
"What upsets us is we need outreach offices to rebuild the credibility of Florida KidCare," she said. "A lot of children have been lost over the last two years. We realize a few probably shouldn't have received coverage, but to punish the children is unfortunate." To tighten eligibility criteria, state lawmakers reduced year-around enrollment in the programs to two one-month windows and significantly increased the documentation families must provide to demonstrate combined income and prove financial need.
Gov. Jeb Bush referenced lower Florida KidCare enrollment figures earlier this year when he recommended a $197 million cut in the state's contribution, a measure he said was justified because the state currently budgets for too many unused slots. There is some good news for families who still want to participate in KidCare. Last year, lawmakers relented and agreed to reinstate year-around enrollment and program officials recently established an Internet Web site (healthykids.org) to assist applicants.
"The challenge is to reach the families that really need these programs and were discouraged when the enrollment process became so difficult," Brockman said. "Many of them don't have computer access. I'm continuing to take phone calls (at 861-2813)." Most families who receive KidCare coverage pay $20 a month for all eligible children. The insurance provides comprehensive health care, vision, hearing and partial dental coverage. There are no deductibles or exclusions for pre-existing conditions. "It's excellent coverage," Brockman said. "Families are responsible for a $5 co-pay when they visit doctors, a $5 co-pay for medications and $10 co-pay if they have to visit an emergency room. Some pay more, and some less, depending on their incomes." Florida KidCare programs are subsidized with a 71 percent federal contribution and 29 percent state contribution. They include HealthyKids for students age 5-18; MediKids for pre-schoolers age 1-4; and Children's Medical Services for special medical needs.
Enrollment took a nose-dive when lawmakers decided families who want coverage must submit pay stubs, federal income tax returns, W-2 forms and proof of unearned income for items such as child support, Social Security and veterans' benefits. In addition to loading up the application requirements, program eligibility rules were further beefed up to exclude any family that is offered health coverage through an employer for less than 5 percent of its combined earned income. Some lawmakers who supported tougher eligibility requirements contended working parents who receive health insurance from employers should sign their children up as dependents, and not attempt to save money by enrolling them in less expensive KidCare programs. [by Jack Gurney, Pelican Press]
4. Medicaid Cuts in Missouri
Timmy Kitrel, 7, who has cerebral palsy, has a session with speech therapist Lucretia Wilkinson at the Kitrels' home in St. Peters. Timmy's parents, Kathy and Matthew Kitrel, expect all three of their children to be dropped from the state's Medicaid coverage. In the eyes of his mother, Timmy Kitrel is a "typical little 7-year-old." Using a touch-screen device to communicate, the first-grader in the Fort Zumwalt School District can identify animals and spell his name.
Timmy, who has cerebral palsy, has made great progress, partly because of the occupational, physical and speech-language therapy he receives through Medicaid, said his mother, Kathy Kitrel of St. Peters. But she's not sure how she and her husband will keep the services going. Timmy and his two siblings are among about 800 children a month in Missouri who are being dropped from Medicaid because of a new, little-noticed law. The law strips children of Medicaid coverage if their parents' employers offer "affordable" insurance. Private insurance qualifies as affordable if the policy covers doctor visits and hospitalization for children for less than $342 a month.
In the past six months the law has forced nearly 5,000 children from the Children's Health Insurance Program, an extension of Medicaid for middle-income families. Some parents must pay as much as 20 percent of their income for the private insurance.The Republican sponsor says the change was inadvertent and may need to be reviewed. Gov. Matt Blunt's spokeswoman said the governor would defer to the Legislature on the issue. Concern centers on what's known as the affordability test. The state has used it for years but never applied it to so many families--including those with incomes slightly above the poverty line.
The change was part of a bill cutting 90,000 parents, elderly people and disabled people from Medicaid. "It was under the radar for us," said Beth Griffin, executive director of Citizens for Missouri's Children. "We didn't realize the implications. And it's serious because it's not really a fair test." Consider a single parent with a $20,000-a-year job and one child. Medicaid costs the family $16 a month, or 1 percent of income. But the child is ineligible for Medicaid if private insurance is available for $342 a month - 21 percent of the family's income. Blunt promised in his campaign in 2004 that he would not reduce eligibility for children's coverage. His press secretary, Jessica Robinson, said last week that he had kept his promise. She said Blunt had not suggested the law shifting more parents to private insurance. The Legislature added the provision to the bill controlling Medicaid's explosive growth.
The choice for Blunt, she said, was "accept the solution as it's presented to you or risk the state's ability to deliver health care services to any and all individuals." Asked whether the affordability test was fair, Robinson said: "Fairness is a relative term and really, an arbitrary question that I'm not in a position to answer. It would be the General Assembly that would need to make a proposal" if the policy is creating problems. The insurance issue illustrates the philosophical shift in the Capitol under Republican rule.
When Democrats called the shots, they established one of the broadest children's health programs in the country. Called MC+ for Kids, it covers children in families earning up to three times the federal poverty rate. That's $60,000 for a family of four, based on the 2006 poverty rate of $20,000 for a family of four. The state set up the program in 1998 as part of a federal initiative. The federal government provided a big carrot - about 73 percent of the money.
The package of services is comprehensive, including everything from physicals and prescription drugs to counseling and dental care. Supporters said the investment paid off in fewer sick children missing school and fewer parents missing work. "It's doing what it's supposed to do - get the best early intervention, preventive care you can get to a population that doesn't have very much money," said Sen. Pat Dougherty, D-St. Louis. On average, a child on the program costs taxpayers $1,336 a year. Put another way, MC+ for Kids accounts for 9 percent of Medicaid's participants but 2.2 percent of the overall cost.
Those arguments have never swayed critics, who say the program discourages personal responsibility and hooks recipients on welfare. After Republicans took over the Legislature in 2002 and the governor's mansion in 2004, Sen. Chuck Purgason, R- Caulfield, proposed that more families pay premiums. His bill required contributions from all those earning at least 151 percent of the poverty level - for example, a family of four making $30,000. To satisfy opponents, premiums were set on a sliding scale, ranging from 1 percent to 5 percent of household income. No one noticed the bigger change--that those same families would be forced out of Medicaid if private insurance was deemed affordable. Even Purgason was surprised last week when that result was pointed out. "It was an unintended consequence," Purgason said. "If it's creating problems for that group, maybe that's something we need to address."
How does the state decide what's affordable? The standard is based on what state employees and legislators pay under the Missouri Consolidated Health Care Plan. Insurance is deemed affordable if it costs no more than 133 percent of the average cost for children in the state workers' plan. Since the change took effect Sept. 1, the test is triggering four times as many rejections as before--about 3,133 children were dropped or denied Medicaid coverage in the policy's first three months, compared with 782 in the prior three months. Rep. Rachel Storch, D-St. Louis, said there was no way to know if those families actually bought private insurance. She said it might be out of reach for many, especially those who had children with special needs or chronic illnesses. "What we've labeled as affordable isn't affordable," Storch said. Some families say the test discourages work--the opposite of the goal expressed by the Republican governor and Legislature.
"It stinks that those of us who go to work can't get help," said Gina Wallis of Franklin County. Her 12-year-old son lost state coverage when she got a job in November at a small insurance company that offers family coverage for $340 a month. Wallis said she could scrape up the $100 monthly co-payments for his antidepressant medicines and $25 monthly payments for his doctor visits. But she worries because he gets teased about his teeth. The family can't afford $4,600 for braces, which would have been covered under the state program.
The affordability test isn't the only change pushing children off Medicaid. Overall, the number of children covered by Medicaid has dropped by 45,697 in a year, down from a high of 556,514 in February 2005. Some families lost coverage because they failed to send in documentation of income, moved out of state or could not be located. Blunt is aggressively enforcing a law that requires families' eligibility to be re-evaluated annually. Others failed to pay the new premiums imposed by the Legislature. Ironically, the premiums are a bargain compared with the affordability test. Families such as the Kitrels can attest to that.
Kathy Kitrel, 34, and her husband Matthew Kitrel, 35, have been paying the state $105 a month to insure their three children. Matthew Kitrel works as a network administrator for a company in O'Fallon, Mo. A family of five is eligible for the state program if household income falls under $70,200. He makes about $50,000. The Kitrels expect to be kicked out of the state plan because his employer offers children's coverage for $220 a month. The problem is, it won't cover the Kitrels' needs. For example, Medicaid sends an aide to the Kitrels' home three times a week to help with Timmy's bathing and personal care, as well as every morning to get him ready for school. Private insurance will cover a maximum of 100 visits a year. Because it is difficult for Timmy to eat, Medicaid covers his liquid nutrition, called Pediasure. Seven cases a month cost $350. His mother doubts the private plan will pay any of that. The list goes on. Co-payments for his medicine and equipment will be higher, and his diapers won't be covered. Kathy Kitrel said it's impractical for her to return to work because of Timmy's many doctor's appointments and seizures at school.
"I can't foresee a time when Timmy isn't going to need services, and neglecting to provide them now will only make things worse in the future," she said. Griffin, who directs Citizens for Missouri's Children, hopes legislators will adjust the affordability standard. "These folks want to pay the premiums," Griffin said. "We were on the right track in trying to insure as many children as possible The governor is saying that kids are his priority. Clearly, they're not." [by Virginia Young, St. Louis Post-Dispatch, 04/01/06]
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