1. Hawaii: Uninsured "Gap Group" Kids
Five percent of Hawai`i's children and youths are uninsured. Who are they and how can we cover them? Hawaii Covering Kids recently sponsored two task force meetings on this important issue--click on the link above for our web page with more details.
2. Connecticut: Proposal to Insure More Newborns and School-Aged Children
Governor M. Jodi Rell announced two new proposals to bring health insurance to thousands of additional Connecticut residents, including the new HUSKY Health 2007 initiative to help ensure that every uninsured newborn and school-age child is enrolled in the state's HUSKY Plan. The state's HUSKY Plan serves children and teenagers in families of all incomes, based on a sliding fee scale. Over 221,000 children are currently enrolled, and coverage is available for uninsured newborns.
Newborns: Governor Rell's HUSKY Health 2007 initiative addresses an entirely preventable gap in children's health--of the 109,025 births in state hospitals over the past 30 months, 2,776 were identified as having no insurance coverage, even though they were eligible. HUSKY Health 2007 waives the premium for the first two months following birth, eliminating any possible reason for not enrolling a newborn.
"We have identified newborns without coverage as a key target because there is no reason for them to not have coverage," Gov. Rell said. "Based on income, HUSKY coverage can be free, or can require a modest premium. Under HUSKY Health 2007, if a family's income is high enough to require a monthly premium for HUSKY coverage, the State will waive the premium for the first two months. This will be our gift to Connecticut's newborns and it will encourage parents fulfill a basic parental responsibility by enrolling their children and keeping them enrolled."
Schoolchildren: Governor Rell's HUSKY Health 2007 initiative also focuses on health coverage for school-aged children. Currently, parents tell schools whether their children have health insurance only at the beginning of kindergarten and sixth grade. The Governor is proposing to require such notification at the beginning of every school year. This would help school systems refer parents to the HUSKY Plan. To assist schools, the Governor has dedicated $130,000 in outreach funding for regional education service centers. These centers will train all staff who come into contact with students and parents about the HUSKY program, including program benefits and how to enroll.
The Governor also believes that HUSKY recipients have been on a roller coaster ride as benefits and coverage have fluctuated in response to fiscal concerns in recent years. "There has been too much instability with the adoption of adverse changes to the program and their subsequent repeal," Gov. Rell said. "Therefore, I am asking the state legislature to adopt a 'no adverse changes' policy in the Husky program for the next two year period as we try to increase enrollment in the program." [Town Times, 01/04/07]
3. Wisconsin: Red Tape Keeps Kids Off State's Health Insurance; 49% of Uninsured Children Are Eligible But Not Enrolled
Angel Strothers' struggle to get her 7-year-old son enrolled in BadgerCare began when she scheduled an appointment with a Milwaukee County worker: She was on hold for an hour and 25 minutes. It got worse from there. Through a series of glitches, Strothers and her daughter, both already enrolled in the state program that insures low-wage workers and their children, temporarily lost their insurance. And her son, Noah, won't be covered until at least February. "If my son gets sick, we're in big trouble," Strothers said recently. "I went through all the hoops. I took all the steps I should take. And my son still has no health insurance."
In his inaugural speech this month, Gov. Jim Doyle again stated his goal of ensuring that every child in Wisconsin has health care coverage. But Strothers' experience shows that reaching that goal will require more than simply expanding existing state programs. Parents often must make their way through a bureaucratic gantlet that includes complex regulations, confusing paperwork and understaffed county agencies. As a result, almost half of the uninsured children in Wisconsin are eligible for state health programs--but not enrolled. The state has worked to make it easier for families to enroll in the three programs that provide health care for low-income families with children: Medicaid, Healthy Start and BadgerCare. A key component of Doyle's proposal is a sweeping overhaul to consolidate and simplify those programs.
Nationwide Problem: Roughly 74% of uninsured children are eligible for existing programs, according to a recent article in Health Affairs, a policy journal. "If we are talking about solving the problem of uninsured children in this country, we need to be increasing enrollment in the programs we already have," said Genevieve Kenney, an economist with the Health Policy Center at The Urban Institute, a policy research organization. "That is really going to get us far along in addressing the problem."
Adding New Complications: Multiple studies show that children with health insurance are more likely to receive immunizations, routine screenings and other basic health services. In addition, broad public support exists for ensuring that children have access to health care. Despite this, state and federal laws have created new obstacles to the goal of providing children with health insurance. For example, when Wisconsin required employers to fill out a form verifying that an employee met certain eligibility requirements, enrollment in the state programs dropped 11.3% in four months. Further, a new federal law requiring proof of citizenship has created an additional burden and hindered the state's push to simplify the application process. The obstacles mean that families enrolled in state health programs frequently lose their coverage, only to re-enroll increasing administrative costs.
Roughly one in four children enrolled in a state health program, for instance, has a four-month or longer gap in coverage each year, said Jim Jones, eligibility director for the state Division of Health Care Financing. The gaps in coverage saddle doctors and hospitals with bad debts from parents who can't afford health care. Gaps also create additional burdens for doctors and other health care providers whose patients might be insured one month and not the next.
Inexpensive to Insure: Wisconsin apparently does a better job than most in enrolling eligible children in its health programs. Still, an estimated 31,000 of the 63,000 children uninsured at certain points in 2005 were eligible for state health programs, according to an annual state survey. Providing health insurance to every child now eligible for the programs would cost money. But insuring healthy children through a Medicaid health maintenance organization is relatively inexpensive. The average annual cost in Wisconsin is $1,295.40 a year. The federal government also pays much of the cost--about 58% for the Medicaid program and about 71% for the BadgerCare program.
In Wisconsin, as a general rule, a family of four with a household income of $37,000 a year is eligible for health insurance through a state program. Yet many people don't know that their families are eligible. "Just putting up an 800 number and a few advertisements in the paper isn't going to be enough if your true goal is to insure all kids," said Glenn Flores, a pediatrician and director of the Center for the Advancement of Underserved Children at the Medical College of Wisconsin and Children's Hospital of Wisconsin. Milwaukee County does more than that. Its employees work out of hospitals and community health centers at times. It also runs a van or mobile office that takes applications at 10 to 12 sites a month.
More Should Be Done: But state officials, policy analysts, advocates, doctors and other experts contend that more needs to be done to tell people about the programs. "If you do outreach, you do find people," said Tim Cullen, a senior vice president of Anthem Blue Cross and Blue Shield. The WellPoint Foundation, an affiliate of Anthem Blue Cross's parent, gave a $500,000 grant to the state two years ago to encourage enrollment. Another obstacle is the complexity of the regulations. Even advocates have trouble understanding the nuances, said Teresa Ortiz of Community Advocates, an organization that helps people get access to health care and other programs.
Consider This: When people in the state health programs change jobs, they have 10 days to send in a new statement of their earnings and a form from their new employer on what health benefits are offered. State law has required the form since 2004. If the applicants miss the deadline, they and their children lose their health insurance. "That absolutely needs to be changed," Ortiz said. "It's ridiculous." State officials agree. "It's been a failure from the beginning," said Jason Helgerson, a spokesman for the Department of Health and Family Services. In 2005, the law was modified to require the state to send the form directly to employers. That proved even more unworkable. The state, unable to figure out where to send the letter, particularly when a company employs thousands of people, has never implemented the change.
Short-staffed Counties: Understaffed county departments, which the state pays to handle applications, renewals and such, are another problem. The state's analysis found that the Economic Support Division of Milwaukee County should have 289 specialists based on its caseload, said Felice Riley, the division's administrator. That's about 69 more people than the division has. The Department of Health and Family Services acknowledges the problems and is working to make it easier for families to enroll in state health programs. Since June, the state has allowed people to apply for the programs online. Through December, it had received 15,688 new applications online, about 15% of the total.
People also have been able to report any changes in their employment or income online since September. Within a year the state hopes to enable people to renew their coverage online. The system isn't flawless. It still often requires trips to county offices to work out glitches. "Each time I applied online, I had to go down there," said Mary Rome, a Milwaukee resident. "I applied online three times and I had to go down there three times."
The new federal law requiring people to prove their citizenship also has complicated the online applications. "It just set up a lot of difficulties for states that were trying to simplify their application process," said Laura Summer, a senior researcher at Georgetown University's Health Policy Institute. One of the key goals of Doyle's proposal to ensure that every child has health insurance is to streamline the application process. "What we want to do is reduce the cost and time for processing any one case," Helgerson said. The governor has proposed one program, called BadgerCare Plus, that would provide health insurance to low-income families and to children who now are not eligible. "The goal is we want all kids to be insured," Helgerson said. [Guy Boulton, Milwaukee Journal Sentinel, 01/15/07)
|
