New restrictions kick some children out of state health insurance programs
By LARRY WHEELER | Gannett News Service
WASHINGTON — States have resorted to a variety of techniques to slow spending on the State Children’s Health Insurance Program, a federal program that helps children of low-income, working parents.
The money-saving methods can be direct or subtle. They all tend to reduce the number of children enrolled in the program, child advocates say.
— Kentucky now requires families applying for help from its children’s health insurance program to meet with an aid worker. Government officials say this helps prevent fraud. Child advocates say it’s a barrier designed to keep eligible children out of the program.
— Minnesota stopped automatically enrolling infants in MinnesotaCare this year.
— Last year, Nebraska eliminated a provision in its Kids Connection program that had essentially exempted 20 percent of a family’s earnings from the state’s income eligibility threshold. As a result, many families’ incomes were too high to qualify their children for enrollment in Kids Connection.
— In Texas, lawmakers crafted sweeping changes to control growth in the TexCare program and help dig the state out of a $10 billion budget hole. The changes included a 90-day waiting period for new enrollees, new asset limits, increased premiums and cost sharing.
One other important change: Families now must prove every six months that they are still eligible for the insurance.
Child advocates contend the six-month renewal requirement is a barrier to enrollment in the program. Many families won’t re-apply because of the hassle or because they don’t understand the system.
“They greatly increased the confusion and bureaucracy,” said Patti Everitt of the Texas Children’s Defense Fund. “They took an elegant, streamlined program and made it complicated and confusing not only to families but to the communities and state as well.”
Arlene Wohlgemuth, a Republican in the Texas House of Representatives, defended the state’s actions.
“We wanted to be very careful in making certain that the people who were on (S-) CHIP were truly qualified,” Wohlgemuth said. “We wanted to make sure those precious state dollars were going to families who really needed them.”
Health care, along with education, is typically the largest spending category in state budgets and often the first place lawmakers look to cut costs. The S-CHIP program is particularly vulnerable to cuts because it was specifically designed by federal lawmakers to give their state counterparts maximum flexibility allowing the program to expand in good times and contract when budgets are tight.
Some states have simply increased the premiums families must pay to enroll in a children’s health insurance program. Nevada, for example, doubled its quarterly premiums for families enrolled in the state’s Check Up program.
“We were more generous than we needed to be,” said Charles Duarte, the program’s administrator.
Duarte explained the S-CHIP effort has undergone an important transition in the past year to 18 months.
“Back when the program first started, the goals were enrollment, enrollment, enrollment,” he said. “Now we’re a lot more aggressive about monitoring eligibility. If they aren’t eligible, we get them off the program.”
Duarte said state officials determined that the increase in premiums would not have a significant impact on S-CHIP participants.
However, several recent studies have shown that even small increases in costs to low-income families on state-run health insurance plans can cause a portion of them to leave the program.
The highest premiums for families on Nevada’s Check Up program are now $70 every three months. They were $35 per quarter, Duarte said.
Some child advocates are reluctant to directly criticize state lawmakers and governors for making cuts to children’s health insurance programs that were intentionally designed to be flexible.
“The states are facing a lot of tough times, and they have made a lot of choices,” said Karen Davenport, who manages the Covering Kids and Families campaign for the Robert Wood Johnson Foundation. “They are genuinely trying to maintain eligibility levels while trying to control enrollment in other ways.”
Many administrative restrictions states have adopted can easily be reversed once budgets improve, Davenport said. Other changes — especially lowering the income eligibility thresholds — would be hard to undo later, she said.