CHRONICALLY ILL KIDS: Program Plagued By Low Reimbursement Rates, Staffing Shortages
Under the California Children's Services program, children with severe and chronic illnesses often wait weeks or months for treatment, according to a new state Senate Research Office report. Alan Watahara, president of the California Children's Lobby, said, "It's not about the misuse of funds or inadequate or improper care. It's about kids not getting care because the infrastructure isn't there." The AP/Contra Costa Times reports that the program manages services for 147,650 patients under age 21 who have a chronic and severe medical condition, such as cancer or cystic fibrosis, and have an annual family income of less than $40,000. Medi-Cal paid about $600 million of the program's 1997-1998 $703 million budget, with the state and counties picking up the remaining costs. But the report points out several problems in the program, including that few doctors will accept program patients because of low reimbursement rates and long periods before the program reimburses them. The report states that the low payment schedule affects "children's access to virtually all services covered by [the program], including hearing aids, laboratory services, X-rays, dentists, orthodontists, audiologists and pharmacy services." Cheri Pies, director of the Family, Maternal and Child Health Program for Contra Costa Health Services, added, "The program doesn't reimburse in a timely manner. That makes it difficult for providers who want to take these children." Additionally, the state's eight not-for-profit children's hospitals that care for about 40% of program participants face an estimated $50 million shortfall this year because of low reimbursement rates, according to Susan Maddox, president of the California Children's Hospitals Association. To address these issues, the report recommends that reimbursement rates be raised to meet Medicare levels, a move that would cost about $46.1 million, to be split between state and federal funding.
Staffing Problems and Income Requirements
The report also identifies two other problems -- patient-to-staff ratios of 1,000:1 and outdated income eligibility requirements. The report recommends altering income requirements by either raising them or eliminating them altogether and then establishing a sliding-scale fee schedule for those with higher incomes. By raising the income requirement from $40,000 to $100,000, 22,000 additional children could enroll in the program. But Maddox said, "Raising the income level still doesn't take care of the issue of having pediatric providers available" (Coleman, AP/Contra Costa Times, 5/31).