KIDDIECARE: STATES MUST NOW DEVELOP PROGRAMS
Under the budget signed last week by President Clinton,This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
states will get "as much as $3.9 billion or as little as $20.7
million over five years to pay for the new children's health
initiative." Detroit News reports that California will get the
largest amount of money, $3.9 billion, while states with fewer
uninsured children will receive smaller amounts (Neus, 8/10).
Philadelphia Inquirer reports the program will only cover
families with incomes up to 200% of the federal poverty level,
but limits how much states can charge for premiums and
deductibles (Salisbury, 8/11). Detroit News reports that the
money will be given to the states in the form of block grants.
Each state will then have until October 1 to design its own
insurance program. Exceptions will be made for New York,
Pennsylvania and Florida, which will be allowed to use their
existing children's insurance programs because they meet the new
federal standards. States that do not request any of the money
within three years could forfeit any of the funding (8/10).
UPCOMING TASKS
According to the Inquirer, states now have three tasks.
First, states must decide what type of program would work most
effectively. Thirty-nine states already have programs that cover
uninsured children not eligible for Medicaid. These states could
simply expand their existing programs, or they could develop new
insurance programs or expand their Medicaid programs. States
that develop their own programs must design one that mirrors the
benefits available in either the most popular HMO in the state,
the Blue Cross/Blue Shield Plan for federal employees, the
coverage offered to state employees, or the "actuarial
equivalent" of the three plans. Secondly, states must keep
"private employers from canceling insurance for their workers'
families and dumping those children into the new state health
programs." According to Health and Human Services Secretary
Donna Shalala, HHS will "work with governors to prevent employers
from using the new program as a substitute for private
insurance." She said, "At the end of the day, we want this money
to add children to the insurance rolls." One way to prevent this
from happening would be to deny coverage under the state program
to "children who have private health insurance in the previous
six months."
NOTIFYING FAMILIES
States may also use 10% of the funds to "[d]evelop systems
to determine who is eligible and inform their families." Some
programs may choose to do this through the schools, while other
states may notify eligible families by placing signs in clinics
and doctors' offices. Minnesota has already started to do this
successfully, by "reach[ing] parents by placing posters,
information and application forms in hospitals, clinics, women's
and infant nutrition programs and a variety of local government
offices" (8/11).
WEST VIRGINIA
West Virginia is expected to receive $23 million for health
insurance, Charleston Daily Mail reports. The state has
assembled a group of legislators, state social service officials
and representatives from the governor's office to look at the
issue and develop a program that will best serve the state's
needs. The committee is expected to look to a public/private
program created in January, called Caring Program for Children,
which provides health insurance for 15,000 uninsured children
through Mountain State Blue Cross-Blue Shield.
STATE OPTIONS
Renate Pore, an analyst with the University System Office of
Health Projects would like to see the Caring Program, which is
targeted to families earning under 150% of the poverty level,
expanded. She said that the amount of money is enough to cover
all uninsured children, if the money is used "to support, not to
cover 100%." She said that one way to ensure that families do
not depend on the state for health insurance, is to "require
[them] to pay into the plan according to their income." State
Delegate Ron Walters (R), said that he would prefer the state to
"establish medical savings accounts" for uninsured children from
families with higher incomes. State Del. Mary Pearl Compton (D),
chair of the Health and Human Resources Committee, suggests
expanding the Caring program, but additionally recommends that
the state also involve the school system and state health
department, "and any other state agency that deals with
children." She said the "state needs to look beyond using
Medicaid," and should consider providing health insurance through
the Public Employees Insurance Agency, if it is cheaper (Ruckle,
8/8).
MAINE
Experts say that nearly 11%, or 33,000 Maine children are
uninsured, Portland Press Herald reports. The state passed
legislation earlier this year that would have set aside $8
million to use as start-up funds for a children's health
insurance program. That money will now be used "to help provide
a required match for the new federal grant," which will be
approximately $4 million a year. Gov. Angus King (R) has
established a 16-member commission to determine how best to use
the funds. The commission has until December to report back to
the governor. However, it has already been determined that there
will not be enough money to cover all uninsured children.
Therefore, the commission must now decide whether to cover fewer
children, but charge nothing for their insurance; cover more
children, but charge premiums and deductibles, or use more state
money to cover uninsured children. Gov. King has expressed
concern about expanding the state Medicaid program, due to fears
that "small employers who now offer health insurance will drop it
if their workers' children can get benefits for free." State
Sen. Joel Abromson (R) said, "We have to be careful how far we
expand or people are going to think it's better not to work"
(Perry, 8/10).