VACCINATIONS: State Should Pick Up Tab, Says Judge
A federal judge ruled Friday that the federal government is not bound to provide about $18 million in vaccination costs for children enrolled in Healthy Families, and exhorted the state to cover the immunizations itself. In doing so, U.S. District Judge Lawrence Karlton "reluctantly tossed out a California Medical Association challenge to [HHS] Secretary Donna Shalala's denial of 100% federal funding for immunization shots." When Congress created the Children's Health Insurance Program in 1997, it gave states the option of expanding their existing Medicaid programs or establishing a separate program. In choosing the latter, state officials assumed eligible children would still qualify for Vaccines for Children, a 1993 federal program created to pay for vaccines for children eligible for Medicaid or uninsured. Shalala disagreed, saying states that created new programs must foot 35% of the bill to the federal government's 65% -- the same as other expenses in the CHIP program. Elizabeth McNeil, the CMA's director of medical policy and economics, said that would amount to $18 million to $25 million in California, leaving less money with which to insure more children. The CMA maintained that Shalala misinterpreted the 1993 law and her stance "violates the equal-protection guarantee of the Fifth Amendment." But Karlton ruled that Shalala's interpretation of the law was sound and that the Fifth Amendment "issue does not apply because the states that chose to extend Medicaid instead of creating separate coverage put themselves in a different situation than California's."
Lighting a Fire
Karlton, however, expressed his reservations about the state's handling of the Healthy Families program. In a footnote, he wrote, "In this opinion, I have done my duty as a judge. As a citizen of this state, I must confess to dismay that the state's previous policy choice leads to this untoward result" (Walsh, Sacramento Bee, 5/1). He continued, "Surely the deprivation of $18 million in medical care for underprivileged children must be a matter of urgent concern to California's Legislature and new governor" ( AP/Contra Costa Times, 5/2). Assembly Health Committee Chair Martin Gallegos (D-El Monte) said "three bills are moving through the Legislature which, in part, are designed to make 1.1 million of the state's uninsured children eligible for federally funded vaccines." Blaming former Gov. Pete Wilson for thwarting the Legislature's attempt at expanded Medi-Cal in 1997, he said, "No way [Wilson] was going to buy extended Medi-Cal, and we didn't feel we had the votes to override a veto. We are now trying to undo the existing program. The bills will blend Medi-Cal and Healthy Families. They cleared my committee two weeks ago and are now before the Appropriations Committee. If we're successful, we should have a new program in place by Jan. 1, 2000" (Bee, 5/1).