States Trying to Sustain Kids’ Health Insurance

State-run programs designed to assure health care for poor children generally succeeded in meeting that goal during the recent economic downturn, a recent study shows.

However, another study shows that 11 states saw enrollment in kids’ health insurance programs decline during the last six months of 2003.

The findings shed new light on health benefits for children provided by Medicaid, the state-federal program for the poor and disabled, and the State Children’s Health Insurance Program (SCHIP), which benefits children whose parents earn too much money to qualify for Medicaid but who cannot afford private insurance.

According to a report unveiled August 3 at a Washington, D.C. press conference, more than five million kids were added to Medicaid and SCHIP rolls since 2001. The report was released in conjunction with the launch of the Robert Wood Johnson Foundation’s “Covering Kids and Families” fifth annual campaign to enroll kids in government health care.

“Low-income children saw gains in public coverage,” said Paul B. Ginsburg, president of the Center for Studying Health System Change, which released the report. He said Medicaid and SCHIP buffered the coverage gap for many children whose families lost employer-based insurance during the economic downturn.

The issue of uninsured children is of such importance to states struggling to maintain youngsters’ health benefits while recovering from record deficits that Virginia Gov. Mark Warner (D), chairman of the National Governors Association, attended the news conference.

Warner was joined by a panel of health policy experts and families who receive government health benefits. Arkansas Gov. Mike Huckabee (R), vice chairman of NGA, gave video-taped remarks.

However, the overall increase in enrollment in public health programs is offset by a steep drop in the number of kids signed-up for SCHIP in several states during the last six months of 2003, according to a recent report by the Kaiser Commission on Medicaid and the Uninsured.

The most notable enrollment declines came in Maryland, New York and Texas, which accounted for 99 percent of the overall decline, the first-ever since SCHIP began in 1997. In addition, enrollment slid in Alabama, Colorado, Connecticut, Florida, Oklahoma, South Carolina, Vermont and Wyoming.

The finding disturbed many public health officials who’ve credited SCHIP with drastically reducing the number of uninsured children nationwide. More than 17 million kids are insured through Medicaid and SCHIP, but 8.5 million children still lack coverage.

The Kaiser report suggests a precarious turning point for SCHIP, according to Barbara Lyons, deputy director of the Commission. “We know that states have been feeling a lot of budget pressure over the past several years, at the same time we know that they really value their (SCHIP) programs and have tried to hold the line to protect that coverage,” Lyons said.

SCHIP has generally withstood budget cuts better than other public health programs because kids are generally healthier and less expensive to pay for than adults. States also get a higher match from the federal government to fund SCHIP than they do for Medicaid, so cutting kids from the rolls is often politically unfavorable, but also doesn’t provide a large cost-savings.

Gov. Warner said he does not support cutting SCHIP to save money. Enrolling kids in SCHIP “is not only the morally right thing to do, but the fiscally right thing to do,” he told Stateline.org.

Before states tightened their budget belts, they made ambitious efforts to enroll children in SCHIP and to streamline the application process with Medicaid. However, many states have now turned their focus to maintaining benefits, policy analysts said.

Lately, Lyons said, states have been employing back door’ strategies to limit enrollment and reduce state spending.

The most dramatic example of this is in Texas, where enrollment in the state’s CHIP program dropped by almost 150,000 kids since the beginning of fiscal 2004 due to the following policy changes approved by the Legislatures in 2003:

• Coverage must be renewed every six months, rather than annually. 
• Children must wait 90 days after being approved for the program to get coverage. 
• Starting Aug. 24, families that earn more than 150 of the federal poverty level and seek benefits must undergo a financial asset test. 
• And child care is no longer an appropriate income deduction in determining eligibility.

Texas also cut dental, vision and eyeglass benefits and increased premiums for the approximately 350,000 children still on the program. Later this month, the grace period for non-payment of the new premiums will end and child advocates said more than 100,000 more children could lose health coverage if they don’t pay up.

State officials said the changes were necessary to balance the state’s finances. “The Texas Legislature, during its 2003 session, faced a revenue shortfall of approximately $10 billion. The Legislature was therefore challenged to achieve cost savings while maintaining important services for people most in need,” Kristie Zamrazil, a spokeswoman for the Texas Health and Human Services Commission, said in an e-mail.

Child advocates in Texas said the changes make it tough for many families to pay for their kids’ doctor’s bills or private insurance.

“The impact on families is that they either delay or avoid (going to the doctor) or delay until it becomes an emergency, then they come into the emergency room . . . and it costs more because it’s more serious,” said Patti Everitt, executive director of the Children’s Defense Fund of Texas, which wants the new policies rescinded.

However, a spokeswoman for state Rep. Arlene Wohlgemuth, a Republican who is running for Congress against U.S. Rep. Chet Edwards (D), said in an e-mail that repealing the changes would be “shortsighted.”

“States, along with the federal government, have a responsibility to ensure that dollars spent through SCHIP are targeted to families in the most financial need, that the program does not become a substitute for private sector insurance and that the program is managed responsibly,” said Gina Hollenbeck, of Wohlgemuth’s campaign.

Florida is also struggling to keep SCHIP afloat. The Sunshine State imposed a freeze on enrollment in the KidCare program in July 2003 and hasn’t lifted it. In 2003, Alabama, Colorado, Montana and Utah also froze SCHIP enrollment, but only Utah and Florida still have the hold in place.

Florida had a waiting list of more 90,000 kids, but dissolved it in March 2004, covering many of the CHIP-eligible children. However, children that qualified after March 11 can’t gain coverage. The state is considering an open-enrollment period in January 2005, but no decision has been made. In addition, the state reduced dental benefits and shortened the period before renewal, said Conni Wells, director of the Florida Institute for Family Involvement, an advocacy group south of Tallahassee, Fla.

“There is no waiting list, there is no notification, there is no nothing,” Wells said.

Despite setbacks in several states, there were some bright spots. For example, Illinois raised the eligibility limit to let more children qualify for SCHIP and Georgia enrolled an additional 10,000 kids over the same six month period in 2003.

Because only a few states comprised the bulk of the enrollment drop, at least one policy analyst said the decline wasn’t necessarily grim news for the future of SCHIP.

Cynthia Pernice, a program manager for the National Academy of State Health Policy in Portland, Maine, said: “It’s not good news because children lost health insurance, but it could have been a lot worse.”