Thursday, August 23, 2007

States Decry Children's Insurance Policy

The Guardian reports:

State health officials are decrying new federal guidelines that require many children to be uninsured for a full year before they have access to government-subsidized coverage.

Waiting periods prevent families from dropping private insurance to get cheaper or better coverage for their kids through the State Children's Health Insurance Program, or SCHIP.

But the vast majority of states require much shorter waits - typically one month to six months - than the Bush administration will require. Only Alaska has a one-year wait; in 16 states, there is no waiting period.

State officials say the policy could prevent pregnant women from having health coverage during any portion of their pregnancy or it could keep children from obtaining insurance even if a parent has died or lost a job.

``It would actually increase the number of uninsured children,'' said Deborah Bachrach, deputy commissioner in New York's Office of Health Insurance Programs. ``We think it's bad policy.''

New York has applied to expand its program coverage to families with incomes up to 400 percent of the poverty level - a threshold that many say the program was not intended to serve. Under the New York policy, a family of three earning as much as $68,680 could participate.

In its request to expand eligibility, the state said it would enact a six-month waiting period. Currently, the state has none.

The one-year wait is ``simply unconscionable,'' Bachrach said. ``New York could not agree to that.''

Many of the state Medicaid directors who participated in a conference call Wednesday to discuss the guidelines were upset.

``Not having any coverage for a year flies in the face of the health care reform efforts the states have been undertaking,'' said Martha Roherty, director of the National Association of State Medicaid Directors.

The one-year minimum applies to states that extend program coverage to more moderate-income families - specifically, to families whose income exceeds 250 percent of the federal poverty level, or $43,925 for a family of three.

It is estimated that 18 states and the District of Columbia are in that category or have plans to expand coverage to at least that level.

Dennis Smith, who oversees the Medicaid program at the Centers for Medicare and Medicaid Services, spelled out in a letter last week several new requirements the administration planned for those particular states. The new requirements were first reported by The Associated Press.

Smith said states that use the children's insurance program to cover families above 250 percent of the poverty level must make some assurances to prevent the substituting of public insurance for private plans.

The program subsidizes the cost of health insurance for families whose incomes are too high to qualify for Medicaid but too low to afford private insurance. Both the Senate and the House passed bills this summer that would increase substantially the spending on the program. Bush has promised to a vet if they reach his desk in their current form.

Several states have lowered their waiting period since the program began a decade ago. Georgia and Florida are the only states to increase theirs. Both states require children to be uninsured for six months before they can enroll.

Connecticut dropped its waiting period from six months to two months. New Jersey has dropped its waiting period twice - it now is three months - and allows for exceptions.

``We think it's very bad public policy to prohibit children from coming onto our program,'' said Ann C. Kohler, deputy commissioner of the New Jersey Department of Human Services. ``There's absolutely no evidence that people are dropping their private coverage to go on SCHIP.''

The Congressional Budget Office said this year the program does result in some substitution of private insurance for public insurance. For every 100 children who enroll, there is a corresponding reduction in private coverage of between 25 and 50 children.

Other states that would be affected by the new guidelines include Maryland and Massachusetts, which have six-month waiting periods. In Minnesota and the state of Washington, children have to be uninsured for four months before they can participate. Vermont has a one-month wait. Rhode Island has none.

Vermont Gov. James Douglas, a Republican, was highly critical of the guidelines.

``I am disappointed and dismayed by the Bush Administration's recent actions regarding SCHIP and by the shortsightedness that seems to continually emanate from Washington,'' said Douglas.