By Mike Shields
KHI News Service
TOPEKA, Jan. 17
As expected, Gov. Kathleen Sebelius” proposed budget for the coming fiscal year repeats her call to expand the state”s health-care coverage program for children ages birth to five.
But though the governor is pushing for less restrictive eligibility for HealthWave enrollment, her budget does not include the dollars requested by the Kansas Health Policy Authority to hire outreach workers to bring more children into public health programs. Studies show that
between 66 percent and 71 percent
of uninsured children are eligible for Medicaid or HealthWave coverage but are not enrolled.
Officials in the governor”s budget office said the health policy authority failed to convince them its plan for enrolling more children would actually work.
“They didn”t give us a rationale why (the KHPA proposal) would bring more children in.” said Julie Thomas, a Budget Office analyst. “And we thought it ought to be a part of what KHPA is already doing.”
The health policy authority had asked for $441,636 from the state general fund; $882,272, all funds, to hire eight outreach workers and equip them with laptop computers and an online screening tool. The request also included $100,000 for marketing.
The governor last year asked lawmakers to provide $3.5 million to expand HealthWave eligibility, a move she said would “insure all Kansas children.”
The request was blocked by GOP opponents in the House.
This year the health policy authority also is endorsing that plan, though it is expected to now cost between $4 million and $6 million to extend coverage to 2,000 of the estimated 16,000 Kansas children ages 5 and under who lack insurance. According to the U.S. Census Bureau, an estimated 46,115 Kansas children ages birth to 18 don”t have health insurance.
Never enrolled
A 2003 report by the Kansas Health Institute
indicated that the vast majority of uninsured children in Kansas, 71 percent, are eligible for public health insurance through either Medicaid or HealthWave. The report also noted that about two-thirds of low-income children eligible for public health insurance have never been enrolled and that they represent almost half the uninsured children in the state.
It is acknowledged by those in the trenches of health care and state health officials that a key part of extending health insurance to youngsters who lack it is getting more eligible persons to sign up.
“The one disappointment I have with HealthWave is that early on they put a lot of resources into marketing, then it fell off. Now it’s nothing,” said Nikki King, executive director at Health Care Access, a clinic for the uninsured in Lawrence. “You have to have outreach. You have to work with clinics like ours, and it has to be face-to-face. This is not a population that reads a newspaper or watches TV
they may not even have a TV. You”ve got to catch them where they are, whether it”s where they work, or where they live or on their doorstep.”
But outreach efforts at the health policy authority have been curtailed since July, when changes in federal law caught up with the agency and forced a re-allocation of resources.
“Prior to July, there was much more outreach and marketing taking place,” said Megan Ingmire, a spokesperson for the health policy authority. “Unfortunately, in July, the marketing budget was reallocated for eligibility staff.”
New federal law required that HealthWave beneficiaries, new or renewing, submit proof of U.S. citizenship. That new requirement created a logjam at the state”s clearinghouse for processing applications and determining eligibility.
Pilot program
For now, the state”s main effort aimed specifically at increasing participation is a pilot project offered at two hospitals and a clinic in Kansas City and Wichita. The pilot program, which enrolled its first child July 3, 2006, is a test of “presumptive eligibility,” which if extended statewide would allow those eligible but not previously enrolled in the programs to receive treatment from medical providers while assuring the providers reimbursement for services.
Marcia Nielsen, executive director of the health policy authority, told legislators last week that 651 children had received treatment through the pilot program; 82 percent of them were screened as potentially eligible for Medicaid, 18 percent were potentially eligible for the SCHIP portion of HealthWave. SCHIP is the acronym for State Children”s Health Insurance Program. Together the programs are called HealthWave.
Of those 651 children, 163 or 38 percent were later deemed eligible for ongoing HealthWave coverage. A review of all presumptive eligibility applications in the pilot June through August showed that 62 percent of the families failed to follow through with complete HealthWave applications.
“Further study is necessary to ascertain what barriers prevent families from supplying application information,” Nielsen said in her
report to lawmakers.
Nielsen reported that 33 additional sites had been identified as possible locations for expanding the pilot program but that early results showed more training and program improvement was needed before that should happen.
“The presumptive eligibility pilot provided increased access to health services for several hundred children during its first few months in operation, enabling participating providers to recoup tens of thousands of dollars in otherwise un-reimbursable costs,” Nielsen reported. “This level of participation is suggestive of the potential for the program to have a significant impact as an outreach and enrollment tool for the HealthWave program. However, the earliest experiences from the three pilot sites indicate the need for program improvement, ongoing monitoring and training at the pilot sites and a measured approach to expansion.”
A December 2006 report was prepared for Kansas Action for Children. Based on a computer database analysis, it showed that a potentially effective and relatively inexpensive way to identify elementary school children potentially eligible for Medicaid or HealthWave would be to match identifying data from free- and reduced-price school lunch programs with existing HealthWave enrollment lists. Other states have already done this.
Mike Shields is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at
mshields@khi.org
or at 785-233-5443, ext. 123.