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Monday, May 18, 1998
Kids' health deal needs shot in arm
A state program that would insure Nevada's children attracts few takers and some federal scrutiny.
By Sean Whaley
Donrey Capital Bureau
CARSON CITY -- Gov. Bob Miller's proposal to offer inexpensive health insurance to children of low-income working parents is facing two threats: modest interest by parents and federal concerns about an aspect of the program.
Despite widespread publicity about the Nevada Checkup program -- which would provide health care coverage, including dentistry and pharmaceuticals, for only a few dollars a year -- the state Department of Human Resources has received applications from the parents of only 3,000 children.
State officials estimate as many as 45,000 children in Nevada are eligible for the cheap health coverage set to begin July 1.
Officials agree that success of the program depends in large part on enrolling as many eligible children as possible to spread the financial risk and the cost of delivering care.
"I had actually expected we would have more applications," said Chris Thompson, administrator of the Health Care Financing and Policy Division, which is implementing the program. "It does say we need to do more to get the word out. It's an ongoing process."
Fred Hillerby, who represents Home Town Health Plan of Reno, a managed care organization that is interested in participating in Nevada Checkup, said the small number of applications so far could pose a problem for the company.
"We'd like to see these children insured and have access to primary health care," he said. "But if the enrollment is not there, it will be hard to create an actuarially sound program."
Sen. Ray Rawson, R-Las Vegas, chairman of the Legislature's Committee on Health Care, said he is concerned about the low level of interest.
"I don't think it's doomsday because we're in the first month of activity, but if it is at the same pace a few months from now, I'll be very concerned," he said. "If we don't get enough kids signed up, the (managed care organizations) will bail out on us, I'm sure."
Rawson said state officials are doing a lot to get the word out, but more outreach is needed.
"These parents feel harassed and under pressure, and they probably don't spend a lot of time on details in life," he said. "We need to overcome that."
The Checkup program would work by having the Human Resources department contract out for health care coverage with interested managed care organizations. The managed care organization then would be reimbursed about $1,050 per child per year to provide medical services. Parents would chose from one of the providers and sign up their children for health care.
But participation by the managed care organizations is not mandatory. The companies are expected to participate because there will be a large pool of children in the program. With only 3,000 children applying so far, the reimbursement amount in the funding plan could be at risk.
Hillerby said the likelihood is that the 3,000 applications received are from parents who have children with ongoing health care needs. Parents who have healthy children may not be interested in the program until they have a need, he said.
As a result, the $1,050 per child may have to be increased to cover the increased potential risk to ensure participation by the health care companies. This also would increase the cost of the program.
Thompson agreed that the rate paid will have to be higher with a smaller pool of participants, but he still expects at least four managed care companies to agree to participate.
In a separate matter, federal officials have thrown a roadblock in front of the program, asking state officials to determine assets of parents before finding children eligible for Nevada Checkup.
Nevada's Checkup proposal, submitted to federal officials for approval in March, recommended no such test, only an income limit.
Under Nevada's plan, parents who earn 200 percent of the federal poverty level would be found eligible for the coverage for their children from birth through age 18. As an example, a family of four earning $32,000 would be eligible.
Charlotte Crawford, director of the Department of Human Resources, said the Checkup program was designed to be as simple as possible to encourage participation.
"An assets test would slow our ability to enroll children in the program, and it would cost us more because we would have to hire more eligibility workers," she said.
The state has asked the Health Care Financing Administration to reconsider its requirement of an assets test, which was not a requirement in the federal law creating the program, Crawford said. The matter is under review.
The reason federal officials want the test is because of a concern that Medicaid-eligible children will enroll in Checkup instead. Medicaid is shared equally by the state and federal government. Checkup is a 65-35 split, with federal funding accounting for the larger share.
Crawford said the state has no intention of diverting Medicaid-eligible children into the Checkup program.
Rawson said requiring an assets test would put one more hoop in place for parents to jump through to insure their children. With a slow response already, another hurdle will only add to the problem, he said.
The children's health insurance program was created by Congress and is funded in Nevada with $16.4 million in state funds and $30.4 million in federal matching funds.
Eligible families will have to pay a small fee to participate. Annual enrollment fees will range from $20 to $50, depending on income, with quarterly fees of $10 to $50 per family. There are also some modest co-payments in the $5-to-$10 range required.
The low-cost plan will include vision care.
Hillerby said he isn't sure what can be done about encouraging more parents to apply.
"These parents are trying to keep their children clothed and fed and are probably not thinking about health insurance," he said.
Hillerby has questioned the wisdom of requiring even a modest payment from parents, saying that $25 or $50 could be difficult for some families to pay.
"I hope the state is right, and parents will pay that amount and be that responsible," he said.
There is also the knowledge among some parents that if their children get sick, they can be treated for free at a hospital emergency room, such as University Medical Center in Las Vegas, Hillerby said.
"We need more education. We need parents to get their kids involved in primary care," he said. "It will take a little time."
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