State’s youngsters remain uninsured despite assistance
With the help of a $1 million check, the Colorado Department of Health will try to answer the riddle of why 57,000 eligible children are not enrolled state-run insurance programs.
There are about 183,000 uninsured children across the state. From those ranks, some 72,000 qualify for either the Colorado Child Health Plan Plus (CCHP) or Medicaid. (The other 100,000 children are not eligible because their family’s income exceeds program limits.)
But the $1 million question is why only 15,000 children are currently enrolled in programs that provide low-cost or free health insurance. So, armed with a grant from the Robert Wood Johnson Foundation, state officials will try to eliminate the barriers that dissuade parents from signing their children up.
“It’s a tragedy that in an economy such as Colorado is enjoying now, there are 183,000 of the state’s children who don’t have health insurance. There is something really wrong,” said Patti Shwayder, the state health department’s executive director.
In the Roaring Fork Valley, the number of children who qualify for CCHP isn’t available, but a clue as to why more aren’t joining the program can be counted on one hand. That single-digit clue represents the number of doctors who accept the low-income insurance plan.
“Our problem is there are no providers,” said Pitkin County Community Health Director Yvonne Hernandez, who only knows of three doctors from Aspen to Glenwood Springs who take CCHP patients. “After that, the next closest are in Clifton or Grand Junction. And how good can you feel about recommending a program that has no providers?”
Targeting families whose household incomes exceed the Medicaid maximum, CCHP is a managed health-care provider that is run by the state. By allowing from $5,000 to $10,000 in household income (depending on the size of the family) CCHP serves as a vital safety net for families who earn too much to qualify for Medicaid, but cannot afford private insurance.
But in Pitkin County, working families often exceed the Medicaid parameters of $14,400 annually for a two-person family or $21,876 for a family of four. In fact, only 55 total households utilized Medicaid services for their children in all of 1998, according to Hernandez.
CCHP’s maximum of $20,073 for a two-person household and $30,430 for a four-person household broadens the pool of eligible families. But the more relevant question for this area is who would accept the CCHP insurance once the children are enrolled?
Down from six accepting doctors (four months ago) to three currently, it seems more likely for one of the three participating physicians to drop from the ranks than for another to join.
“It’s very frustrating. The [CCHP] program is definitely underutilized, but it’s also badly administered and cumbersome for physicians,” said Dr. Mark Hilberman, whose practice in Carbondale consists of about two-thirds Medicaid and one-eighth CCHP patients. “Neither pay for the cost of the care that’s expected, but at least Medicaid pays too little on time.”
The office manager for the Basalt Mid-Valley Family Practice agrees that “nine times out of ten” the clinic is under-reimbursed by the CCHP and Medicaid. And even though 35 percent of the practice is private and 55 percent is private managed care, the 10 percent (1,000 patients) who use CCHP and Medicaid are enough to make put the practice in the red at the end of a year.
“I would say we lose money every year and eventually we’ll be out of business. But hopefully that won’t be for a long, long time,” said Carla McCallister, office manager for the family practice.
Both McCallister and Hilberman agree with Hernandez that the first step to increasing enrollment with CCHP is to recruit more area doctors who will accept the program. But that’s not likely to happen until program directors clean up its “irresponsible” administrative act, Hilberman said.
“I think it’s wrong that more people won’t serve the area’s poor. But I completely understand it,” Hilberman said.
Starting with pilot programs in Denver, Adams County, and Prowers County, the state department of public health will explore what improvements would make CCHP an insurance option for more children in the state.
Some initial goals for the pilot program will be to streamline the application process, make sure the applications are “linguistically and culturally” accessible, develop community networks, and create a coordinated marketing plan.
The Johnson grant is part of a 20-state, $47 million initiative to boost insurance enrollment across the country.
In terms of timing it couldn’t better, considering that Gov. Bill Owens proposed last week to use $380 million from Colorado’s share of the national tobacco settlement on CCHP.
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