By Katie Kerwin McCrimmon
In what advocates are calling a “home run for children’s health,” kids enrolled in public health insurance programs now will get coverage for 12 months at a time.
In the past, children who qualified for Medicaid or the Child Health Plan Plus often got bounced off the programs every few months if the family’s income changed and thus lost access to reliable care. Colorado managers of those programs expect the new policy to affect about 535,000 children.
“It’s a big deal,” said Dr. Steve Federico, a Denver pediatrician and past president of Colorado’s chapter of the American Academy of Pediatrics.
Federico called the long-awaited policy a “home run” for kids because he said when children temporarily lose health coverage, those with chronic diseases like asthma often stop taking medication, decline and end up in ERs.
“We’ve been advocating for this for several years,” said Federico, who used to staff an emergency center for children.
“What I would see over and over would be the same families or similar families,” he said. “The patient comes in and he’s been doing well for six months, then gets acutely ill. He was getting his meds and was doing great. Then the family went to get his meds refilled and found out he had fallen off Medicaid and couldn’t get them. So they didn’t fill the prescription for a few months.
“The problem isn’t that families aren’t trying to do the right thing,” Federico said. “It’s a health coverage system that’s failing the families.”
Studies have shown that it’s both more expensive and harmful to health outcomes to have children “churning” on and off public health programs rather than giving them continuous coverage, Federico said.
“Health coverage only does good if you have it when you need it,” Federico said.
Adults on Medicaid still fall victim to so-called “churning” since they have to keep re-qualifying for the program. Colorado’s 208 Commission on health care first proposed 12-month eligibility for children back in 2006. Then in 2009, lawmakers required year-long coverage for children as part of the Colorado Health Care Affordability Act passed that year. But public health managers could not implement the change until the funds became available. And changing the policy was the fifth of five priorities that managers had to implement in order.
Susan Birch, who oversees Medicaid and CHP+ in Colorado, said continuous coverage will boost preventive care and help kids get consistent care from providers who know them. Families will not need to do anything to ensure their children get covered for a year at a time. The change should be automatic, Birch said in a written statement.
Cody Belzley, vice president of health initiatives for the Colorado Children’s Campaign, said the change should dramatically help Colorado kids and their families.
The previous policy “created uncertainty and anxiety for parents. When they showed up, they had to worry about whether the care would be there for them and many would delay or forgo care.”
“This brings peace of mind to parents. They can take a seasonal job or otherwise grow their income without risking the loss of health insurance for their kids,” Belzley.
The new policy should also help doctors and safety-net providers who will know that bills will be paid for kids with public health insurance.
Belzley said Colorado Medicaid managers did not drag their feet on implementing the change.
“This was the fifth of five priorities,” Belzley said. “The job of implementing the provider fee has been a Herculean task and the Department (of Health Care Policy and Financing) has been persistent. We’re excited to see this last piece…get put into action.”