Linda McConnell © Special to the Rocky Susan Molina gets help in the kitchen from her children Bernadette, 14, and Joseph, 11. Until a year ago, the children were covered by Child Health Plan Plus, but a new job pushed Molina's income slightly too high, and the kids are no longer covered.

Colorado seeking ways to keep health insurance program funded

By Lisa Ryckman, Rocky Mountain News
October 13, 2007

When Susan Molina's son came down with the flu, she did the best she could at the drugstore. And as she drove home with her bag full of chest rub and pain reliever and cough medicine, she began to cry.

"I felt ashamed that I couldn't just take my son to the doctor right there and then," she said. "It's sad that as parents we have to make hard choices - whether to pay a bill or buy groceries or take our children to the doctor. I felt like a failure."

Until a year ago, Molina's two children were covered by Child Health Plan Plus (CHP+), the state version of a federal health insurance program for working families.

But a new job pushed her income slightly above the state ceiling for eligibility, and she had no employer insurance.

Molina's children might have been able to rejoin CHP+ under a bill that reflects the much larger debate over what role the government should play in making health insurance available to low-income working families.

Last month, Congress voted to spend $35 billion over five years to fund the State Children's Health Insurance Program (SCHIP), the CHP+ parent program. But President Bush vetoed the bill, setting up an override vote this week.

'Crowd out' a concern

Backers of SCHIP say it's a cost-effective program that works, reducing the number of uninsured children by more than 25 percent in the past 10 years and providing inexpensive preventive care for problems that might otherwise mean costly trips to the emergency room.

But Bush and other critics say the bill was a step toward "federalizing" health care and opened the door to too many families, some of whom would drop private insurance for cheaper coverage under the program, a phenomenon known as "crowd out."

Colorado has enough in CHP+ reserves to keep the program going for at least a year, possibly longer, if a compromise isn't reached.

Supporters of CHP+ insist that keeping out those who can afford other options is not a problem in Colorado because of strict eligibility standards. The most pressing issue, they say, is how to enroll thousands of eligible but uninsured kids - something the SCHIP expansion would have helped make possible.

"A lot of people think they aren't poor enough or make too much money because both parents work," said Joanne Lindsay of the Colorado Department of Health Care Policy and Financing. "Some of it is getting people to value health insurance. We try to educate people through our outreach efforts."

Only 54,000 of the 97,000 eligible Colorado children are covered by CHP+, along with 1,342 pregnant women.

In 2004, about 16 percent of the 700,000 children under the age of 19 living in the seven-county Denver metro area were uninsured, mostly because their families were unable to afford the full cost of private coverage, according to Kids Health Care Access, a study commissioned by four Colorado non-profit foundations.

The SCHIP bill would have extended health insurance to as many as 60,000 Colorado families like Molina's, who earn too much to qualify for CHP+ but not enough to pay for private insurance, said Lorez Meinhold, senior program officer at the Colorado Health Foundation.

"The cost of health insurance has been growing faster than wages, and as employers look to get that under control, they push the costs to employees - and they can't afford it," she said.

Molina's new job as a property manager pushed her income slightly above $34,344, which is is 200 percent of the poverty level for a family of three and the state ceiling for eligibility for a family of that size. Her job doesn't offer health insurance, so her children returned to the ranks of 180,000 uninsured kids in Colorado.

Coalition enrolls families

If Colorado's program covered families with incomes up to 300 percent of the federal poverty level as some states do - $51,510 for a family of three - the uninsured level in the Denver metro area would drop to less than 3 percent, according to the Kids Health Care Access study.

Under Colorado's program, applicants can subtract child and elder care costs, medical expenses, child support and alimony to reduce their income to the 200 percent threshold.

Required documentation, including parents' pay stubs and verification of the child's citizenship, are meant to make the system fairly impervious to abuse.

"All states have been required to have process in place to ensure the program didn't support crowd out," said Stacey Moody, project director of Covering Kids and Families, a statewide coalition that works to enroll uninsured families in the right program.

"Colorado has built that policy into the process and includes it in the application. I've never heard of any problems or any concerns about it."

Last February, Molina testified before Congress about what the program had done for her family; she hopes that at some point, she'll be able to re-enroll her kids.

"Not having the luxury of that security is very devastating for any parent. Thankfully, they haven't had any major things happen where I'd have to rush them to the emergency room," Molina said.

"The children are the future. What does that mean if we're not willing to make sure they grow up healthy?"

Insurance information

Here are states with the highest percentage of uninsured children:

1. Texas   20.0%

2. New Mexico   17.6%

3. Florida   16.8%

4. Arizona   15.9%

5. Nevada   15.7%

6. Colorado   14.2%

7. Montana   14.1%

8. Oklahoma   14.1%

9. California   13.2%

10. Mississippi   12.9%

SOURCE: Robert Wood Johnson Foundation

What is Child Health Plan Plus(CHP+)?

CHP+ is affordable health insurance for Colorado children and pregnant women, funded jointly by a state-federal partnership and serves families earning up to 200 percent of the U.S. poverty level.Typically, it provides health care coverage for families earning too much to qualify for Medicaid but not offered or unable to afford private coverage.

CHP+ Insurance information, guidelines

Maximum income levels*

FAMILY SIZE INCOME MONTHLY HOURLY

1 $20,424 $1,702 $10

2 $27,384 $2,282 $13

3 $34,344 $2,862 $17

4 $41,304 $3,442 $20

*Certain expenses such as child and elder care, medical costs, adult health insurance premiums, child support and alimony payments may be deducted from a family's gross income.

Health benefits include:

Physicals and doctor visits, immunizations, dental care (children only), hospital services, eye care and eye glasses, prescriptions, mental/behavioral health care, hearing aids, prenatal care.

Who is eligible?

• Children 18 and under who do not have Medicaid or any other health insurance.

• Colorado children who are U.S. citizens or legal permanent residents for at least 5 years. Parents' citizenship/residency status is not considered when determining CHP+ eligibility for children.

• Children cannot have access to state employee health insurance.

• Pregnant women 19 and older who live in Colorado and do not have Medicaid, other health insurance, or access to Colorado state employee benefits. They must also be U.S. citizens or are legal permanent residents for at least 5 years.

• Must meet financial qualifications, listed at http://www.chpplus.org/ or toll free 800-359-1991.

What does CHP+ cost?

Depends on family size and income. Some families may pay nothing; others must pay $25 to enroll one child or $35 to enroll two or more children each year.

Co-payments of $2 or $5 for health, dental services may be required. How does a family apply?

Application must be completed and is available in English and Spanish. Download at http://www.chpplus.org/ or call 800-359-1991.Source: Robert Wood Johnson Foundation What Is Child Health Plan Plus (Chp+)? Chp+ Is Affordable Health Insurance For Colorado Children And Pregna ...

ryckmanl@RockyMountainNews.com

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