Children of working poor to get health care in Md. Medicaid waiver allows coverage

August 12, 1993|By John W. Frece | John W. Frece,Staff Writer Staff writer Laura Lippman contributed to this article.

As many as 15,000 Maryland children from families too poor to afford health insurance will be able to obtain primary medical care, prescription drugs and other services under a new state program that should be in place by October.

The program is aimed at children between the ages of 1 and 9 1/2 whose families make no more than $2,212 a month for a family of four, or 185 percent of the federal poverty level. The working poor earn too much to be eligible for Medicaid, but often not enough to buy health insurance.

The plan would pay for preventive pediatric care including well-child visits, immunizations, and screening for problems such as lead poisoning. It also will include sick care in physician offices, laboratory and diagnostic tests, vision care including eyeglasses, and drug coverage with a $5 co-payment for each prescription.

Taxpayers, of course, will foot the bill: $1.5 million a year from the federal government and another $1.5 million from the state. But Nelson J. Sabatini, the state health secretary, said the program will undoubtedly save money in the long run by keeping children healthy who otherwise might become ill and end up in expensive hospital emergency rooms.

It's a familiar story to Angela Hawkes, a social worker at Baltimore Medical Systems Healthy Start, on Orleans Street. She said the clinic sees families who postpone visits until their children are screaming with the pain of ear infections.

"Shots, a lot of times they miss shots," Ms. Hawkes said. "Or they'll use home remedies. They come up with all kinds of stuff."

Emergency room visits are the last resort because hospitals cannot turn the patients away. But if the families cannot pay for the emergency room care, other patients end up absorbing the cost through higher hospital rates.

State officials six months ago sought a waiver to Medicaid

regulations that permits Maryland to offer children a less expensive version of the standard Medicaid package. The major difference is that Maryland will not offer the children inpatient and outpatient hospital care.

The waiver, received this week, allows the state to offer a scaled-back package that will cost about $200 per child. By contrast, the full Medicaid package costs about $800 for each recipient, Mr. Sabatini said.

Mr. Sabatini boasted that Maryland may be the first state in the nation to offer such a program. A federal official described the Maryland plan as "modest, but significant" and said other states were on a similar course.

"Our view is that we want to encourage states who want to expand services, especially preventive health services and primary care services, even on an incremental basis," said Joseph R. Antos, director of research and demonstrations in the Health Care Financing Administration office in Baltimore.

The federal government has granted a waiver for a similar program in Hawaii, which already mandates that employers offer health care. The Clinton administration also has approved and a far more sweeping change in Oregon, where Medicaid will be allowed to drop certain procedures in order to extend coverage to the working poor. Waivers also are in the works for Kentucky, Rhode Island and Tennessee.

Gov. William Donald Schaefer said that "prevention has been a high priority" of his administration.

"We've been concerned about young children to make sure they get the right medical care now so they can grow up healthy later on," he said. "A lot of families can't afford a regular check-up."

Shari Harris, 30, an East Baltimore mother of four, fits that description. Just last week, Ms. Harris canceled a pediatric visit for two of her four children because the family was short on funds. Her husband, a painter who makes about $320 a week when he's working full-time, had a bad month, she explained, and their refrigerator had broken, forcing them to rent a new one.

"You play Russian roulette," she said. "You catch up on one bill, then pay the rent late. You never get ahead."

Daniel Harris could buy health insurance through his job, but it would cost $260 a month, far beyond the family's budget. So his wife has learned to make do -- taking a doctor's prescription samples, for example, and mixing the correct dosage at home. Or treating laryngitis with hot tea and Tylenol, as she said she was doing yesterday.

Mr. Schaefer said, "It is my intention that the parents of these so-called 'gray-area' children . . . will no longer have to choose between paying for food, clothing and utilities or taking their children to see a doctor when it's necessary."

Health department officials said the estimate of 15,000 children without health insurance came from a recent study of state health issues conducted by the Feinblatt Commission. The children are mostly from the populous Baltimore-Washington corridor, they said.

Once program regulations are in place, families may apply for assistance through their local social services offices, said health department spokesman Mike Golden.

In Maryland, the Medicaid program currently covers a full range of health services for children from birth up to age 1 if their families' income does not exceed 185 percent of the federal poverty level. But the threshold for coverage drops to 133 percent of the poverty level for children between the ages of 1 and 6 and drops further for children between 6 and 9 1/2 .

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