A new approach to health care for children

September 02, 1997|By John Adams Hurson

THE FEDERAL GOVERNMENT has created the first new health-care program in decades with the passage of the Children's Health Initiative. This program will bring more than $60 million to Maryland next month, which could be matched with $30 million in state dollars for extending health care to Maryland's approximately 170,000 children without health insurance.

This opportunity for Maryland must not be lost because of poor planning and conflicting programs. But that could happen.

Maryland's efforts to provide adequate health care for indigent children have been well intentioned, but sporadic. The Children's Medical System has endeavored to provide children with severe disabilities with assistance not available through Medicaid, but it has been funded at a minimal level of $5 million. The ''KidsCount'' program, a Medicaid expansion, has had disappointing enrollment. Oddly, the governor's ''Thrive by Three'' proposal, which failed last year in the General Assembly, would have resulted in penalizing Maryland under the new federal initiative.

This summer all Maryland residents who are served by Medicaid were required to enroll in private managed-care plans that will replace the previous system of paying doctors and other health-care professionals directly for individual services. Not surprisingly, there have been start-up difficulties. For example, while the new system is supposed to allow Medicaid recipients to choose which HMO to enroll in, more than 50 percent of the new enrollees are automatically assigned to an HMO because they do not respond within 15 days of receiving packets of materials describing the different plans.

Expansion of this shaky Medicaid managed-care program to take on the new federal children's-health program might cause it to collapse under the weight of trying to accommodate 170,000 additional participants. But so far, the Maryland Health Department appears headed in this direction.

Children's health-care summit

Rather than throwing $90 million at a new program in its start-up phase, the governor and the legislative leadership should convene a Children's Health Care Summit that invites all interested parties to help design the best system. The new Maryland program for children should meet some minimum standards:

It should seek to cover children and their families. Most uninsured children live with parents who also are uninsured. Federal planners will allow the plans devised by the states to cover all uninsured family members, if the states can show that this is cost-effective and that family members currently covered by health insurance will not simply drop that coverage and sign up for the new system.

Children with special medical problems should get the health care they need without the tortuous procedures now required in Maryland. The new federal program allows the state to treat special children as, well, special. The stress for these children and their families is high enough. Let's look for a way to ease it.

TTC The new federal dollars can be used to reduce the injustice of Maryland's foster-care system, which subjects children of years of limbo in constantly shifting families. Many of these children cannot be reunited with parents who are addicts unable to get into treatment programs. If the new federal funds could provide such programs, perhaps fewer children would need foster care. Their health might improve, too.

Programs that work are those that create a community effort. If we simply have bureaucrats hand out checks or services, little changes and few are helped. Last session, the General Assembly created a Health Care Foundation intended to bring public and private resources together to increase coverage for the uninsured. Involving our whole state, its communities, its leaders and its good-hearted citizens will guarantee success.

Maryland has the chance to be ahead of the curve in providing health care for children. Together, government and the private sector can design the right program. After all, it is about kids, not politics.

John Adams Hurson, D-Montgomery County, is majority leader of the House of Delegates.

Pub Date: 9/02/97

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