Health care for children is expanded Government program covers uninsured

November 29, 1998|By JoAnna Daemmrich | JoAnna Daemmrich,SUN STAFF

Thousands of Maryland's working poor are rushing to enroll in a new state program that makes it possible to take their children to the doctor without getting sick over the bill.

In the first five months, the state has extended government-paid health coverage to as many as 30,946 children and 74 pregnant women from low-income households. Families have flooded a state hot line with calls, snapped up brochures at schools and churches and surprised state officials with their dash to sign up.

"We were prepared for a big turnout, but the acceptance of the program was faster and more widespread than we had anticipated," said Ned Wollman, eligibility director for the Children's Health Program for the state Health Department.

Maryland is halfway to its goal of providing basic coverage for 60,000 uninsured children and expectant mothers -- and leading other states that have begun similar initiatives.

The program, which provides primary care and preventive services such as immunizations, dental care and vision care, is available for households with incomes of up to $27,300 for a family of three and $32,900 for four.

It covers teen-agers who were previously excluded from Medicaid, the state-federal insurance for the poor and disabled. And it expands benefits to a small number of low-wage pregnant women who earned slightly too much to receive state health care in the past.

Karen Brockington-Hamilton lost no time in enrolling her two boys, ages 1 and 3. Her husband, Robert, works as a long-distance truck driver for a company that does not provide insurance. The family had been paying for each routine checkup and inoculation, and the bills were quickly adding up.

"We paid out of pocket because I know how important health care is," said the 31-year-old mother in Essex. "But it got scary sometimes. It can cost $50 just to walk in the door of the doctor's office."

Supported by a 1997 federal law providing $2 for every dollar of state funding, 48 states are ex- panding health coverage for uninsured children. Their parents generally work at jobs that offer limited or no insurance but make too much money to qualify for Medicaid.

Maryland is considerably ahead of most states, which have largely gotten off to a slow start, said Gregg Haifley, deputy health director for the Washington-based Children's Defense Fund. The federal government has given the states a reprieve from an earlier one-year deadline to get their programs under way.

"There's plenty of time," Haifley said, "but frankly, every day that goes by, kids are getting by without the health care services they need."

Possible expansion

Some Maryland lawmakers and advocates for the poor say the fast enrollment pace suggests more uninsured children than initially estimated. They are looking to expand the program, which will cost $76.2 million in the first year, possibly to include more families by using funds from the state's lucrative settlement with the tobacco industry.

"We'd like to try to help more parents and children who still might be falling between the cracks," said Del. Michael E. Busch, a Democrat from Anne Arundel and chairman of the House Economic Matters Committee.

The first priority of advocates is to fight a provision that could force some recipients to pay an insurance premium in coming years.

Under the legislation passed this year, the state is providing coverage to families with incomes of up to 200 percent of the federal poverty level in the first year. But a contribution might be required from those above 185 percent of the poverty standard thereafter. State health officials have been asked to determine if that plan makes sense.

Maryland's enrollment got off to a quick start because 9,000 children were shifted from the state's "Kids Count" program, which used to provide health coverage for some non-Medicaid children.

Advocacy groups are concerned that pregnant women have been slower to get the message. At Gov. Parris N. Glendening's urging, the program was expanded to include pregnant women with the same income levels. It closed a gap in coverage because pregnant women were receiving health care only if their incomes were up to 185 percent of the poverty line.

"We've not seen as much of an increase with women," said William Sciarillo, program director for Baltimore Healthcare Access, which works with uninsured families.

He and others say families sometimes wait too long to pick a doctor in a participating managed care plan, ending up with a computer assignment. Families often skip appointments when they're assigned to doctors far from home and have to take two or three buses to get there.

Still, Maryland's recruitment has been an overall success. The state simplified its application forms and launched an aggressive marketing campaign as soon as the program went into effect July 1. Radio commercials aired in the fall, and local health agencies have distributed scores of brochures.

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