Medicare Compliance & Reimbursement

Budget may dictate postponement of a solution.

Federal and state politicians are considering cuts to public health insurance programs that, in many cases, are still not covering more than 650,000 sick and disabled children. And if legislatures do pass cuts, children's health care access will only get worse, suggests a new study by the Center for Studying Health System Change.

"Public health insurance clearly provides a critical safety net to millions of children with special health care needs, but hundreds of thousands of these medically
vulnerable children remain uninsured," HSC's president Paul B. Ginsburg, Ph.D. said in a statement.

In 2003, Medicaid or the State Children's Health Insurance Program (SCHIP) covered nearly 5.2 million children with "special health care needs," the study found. That same year, approximately 13.5 million children (18.5 percent) had a special health care need.

Of the 650,000 children who had no insurance, many were most likely eligible for public coverage but were not enrollees. "The findings should help dispel the myth that all uninsured children are healthy," noted Ha T. Tu, a HSC health researcher and study co-author.

Among special-needs children, those with public and private coverage reported about equal rates of problems obtaining health care, indicating Medicaid and SCHIP provide comparable access to care. Overall, these children faced more access problems than their peers, and their families reported more difficulties with paying medical bills, the study discovered.

Federal efforts to reduce Medicaid spending growth have focused mostly on eligibility and services for adults, but over the last year some states have made obtaining and sustaining public coverage more difficult for eligible children. Such measures include increasing required premiums, imposing SCHIP enrollment freezes and reinstating administrative barriers in both Medicaid and SCHIP.

The study's other findings include:

• Special-needs children are less likely than other children to have private insurance (55.6 percent versus 63.6 percent). Because special-needs children are enrolled in public insurance programs at much higher rates than other children, their uninsured rate is lower--4.8 percent, compared with 8.3 percent for other children.

• The special-needs children most likely to lack health insurance belong to families with incomes ranging from 100 percent to 300 percent of the federal poverty level--or $18,400 to $55,200 for a family of four in 2003. Those with family incomes between 100 percent and 200 percent of the poverty level have an uninsured rate of 8.2 percent, while the rate in families with incomes from 200 percent to 300 percent of poverty was 9.8 percent.