Children’s Medicaid/CHIP enrollment up in May for Texas and Tarrant County

Enrollment was up again in May, a new record for both Tarrant County and the state. We now have 196,343 Tarrant County kids insured through Medicaid and CHIP.

• State enrollment in Medicaid and CHIP was up by more than 1,600 this month. In  Tarrant County, enrollment was up 1,168 — 820 more in Medicaid and 348 more in CHIP. (Good work, child advocates here!)
• Since May 2011, state enrollment in children’s Medicaid and CHIP is up 5.9%. In Tarrant County, it’s up 8.6%

So, regulations are bad for corporations, but good for families who need Medicaid and CHIP?

Earlier this month, I recommended that some of you contact US Rep. Joe Barton. Barton convinced the House Energy and Commerce Committee to eliminate performance bonuses for states that streamline their Medicaid and CHIP procedures so that more eligible low-income children can get and keep health coverage. States that receive these bonuses are implementing technology solutions and lowering barriers to insure kids who have been uninsured.

Well, last week Barton wrote me back, and here was his main argument: “Two years ago President Obama signed a law allowing it to grow and unfortunately opening up the door to fraud and waste. The bonus program relaxed the eligibility requirements and paid states extra money for each new child enrolled – whether they truly needed it or not. This program tossed out both the in-person interview requirement and the assets test in SCHIP, two aspects that were designed to ensure that the money allocated for SCHIP went to the children who really needed it the most.”

First, I objected to the phrase “whether they truly needed it or not”. All uninsured kids need healthcare.

But, this defense about fraud and waste is just political rhetoric. Every politician is against waste and fraud. It’s like being against tornadoes.

How can government defeat waste and fraud? Well, there are two basic methods. There’s what’s called “pay and chase.” For example, you pay providers with Medicare or Medicaid funds, then audit the fraudsters later and try to recoup. Then, there’s the preventive method, which is add to or tighten regulations.

But, I thought Barton hated more regulations. Here’s his statement straight off his website:

“The Obama administration says publicly that they are in favor of energy production then use rules and regulations to stifle development. New technologies are unlocking vast reserves of oil and natural gas that can power our nation for generations in an environmentally friendly way…. We should be focusing on solutions to remove government barriers to affordable energy. Instead, the administration continues to layer regulation after regulation that will drive electricity and fuel prices even higher.”

Let’s turn that logic on Barton:

“Barton says publicly that he is in favor of children’s healthcare then uses rules and regulations to stifle their development. New technologies are unlocking vast ways to open eligibility for kids that can power our nation for generations in a prevention friendly way… We should be focusing on solutions to remove government barriers to keep kids healthy. Instead, Barton wants to layer regulation after regulation that will drive healthcare costs even higher.”

My point is this: just as regulations add cost and hassle to oil companies so do they to needy families.

Barton must have gotten other gripes about his stand, because he posted the same points he wrote to me on his website under the ironic headline “Increasing Care for Kids, Cutting Waste.” Click here to view. He reiterates: My amendment does not take a dime from any child eligible for SCHIP.” OK, but how does that “increase care”?

Speaking up for kids in other states on CHIPRA bonuses

More low-income children have health insurance coverage now than ever before. That’s a sentence worth savoring, and defending.

How did this happen? It’s the result of millions of little actions. Someone made a phone call, someone funded an outreaach worker, someone sent an e-mail, someone donated to the cause. It was a wonderful array of people doing something that would benefit millions of kids.

A new report, Applying Advocacy Skills in Tumultuous Times: Adaptive Capacity of Insuring America’s Children Grantees, provides a behind-the-scenes look at how one important effort focused advocates in many states on a common goal of children’s coverage. The effort was called Insuring America’s Children and it was funded by the David and Lucile Packard Foundation.

In Texas, the funding helped the Children’s Defense Fund work with the Center for Public Policy Priorities and Texans Care For Children on numerous public education events and campaigns. I’ve shared with you much of their work in the past.

A couple of things in the report really called out to me:

Texas’ uninsured kids have been fortunate to have such a collaborative effort fighting for them that leverages a boots-on-the-ground strategy.

The California-based Packard Foundation — for some reason — thought Texas kids were important enough to fight for.

The advocacy work in Texas cascaded into thousands of actions, and although we still face opponents of children’s coverage here, we know we have a network to draw on to help us make the right arguments and bust through the myths.

So on that note, let us speak up for other children, too. Last week, The House Energy and Commerce Committee voted to eliminate performance bonuses for states that streamline their Medicaid and CHIP procedures and reduce red tape so that more eligible low-income children can get and keep health coverage. To be clear — Texas has never received these bonuses because we haven’t done the streamling required.

Unfortunately, Texas Cong. Joe Barton is leading the charge on slashing this funding — click here to read more.

If you’re in Barton’s district let him know that states that receive these bonuses are implementing technology solutions and lowering barriers to insure kids who have been uninsured. This is worthwhile and keeps kids from being uninsured.

When Medicaid kids are in harm’s way — the dental fiasco

Medicaid dollars are a precious resource. So many good people fight so hard for them. It’s excruciating to see them wasted.

I remember in 2009, the Legislature refused to spend $38 million over two years for a CHIP buy-in program that could have covered as many as 80,000 more kids. A small amount that would benefit so many. But no.

So, to see Texas Medicaid’s dental benefit so totally mismanaged and costing $500 million… It’s unbelievable that we haven’t seen more outrage. Earlier this month, the Texas Trbune ran a story, Texas Dental Board is Accused of Ineptitude, about how Texas toddlers enrolled in Medicaid were being held in restraints as dentists performed unnecessary root canals. Some blamed “an underfunded and understaffed state board” that was supposed to be regulating the industry.

Then, last week, the House Committee on Oversight and Government Reform had a hearing on Medicaid fraud and oversight in which Texas was on center stage. Here is the testimony of UT Southwestern orthodontist Dr. Christine Ellis:

“Texas has learned a painful and expensive lesson in the folly of simply increasing public funds in hopes of increasing access to care. Several years ago, Texas settled the long running Frew class action lawsuit. It claimed, among other things, that children covered by Medicaid did not have access to care mandated under EPSDT (Early and Periodic Screening, Diagnosis, and Treatment program). Part of the settlement mandated the increased spending of $1.2 billion to increase their access to care… “Five years and over half a billion dollars later, Texas has spent a lot of money straightening basically already straight teeth and has gained a lot of fraudulent orthodontic providers…The sad conclusion to this entitlement driven transfer of money is that in Texas we have used the mouths of children to enrich unethical providers and private equity investors. While access to care has increased, access to quality care remains a problem.

“In fact, it is possible that these children are more at risk of receiving unneeded poor quality care than they were before the changes mandated by Frew took effect.”

This makes me so angry. On one hand, we hear from proponents of Medicaid block grants that Texas could do a better job managing its own Medicaid dollars without strings from DC. But then, I see this. This should be Exhibit A in what a poor job Texas has done managing Medicaid spending.

To waste millions is bad enough, but to hurt children while doing so is excrutiating. Obviously, the state is focusing on the wrong villains. We’ve got hundreds of state workers triple-checking to make sure some poor mother mails in the right pay stubs to qualify for Medicaid, but far too few people looking to make sure providers are actually delivering quality care.

Is this enrollment level the New Normal for children’s Medicaid and CHIP in Texas?

It was a different time. Back in 2000, 10% of Tarrant County kids were on Medicaid. By the end of 2010, it was 26%.

The data come from KIDS COUNT, an annual report on the well-being of children at the state and local levels from the Annie E. Casey Foundation. (By the way, these percentages don’t include kids enrolled in CHIP.) Our trend is no anomaly; it occurred in every county across the state. Overall, Texas went from 16% of kids in Medicaid in 2000 to 31% in 2010.

So, this may be the New Normal. The reason why I think that this is the New Normal is that the economy started improving in 2011 and 2012. Yet, we’re not seeing drops in Medicaid enrollment. I just downloaded the April 2012 numbers from the state, and enrollment jumped everywhere, including here.

•  State enrollment in Medicaid and CHIP was up by more than 45,000 this month. Believe it or not, 10% of those kids live in Tarrant County. (Good work, child advocates here!)
• Since April 2011, state enrollment in children’s Medicaid and CHIP is up 6.4%. In Tarrant County, it’s up 9.1%

Click on the chart to enlarge.

Another reason I think this is the New Normal is I don’t see any indication that more Texas businesses will offer to pay for worker health insurance. In fact, the opposite is true, according to a survey this month by Texas Comptroller Susan Combs. While Texas continues to add jobs, lots of employers are shedding or cutting back on health coverage. More than 100 of the more than 900 business execs surveyed by the state said they have already reduced or eliminated coverage and a similar number anticipate doing so within the next 2 years.

Now, this could reverse in 2014 if the Affordable Care Act holds and employers that don’t provide coverage have to pay a penalty. So, maybe this is only the New Normal til then. We’ll have to wait to hear from the Supreme Court in July on that.

 The KIDS COUNT Data Book is worth a read — although it’s a bit depressing. The Texas results warranted a front-page story in the Fort Worth Star-Telegram. Click here to read.

By the way, Tarrant County ranked 58th statewide by percent of uninsured children — 16.8%. It’s not great, but not bad among Texas’ 254 counties with the worst being Jeff Davis with a 29.3% rate. In fact, we fared pretty well among urban areas in Texas. Bexar County (home to San Antonio) was better at 13.6%.

To view all of the Tarrant County numbers, click here.

Change begins with a lot of little conversations

Almost a year ago, our Tarrant County CHIP Coalition started noticing that we weren’t getting the turnout we wanted at our application assistance events. A small group of us got together for lunch to brainstorm how to move forward. We decided to try to be more targeted in our outreach. Great idea! Now, where do we target? Well, we knew that the largest group of uninsured kids is in the Hispanic community.

One of our steering committee members, Paula Zalucki, suggested that we needed some outside expertise. When she had worked at JPS, she worked with a marketing agency, Cinco Strategy Group, which specializes in Hispanic marketing.

Paula called and arranged a meeting, and we were thrilled to be able to meet with them. We outlined our problem. The Cinco team listened, asked questions and requested more information. A few weeks later, we all met again. They understood the issue and had a passion for solving it. Would they help us? Yes!

Cinco has now met with our coalition several times, and with each converation we have all learned from each other. Cinco is helping us size up our market of uninsured Hispanic children and how to reach them. Most importantly, they are helping us research the application and enrollment barriers facing Hispanic families.

Here’s the thing. We know there are barriers that we can’t do anything about. But, there are some barriers that we can do something about.

I know I often tend to curse the darkness when it comes to uninsured kids. But, we need to ask ourselves — are we doing all that we can? If the answer is — I don’t think so — then, we need to find out how we can do more.

And if you’d like to join us, we’ll be meeting again on Wednesday in Fort Worth. Send me an e-mail, if you can come.

Coincidetally, this week Enroll America came out with an Enrollment Checklist for 2012 and one of its recommendations was:

“Identify segments of the uninsured to target.

The uninsured are not a homogenous group, and different populations will require different messages and different outreach strategies. In order to develop the most appropriate and effective outreach campaign, it will be important to know who the uninsured are in your state or region and to pick specific segments of that population to target in an outreach campaign.”

Right on target!

Obamacare and kids

Once in a while I hear critics of the Affordable Care Act (ACA) — which some call  Obamacare — say it’s bad for kids. I’m always flabbergasted  by such talk because it’s blatantly unfair and untrue.

It’s been two years since the ACA passed, and while many of the law’s provisions have yet to kick in, there’s already concrete evidence that it’s been good for kids.

Here’s how:

• Insurers must cover preventive services without cost-sharing. No co-pay provides an incentive for parents to get preventive care. The Georgetown University Health Policy Institute’s Center on Health Insurance Studies estimates this affects more than 1 million children in Texas.
• Children must now be covered until they are 26 years old on their parent’s health plan. Even though critics have said this would add huge costs to employers, it hasn’t. Most employers were already covering children while they’re in college, and covering additional young adults — who tend to be healthy — is actually good for risk-pooling. It’s impossible to know how many people gained coverage because of this, but we do know the number of young Americans ages 19-25 lacking health insurance has shrunk by 2.5 million since this provision took effect.
• Children under 19 can’t be denied coverage based on pre-existing conditions. Who wants to see insurers turns down coverage for kids with asthma or diabetes? And yet, this provision, which had the best intentions has had negative consequences. Most insurers stopped selling child-only policies. But there’s an easy fix. Many states have instituted annual enrollment periods — like Medicare has for Part D drug plans — to make this market work for insurers.
• Insurers can no longer put lifetime limits on health benefits for children. This is especially important to children who face life-threatening conditions such as leukemia or hemophilia.

These are just a few of the ways the ACA helps kids. To read even more, download this fact sheet form First Focus, a DC-based bipartisan advocacy organization dedicated to making children and families a priority in federal policy and budget decisions. Click here.

Quote of the Week

“A 1964 government report, One Third of a Nation: A Report on Young Men Found Unqualified for Military Service, found an alarming 50% rejection rate among young men drafted into the military in 1962. Many of them were disqualified for physical and mental conditions that could have been effectively treated in childhood. Those findings helped spur Medicaid’s creation with its comprehensive benefits for children. Nearly 50 years later, Medicaid is a vital safety net, strengthened by the new health reform law to provide a stronger web of support and protection for children and families.” — Marian Wright Edelman,  President of the Children’s Defense Fund.

Pay now or pay later. We all pay.

Last week, the Commonwealth Fund released the first-ever Scorecard on Local Health System Performance. It’s really quite an extraordinary report because of the breadth of health metrics analyzed. It looks at access, quality, costs, and health outcomes.

According to the Commonwealth report:

• Out of 306 communities in all 50 states, Fort Worth ranked 244th overall; Dallas ranked 266th.
• With such a dismal ranking, you’d think our residents didn’t get much healthcare. Just the opposite! Texans insured through commercial plans and Medicare rack up a ton of medical bills.  The research looked at per capita spending by metro area, and most Texas metro areas — including Dallas and Forth Worth were among the highest nationally. Examples of low spending area were Honolulu, San Francisco, and Syracuse, NY.
• How much higher are we? Medicare reimbursements per Fort Worth-area beneficiary were 121% of the national median.

Wow. Why would that be? I contend it’s partly because of our high uninsured rate. Texas has a lot of uninsured adults that turn 65 with all kinds of untreated health problems. They’re bound to cost more, and Medicare pays because Texas Medicaid wouldn’t cover them.

Now, let”s look at Texans with commercial insurance. Spending was 114% of the national median. Why would that be? Again, the uninsured play a role. When the uninsured show up at the ER, their costs are shifted to those with commercial insurance.

Pay now, or pay later. We all pay.

Read the Commonwealth report here. 

More poor kids coming to Texas

You don’t have to be a biology major to know that when you take away birth control from poor women, you’d better expect more poor babies.

The reason for all this is the threatened end of the Women’s Health Program, which supplies birth control and other services to 115,000 women in Texas. For background, read here.

Once in a while, an issue comes forth that perfectly captures the dysfunctionality of our health system. We don’t have a “system” at all. We have a confusing jumble that resembles that kitchen drawer at home where I stick everything, and no one can find anything. See, in countries that have universal coverage, you don’t have a patchwork of health programs where the only commonality is complexity.

Here in Texas we have the worst kitchen drawer of all: If you have this income, you get these services, but if you have this income you don’t. If your kid is this old, she gets this much medicine, but when she gets older, she doesn’t. Unless she gets pregnant; then, she gets this. You can get birth control and other women’s services, but nothing else. Oh, wait, you can get them, but there’s no one to deliver them. Or, if you don’t have any money, fill out these forms, and a hospital might treat you for free. Or maybe they’ll have a health fair where they’ll have mammograms at a reduced cost. Just wait for it.

In countries with universal coverage, everyone’s covered. Women’s birth control isn’t only for the rich and middle class. What a cruel joke THAT would be.

Is there any government policy that would be more prone to keeping poor women poor than to take away their access to birth control? Is there anything that will guarantee more kids on Medicaid than ending birth control for poor women? Gosh, if we’re really worried about expanding Medicaid budgets, we’d want to ensure poor women don’t have unplanned pregnancies that they can’t afford.

I want to see all children have health insurance coverage. But, their mothers deserve healthcare, too.

Free seminar

The Texas Health Steps Coalition is holding  a free seminar that sounds great.

Topics include:

Better understanding of the eligibility, application and enrollment process for Children’s Medicaid

Greater awareness of the benefits and services available through Children’s Medicaid

Updated information about other related healthcare programs for children

Networking opportunities  and interagency communication

When and where:

Huguley Hospital Fitness Center Amphitheater
11801 South Freeway (I-35W) Burleson, TX

March 20, 9 to noon

Registration begins at 8:30

To register, e-mail: Susie.hamsho@dshs.state.tx.us

The state we’re in: Texas kids are growing up on government-run healthcare

There probably isn’t a term more maligned in this state than “government-run healthcare.” And yet, we should look around because a whole generation — for better or worse — is relying on it.

I say this based on a new report released last week that detailed how more and more employers have dropped health coverage, especially dependent coverage in the past decade.

Between 2000 and 2010, nearly 300,000 children in Texas lost employer-based health coverage, according to the report by the Economic Policy Institute.  This loss in health coverage has coincided with growth in Medicaid and CHIP. More working parents have no choice but to turn to these programs to pay for medical care.

It may be startling to find out that the trend lines are about to intersect. At the end of 2010, 3.16 million Texas children were covered by employer-based insurance and 3.01 million were covered under children’s Medicaid and CHIP. That’s right: the number of children covered by Medicaid/CHIP in Texas is  nearly equal to those covered by employer-based insurance.

Only 45% of children in Texas were covered by employer-sponsored health insurance in 2010 compared to 68% in Utah, Massachusetts or New Jersey, or 69% in Wisconsin. Those are states that can say they have employer-sponsored health insurance systems for most kids.

We cannot.

Maybe it’s time stop thinking about how we can cut services and keep families off Medicaid and instead think about how we can improve the government-based system of care that 3 million kids depend upon. Maybe we could be advocates for these families stuck in a system that’s kind of a mess because we don’t make it a priority. It’s an also-ran on the list of lawmakers’ priorities.  

The thing is this. Why do employers provide health insurance? To compete for talent. That’s it. That’s the main reason. In Texas, if so many other employers aren’t offering health insurance, why bother?  The employers that tend not to provide health insurance tend to have low wage workers, and it’s unlikely they’re going to start offering it when their competitors don’t.  It’s the state we’re in.

Until things change in 2014.

Then, the employer mandate kicks in, and maybe Texas’ government-run healthcare system for kids will shrink as more gain coverage from employers.

Read the entire report here.  CPPP has its analysis of the numbers here.

Medicaid math

Click here for a simple clear chart about how to cut Medicaid spending.

In short: “If we cut 1 million elderly from the Medicaid rolls, we reduce Medicaid spending by about 5%. If we cut 1 million adults, however, we reduce Medicaid spending by only 1%. We need to cut 5 times as many adults. If we want to cut Medicaid spending by 10% (which is far less than some propose), we’d need to drop more than 10 million adults from Medicaid. That’s almost three-quarters of all of them. If we want to cut overall Medicaid spending by 20%, then we’d need to drop all non-elderly adults, including all pregnant women, as well as about 10 million kids, or more than a third of them.