Sunday, July 16, 2000

KCHIP: Poor turnout

Ky. enrollment lags in insurance program

By Susan Vela
The Cincinnati Enquirer

        BELLEVUE — When Amanda Faecher sees her blonde, blue-eyed daughter play peekaboo, patty-cake or more rambunctious games, she feels blessed by the knowledge that at least 2-year-old Courtney has medical coverage.

(Patrick Reddy photo)
| ZOOM |
        Courtney Page, of Bellevue, is covered by KCHIP, the Kentucky Children's Health Insurance Program, which evolved from a federal, $24 billion initiative in 1997 to fund medical coverage for low-income children of working parents.

        KCHIP allowed Ms. Faecher to not think twice about taking Courtney to the doctor when the child was stricken about a year ago with a bad case of chicken pox. On Friday, Courtney was tested for possible lead exposure.

        “If it weren't for KCHIP, I'd still be paying” the chicken pox visit, said Ms. Faecher, 20, who enrolled her daughter after seeing a TV commercial.

        July marks the two-year anniversary of KCHIP, which provides $63 million annually in health coverage to Kentucky's lower-income children.

        But despite the support of beneficiaries like Ms. Faecher and numerous social workers, health officials and Kentucky's famous Judds, enrollment is still lagging.

        Officials estimate that three out of five eligible children in Kentucky are not yet enrolled. In Northern Kentucky, only one in 10 eligible children have been enrolled.

    About 10,000 Northern Kentucky children are eligible for K-CHIP, yet fewer than 20 percent are enrolled. Through April 2000, the numbers were as follows:
• Boone: 256
• Campbell: 365
• Gallatin: 68
• Grant: 220
• Kenton: 607
• Pendleton: 100
• Total: 1,616
*from Tristate program administrators
        By comparison, similar programs in Ohio and Indiana have more enrollment success. Both states have enrolled three out of four eligible children.

        KCHIP covers physician visits, vision and dental care, prescription medicines, lab and X-ray procedures, hospital stays and other medical services. There are no co-payments.

        In Kentucky about 47,430 children age 18 and younger are enrolled; about 75,000 more remain eligible. In Northern Kentucky, approximately 10,000 are supposed to be eligible, but only 1,616 have enrolled.

        Kentucky's lagging enrollment comes despite outreach efforts at schools, clinics and health fairs. There is also a TV and radio ad campaign featuring country singer Naomi Judd, a former nurse and welfare mom.

        The working families that KCHIP targets are at the crux of the dilemma. A family of four with an annual income of up to $34,100 — or 200 percent of the federal poverty level — would be eligible for KCHIP.

        KCHIP administrators and outreach workers said families tend to shy away from efforts characterized as “hand-outs” or government entitlement programs.

        “We just couldn't get people signed up. They didn't want to be tied to the system,” said Terri Green, patient services director at Northern Kentucky Family Health Centers Inc.

        The Covington-based agency hired someone to do KCHIP outreach but had such a poor response that they let the person go last month. In a 10-month period, the agency enrolled fewer than 100 children.

        Barbara Hadley Smith, spokes woman for the Kentucky Cabinet for Health Services, and Doris Goldstein, a KCHIP supervisor for the cabinet, stress the positives of the program:

        • Through KCHIP outreach, about 25,000 children have qualified for traditional Medicaid, which is provided to those on welfare.

        • The state also has streamlined the application process and made Spanish-language applications available.

        • Interested parents no longer have to visit eligibility offices. Instead, they can get an application at their county health department and mail it in.

        Ms. Smith and Ms. Goldstein concede that more time is needed before those who are eligible to enroll in KCHIP do so without feeling ashamed.

        To destigmatize the program, officials emphasize that it is a taxpayer's program.

        KCHIP is funded by federal and state tax money. For every 79 cents contributed federally , the state matches with 21 cents.

        “The difficulty is going to be to reach those who are more reluctant to sign up,” Ms. Smith said. But, “they've paid for it. They're taxpayers, too.”

        What Kentucky is experiencing is common to other states, said Christina Chang, policy analyst for the Kaiser Commission on Medicaid and the Uninsured in Washington, D.C.

        The group has taken a special interest in the Children's Health Program (CHIP) since President Bill Clinton signed it into law. The legislation became known as the largest children's health coverage expansion since Medicaid.

        It sparked states to seek approval for their own programs, including Hoosier Healthwise in Indiana and Healthy Start in Ohio. Most were approved in 1998.

        The Indiana program covers about 124,000 children. Up to 40,000 remain uninsured but eligible. Ohio's effort covers approximately 577,000. About 174,000 more remain eligible.

        Nationwide, about 2 million children are enrolled in CHIP programs. The ultimate goal is to cover 5 million.

        “You have to remember, (CHIP) has only been in some states for only a year or ... a year and a half,” Ms. Chang said. “What we really need to keep in mind is that it takes awhile for these programs to get started.

        “It takes time to find these parents and let them know their children are eligible. It (takes) a lot of experimentation to try to find (these) families and bring them in.”

        Kentucky's push to stress KCHIP's reliance on tax dollars is the right move, she said.

        “When you recast it in that light, people become a little more receptive. It's so that people don't feel like they're applying for welfare,” she said.

        Cindy Withrow, a regional administrator for Kentucky's health services cabinet, noted that about 250 Northern Kentuckians are enrolling in KCHIP each month. There's no way to gauge whether its popularity is increasing, because the number fluctuates from month to month, she said.

        “We're trying to do away with the myth that it is a welfare program,” she said. Indiana has been recognized for its Hoosier Healthwise outreach efforts, which have included stocking county offices with CHIP information and enrolling children at shopping malls.

        The efforts allowed Indiana to enroll almost 30,000 more children than they originally targeted.

        “There was an incredible amount of destigmatization that we had to do. (But) this program is only good if people access it,” said Andrew Stoner, spokesman for the Indiana Family and Social Services Administration.

        Dave Mauch is senior vice president of Southern Ohio Health Services Network, a chain of medical centers in Clermont, Adams, Brown, Fayette and Highland counties.

        In 1997, the company lost a record $1 million, mainly from treating the uninsured. He doesn't know the total monetary loss for the last two years but he believes Ohio's CHIP program has cushioned the blow.

        “I think the health care system is at risk right now,” he said. “It becomes difficult to operate ... without the proper funding. There's just so much stress and tension right now because of the lack of funding. Everybody understands (CHIP). Now, it's just a matter of getting the work done.”

        Those interested in applying for a CHIP program can call these toll-free numbers: 1-877-524-4718 in Kentucky, 1-800-889-9949 in Indiana, and 1-800-324-8680 in Ohio.



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