By TRACEY GLAZENER
Capital News Service
LANSING — Gov. John Engler wants to extend health care coverage to 222,000 uninsured citizens, but child and health-care advocates worry the state’s Medicaid system can’t handle such an expansion.
Sharon Peters, president of Michigan’s Children, a child advocacy organization, said the organization supports the expansion and integration of health care coverage, but those in extreme poverty cannot afford the proposed changes.
“Reducing the scope of benefits to the population at or below 50 percent of the federal poverty level is a real concern, and imposing co-payments and premiums on them in addition is a major problem,” she said.
As explained Feb. 4 at a public forum, the plan would extend health coverage to parents and adults earning low wages, working adults with disabilities and individuals not qualified for Medicaid who can’t afford private health insurance.
Medicaid recipient Bobbie Lemon, an Eaton County mother of three, attended the forum. She worries that changes to Medicaid will negatively impact Michigan families.
“How are Michigan officials going to ensure that they are not putting more families at risk?” she said. “I am worried that people are not going to be able to process this information fast enough to appropriately react to this proposal.”
Federal law encourages states to propose plans that maximize private health insurance options and federal dollars in exchange for a waiver, allowing reallocation of state health care expenditures. So far, Arizona and California have been granted such waivers.
“The waiver, called MIFamily, will allow us to use dollars we already spend on county health programs to increase federal funding of health care,” said Geralyn Lasher, director of communications for the state Department of Community Health.
Meanwhile, Robert Marquardt, president of Memorial Medical Center in Ludington, said insuring more people through Medicaid may help the hospital receive compensation for treating low-income patients.
Therefore, he said, the hospital views MIFamily as a positive development, and he thinks officials of most hospitals would agree with him.
“We serve about 700,000 charity cases a year that we write off as bad debt,” he said. “But serving people is part of our mission, and receiving some payment is probably a good thing.”
Lasher said the expansion of coverage to 222,000 of Michigan’s uninsured will require revising Medicaid recipient’s benefits. For example, parents at or below 50 percent of the federal poverty level — currently $7,534 or less per year for a family of three — will no longer be eligible for full Medicaid services. In addition, that group will be required to make co-payments for outpatient, substance abuse, pharmacy and limited inpatient benefits.
Extend Medicaid coverage to pregnant women at or below 200 percent of the federal poverty level.
Provide 12-month continuous coverage to children covered by the Medicaid Health Kids Program.
Allow disabled persons to earn more money while maintaining existing Medicaid benefits.
Provide parents and caregivers between 51 and 100 percent of the federal poverty level with an HMO-like benefit, which includes limited inpatient coverage.
Provide single adults below 35 percent of the federal poverty level with an outpatient benefit.
All groups will receive a pharmacy benefit, and a voucher option will be available to purchase existing employer-sponsored or private coverage.
Lasher said the point is to attempt to provide everyone with some coverage rather than some people with full coverage.
“There are people out there with nothing who really need coverage,” Lasher said. “We’re trying to maximize benefits to help more people.”
An important requirement of the waiver is that benefits and eligibility be reviewed annually through the public process, but the review process was not explained at the public forum, when the plan was announced Feb. 4.
The DCH accepted comments in writing — by e-mail or standard mail — through Feb. 11, giving the public one week to review the proposal and compose constructive criticism. After reviewing the public’s comments, the department will complete the waiver paperwork for submission to the U.S. Department of Health and Human Services by March 1.
Mark Reinstein, vice president of the Mental Health Association in Michigan, said he commends the department for seeking to expand health coverage to the uninsured and making positive use of all funds to which the state has access. He is disappointed, however, in the lack of public involvement in the waiver proposal.
“I do not commend the department for failing to involve outside groups in related discussions prior to the Feb. 4 public forum, giving the public only one week to make written comment and refusing to meet on or before Feb. 11 with a coalition of health care groups requesting such a session.”
Reinstein is also concerned that mental health services will be neglected by MIFamily, because the plan provides a limited benefit with all services provided through county mental health programs — programs receiving no additional funds to cover the new Medicaid populations.
“The state assumes that $56 million can be safely moved from the state’s non-Medicaid community mental health budget to the new Medicaid population,” he said. “But they don’t know how many statewide non-Medicaid mental health clients there are, and they don’t know how many additional mental health clients will receive Medicaid entitlements through the waiver.”
Reinstein said the DCH’s assumption kicks off a chain reaction of important fiscal steps. If proven inaccurate, a major imbalance in the system will exist, causing serious problems for community mental health service providers and their patients, he contends.
Peters said Michigan’s Children also objects to MIFamily’s limited coverage of Early Periodic Screening, Diagnosis and Treatment — a well-child screening program required of state Medicaid programs. MIFamily will not fully cover EPSDT screenings for all groups eligible for MIFamily.
EPSDT screenings are especially important for low-income residents, because statistics suggest that those people produce higher proportions of children with mental and physical deficiencies.
“It is required by Medicaid that 80 percent of children served receive all EPSDT screenings,” Peters said. “But according to our data, we already don’t do near that, and MIFamily seems to limit that further.”
On the other hand, Marquardt added that MIFamily seems like a good idea for a short-term solution, but unknown long-term consequences may create bigger problems for the state’s Medicaid programs.
Lasher said the department received indication that the proposal will be on the fast-track to approval once submitted, and if approved, MIFamily is expected to begin in October.
© 2002, Capital News Service, Michigan State University School of Journalism
By TRACEY GLAZENER