(Originally published Aug. 18, 2011)
Imagine a city somewhere between the size of Lansing (114,000) and Sterling Heights (129,000). Imagine this city is populated only by children. Imagine every single one of these children lacks basic health insurance.
That's the reality in Michigan, says a health expert engaged in a campaign to get tens of thousands of uninsured children signed up for one of the state's public health programs. Phillip Bergquist of the Michigan Primary Care Association says the Census Bureau estimates that in 2009 (most recent figures available), Michigan had 127,000 children not covered either by a private insurance policy or public health program.
Bergquist's group has allied with the Michigan Health & Hospital Association and the Middle Cities Education Association to spearhead the "Enroll Michigan" campaign to address the gap. On Aug. 23, the group will launch a "back to school" push to enroll uninsured children in one of the state's public health programs since 65 percent of such children (more than 80,000) are eligible for the Medicaid or MIChild public programs.
Even if a child is enrolled, however, prompt medical visits are not assured. A survey released in June by the Center for Healthcare Research & Transformation (a nonprofit partnership between the University of Michigan and Blue Cross Blue Shield of Michigan) found that:
* "Forty-two percent of Medicaid recipients reported having been told their primary care doctor was not accepting their coverage, compared to just 15 percent of those with Medicare, 12 percent of those with employer-based coverage, and 10 percent of individual insurance holders."
* "Forty-six percent of those with Healthy Kids (Michigan’s Medicaid program for children and pregnant women) reported having been told their specialist would not accept their child’s coverage, compared to 14 percent with MIChild (Michigan's Children's Health Insurance Program for uninsured children of working families.)"
Those trends track with a study published this summer in the New England Journal of Medicine that found 66 percent "of those who mentioned Medicaid-CHIP (Children’s Health Insurance Program) were denied appointments, compared with 11 percent who said they had private insurance," reported the New York Times.
“As we know, kids need to arrive at school healthy in order to succeed academically and later in life. However, low-income children who have public health insurance, like Medicaid, aren’t always able to access needed health-care services. More than one-third of parents whose children are covered by Medicaid report they have trouble finding a doctor who will see their children. With 1 million children in Michigan covered by Medicaid, this is a real issue," said Jack Kresnak, who heads the advocacy group Michigan's Children.
For fiscal 2012, Michigan will spend $12 billion on Medicaid with $2 billion coming from the state's $8 billion general fund. (Federal funds constitute the lion's share of Medicaid spending.) Michigan spends another $50 million ($13 million from the general fund) on MIChild. Nevertheless, Michigan's payments to doctors and other medical providers for Medicaid patients have trailed the national average, which has led to providers limiting the number of Medicaid patients they accept.
Michigan has 1 million children already enrolled in either Medicaid (966,828) or MIChild (36,182). However, while children constitute a slight majority of all Medicaid recipients, they received less than 20 percent of overall spending in 2007 (most recent figures available from statehealthfacts.org). By contrast, senior and disabled Medicaid recipients received two-thirds of all Medicaid payments.
Medical homes eyed for savings
On Monday, a coalition of advocacy groups touted the results of an independent review of a Kent County program that "is succeeding in significantly reducing the number of expensive emergency room visits and hospital admissions while improving kids’ health."
The premise of the program is to provide better coordination of medical and social services, and incentives, to ensure needy children on public programs always have a medical "home" -- a doctor's office or clinic -- where they can be seen for preventive care and illnesses.
The evaluation of the Kent County Children Healthcare Access Program found that when "societal benefits," such as fewer missed school days were included, CHAP provided a return of $1.20 for each $1 invested.
However, the Kent program and a similar one gearing up in Wayne County are built on investments from private foundations.
"The premise of CHAP in Kent County and now in Wayne County is that these are demonstration projects. It has been our goal from the beginning to demonstrate that this approach could be funded with existing health care dollars, as long as we have the policy change to support it," explained Amy Turner-Thole of First Steps Kent, one of the coalition partners. "If CHAP continues to show positive results in the state’s two largest population centers, we believe we can make a strong case that the state should look at this approach for all children with Medicaid in Michigan. We recognize that philanthropic investment cannot sustain CHAP long-term."
Delonda McCullum of Wayne, as a young single mother, had to navigate the Medicaid system for her children. Now, she is assisting others as the intake coordinator for the Wayne CHAP.
"If we educate the people and let me know the important of what is out there in community, we can ensure the whole community is taken care of," she said.
“Kent CHAP has demonstrated that a medical home model with a focus on prevention and access can help stem the rising cost of health care by reducing hospital admissions and emergency room visits," said Kresnak of Michigan's Children. "Medical homes allow for kids and families to form strong relationships with their primary care doctors, and kids get better health care so that conditions like asthma can be caught earlier and managed without expensive trips to the ER.”