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Child health changes irk state

Washington officials vowed Tuesday to oppose surprise federal rules aimed at limiting expansion of the popular State Children’s Health Insurance Program, a move that would affect about 10,000 children.

Doug Porter, an official with the Department of Social and Health Services, questioned not only the effect of new Bush administration rules, which would make it harder to insure all but the state’s lowest-income children, but also the way the change was announced last week.

“It’s just a letter, which I find a very provocative act,” said Porter, assistant secretary for Health and Recovery Service.

Federal officials said the changes would help prevent parents with private insurance from switching their kids to state subsidized plans, targeting more resources for those most in need.

Washington lawmakers criticized the rules, issued late on a Friday during a monthlong recess, as the latest salvo in a fight with Congress over whether the children’s insurance program should be expanded.

“The president knows that Congress has enough votes from both parties to overcome the veto he threatened over this bill, so now he’s trying something else,” Sen. Maria Cantwell, D-Wash., said in a statement Tuesday. “I hope he will stop and put aside political grandstanding so that more than 10 million American children can have a healthier future.”

State Sen. Chris Marr, D-Spokane, who sponsored the Washington bill expanding the SCHIP program, said the unexpected changes were an example of “legislating by agency edict.”

“It’s a process that isn’t answerable to the public or to the legislators,” Marr said.

Porter and other directors of state Medicaid programs received a notice late Friday from the Centers for Medicare and Medicaid Services. Under the new plan, states seeking to enroll children from families earning more than 250 percent of the federal poverty level – or about $52,000 for a family of four – must make sure the children have been without insurance for at least a year.

The state must also show that it has provided state or Medicaid insurance to at least 95 percent of children in families earning less than 200 percent of the poverty level.

So far, no state has reached that enrollment level. In Washington, about 94.5 percent of children in that category meet the standard, Porter said.

The states have a year to enact the new rules or face penalties, according to the letter from Dennis G. Smith, director of the Center for Medicaid and State Operations.

“We would not expect any effect on current enrollees from this review strategy, and anticipate that the entire program will be strengthened by the focus on effective and efficient operation of the program for the core uninsured targeted low-income population,” Smith wrote.

The move undermines Gov. Chris Gregoire’s plans to extend health insurance to all children by 2010. The state would not be able to use SCHIP reimbursement to expand insurance to families earning three times the federal poverty level – or nearly $62,000 for a family of four – by 2009, Porter said.

The new rules were greeted with dismay by the Washington state Hospital Association.

“It makes kids go without insurance for a full year,” said Cassie Sauer, a spokeswoman for the agency. “How contrary is that to what we want to do?”

Under Washington’s plan, children would have to be without private insurance for four months before they were eligible, although some would be accepted sooner.

President Bush has been wrangling with Congress over the future of the $5 billion-a-year SCHIP program created in 1997 to insure children whose families earned too much to qualify for Medicaid but not enough to afford insurance on their own.

The Senate and the House have passed legislation that would dramatically expand funding for the program and expand the number of children served from about 6.6 million to nearly 10 million. But Bush wants to limit the program to about its current level, contending that expansion would inappropriately increase the federal role in providing health care. The program will expire at the end of September if Congress does not reauthorize it.

Marr said he expected that Washington would continue efforts to expand insurance for the working poor even if the SCHIP limits remain. It costs less to provide access to preventive care than it does to pay for emergency treatment, he noted.

Porter said that in the meantime he would confer with other state Medicaid directors this week to decide how to respond to what he described as the “dismaying” new rules.


 

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