Miles apart on health insurance

Getting a raise last year was good news for Kelly Jensen of Hayden, Idaho. But it meant her two teenagers no longer qualified for Idaho’s Children’s Health Insurance Program, CHIP.

She made too much money. The raise put her just over the limit.

Now Jensen is pinning her hopes on getting her children into a new Idaho program, CHIP B. The deadline for applications is Friday.

Whether parents can get state health insurance for their children depends on what state they live in. And what a difference 30 miles makes.

Jensen would qualify for free children’s health insurance in Washington state, where income eligibility levels are higher.

The difference in income eligibility between the two states is no surprise to children’s health advocates.

“There are (Idaho) families that send a child to Washington to live with relatives,” said Ralph DeCristoforo, coordinator of the Health for All project in Spokane.

In Idaho, a family of three can earn an annual income of $23,508 and qualify for free children’s health coverage.

In Washington, a family of three can earn $31,344 a year and qualify for free children’s coverage.

In Idaho, a family of three can make up to $28,992 a year and qualify for the new CHIP B program, which requires a $15-per-child monthly premium. In Washington, a family of three can make $39,180 a year and qualify for a children’s health plan that requires a $15-per-child monthly premium.

The states are edging slightly closer, as Washington takes a step back to cut costs and Idaho takes a step forward to cover more children.

Washington, among the states that aggressively expanded children’s coverage in the 1990s, recently added the $15-per-child monthly premiums for families earning 200 percent to 250 percent of the federal poverty level income.

In addition, Washington state last year started enforcing stricter and more frequent requirements for verifying family income, resulting in tens of thousands of children dropping off the caseload.

Governing magazine called those types of changes “budget cutting by stealth.”

Idaho is going the other direction, expanding coverage to an estimated 5,600 more children.

Idaho can expand now because it didn’t expand earlier. Idaho’s new CHIP B – and a similar Access Card program – will cover children in families making up to 185 percent of the federal poverty level.

The Children’s Health Insurance Program was created by Congress seven years ago. It offers states higher rates of federal matching money than Medicaid does.

For example, Washington state gets about $1.13 from the federal government for each state dollar spent on Medicaid. The state gets almost $2 from the federal government for every state dollar spent on CHIP.

Congress’s goal was to get health insurance to more children – children whose parents made too much to qualify for Medicaid, but still couldn’t afford to buy health insurance for their kids.

“This is a group of people who are conscientious about their health. They’re making the right decisions. They’re working. They want to do the right thing,” said Jessica Blankenship, a Kootenai Medical Center social worker who helps families sign up for CHIP.

Every state established a CHIP plan, substantially expanding the number of low-income children with health insurance, said Julia Paradise, senior associate at the Kaiser Commission on Medicaid and the Uninsured. “The higher match rate was an inducement,” she said.

Now, almost 1 in 4 American children gets health insurance through Medicaid or CHIP.

CHIP, like Medicaid, gives states flexibility to raise income eligibility levels and streamline enrollment rules, Paradise said. Unlike Medicaid, CHIP does not establish any minimum eligibility levels that states must cover.

New Jersey has the most generous eligibility; children in families making up to 350 percent of the federal poverty level qualify for coverage.

Wyoming, on the other hand, offers CHIP to children whose families make up to 133 percent of the federal poverty level.

“What you’re entitled to, what you have access to, depends on where you live,” Paradise said.

In addition to state differences, children have another obstacle to health care: whether they can find a doctor willing to take state health insurance.

“While insurance coverage is not a guarantee of access to care, the research literature shows consistently that low-income children with Medicaid or CHIP are far more likely than uninsured children to get the health care they need,” Paradise said.

Jensen, the Idaho parent who hopes she’ll get health insurance for her kids through CHIP B, will pay $30 a month for the coverage if her application is approved.

She doesn’t know what she’ll do if she can’t get her kids signed up.

“I’m praying about it, literally,” she said Tuesday. Even with the raise she got last year, Jensen, a single parent, can’t afford $167 a month to buy coverage for her children through her employer’s health plan.

“I’ve thought about it a hundred different ways: How could I do it? What could I cut?” she said.

She makes about $24,000 a year working in the admitting department of Kootenai Medical Center in Coeur d’Alene.

Ironically, part of her job at the hospital involves telling parents about CHIP.

“We know that children live healthier and learn better when they are insured,” said Kelly Richards, coordinator of Covering Kids and Families at the Coeur d’Alene hospital. “With insurance, children are more likely to see a doctor when they are sick instead of putting off care until the problem is serious. … It is important for families who think they may be eligible to apply now.”