HD32 - Study of the Issues Impacting Universal Access to Health Care for Virginia's Uninsured Children

Executive Summary:

House Joint Resolution (HJR) 183 of the 1994 Session of the General Assembly requested the Joint Commission on Health Care to study the issues impacting universal access to health care for Virginia's uninsured children and the extent to which current initiatives should be expanded or revised to ensure that such access exists.

Specifically, HJR 183 directed that the study evaluate: (0 the impact of the expanded coverage for children under the "Kids' Care" program; (ii) the need, if any, to modify the benefits provided under the plan; (iii) the extent to which the program should be expanded to include a larger target population; and (iv) how federal funds can be maximized to support such expanded coverage.

While HJR 183 directed the Joint Commission on Health Care to conduct this study, a document which was recently prepared by the staff of the Department of Medical Assistance Services (DMAS) on this issue is being submitted in response to this request. Robert Metcalf, Director of the Department of Medical Assistance Services, presented the enclosed report to the Joint Commission on Health Care on September 26, 1994, and its contents are included herein without alteration.

DMAS found that the "Kids' Care" program, which was established to provide preventive and primary care services to children from birth to age 1 who have no other insurance coverage (i.e., private insurance or Medicaid), had enrolled only 35 children as of August 1, 1994. DMAS concluded the reason that the number of children enrolled in "Kids' Care" is far less than originally estimated is because changes to Medicaid policy adopted in 1989 made these children eligible for Medicaid benefits. Accordingly, much of the funding appropriated by the General Assembly for the "Kids' Care" program has not been expended.

DMAS also found that there is confusion among providers and families regarding the identity, services, funding, eligibility requirements and administration of the "Kids Care" program. The confusion stems from a similar program entitled "The Caring Program for Children" which is funded through private donations and administered by "The Virginia Caring Program, Inc.," a public charity formed by Trigon, Blue Cross Blue Shield. (Trigon also provides in-kind administrative services for the "Kids' Care" program.) "The Caring Program for Children" provides similar services to uninsured children from age 1 through 19. The separate administration of these two similar programs has resulted in confusion among the two target populations and administrative inefficiencies (e.g. maintaining two sets of applications, brochures, provider handbooks, etc.).

DMAS presents three options for addressing the various issues regarding coverage for uninsured children. Option I would be to pursue the federal waiver already submitted by DMAS to the Health Care Financing Administration (HCFA) to obtain matching federal funds to expand "Kids' Care" up to age three. Option II would have DMAS submit a revised waiver request to HCFA expanding the age range of "Kids' Care" within the current appropriation ($3.4 million for FY-96), possibly to age four. Option III would withdraw the waiver request to HCFA and leave "Kids' Care" as a state-only program with no federal funding. This option would provide the Commonwealth more flexibility in determining the age range for the program.

DMAS recommended that whichever option is chosen, the identity of the "Kids' Care" program should be merged with the "Caring Program for Children" to eliminate the current confusion between the two programs and the current inefficiencies in administering costs.

It should be noted that, subsequent to the completion of the DMAS study, Governor Allen recommended in his proposed amendments to the 1994-96 budget that the "Kids' Care" program be eliminated.