Seventy-five percent of Minnesota’s uninsured children are eligible for state public health-care programs but their parents probably don’t realize it.
A coalition of four nonprofit groups, however, has received a $988,000 federal grant from the Children’s Health Insurance Program Reauthorization Act to get the word out and to enroll 4,000 kids over a two-year period.
It’s no easy task. For one thing, it’s taking the Department of Human Services an average of 90 days — three times longer than the statute technically allows — to approve or deny applicants for MinnesotaCare, a premium-based program for low-income residents. And, it takes counties about 45 days to qualify people for Medical Assistance, Minnesota’s version of Medicaid, a federal program that picks up half the costs.
“Although it is difficult to say how much of the increase is due to the economic downturn, it is well understood that demand for social services of all types increases during such times,” said DHS spokeswoman Lisa Wilder in an email. “This in turn puts a strain on the entire social services system, which is also working under budget constraints. DHS, which oversees health care programs administered here and in all county offices, is developing strategies to expedite and streamline the application process.”
Wilder also said that while “delays in hiring staff contributed in part to processing delays…the primary reason is the increased demand for services.”
Overcoming skepticism and ‘form-itis’
Other big hurdles include convincing skeptical parents that their children are eligible and that the effort is worth navigating the paperwork and bureaucracy.
“I call it form-itis,” said Jenny Peterson, program development director for Duluth-based Generations Health Care Initiatives, a partner in the Minnesota Coalition for Kids Health Coverage. “It’s kind of like doing your taxes…for some people it’s just overwhelming.”
But the coalition has specially trained counselors to determine eligibility and to fill out the paperwork in an appointment that can take 30 minutes to 90 minutes. A new website, HealthyKidsMn.org, guides parents to the nonprofit partners serving the state’s 87 counties. And there are outreach efforts at schools, clinics, hospitals and social service agencies.
The coalition includes St. Paul-based Portico Healthnet, St. Cloud Area Legal Services and Olmsted County Community Action Partnership.
Uninsurance rate by age, 2009
* Indicates statistically significant difference from previous year shown.
^ Indicates statistically significant difference from statewide average.
“The biggest barrier that we have is families that don’t think they qualify for anything because they work and they don’t qualify for food stamps,” said Bill Gray, spokesman for Portico Healthnet, the lead partner in the coalition. “For kids, the household income limits are much higher. For that family working two and three part-time jobs and that doesn’t have access to health care because it’s only offered to full-time workers, here is a program to help their kids get insurance.”
Children are potentially eligible for MinnesotaCare or Medical Assistance if they come from households making no more than 275 percent of Federal Poverty Guidelines. For a family of four, the top income would be $60,637. MinnesotaCare, which was launched in the early 1990s, originally covered only children but was gradually expanded to cover adults.
“We think it’s in everybody’s best interests to have health care coverage,” said Peterson about the intensified effort. “Otherwise, they end up in emergency rooms, so it’s costly to the health care provider. If children and parents are sick, it impacts the ability of a business to be productive. We know that sick kids don’t learn as well.…A lack of health coverage really impacts our whole society.”
A rising rate of uninsured kids
Despite all the efforts to cover more kids, the statewide uninsured rate for children under age 18 has climbed since 2001, according to the Minnesota Department of Health’s Health Economics Program. The rate increased from 4.7 percent in 2001 to 6.7 percent last year, meaning that about 85,000 children are now uninsured statewide.
But the uninsured rates for children are even higher in greater Minnesota than in the Twin Cities: 5.1 percent vs. 4.3 percent in 2001 and 7.2 percent vs. 6.3 percent in 2009, according to research the program prepared for MinnPost. This spreadsheet [xls] breaks down uninsured rates by age and it reveals that 75 percent of uninsured children are eligible for public health programs. And 22 percent of all uninsured Minnesotans are children.
So, why aren’t they enrolled?
“When we ask them [parents in surveys], a really big part has to do with people being unsure about the paperwork and worrying about the hassle of where to go for information,” said Stefan Gildemeister, deputy director of the Health Economics Program, which oversees the Minnesota Health Access Survey. “Very few say they are worried about the stigma. Some are worried about the cost but they also might have the expectation that being on a public program is more costly than it is.”
Ph.D.s seeking aid
Ralonda Mason, supervising attorney for St. Cloud Area Legal Services, says her office is seeing more people who never have worried about having health insurance.
“They’ve had jobs providing insurance in the past and now they’ve lost those jobs or the insurance isn’t available, or their salaries have been cut and they can no longer afford health insurance,” Mason said. “We’re seeing more families who don’t know anything about these programs because they’ve never been in this situation.…People are very frustrated and frightened.”
Teachers and professors also are seeking assistance. “We’re starting to see people at one of the colleges or tech schools because their employers are hiring them on as adjuncts and they don’t offer benefits,” she said. “These are people with Ph.D.s or master’s degrees…who never really anticipated they’d be in a position where their jobs didn’t provide access to insurance or the financial means to get insurance in the private market.”
Minnesota has long prided itself on its low overall uninsured rate, which places it below only two other states — Massachusetts, which has an individual mandate, and Hawaii, which has an employer mandate. Employer-based insurance, MinnesotaCare, a more-generous Medicaid program, and General Assistance Medical Care (for childless adults) are credited for the relatively low level of uninsured. But last year, the state’s overall uninsured rate climbed to 9.1 percent from 6.1 percent in 2001, according to the 2009 Minnesota Health Care Access survey [PDF]. More than 60 percent of uninsured adults in Minnesota also are eligible for public health programs.
“We see people who just can’t navigate through that entire process and once they submit applications, it’s not uncommon for them to have repeated contacts with a county or state worker,” Mason said. “We think our clients are much less likely to have repeated calls with our help.…It’s very frustrating for people. They give up. They may have long waits to get through the phone system at DHS. I had one who waited 25 minutes to get her call answered and then she got disconnected. When that happens, they say, ‘I’m done; I’m done.’ ”
Unknowns on the reform horizon
Although implementation of federal health-care reform is a few years out, the coalition sees a need for interim aid to vulnerable people, particularly children. A lot of unknowns are on the horizon, however. One unknown is whether the state will opt to expand right away its Medicaid program with a federal match to include childless adults. Another is the impact on existing state programs like MinnesotaCare.
“It is too soon to estimate the effect of federal health reform on state health care programs,” said Wilder of DHS. “We are analyzing the legislation and seeking clarification from the federal Centers for Medicare & Medicaid Services. Our analysis will be based on a projection of how many people who are eligible for our programs are expected to be enrolled. We would not expect everyone who is eligible to be enrolled.”
Meanwhile, counselors who enroll the uninsured in public health programs try to keep up with ongoing changes. Jessica Crowley has watched eligibility guidelines and coverage fluctuate in her six years at the Lake Superior Community Health Center’s Health Care Access Office in Duluth. The center is a partner of Generations Health Care Initiatives.
“It’s just kind of a moving target,” said Crowley, the social service department coordinator. “You never know from year to year what benefits people are going to have.…And, now it’s an interesting time between the new federal legislation” and the state’s continuing budget cuts to public health programs. “We have no idea in the next few months how it’s all going to play out.”
Casey Selix, a founding news editor and staff writer for MinnPost.com, can be reached at cselix[at]minnpost[dot]com. Follow her on Twitter.