October 08, 2010

Government Helps to Insure Children, Even Above the Poverty Line

Leah Nash   ·  New York Times   ·  Link to Article

The last few years have not been easy for Dean McCrea.

In 2007, Mr. McCrea, 55, lost his wife of nearly 30 years. Then last November the company he worked for folded, and he could not afford to pay the steep Cobra premiums required to keep health insurance for him and his son, Henry, 16.

Mr. McCrea, a media producer in Portland, Ore., receives $380 a week in unemployment benefits, which barely covers his mortgage; Henry receives a small stipend from Social Security each month. "The last years have been a constant navigation of what feels like Class 5 rapids," he said.

In June, Mr. McCrea's luck turned, a little. He learned about Healthy Kids, the state's health insurance program for middle-class families, and promptly enrolled his son. The program provides Henry with full health coverage, including vision and dental. The cost: $38 a month.

"A lot of people in my circle, solid middle-class families, are struggling," Mr. McCrea said. "The peace of mind that this program has supplied me is not measurable."

Government health insurance for children is no longer available only for the poorest households. Now middle-class families like the McCreas, struggling through the recession, can benefit as well.

The Census Bureau recently reported that the poverty rate was up, and the number of insured adults was down. But the news was brighter for children. The percentage of children under age 19 with insurance edged up to 91 percent last year, a record high, from 90.3 percent in 2008.

"To a surprising extent, the government has really stepped up to provide affordable coverage options for middle-class kids, along with their lower-income counterparts," said Jocelyn Guyer, co-executive director of the Center for Children and Families at Georgetown University. "It's a success story."

Success is not a word you often hear in concert with health insurance. But government programs like Medicaid and the Children's Health Insurance Program (CHIP), which blend state and federal assistance, have expanded their reach over the last several years to cover a wider swath of the population.

Children in families with incomes of up to $44,100 (for a family of four) are likely to be eligible for some kind of government health insurance. In states where the cost of living is high, the income limits are even greater. In New York State, the cutoff for a family of four is $88,200; in New Jersey, it is $77,175.

The news is good for children, but it could better. Almost 10 percent of children, or seven million of them, still do not have insurance. According to a recent report published in the journal Health Affairs, 4.7 million of those uninsured children are eligible for government coverage.

"Not enough people know about these plans," said Mr. McCrea, referring to Oregon's Healthy Kids program, which is part of CHIP. "Or they think they are a hassle to join, but they're not."

If you have a child who is not covered, or your Cobra coverage is about to expire, or you're worried that you might be laid off, government plans in your state may be helpful. Even if your family was not eligible for coverage a few years ago, you may be eligible now; household income limits have been raised, and many CHIP programs have added new ways to qualify.

Last year Oregon created an insurance exchange, Healthy Kids Connect, that offers subsidized coverage to families with incomes between 200 to 300 percent of the federal poverty limit. (Families under the 200 percent threshold receive free coverage.) This is the program that Henry McCrea joined.

"Our biggest obstacle has been to convince families that don't qualify for food stamps or other subsidies that they qualify for our program," said Cathy Kaufmann, administrator of the Healthy Kids program in Oregon.

And if you live in a state where insurers are rapidly dropping child-only policies, a government program could be a refuge. Some states let families with incomes above the cutoff limit enroll in CHIP plans so long as they pay full fare, without subsidies. Even though states are strapped, most are still accepting new children - except for Arizona, which has stopped enrolling children in its CHIP program.

The simplest way to find out about the programs in your state is to go to the federal government's Web site, InsureKidsNow.gov. Here's a breakdown of what's available and how to apply.

LOW-INCOME FAMILIES Medicaid provides free, or very low cost, health coverage for people under 21 who live in families with poverty-level incomes, currently $22,050 for a family of four. The program also covers children under age 6 who live in families with incomes at or below $29,326 (133 percent of the poverty level).

Children who are covered by Medicaid receive a full range of services, including immunizations, vision and dental care. Eligibility rules vary by state.

MIDDLE-INCOME FAMILIES Created in 1997 and expanded by President Obama in 2009, CHIP provides low-cost health insurance for children in middle-class families who make too much to qualify for Medicaid. Each state designs its own plan and determines its own income requirements. In some states, coverage may be free; typically, it is subsidized.

Every state plan must provide free preventive care and immunizations to children in the program, as well as free or reduced-fee checkups, prescription medications, and dental and hospital care.

SIGNING UP To find out whether you qualify for Medicaid or CHIP, go to the map at InsureKidsNow.gov and click on your state, or call 877-543-7669.

In most states, applicants fill out just one short application to find out if they qualify for Medicaid or CHIP. Many states allow you to apply online, and some let you apply over the phone. (They then send a filled-out application for you to sign.)

After submitting your application, you should have an answer within 45 days, often much sooner, according to Cindy Mann of the federal Centers for Medicare & Medicaid Services. Eleven states, including New York, also allow qualified providers to grant immediate, temporary coverage for children in both Medicaid and CHIP if they appear to be eligible.

UPPER-MIDDLE INCOME FAMILIES If your income is too high for a government plan, you should first find out whether your state's CHIP program allows families to buy in - that is, pay the full cost without receiving a subsidy. About a dozen states have this option.

If not, a child-only policy from a private insurer might be affordable. Under the new health care law, insurers that offer child-only policies must accept every child who applies, and they cannot change rates based on a child's health.

When this part of health reform went into effect last month, many providers promptly dropped their child-only policies. Still, some insurers continue to offer this coverage, which costs an average of $1,350 a year, according to a survey by America's Health Insurance Plans, an industry trade group.

To look for a child-only policy, you can go to the government's new health insurance Web site, healthcare.gov, and enter your child's information. The site will give you a list of possible policy choices.

I plugged in Henry McCrea's age and home state and found a range of options. They included a policy that cost $24 a month but had a $10,000 deductible, and another that ran $178 a month with a $500 deductible.

You can use the site to shop for health insurance for families and adults, as well. The site also includes information on Medicaid, CHIP and government-sponsored high-risk pools.