Michigan struggles to insure kids : Kim Kozlowski
Michigan's budget crisis is expected to prevent expansion of children's health insurance coverage because the state can't afford to match an extra $100 million in federal funds.
Michigan has to come up with a 26 percent match, or about $33 million, for its MIChild program to get federal funds from the recently renewed Children's Health Insurance Program, state health officials say. But the need comes as lawmakers scramble to close a $2.8 billion deficit for the fiscal year that begins Oct. 1.
Democratic and Republican lawmakers agree it is unlikely the state can come up with the $33 million at a time when budget talks are focused on cuts, and millions of federal dollars for other health programs have been bypassed due to cuts made earlier this year.
"Show me where the $30 million is and give me a way to mark that against other priorities," said Sen. Roger Kahn, R-Saginaw, chairman of the Senate budget committee that oversees the Michigan Department of Community Health.
But some are dismayed that Michigan won't be able to take advantage of the extra $100 million from the federal government.
"It would be such a tragedy to walk away from those funds," said Marianne Udow, director of the Center for Healthcare Research and Transformation. "Our priority as a state and a country ought to (be making) sure that all our children have health insurance coverage."
For now, advocates for the uninsuredhave launched a two-year effort to get 50,000 more children enrolled either in Medicaid or the existing funds already dedicated to MIChild program, which covers routine care, dental, vision, mental health and prescriptions.
About 983,000 children are enrolled in Michigan public uninsured programs. But about 160,000 children still lack health insurance.
More than ever, more people need health coverage, even if it's only for their kids, said Doug Halladay, director of the Michigan Cover the Uninsured Network, a network of organizations working for affordable coverage.
"With the economy and unemployment rate, people are losing their (health insurance) and increasingly having to make choices about health insurance and paying their mortgage," Halladay said. "It's not a poor people's problem. It's a middle-class issue."
The Children's Health Insurance Program is a federal/state initiative created in 1997 to provide health care to children in families too poor to qualify for Medicaid but not earning enough to afford a private plan. The five-year reauthorization, approved by Congress in January, continues coverage for 7million children nationally, and provides additional funds to insure 4 million more kids, including children of legal immigrants and pregnant women. When President Barack Obama signed the $69 billion law, he called it a "down payment on my commitment to cover every single American."
Under the new program, Michigan was allotted an additional $75 million for the fiscal year that ends Sept. 30, and the state could get a similar allotment during the five-year program if it can provide matching funds.
The new funds could be used to expand the program to cover families with higher incomes and offer dental benefits to children with private health insurance.
Rep. Gary McDowell, chair of the House committee overseeing the community health budget, said the state already will miss out on about $44 million in federal money because Gov. Jennifer Granholm cut Medicaid provider reimbursement rates by 4 percent in May as part of a $304 million executive order to balance the budget.
"It just shows how dire the situation is," said McDowell, D-Rudyard.
Granholm, an advocate for universal health care, said she wants to provide better access to health care for children.
"We would support ways to match these federal dollars, expand coverage to more Michigan children, and we look forward to working with the Legislature at the appropriate time to do that," said Liz Boyd, Granholm's spokeswoman.
Part of the reason Michigan will be so flush with cash for the children's health program is because the funds can no longer be used to cover adults -- something the state has done for six years.
Early in the program, Michigan was unable to spend all of the funds to insure low-income children so it lost $161.8 million to other states from 1998-2001, according to the Centers for Medicare and Medicaid Services. The federal government began allowing states to use unspent funds to cover other uninsured populations.
Michigan got approval in 1994 to provide health insurance to childless adults earning about $3,900 annually.
This year, the $258 million program covered 41,000 children at a cost of $58 million and 62,000 adults at a cost of $200 million. But new federal rules require Michigan to use Medicaid funds by January for childless adults, which will leave a surplus of about $100 million.
"It's tough to talk about expansion when we are talking about budget cuts," said Steve Fitton, acting Medicaid director for the Michigan Department of Community Health.
But the state has looked at costs of increasing eligibility from its current threshold of children living in families earning between 150-200 percent of poverty.
For a family of four, that means annual incomes between $33,075 and $44,100.
Michigan has looked at increasing MIChild eligibility to 250 and 300 percent of poverty -- thresholds that many states already have -- which would qualify a family of four annually earning up to $66,150.
Detroit resident Phoenicia Jackson thought she made too much money to get public health insurance for her 10-year-old daughter, Rose, when she was earning $35,000 as a development manager at a nonprofit.
"Any type of government assistance, you really have to be just one step up from the street before you can get any help," said Jackson, who is now unemployed. "I was surprised that she qualified."
The state is also looking into covering more low-income children by finding them through school lunch programs. "I would really like to see the state come up with the funding to get these federal funds, particularly in this very tough economic time," said Jan Hudson, health policy analyst for the Michigan League for Human Services. "It would be terrible for the state to have the opportunity to provide health care service to children for only a quarter on the dollar, and not be able to do it."
