This column features selected short items about state health care policy.
Louisiana SCHIP to cover pregnant women
BATON ROUGE, LA—Louisiana has made a big push to get more of its children covered by government-funded health insurance.
Now it’s pregnant women’s turn as the state expands its effort to produce healthier children and save money by treating fewer sick children. Later this year, pregnant women in working-poor families will be able to apply for free health insurance benefits previously available only to the poorest people.
The benefits start Jan. 1. Women in families with incomes up to double the federal poverty level will be eligible. "It’s logical," said David Hood, secretary of the State Department of Health and Hospitals.
"The child, in order to be totally healthy, needs care from conception, not just birth," Mr. Hood said.
Today all children in families with incomes up to twice the federal poverty level are eligible for the Louisiana Children’s Health Insurance Program (LaCHIP). Since LaCHIP started in fall 1998, 74,407 children have been enrolled, and another 144,385 children have been added to traditional Medicaid, which offers free health care to poor people.
There are 534,063 children covered by the two programs. LaCHIP already provides health insurance for teens under age 19 who get pregnant.
The new program will expand the coverage to women of all ages who meet the requirements.
"It’s been a policy disconnect’ to have the babies eligible for Medicaid at birth and have the mother with no prenatal care," said Sandra Adams, director of the Louisiana Coalition for Maternal and Child Health. Ms. Adams said the new program helps "a small population, but it’s a population that absolutely cannot get care other than through public facilities."
—Baton Rouge Advocate, July 21
Medicaid expands to pay psychologists
BATON ROUGE—Louisiana’s failure to meet a federal court deadline to get psychological services to developmentally disabled children is leading to a costly expansion of Medicaid, the government’s health insurance program for the poor.
The state is expanding the Medicaid provider list to include psychologists, and the services they offer won’t be limited to the special class of 3,400 mentally retarded and developmentally disabled children in a federal lawsuit.
Under federal law, some 400,000 Medicaid-eligible recipients younger than 21 also could benefit from the services if needed.
State health officials estimate the Medicaid expansion could cost up to $30 million annually in state and federal funds.
The provision of behavioral and psychological services for children with autism and other developmental disorders is one component of a 1997 federal lawsuit, known as the Chisholm case.
The case sought help for Medicaid-eligible children who were on a waiting list for specialized services for the mentally retarded and developmentally disabled.
David Hood, secretary of the State Department of Health and Hospitals (DHH), said his agency didn’t intentionally miss the deadline U.S. District Judge Carl Barbier set for compliance.
It’s just that DHH’s initial service delivery plan didn’t work, he said.
—Baton Rouge Advocate, July 31
Medicaid costs under budget
INDIANAPOLIS—A lawsuit increasing the number of people who get taxpayer-paid health care didn’t turn out to be the budget-buster Indiana state officials had feared.
Final figures aren’t in, but officials say they expect the landmark Patricia Day case to cost Indiana Medicaid about $130 million — not $850 million, as had been projected.
The lawsuit helped expand Medicaid from a program that covers just permanent, untreatable disabilities to one that covers disabilities expected to last at least four years if left untreated.
That opened the door for thousands of Hoosiers turned down for Medicaid during a nearly eight-year period to get publicly funded health care. The state lost the legal battle in June 2001 when the Indiana Supreme Court upheld a lower-court ruling.
Records compiled so far show just 3,665 of 17,559 people state officials tried to contact afterward signed up, said Melanie Bella, the state’s Medicaid director.
State officials caution that the lower-than-projected response won’t mean a windfall.
"It’s not going to give us extra money to go shopping with," State Budget Director Marilyn Schultz said.
It also won’t ease Indiana Medicaid’s funding deficit, which has resulted in nearly $660 million in cuts in payments to nursing homes, hospitals, pharmacies, and other caregivers.
—Indianapolis Star, Aug. 1