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Ensuring coverage for youngsters

Advocates begin effort to enroll all Mass. children

Lissette Cebeno with her daughter, Danieliss Gomes, who is insured by MassHealth. The toddler’s coverage has been dropped three times. Lissette Cebeno with her daughter, Danieliss Gomes, who is insured by MassHealth. The toddler’s coverage has been dropped three times. (David L. Ryan/ Globe Staff)
By Kay Lazar
Globe Staff / May 10, 2011

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Thousands of Massachusetts children remain without health care coverage despite the state’s universal insurance law, a chasm that is prompting the launch today of a campaign by state leaders and consumer advocates to get all youngsters enrolled.

This month, teams of workers from a consortium of hospitals and community health centers, armed with fliers and posters in eight languages, will redouble efforts to search out uninsured children and sign them up, said Amy Whitcomb Slemmer, executive director of Health Care for All, a Boston-based consumer group that is leading the initiative.

“Families have been laid off or lost their jobs and have been disconnected from their employer’s health insurance, or they’re struggling to pay for their premiums,’’ Slemmer said. “But in the meantime, there is no reason that a child in Massachusetts should not have health insurance.’’

Massachusetts has one of the highest coverage rates for children in the nation. The state’s latest count indicates that 99.8 percent of youngsters had insurance in 2010, up from 98.1 percent the previous year. But about 3,300 remain uninsured.

Among them is Danieliss Gomes of Dorchester, 1 1/2, who has been dropped from state-subsidized health insurance three times since last October because of paperwork glitches, said her mother, Lissette Cebeno.

“I get scared if she gets sick and she goes to the hospital, they are going to send me a bill I can’t afford to pay,’’ Cebeno said.

The state’s 2006 health care law does not require parents to insure their children, but it created programs aimed at making coverage more affordable. Another state program provides financial assistance to families with difficulties paying monthly premiums from coverage through their employers.

But some families are living so close to the edge that having a monthly premium deducted from their paychecks, then waiting for reimbursement from the state, becomes unbearable, said Kate Bicego, Health Care for All’s consumer education and enrollment manager, who also directs the group’s consumer HelpLine.

“They’re forced to choose between feeding their families and covering their kids with health insurance,’’ Bicego said.

Other families, she said, fall through considerable bureaucratic cracks.

For instance, Bicego said, the state requires that single parents who apply for subsidized insurance through the Medicaid program, known as MassHealth, provide information about any health insurance the absent parent might have that could cover the couple’s children, instead of state-funded care.

This information had been required for those who applied online, but the state just added that requirement in January for those who fax or mail in their applications.

“Some folks don’t know where the absent parent is, or they have been having trouble with that form,’’ Bicego said. “This is one of the things that has been confusing folks and has led to erroneous terminations.’’

It is one of the issues that snagged Cebeno, 20, who had to put off her daughter’s first-birthday checkup in January, along with scheduled vaccinations, because they were both dropped from MassHealth.

Cebeno said the state first terminated their coverage in October because officials were unable to verify her immigration status — she is a legal immigrant — and her Social Security number.

Her daughter was reinstated, then cut off again in January, when Cebeno received one of those absent parent letters; the state was seeking financial information about Cebeno’s boyfriend, the father of Danieliss.

“I was worried because she couldn’t get her vaccine,’’ Cebeno said.

After spending hours trying to resolve the issue on her own, Cebeno called Health Care for All, and a counselor helped her send in the correct paperwork to get her daughter reinstated, and finally, to get her overdue check-up and vaccines.

Then, after another paperwork glitch, her daughter was dropped again earlier this month.

Dr. JudyAnn Bigby, state health and human services secretary, said her agency is working to streamline the enrollment process so that coverage for children is not so often dropped inadvertently.

“We know that parents without insurance worry about taking their kids to the doctor and may wait until they are very sick and then take them to the emergency department,’’ Bigby said.

Also, pediatricians routinely check children for developmental delays, and a child who misses regular screenings may lose out on the opportunity for early intervention and treatment, she said.

Even in families that can afford private insurance, children can sometimes go uncovered. For Teresa Persico, 39, a Milford attorney, and her husband, Marino, 42, an information technology manager at an electronic media company, the issue was timing.

The couple has health insurance for themselves and their 5-year-old son through Marino’s employer, but missed the 30-day window to add their 2-month-old daughter to that plan because they mistakenly thought they first needed to have a Social Security number for her.

The insurance company was willing to bend the rules, but Teresa Persico said her husband’s employer was not and insisted they wait until the company’s annual open enrollment period this fall to add her to the plan.

As a result, the couple has been paying out of pocket for coverage for their newborn until insurance they just purchased starts next month.

That will cost them $400 a month, in addition to the $400 they now pay for their family coverage through Marino’s employer.

“What if we couldn’t afford it?’’ Persico said.

Kay Lazar can be reached at klazar@globe.com.