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Red tape cited in health gap for young

Complex rules keep children unenrolled

By Kay Lazar
Globe Staff / June 14, 2011

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Many children are going without health insurance, despite the state’s universal insurance law, because of confusing rules about how to sign up and when to renew the government-subsidized coverage, according to findings to be released today by consumer advocates.

A monthlong campaign to search out and enroll many of the estimated 3,300 remaining uninsured children has resulted in new coverage for 1,479 youngsters, according to Health Care for All, a Boston-based consumer group that is leading the initiative. But advocates say the campaign has also highlighted burdensome paperwork requirements that often result in children being booted off of Medicaid, the state and federal program for low-income people, though they are still eligible.

Families are required to re-enroll every year, and children can be cut from the program if parents do not notify the state of changes in address, income, or employment. Each time a person is dropped and then re-enrolled, it costs the state about $200 in administrative costs, according to a University of Massachusetts report last year that suggested that eliminating those costs could save the state millions of dollars.

“We are delighted by the results of our enrollment campaign, but it points to the broader problem,’’ said Amy Whitcomb Slemmer, Health Care for All’s executive director. The group now plans a campaign to educate parents about how to keep children insured, and legislation has been filed to make it easier for children to stay on Medicaid.

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 advocates and the state hope to get all children insured.

Teams of workers from a consortium of 66 hospitals and community health centers scoured schools and communities during the past month to connect uninsured children with coverage. Some used Facebook to alert followers about the mission or detailed the campaign in their monthly newsletters to community groups. The nearly 1,500 they enrolled are those who have not had state subsidized coverage for at least one year and are considered new enrollees.

Advocates said many are new to the state or are from families whose insurance ended when parents lost their employment.

“We do a lot of outreach at career centers, and we have seen a lot of people out of work,’’ said Eleni Kontogli, director of marketing at Harbor Health Services, which includes Geiger Gibson and Neponset health centers in Dorchester and the Mid Upper Cape Community Health Center in Hyannis.

Harbor Health typically enrolls about four children a month, but during the past month’s campaign signed up 36, Kontogli said.

In addition to these new enrollees, there were many others who were signed up after they had been bumped off state coverage, sometimes a couple of times in one year, Kontogli and other advocates said.

Jackie Coogan, president of the Everett-based Joint Committee for Children’s Healthcare, said her organization newly enrolled 18 children in Medicaid in the past month but reenrolled 41 who had recently lost coverage.

A report last year by the Center for Health Law and Economics at UMass Medical School found that in an average month, more than 12,000 adults and children who were dropped from subsidized coverage, Commonwealth Care and MassHealth, for an administrative reason within the preceding 90 days were reenrolled. That amounted to nearly a quarter of all residents who were disenrolled for administrative reasons, a pattern that suggests many of the residents probably were still eligible despite the lost coverage, the report said.

Senator James Eldridge, an Acton Democrat, has proposed legislation to ease the problem and provide youngsters with consistent access to needed health care by allowing children and families to remain on state-subsidized coverage continuously for a year, even if the family’s income or address changes. The bill would require Dr. JudyAnn Bigby, state health and human services secretary, to seek federal approval for the change, because the federal government funds half of the state’s Medicaid health insurance program.

Thirty-three other states have already enacted similar legislation, according to federal figures.

Bigby said in an interview with the Globe last month that her agency is working to streamline the enrollment process so that coverage for children is not so often dropped inadvertently. But Bigby has not sought federal permission for the continuous coverage provision spelled out in Eldridge’s bill, according to spokeswoman Paulette Song.

Advocates say the monthlong enrollment campaign is just the first step. The next challenge, they said, is to help parents understand how to keep that insurance active. Consumer groups will be distributing personalized refrigerator magnets, bookmarks, and other materials that will include the date by which a family must submit an application to renew its state-subsidized coverage each year, and contact information for help with that process. The materials also list specific actions, such as a change in address or income, that require them to notify state officials within 10 days or risk losing coverage.

Kay Lazar can be reached at klazar@globe.com. For more information, call the Health Care for All HelpLine at 800-272-4232 or go to hcfama.org.