WASHINGTON – Budget tightening pushed more than 23,000 children off the Maryland Children’s Health Insurance Program in the last six months of 2003, a 21 percent drop in enrollment that was among the steepest in the nation.
But state officials said few, if any, of those children lost insurance coverage as a result of the restrictions that were placed on the plan, which included an enrollment freeze and a premium for some families who had not had to pay before. And both of those measures were reversed this summer.
Health care advocates, who challenged the claim that no one was hurt by the program cuts, welcomed the return to the original MCHIP standards.
“I think low-income families are extremely sensitive to premiums, and particularly when they are experiencing budget concerns themselves,” said Barbara Lyons, Medicaid director for the Kaiser Family Foundation.
The State Children’s Health Insurance Program, or SCHIP, is a federal program that provides coverage to low-income families who make too much money to be eligible for Medicaid, yet cannot afford private insurance.
The program grew every year from its inception in 1997 until enrollment peaked at close to 4 million children in June 2003. By December, however, nationwide enrollment had dropped by 37,000.
Maryland’s decline, driven by state budget cuts, contributed to that nationwide decrease. Maryland’s drop was second to that of Texas and comparable to New York’s.
In June 2003, Maryland changed enrollment requirements for MCHIP and reviewed the eligibility of children already in the program. It removed roughly 15,000 children from MCHIP after finding they were eligible for some form of Medicaid coverage. Another 2,300 children were removed after the state found their parents had employer-sponsored health insurance.
MCHIP also charged some families a $37-a-month premium, and closed enrollment to families with incomes of more than twice the poverty level. Another 1,600 children dropped out of the program after the premium was added.
Officials at the Maryland Department of Health and Mental Hygiene and at Kaiser, which issued a report on the drop in SCHIP enrollment, said they could not account for the remaining 4,100 children who left the program last year, except to say they are not covered by MCHIP.
Maryland officials believe the majority of healthcare recipients simply switched providers, and that the requirements imposed last summer were not wholly responsible for the enrollment drop.
The premium’s effect on enrollment has been small, according to a report by John G. Folkemer, Medicaid director of the state health department. Since December, he said, enrollment has grown among families required to pay a premium, and 14 percent of those who pulled out of the program last year had re-enrolled by June 2004.
In the report’s sample survey of families who were required to pay the premium and later dropped out, most said the fee was affordable and more than half said the $37 fee was not their reason for leaving the program, Folkemer said. Some cited problems navigating the bureaucracy of the system, he said, and others found other health coverage programs that did not charge a fee.
“And some of them just said they didn’t think it was worth it,” Folkemer said.
The majority of those dropped from MCHIP still have coverage, just under a different program, he said.
But Lyons said Maryland’s enrollment was hurt by the premiums, and the General Assembly knew that when it voted against extending the premium and the enrollment freeze beyond this summer, she said.
“We thought (that) was very positive,” she said.
-30- CNS 09-17-04