Minnesota needs to give kids without health insurance ACCESS

Over 80,000 kids in Minnesota âÄî 6 percent of all kids in the state âÄî were uninsured in 2009, according to the Minnesota Department of Health. This is concerning because according to the Institute of Medicine, children without health insurance are more likely to suffer worse health outcomes and earlier death than children with insurance.

Implementation of the Patient Protection and Affordable Care Act of 2010 should theoretically solve this problem, but being eligible for public health insurance coverage does not necessarily mean one will enroll in it.

In Minnesota, children from a family of four making up to about $61,000 can qualify for Medicaid or ChildrenâÄôs Health Insurance Program. ThatâÄôs why itâÄôs not surprising that the MDH estimates that about 75 percent of the uninsured kids in Minnesota are eligible for health insurance coverage through public programs.

The MDHâÄôs survey of MinnesotaâÄôs uninsured shows that the main barriers to enrollment in public coverage are the hassles associated with the process, lack of knowledge about programs and cost of public insurance (which may or may not be from actual cost information).

According to Bill Gray, spokesman for a coalition which received a grant to enroll eligible uninsured kids in public programs, âÄúthe biggest barrier that we have is families that donâÄôt think they qualify for anything because they work and they donâÄôt qualify for food stamps, [when in reality] for kids, the household income limits are much higher.âÄù

The good news is that the 2009 CHIP Reauthorization Act created a performance bonus program for states that simplify enrollment and renewal procedures and beat their target for enrolling eligible uninsured children.

Our neighbors in Wisconsin have found a way to beat their target and as a result received over $23 million in incentive payments from CHIPRA in 2009. One of the reasons for WisconsinâÄôs success is ACCESS, which stands for Access to Eligibility Support Services, a web-based, self-service tool to check eligibility for various public programs like Medicaid, CHIP and food stamps. One can also use ACCESS to apply for benefits, report changes to keep eligibility and renew benefits.

Having one website where parents can go for all the information and processes relating to various state programs for which their children may qualify has raised awareness about public programs and simplified the process of enrollment. More than 60 percent of WisconsinâÄôs Medicaid and CHIP participants enroll through the ACCESS internet portal.

The time to start setting up such a system in Minnesota is now.

At a time when we are facing unprecedented budget deficit in the state and the federal government, one might say that we canâÄôt afford to spend more money to enroll uninsured children. On the contrary, research by Mary Rimsza and others in the journal Pediatrics shows the total cost of health care to the community increases when children lose Medicaid or CHIP coverage. Instead of being treated in less expensive outpatient settings, they are treated in the emergency department or in the hospital.

Therefore, policymakers must ask how we can get the publicly eligible uninsured kids to enroll and stay enrolled, for as long as they qualify, in public health insurance coverage. One of the answers is a Wisconsin-like web portal which will increase health insurance coverage for children and bring in millions of dollars in federal funding to the state. The sooner we do this, the sooner the uninsured children who are going to the emergency room or to the hospital today would be treated by a dedicated pediatrician and have a better chance of leading a healthy, productive life.