The impact of Healthy Kids switch examined
CONCORD — The NH Department of Health and Human Services has announced that more than 8,000 children currently covered under the New Hampshire Healthy Kids Gold and Silver programs will, as of July 1, be covered instead under the state Medicaid program.
The switch is the result of changes to state law which were made in an effort to save money. The state estimated last year that the switch could save as much as $6.6 million during the 2012-2013 biennium.
Under the changes, the programs “Healthy Kids Silver” and “Healthy Kids Gold” will cease to exist and transition to New Hampshire Medicaid. Families will receive new insurance cards for their children at the beginning of June, covering both medical and dental expenses.
New Hampshire Healthy Kids is a 501(c)(3) nonprofit organization that had contracted with the NHDHHS, Harvard Pilgrim Health Care, and Northeast Delta Dental to provide access to low-cost or free health coverage to the state’s uninsured children and teens.
Gail Garceau, executive director of New Hampshire Healthy Kids, said that, with the state contract ending, they are in the process of refocusing their organization which will continue to advocate for health care access for children and families and to support the building of strong and healthy families.
Garceau said how they will achieve those goals is what they are talking about now, while at the same time helping to make the transition to the state Medicaid program a smooth one.
In addition to the Gold and Silver programs, New Hampshire Healthy Kids also offered a buy-in program for families who make more than 300 percent of the federal poverty level, which is the income limit for the Silver program. The buy-in program provided coverage for and additional 800 children who will not be eligible for state Medicaid.
Garceau said her organization is trying to find alternatives for those families, though they are not ready to release specific details yet. She said if they do not have alternative options in place by July 1, an extension of the buy-in program is something they also are considering.
For families in the Lakes Region wondering how the switch to Medicaid will impact their children’s access to care, representatives of two of the area’s major health care providers, LRGHealthcare and the Health First Family Care centers, located in Laconia and Franklin, said children will continue to receive primary and emergency care.
Henry Lipman, senior vicepresident of financial strategy and external relations at LRGHealthcare, said that, earlier this year, when the organization made the decision to stop providing primary care to adults covered by Medicaid, they made it clear that they would continue to provide primary care services to children.
“That won’t change,” Lipman said Thursday.
LRGHealthcare is the parent company of Lakes Region and Franklin Regional hospitals, the Laconia Clinic, and affiliated medical providers HealthLink, Community Wellness centers in Laconia and Center Harbor, the Dental Resource Center, the Holistic Health Center, and several other community-based health initiatives.
Rick Silverberg, executive director of the Health First Family Care Centers in Laconia and Franklin, said that organization provides care to all, regardless of ability to pay, so the switch would not impact the children they serve.
Lisabritt Solsky, deputy director of the Office of Medicaid Business and Policy, said Wednesday in a phone interview that the change is positive for families and will result in better coverage for children currently served by the Silver program.
Children currently covered by the Gold program will not see any change in services, only a change in the program’s name.
“The Medicaid benefit package is a little bit richer than what was available through [the Silver program],” Solsky said.
An example is that, under the Silver program, dental services are capped at $600 a year, but there will be no cap for dental services under Medicaid.
Solsky added that more coverage for treatment and services for children who have autism spectrum disorders will be covered under Medicaid than under the Silver Program.
Another positive is that there will be no copayments for doctor’s office visits or prescriptions. The state also is offering a temporary “premium holiday” for Silver program families who currently pay monthly premiums of between $32 and $54 per child, per month, based on income.
Solsky said the premium break is anticipated to last 18 months, until January 2014, at which point the NHDHHS “will take a fresh look at the appropriateness of premiums.”
Solsky said it is too soon to say whether or not the NHDHHS would add premiums at certain income levels in 2014 or what those premiums might be. She said they have to determine if — or at what level — premiums should be required of people covered under a publicly funded program.
The issue is also tied to the larger issue of whether or not the Affordable Health Care Act, backed by the Obama administration and passed by Congress in March 2010, is constitutional.
The act currently requires that, beginning in 2014, Medicaid eligibility will be expanded to cover people under age 65, including people with disabilities, with annual gross incomes of up to $15,000 for an individual, with higher income limits for couples and families with children.
The current yearly gross income limit for a New Hampshire adult under the age of 65 who is not disabled is $7,092, so the change would greatly increase the number of people eligible for coverage under the state Medicaid program, Solsky said. Some 78,000 people currently are covered under Medicaid in New Hampshire, she added.
The state also is in the process of switching the entire Medicaid program to managed care which will see three private health insurance companies providing different packages to those eligible for Medicaid. The switch has not occurred yet because the contract has not been approved.
State Rep. Neal Kurk (RWeare), chair of the House Finance Committee III, said he anticipates the Governor’s Executive Council will approve the contract within the coming months.
Solsky said Medicaid should make the switch to managed care either by end of this year or by the beginning of 2013.
Back to the premium question, Solsky said that, if premiums were reintroduced, they would be reasonable.
“We certainly would not set a premium in a such a way that it would create a barrier for adults and children to have access to care,” Solsky said.
Another advantage of the switch is that there will no gaps in coverage for families whose income currently fluctuates above the Gold program eligibility level — which is up to 185 percent of the federal poverty level — into the Silver program eligibility level — which is up to 300 percent of the federal poverty level — which forces them to enroll and re-enroll in each program.
Under the state Medicaid program, children under the age of 19 who live at up to 300 percent of the federal poverty level will be covered. That means that a family of four may be eligible for Medicaid coverage when the family’s total monthly income is at or below $5,763, said Katie Dunn, director of the Office of Medicaid Business and Policy, in a release.
“It will be seamless for the families,” Solsky said. “We can cover as many or more children for less money than are covered now.”
Currently, there are approximately 8,200 children covered under the Gold and Silver programs of NH Healthy Kids.
Solsky said reimbursement rates to health care providers will change under Medicaid for children currently covered under the Silver program. She said reimbursement rates will be less than what is currently paid, but she did not have an average percentage or specific example readily available.
Solsky said reimbursement rates from private insurance companies — including the company that currently provides coverage for children in the Silver program , which is Harvard Pilgrim Health Care — differ greatly from company to company.
The reduced reimbursement rates will negatively impact LRGHealthcare, Lipman said. While the NHDHHS did not have any firm numbers available, Lipman said reimbursement rates will be reduced by as much as 40 percent. Using that as an average percentage, Lipman said a ballpark estimate is that the health care organization would lose approximately $200,000 in a year.
Since most of the children they see are covered under the Gold program, the benefits of which already are provided by the state but are administered by New Hampshire Healthy Kids, Silverberg said he does not think there will be a large reduction in reimbursement rates.
For more information about the state Medicaid program, visit www.dhhs.state.nh.us/ombp/ medicaid/index.htm, or call 1-800-852-3345 ext. 4344.