Children’s Care Introduction

States that Stand Out

SUCCESS STORIES

Alabama
Although sub-par in many health indicators, Alabama has a good statewide children’s dentistry program. By working closely with professional dental groups, the state has been able to target the problems that keep dentists in other states from treating Medicaid patients: rejected claims, no-shows and low payment rates. Since the official kickoff of Smile Alabama in 2000, 260 providers have been added to the program, and 50,000 more children have received dental care.

Illinois, Louisiana and Virginia
Although none of these states has been a leader in child health in the past, all three made it a priority last year, countering the national trend to pull back. Illinois expanded participation in its KidCare program by 20,000. Virginia increased outreach and adopted new policies aimed at simplifying the enrollment process, and Louisiana increased low provider rates, boosted eligibility levels for pregnant women and continued to expand primary care case management.

Maine, Minnesota and Wisconsin
These states stand out in using information to improve their child health programs. Managed care organizations in Minnesota and Wisconsin are offered financial incentives for improved performance. Maine approaches individual practitioners with the same techniques, an even more difficult feat.

Massachusetts
In a poll conducted by the American Academy of Pediatrics, Bay State pediatricians complained far less than doctors in most other states about heavy paperwork, low reimbursement or unpredictable payments. The state has one of the country’s highest pediatric participation rates in Medicaid, one of the lowest infant mortality rates and the highest rate of immunizations.

Missouri, New Hampshire, New Jersey and Vermont
These four states expanded their children’s coverage well beyond that of most other states — and have so far avoided the temptation to cut back on children’s programs despite fiscal shortfalls. Missouri and New Jersey have cut back substantially on parents’ coverage, however.

Rhode Island
Rhode Island has the best record in the country at providing women with prenatal care. Credit goes to its Rite Care program, which has improved children’s health generally. The key to this managed care effort comes in setting standards for provider performance and then following up to see that they are met. Attention to pre- and post-natal care results in lower infant mortality.

TROUBLE SPOTS

Alabama, Colorado, Florida, Montana and Utah
All five states have frozen enrollment in the Children’s Health Insurance Program. This avoids hard decisions as to who should be included by simply closing the door on new applicants, regardless of how needy they may be. Since these states have Medicaid programs that provide eligibility only at the minimum levels, the freezes impact children from the poorest families.

Connecticut, Indiana, Nebraska and Washington
These four pulled back on the length of time children retain their eligibility for Medicaid. They had provided 12 months of continuous coverage but have now reverted to a six-month eligibility period. This increases administrative costs and adds to the “hassle factor” for families. The states will save money when more children drop off the rolls at renewal time, but studies suggest that it may be the poorest who lose coverage.

Nevada
While Nevada offers relatively limited benefits, maintains low eligibility levels and has the second highest rate of uninsured children in the country (19.3 percent), the state nevertheless treats its doctors with unusual generosity, reimbursing them better than most other states. “We didn’t do a good job of managing our fee schedules,” the state’s Medicaid director admits. Nevada tried to pull back on those rates last year, but pediatric specialists and obstetricians threatened to boycott the Medicaid program, and government officials backed down.

Texas
Far more children lack health care coverage in Texas than in any other state — about 23 percent of the population under 19. Efforts to expand coverage through SCHIP looked promising. But in the past year, the state has taken steps to cut costs, instituting waiting periods for coverage, creating an asset test for new enrollees and changing the rules for income calculation in a way that makes it more difficult to qualify.

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