CHIP changes fluster families
Kids' insurance cut by mistake as program alters enrollment rules
09:22 PM CST on Sunday, March 26, 2006
By ROBERT T. GARRETT / The Dallas Morning News
AUSTIN – Ida Grayson is out almost a thousand dollars for her daughter's chronic stomach ailments because of mistakes – hers or the state's.
Beyond dispute is that Amber Nicole "Niki" Grayson, 16, fell off the rolls of the Children's Health Insurance Program on Jan. 1.
Ms. Grayson, a single mother and Fort Worth child care worker, says the state's new CHIP enrollment broker "lost a bunch of my stuff," even though she met deadlines and supplied proof she makes only $17,000 a year and drives a 1999 Chevrolet Lumina worth $1,400.
A spokeswoman for the state's main social services agency said it was Ms. Grayson's fault that Niki's CHIP coverage lapsed for January, though a separate error by the vendor wrongly kept the girl uninsured last month and this month.
Between errors and confusion about enrollment policies, hundreds if not thousands of poor Texas families have struggled, like Ms. Grayson, to keep their children on CHIP. State officials describe a "learning curve" – when the state changed vendors, altered rules and placed new obligations upon families. At the same time, a larger privatization effort has cast new scrutiny upon the process by which Texans apply for social programs.
Turmoil is fast becoming a constant for CHIP, a popular program Congress created nearly a decade ago to help families who make too much money to qualify for Medicaid but not enough to afford private insurance.
Deep budget cuts and an earlier round of policy changes in 2003 bumped about a third of the 507,000 children covered.
Last year, Texas lawmakers tried to reinvigorate CHIP. They voted to restore services they had cut earlier, such as eyeglasses and dental care, and budgeted for modest enrollment growth.
But eight months into a new budget year, families are still waiting for the dental coverage, which arrives Saturday. And enrollment is shrinking, not growing – in the past three months, nearly 30,000 fewer children had coverage, and the total sank briefly below 300,000 for the first time in five years.
"We're concerned, sure, because when you look at the numbers, we anticipated they would be going up," said Rep. John Davis, a Houston Republican who was lead writer of the House's social services budget. "It's real families that are going to be paying the price."
Among the recent problems:
• A newly hired Georgia vendor misprinted dental coverage ID cards for 45,000 children last week, mixing up birthdays with the effective date of April 1. Another batch had to be mailed.
• This month, officials reinstated 6,000 youngsters whose families hadn't paid new enrollment fees. Letters mailed by another vendor in January and February reminding families to reapply inadvertently failed to mention the fees, which vary by income but can reach $50 for the six-month term.
• Earlier letters – sent by the same vendor, a group led by Bermuda-based Accenture – misstated the co-payments families must pay at doctors' offices and pharmacies.
• Nonprofit groups that work with CHIP families were deluged with complaints in January and February that coverage was cut off even though families had met deadlines for mailing renewal applications. "People's information was just plain getting lost," said Anita McNew, CHIP outreach coordinator for Catholic Charities of Fort Worth. Some children lost coverage for three months or more, she said.
Stephanie Goodman, a spokeswoman for the Health and Human Services Commission, said a major push is under way to fix problems.
"Any time we find a mistake, we're going to correct that as quickly as we can in the way that's fairest to the consumer," she said.
Problems flared after Nov. 28, when the state switched CHIP enrollment brokers. Dallas-based ACS, the old contractor, handed off an Austin call center and the job of determining families' eligibility to the Texas Access Alliance, led by Accenture.
Its children's health enrollment duties are part of a much broader contract the alliance has to establish and run other call centers for Medicaid, food stamps and other social programs. Poor, sick and elderly people in the Dallas area will begin using those call centers in December, though traditional weekday visits to state offices will remain an option.
State Health and Human Services Commissioner Albert Hawkins has declined requests to suspend policies that have bumped families, saying it's unclear whether they were truly eligible or other factors caused them not to meet re-enrollment requirements. He has commissioned a survey of 900 CHIP families to try to get answers.
Critics say Mr. Hawkins should already be aware of the problems.
Anne Dunkelberg, a former state Medicaid official who closely tracks children's health programs for the Center for Public Policy Priorities, a liberal Austin think tank, said eligible families are turned away because procedures are too cumbersome, the state has lost veteran eligibility workers, and it is not requiring that private call center employees be well-trained.
She said that if officials were candid, they would say: "We wanted to do something bad, just not that bad."
Ms. Goodman, however, insists the use of modern technology and private firms will lead to a better system. She defended recent policy changes, such as making CHIP families submit pay stubs and supply more information at renewal. Families are now enrolled every six months, instead of annually.
"We wanted to build more accountability into the whole process," she said.
Health policy analyst Mary Katherine Stout of the conservative Texas Public Policy Foundation said an improving economy and resettlement of hurricane victims also may have trimmed the CHIP rolls.
"It's disingenuous to say it's all related to the call centers or the enrollment fee," she said.
Veteran executives and social workers at the nonprofit agencies that helped Texas launch CHIP successfully are dispirited.
Martha Blaine, executive director of the Community Council of Greater Dallas, said the state used to inundate its 50 nonprofit outreach contractors with free brochures. The state also spent more than $2 million a year to advertise the program. But the ads and brochures disappeared in 2003, and the state sent other signals that nonprofit groups shouldn't beat the bushes to find new families, she said.
Ms. Goodman said the state will revive its marketing of CHIP this spring, but GOP lawmakers such as Mr. Davis fear potential chaos as more than half of the children now on the rolls come up for renewal in April, May and June.
"We need to make sure we get it taken care of," he said.
No fix, though, can rescue Ms. Grayson's finances.
"I live paycheck to paycheck and sometimes have to borrow," she said, staring at a bill for $948.40 for Niki's visits to an urgent care center on Feb. 8 and March 1, when she was uninsured.
The state says that in November, Ms. Grayson failed to fill in a box on the renewal application asking how much money she had in cash and bank balances. By the time she did, it was too late to avoid a lapse in Niki's coverage, the state says.
"They're grasping at straws, trying to come up with a good reason," Ms. Grayson said. "But it's their fault, I'm sorry."
The state says its vendor inexplicably failed to record in Niki's electronic case record her mother's response about cash and bank balances. The girl should have been re-enrolled Feb. 1 but will not be until Saturday, Ms. Goodman of the commission said. "We can work with Ms. Grayson to see if there are other programs – such as the Medicaid spend-down program – that could help with the February bills," she said.