CHIP Grants Reprieve in 28,000 Cases

CHIP Grants Reprieve in 28,000 Cases

Polly Ross Hughes
Houston Chronicle
4/29/2006

AUSTIN - Admitting that a new system clogged by bureaucracy is unfairly denying health insurance to eligible children, state officials said Friday they're granting a reprieve to another 28,000 children who would have lost coverage in May.

 

Texas Health and Human Services Commissioner Albert Hawkins, meanwhile, has asked a team of state employees to revamp how policies are carried out so families are treated fairly and taxpayers are protected, said commission spokeswoman Stephanie Goodman.

 

The decision came after Hawkins discovered families reapplying for the Children's Health Insurance Program were given too little time to respond to letters requesting enrollment fees or missing information.

 

For instance, the commission found cases in which an independent data broker had already verified that families qualified under new stricter income and asset rules, but parents were still sent denial notices citing "missing information," Goodman said.

"We still think it's important to verify income and assets," she said, but added how the rules are applied is key. "You don't want the bureaucracy to get in the way of the end goal to make sure the family qualifies."

 

Hawkins' action comes amid growing criticism and concerns from lawmakers, children's advocates and worried managers of health plans who were already alarmed that 30,000 children have been dropped from the CHIP since December.

 

"Unless we get to the bottom of it and put forth every effort to turn it around, you could get to a program that only serves 200,000 children, from a peak of 500,000 in 2003," said state Rep. Sylvester Turner, D-Houston.

"There's been a precipitous drop in enrollment."

 

Without Friday's action, the number of children dropped from CHIP since December would have nearly doubled to 58,000.

 

Instead CHIP enrollment in May will stay steady with April at just over 294,000 children, officials said.

 

Heather Wilson of Conroe said her daughter lost CHIP coverage amid confusion as the state switched from one private call center last November to a new call center in Midland headed by the outsourcing giant Accenture LLP.

 

Complicating matters further, the state switched its contractors at the same time it issued stricter rules requiring proof of income and assets.

 

Frustration sets in

 

Wilson's family of four lives on $29,000 in wages her husband makes as a general laborer for a sign company, so daughter Payton, 3, still qualified for CHIP while her baby brother qualified for Medicaid.

 

Generally CHIP is for children in families earning too much to qualify for Medicaid for the very poor but who can't afford private family health coverage. However, Medicaid allows infants and very young children to retain their coverage in some cases.

 

So, Payton qualified for CHIP but just couldn't get it.

 

First a screener thought the family had too much income and only three members rather than four. Once that was cleared up, a letter arrived saying Payton was eligible.

An insurance card never followed, Wilson said, and that's when frustration set in.

"They kept saying information was missing," she said, insisting her family owns three trucks when it only owns one. "I sent them stuff in writing like they asked me to. They just never fixed it."

 

After 20 phone calls and waiting on hold 10 minutes or more each time (What?  I thought they were only holding for no longer than 2 minutes!), she said Payton is to regain her CHIP coverage on Monday. The insurance card, however, still has not arrived.

 

"It's ridiculous. It's a headache," Wilson said. "I never talk to the same person." (Ahhh! But it's more convenient, right?  After all, no one has to leave the comfort of their home for help!  I mean, what is it about clients having the ability to come into a local office and talk face to face with a worker when there is a problem?)

 

Goodman said the commission found that of the nearly 28,000 children who were set to lose coverage by Monday, nearly 20,000 had received "missing information" notices and nearly 8,000 received letters asking for enrollment fees.  (But didn't the guy from Accenture say they captured every piece of paper sent to them?  Didn't he say they all got scanned?  How in the WORLD could anything ever go missing?)

 

The agency found that families faced the most difficulty when they tried to renew their children's coverage, Goodman said, so the state is examining whether it is needlessly requiring too much information.  (No, requiring ONE checkstub is not TOO MUCH INFORMATION- how about this....maybe it's the folks on the receiving end of the information that's having a difficult time)

 

"Commissioner Hawkins directed a team of state employees to go in and hone in on that particular issue," she said. "We just want to make sure the process is reasonable and logical and we haven't built anything into the process that's creating an unnecessary barrier."  (Wait!  So, "State Employees" are important enough to help go in and fix a mess, but we weren't good enough to keep doing the jobs we've been doing all these years?  We are good enough to go in and 'hone in on a particular issue' but the bottom line is most of us are being replaced with ill trained call center folks who know squat about what we do)

 

Barbara Best, Texas executive director of the Children's Defense Fund in Houston, said she welcomes the agency's greater scrutiny of its procedures.

 

'Creating a huge delay'

 

"I think that's an excellent first step," she said of Hawkins' plans. "I hope they will address some of these processing issues."

 

For instance, Heather Wilson's family of four earns less than $30,000 so they earn too little to be subjected to the assets test under the law, she said.

 

"They're testing all the families for assets when they shouldn't be. It's not required," Best added. "It's just creating a huge delay."  (Wow, that's kinda like most of the clients who have dealt with TAA so far- getting pended for information that isn't even required......)

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