Monday, June 12, 2006

Article from Harlingen Valley Morning Star

CHIP-ing Away: Fewer Valley Children Enrolled in Program
Melissa McEver
Harlingen Valley Morning Star
BROWNSVILLE - Rosa Maria Solis never thought about enrolling her kids in the Children's Health Insurance Program. Then her daughter became ill.
This week, Solis filled out a CHIP application for her 18-year-old daughter Ana and 16-year-old son Victor. She's hoping the program will help offset mounting medical bills - at least until Ana turns 19 and no longer qualifies.
The family visited the Brownsville Community Health Center on Wednesday.
"I heard (CHIP) was a good program," said Solis, who didn't identify her daughter's health problems. "I heard it would help us."
Although some Rio Grande Valley families are reaping the benefits of CHIP, many others have dropped out of the program - or the program has dropped them.
Far fewer Valley children are participating in CHIP than in previous years, according to state figures. In the Valley, enrollment in CHIP has decreased by more than 40 percent since 2003, and many families who qualify still aren't enrolled, said Barbara Best, state director of the Children's Research Fund.
The organization is calling for the state to make sweeping changes to the program.
"We've got to restore CHIP," Best said. "We've got to remove the barriers for working families."
CHIP covers children whose families make too much for Medicaid but too little to afford private insurance. Enrollment in the program in Hidalgo, Cameron, Starr and Willacy counties was at a high of 46,000 in 2003, but has dropped to 26,000 as of April, the state has reported.
Statewide, enrollment has dropped from more than 500,000 since 2003 to 294,000 so far in 2006.
Clinic officials and advocates cite numerous reasons for the decline in CHIP enrollment in the Valley and statewide. They say that because of numerous changes to coverage, families are confused about what the program does and doesn't pay for, so they don't reapply. Policy changes have caused some families to become ineligible. And others complain of excessive red tape, processing errors and delays in obtaining coverage.
"They're intimidated," said Delma Sanchez, a social worker at Brownsville Community Health Center. "They think it's too much paperwork."
CHIP has gone through many changes since its creation, adding layers of confusion for participants. In 2003, the Texas Legislature cut dental, vision and mental-health benefits from the program - benefits that were mostly restored during the 2005 legislative session. Lawmakers also have tinkered with income limits, enrollment fees and waiting periods.
It's tough for families to keep track of so many revisions, said Dr. Elena Marin, executive director of Harlingen-based Su Clinica Familiar.
"There are people who still aren't aware that things have changed, that dental benefits are back in, and mental-health benefits," Marin said. "There needs to be more community outreach."
Families must now re-enroll every six months and pay an enrollment fee of up to $50, and some parents forget or consider it to be too much of a hassle, said Adela Aldrete, an outreach worker at the community-health center in Brownsville. Until 2003, families paid a monthly premium on a sliding scale, and had to reapply only once a year.
"It's difficult to reapply and reapply, over and over," Aldrete said. "They say it takes a lot of time."
Some families are no longer eligible because of changes in income requirements. For example, parents must now include their cars when totaling their assets, which cannot be greater than $5,000. Families with two cars might find themselves out of coverage, Best said.
Many of these policies unfairly punish working families, she said.
"We know these families are working, but don't receive coverage from their employers," she said. "They don't qualify for Medicaid but can't afford private insurance ... yet they're being penalized if they have transportation to work, or if they've set aside some money for their children's education."
State officials have tried to keep the CHIP-application process as streamlined as possible, and have tried to inform patients of changes quickly, said Stephanie Goodman, spokeswoman for the Texas Health and Human Services Commission, which is in charge of CHIP.
"CHIP is one of the simpler programs, and always has been," Goodman said. "We consistently hear that the process is simple."
Goodman said the agency has seen two major drops in CHIP enrollment - in 2003, when the enrollment period was shortened to six months, and in the last year, when the agency started requiring the submission of paycheck stubs twice a year.
Officials are evaluating the enrollment process and surveying families to find out why some aren't renewing coverage, Goodman said.
Families also have complained of paperwork snafus. In January, about 6,000 children were dropped because their families weren't notified about the enrollment fee. The Houston Chronicle recently reported that at least 150 Texas CHIP applications were faxed to a Seattle warehouse because applicants were given the wrong fax number.
The Health and Human Services Commission contracts with a private agency to staff call centers and serve clients.
Best said she hears complaints regularly from families struggling to navigate the system.
"I know families who have called 10 or 15 times, and their information is lost," she said. "I've heard of children being denied because they were not citizens, when they were."
The Children's Defense Fund is calling for the Health and Human Services Commission to stop dropping families until the bureaucratic problems are fixed. The organization also wants the 12-month coverage period reinstated.
"The enrollment used to be high," Best said. With some changes, it could be high again, she said.
In the meantime, outreach workers and clinics will keep trying to get the word out about CHIP and its benefits to Valley residents, Sanchez said.
"We take applications everywhere we go," she said.

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