Eligibility rules to be revised in plan for poor kids' health care

State officials have agreed to restructure a proposed program to provide poor children with health insurance.

The program, Nevada Check Up, was scheduled to begin July 1, but the start date has been pushed back until sometime this fall.

The Health Care Financing Administration (HCFA), a federal agency that oversees Medicaid, rejected the state plan until a more structured application process is devised to identify eligible children.

HCFA wants Nevada to question families about their assets. State officials balked at the demand, opting to assign children to either Nevada Check Up or Medicaid, based solely on family income.

Nevada has now agreed to ask for an assets test if a family has more than $3,300 in assets. Such families also will be asked to fill out a Medicaid application.

If an application came from a family of four whose income was no more than $21,800 a year with assets of $3,300 or less, that family would automatically be placed in Nevada Check Up. They wouldn't have to answer questions about their assets.

"What we are being required to do is go through these additional steps for the Medicaid application," said Christopher Thompson, administrator of the state division of Health Care Financing and Policy. "We will now have more administrative costs, and the families will have to fill out more forms."

Estimates last year placed Nevada's population of poor children at 60,000. But a report released this March by the Urban Institute in Washington, D.C., said the number was closer to 17,000.

Thompson said when estimates of children needing insurance was 60,000, the federal government had earmarked $30.4 million, and the state was to contribute $16.4 million.

A second survey is being conducted by UNLV researchers, Thompson said. It's scheduled to be released next month. If the numbers match the Urban Institute survey, the federal government will award $13 million and the state will contribute $7 million.

Richard Chambers, associate regional administrator of HCFA in San Francisco, said he is confident the Nevada Check Up program will begin by Oct. 1.

"There's a few little issues left, but nothing that can't be worked out," Chambers said. "We want to know the source of funding for Nevada Check Up, and they (Nevada) will have to renegotiate with the HMOs."

Thompson said his office has, to date, signed contracts with four health maintenance organizations to administer health care for Nevada's poor children.

The HMOs include Sierra Health Services, Amil International of Nevada and Nevada Health Solutions in Southern Nevada. Hometown Health Plan has agreed to participate in the Reno area.

Whatever the final count of poor children turns out to be in Nevada, Thompson said the state -- by federal law -- can mandate only 10 percent of the total budget for administrative costs.

Under HCFA's new guidelines, Thompson said he may have no choice but to spend the full $2 million available for such costs from the proposed $20 million federal and state matching funds.

archive