State falls short of target for kids in insurance plan

Art Nadler

Friday, Dec. 18, 1998 | 11:38 a.m.

Nearly 3,000 children of low-income families have been enrolled under the state's Nevada Check-Up health insurance program since it began Oct. 1, the Division of Health Care Financing and Policy has reported.

But there is still a long way to go toward getting the state's poor children health-care coverage. Several thousand are still pending, the Governor's Maternal and Child Health Advisory Board was told Thursday.

The state hopes to have 10,000 children and teenagers up to age 18 enrolled within a year, said Joanne Grundman of the Division of Health Care Financing. More than 8,000 applications have been received so far. The deadline is Monday for families who want coverage to begin Jan. 1.

Delays are being caused by families not including copies of their tax returns or pay stubs with the applications and failing to include the first quarter premiums, which range from $10 to $50 depending on income, she said.

But even when the state meets its goal of 10,000, the job won't be done, the advisory board was told. There are an estimated 20,000 to 25,000 eligible low-income children in the state, said Christopher Thompson, administrator for the division.

Children who qualify for Medicaid are required to be enrolled in it. Children ineligible for Medicaid will be covered by Nevada Check Up until the next determination date of Oct. 1.

Thompson said if 10,000 children are enrolled within the year, the state will receive $8.5 million in matching federal money. The Legislature will have to earmark $4.6 million to receive the match.

Health maintenance organizations have been contracted to deliver care to Nevada Check-Up patients. They include Sierra Health Services, Nevada Health Solutions and Amil International in Southern Nevada and Hometown Health Plan in the Reno area.

On Dec. 1, Medicaid in Nevada went to a similar system. Medicaid patients are now required to abandon their previous fee-for-service system -- where they chose a doctor of their choice -- and sign with an HMO.

The problem, Thompson said, is that the federal government requires that children with special needs -- such as children with diabetes -- remain with a fee-for-service system.

Some parents have indicated that they would like to be under the Medicaid managed-care system because many HMO groups provide a wider choice of specialists.

Thompson said the division is currently talking with HMOs to arrive at reasonable premiums for these children.