An HMO and a children's hospital in Dayton, Ohio, have teamed up to offer low-cost healthcare to children who lack coverage because of divorce or other custody issues.
The Montgomery County (Ohio) Kids Care Plan will cover patients under age 19 whose parents are ordered by courts to provide their health insurance because of divorce, foster care or legal guardianship arrangements.
Executives of the DayMed Health Maintenance Plan, which created the program, said they believe it's the first of its kind in Ohio, if not the country.
Neither DayMed nor Children's Medical Center, which will provide most of the care at a capitated rate, said they expect to make money.
Monthly premiums are $61.69 per child, or $123.38 for two or more children in a family.
Montgomery County authorities, who worked with DayMed to develop the plan, grew concerned about children who lacked coverage despite court orders, which left their families in financial peril if there were costly medical problems.
Many parents cannot afford to extend their individual coverage to family coverage, which can run $400 a month, DayMed spokesman Mark Anderson said.
Also, many plans refuse to cover children who do not live with a parent. In Dayton, a bare-bones individual policy starts at around $100 per month, Anderson said.
DayMed estimates 8,000 to 10,000 children are eligible under the plan.
DayMed and Children's Medical, which have worked together on Medicaid contracts, saw the plan as a natural fit.
"People have recognized it as an innovative initiative with a branch of government, a managed-care plan and a hospital working together to solve a problem that no one of them would be able to handle themselves," said David Miller, the medical center's vice president for finance.
Coverage starts March 1, but Miller expects it will take some time to determine whether it's effective.
"I think it is something people will evaluate as an option as (their cases are adjudicated), and that doesn't happen in a tidal wave," he said.
Children's Medical will provide physician services at its on-site clinic, as well as specialty and hospital services.
Benefits include physician services, inpatient and outpatient hospital care, laboratory and X-ray services, prescription drugs, preventive dental care and emergency services. Most services require a $10 copayment.