Low payments to healthcare providers and faulty coordination among state-run programs are limiting impoverished children's access to healthcare, the General Accounting Office said in a new analysis based on information from Medicaid and the State Children's Health Insurance Program in 10 states.
For example, applications often bounced between the two programs, delaying coverage, the GAO said. In some cases in Colorado, families denied Medicaid weren't told their applications had been forwarded to SCHIP and discovered their eligibility only when they received a notice that SCHIP premiums were due, the GAO said.
Meanwhile, in four states evaluated, Medicaid paid just 29% to 61% of Medicare rates for certain preventive medical services for children. An earlier survey had found that pediatricians cited low fees as one of the most important factors in their decisions to limit Medicaid participation. Medicaid rates for preventive services were about half of SCHIP rates in two states specifically evaluated to compare the programs.
In response to the report, the American Academy of Pediatrics, the American Hospital Association and 12 other healthcare organizations told HHS Secretary Tommy Thompson in a letter last week that states should improve Medicaid and SCHIP application processes and raise provider payments under both programs.
Medicaid programs cover children from families with incomes at or just above the federal poverty level; SCHIP insures children from families with slightly higher incomes. Because Medicaid's income requirements change with the age of the child, families may end up with children enrolled in both programs.
Many states use a joint application process, but the data and documents required for Medicaid and SCHIP aren't always the same. In states with more discrepancies in the application processes, coverage for families was more likely to be delayed or denied, the GAO said.