Monday, November 09, 2009

Increased demand stresses Wyoming Medicaid funding

A story in Monday's Wyoming Tribune-Eagle addressed the state's Medicaid and CHIP programs.

The number of children on Wyoming Kid Care CHIP is declining, but the number of children on Medicaid is going up.

Bob Peck, chief financial officer for the Wyoming Department of Health, said one explanation could be that parents are losing their jobs.

Formerly working parents who had their children on the Kid Care program for child health insurance may be having to enroll their families directly into Medicaid, he said.

Medicaid is the health program for lower-income people that is funded by the states, as well as the federal government. Kid Care CHIP offers health insurance coverage for Wyoming's children and teens through age 18 that are uninsured and meet income and eligibility guidelines.

Peck said the number of Kid Care children dropped from 6,200 to 5,400 over the past year. The number of children enrolled in Medicaid in fiscal year 2008 was 49,719, while in fiscal 2009 it was 52,185.

The number of children receiving Medicaid services in fiscal 2008 was 44,114, while in fiscal 2009 it was 45,746. Medicaid expenditures for children jumped from $126.4 million to $143.8 million, according to information Peck provided to the Wyoming Legislature's Joint Appropriations Interim Committee last week.

My daughter Annie was one of the 44,114 on the Medicaid rolls in FY 2008 and one of the 45,746 children receiving Medicaid services in FY 2009.

As I've said in earlier posts, Annie qualified for Medicaid coverage under the Children's Mental Health Waiver. In that program, teens can qualify for Medicaid coverage because the Wyoming Health Department factors in their income and not their parents. If the incomes of my wife and I were factored in, Annie would not have qualified. She would not have received intensive inpatient mental health services and we don't know where she would be now. Still dealing with her mental illness, and untreated. Still suicidal and still cutting her arms and her legs.

But she did get the appropriate care, thanks to federal health care programs, and she is now back in school and taking mainstream classes instead of special ed courses. I have nothing against accommodations made for K-12 students. In fact, I'm all for it. My tax dollars -- and yours -- at work. Those taxes being spent on special ed and mental health care come mainly from the feds, as Wyoming has ridiculously low tax rates -- and no state income tax.

But educational services such as I.E.P.s and special classes don't have to last forever. They exist to give young people a helping hand and when that helping hand is no longer needed, it is released and can be used for another deserving student. There always are more deserving students.

All told, Annie spent 11 months in mental health rehabilitation centers, both in Colorado and Wyoming. The Wyoming Mental Health Waiver kicked in when our insurance ran out after 45 days. Medicaid paid for 225 more days on treatment by nurses and psychiatrists and other mental health professionals. Total bill for her care was in six figures.

As parents, we did the paperwork and wrangled with insurance companies. We visited every weekend and went to family therapy sessions once or twice a week. We checked out Annie for short shopping excursions and spent the weekend with friends in Casper so we could see Annie another day before driving the 180 miles back to Cheyenne to our jobs and other responsibilities.

Chris and I have means. I work for the state and Chris works for the YMCA. We don't have big salaries. We do own a house and have two used cars. We eat on a regular basis, and occasionally take a vacation. We don't own any solid gold umbrella stands, unlike the Wall Street rip-off artists who ran this country into the ground. We aren't war profiteers like Dick Cheney. He may not own a solid gold umbrella stand, as umbrellas are as rare in Wyoming as humidity. But I hear tell that Cheney has a gilded shotgun.

Wyoming is notoriously cheap. I worked for ten years without a raise. When Annie was born in 1993, my wife was unemployed and we enrolled in the WIC program so we could get milk and juice and cereal for our family. My wife's workplace offers health insurance but at a price so steep that she and my daughter are on my state plan. If the House health care bill passes the Senate (not likely) and its provisions enacted immediately, my 24-year-old son could be covered for three years under my insurance plan. Alas, even if the Senate concurred with the House bill, most of its provisions won't be enacted until 2013. My son will be a year too old for the 27-year-old coverage stipulation.

That's the problem. As we dither over health care reform, real people are getting sick and dying. Rep. Grayson had it right when he described the Repubs' health care plan: "Don't get sick. If you get sick, die quickly."

But my subject is mental health. The Medicaid plan is crucial for those families faced with a bipolar or depressed or suicidal teen -- and no idea what to do or where to go for help. Help is hard to find in this state. When you do, it has a cost.

Much more on this subject in the coming weeks...

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