You Rock George!!!!!!

Confusion over health insurance leaves children sufferingSome mistakenly cut from the rolls as state makes program changes

By POLLY ROSS HUGHES
Copyright 2006 Houston Chronicle Austin Bureau


AUSTIN - Three-year-old Ryla Woodard spent a weekend in the hospital earlier this year when she broke out in a rash, her fever spiked to 103 and doctors diagnosed her with mononucleosis.


Just days later she lost her government-sponsored health coverage, and her family can't afford a second follow-up blood test to see if she's still infected with the virus that can cause fatigue and swelling, or even rupturing, of the spleen.

"She's complaining of a sore throat. It lingers in your system a while," said Ryla's mother, Traci Woodard, from the East Texas town of Orange. "Today I cannot take her anywhere to see if she still tests positive for mono because I have no health insurance. I'm hitting walls and locked doors."

The Woodards aren't the only family complaining about confusion in the Children's Health Insurance Program as enrollments nose-dived the past three months with new rules and a new company screening applications.With Ryla's coverage mistakenly cut, her mother said Galveston County, two hours away, is the closest place to qualify for indigent health care.
Ryla and her sister Dara, 4, lost CHIP coverage for February and March, but that was the state's mistake, not theirs.

The Texas Health and Human Services Commission confirms the sisters got mistakenly caught up in confusion when an eligibility-screening contract switched Nov. 28 to a Midland call center headed by the private outsourcing firm Accenture.

"Clearly there are some learning-curve issues," commission spokeswoman Stephanie Goodman said of the new call center.

The Woodard sisters are among the young faces behind plummeting enrollment in the insurance program, which fell below 300,000 on March 1 for the first time since April 2001.
Enrollment has plunged by 28,000 children since December, when tougher proof-of-income rules kicked in just as the call-center contract switched to Accenture. The health commission is still trying to sort out rejections caused by mistakes in the screening process from cuts caused by the state's stricter eligibility rules.

Last spring, lawmakers restored vision, dental and mental health benefits to CHIP and budgeted for enrollments averaging nearly 350,000 — at least 50,000 more children than are on the rolls.

Meanwhile, the Texas Association of Health Plans calls a 73 percent denial rate for families attempting to renew last month "staggering," and appeals of those terminations have more than tripled since last year to nearly 2,500.

117,000 more could be cutIf current CHIP trends persist, about 117,000 more children could lose coverage by the end of June, the group warns.

"I think it's a crisis. We can't afford to lose any more children from the program," said Barbara Best, Texas executive director of the Children's Defense Fund, based in Houston. "Enrollments should be growing, not shrinking. It's the children who are suffering."

The two older Woodard sisters fell through the cracks switching from Medicaid for the very poor to CHIP for working families unable to afford private health insurance. Of children bumped from CHIP last month, only 13 percent lost coverage because their family income rose too high. More than half lost coverage because applications had "missing information" or renewal information was not received.

"Obviously the staff at the new call center is newer," said Goodman. "They've been through training, but they're overwhelmed. Sometimes if they can't provide immediate assistance, they tell (families) to file an appeal. That's kind of the last guidance they give them on the phone.
"One of our struggles right now is to sort out where there are trends, so it's not an isolated transition issue, but it's a symptom of a larger problem we need to go in and address," she added.

Two weeks ago, Accenture and the commission discovered they'd mistakenly canceled 6,000 children from CHIP for not paying a fee parents hadn't been told to pay. HHSC Commissioner Albert Hawkins ordered those children immediately restored to the rolls.
But other eligible children erroneously dropped, such as Ryla and Dara, are having to wait until April 1, left uncovered for two full months.

Traci Woodard, noting that all three of her daughters were supposed to automatically switch into CHIP when family income rose too high for Medicaid in November, said everything seemed to go wrong. With CHIP coverage not kicking in, Medicaid extended coverage for all three girls through the end of January. On Feb. 1, baby Tristia was enrolled in CHIP but not Ryla and Dara. Call-center employees even informed Woodard she'd have to pay a second enrollment fee for the older girls, even though the rule is one fee per family. "The state of Texas is trying to cut corners and everything. That's great, but we're suffering for it," said Woodard, who acknowledged losing her temper with one call-center worker who first refused to give her his name or ID number.

"Whoever the state has contracted to do this CHIP insurance, they have dropped the ball," she added. "It's one thing to mess with me, but you're messing with my kids."
Accenture spokesman Peter Soh said, "My understanding is the state is investigating each and every case that's brought to their attention to find out what's going on."
He said Friday the company thinks its call-center processes are now working, but other parents are complaining of snafus similar to Woodard's.

Debra Berg of Houston said the former private eligibility-screening contractor told her last November that she needed to send proof her daughters are U.S. citizens, a problem that Goodman said might have resulted when the contractor lost staff as it prepared to shift call centers to Accenture.

"I said, my kids cannot just switch countries. You have their birth certificates. What else do you need me to prove?" She said she thought the problem was cleared up after calling the new call center to explain.

Shocking discoveryShe assumed everything was fine until Feb. 1 when she took her 7-year-old daughter to the doctor for suspected whooping cough. "We were quite shocked when February came around and we didn't have insurance," Berg said. She also had to cancel an evening counseling session for an older daughter diagnosed with anxiety and obsessive-compulsive disorder. The next day, the Midland call center advised her to file an appeal. A psychiatrist agreed to see the older girl later that month, but still there was no insurance for medications that were running out. Jay Haevischer, a disabled father in Bellville, said 10-year-old Colby's CHIP coverage was suddenly terminated in late February. The only explanation? Missing information.

Haevischer said he had failed to sign the new CHIP renewal form when he first sent it in but quickly corrected the error when contacted by the call center. He then called to make sure his corrected form arrived and said he was told it did and not to worry. So the father said he was floored when a cancellation letter arrived a month later saying his son's longtime CHIP coverage was being terminated for lack of information.