2,500 may lose health insurance in county

Program was allowed to expire; it's 'scary for kids caught in the crosshairs,' official says

After Congress let funding for the national Children’s Health Insurance Program expire at the end of September, local health care providers are working to educate families on options should they lose access to affordable health care for their children next year.

Mesa County has more than 2,500 children and pregnant mothers who receive health care through Colorado’s Child Health Plan Plus (CHP+) who would no longer receive health care, and most likely would not be eligible for Medicaid, leaving them to search for other options. There are approximately 11,000 kids in the program across western Colorado and 75,000 in the state.

“If it goes away, between 2,500 and 3,000 kids lose access to affordable coverage (in the county). There are no immediate alternatives with them. The state will work to transition them to private or exchange coverage, but a lot will run the risk of falling through the cracks,” said Patrick Gordon, associate vice president of Rocky Mountain Health Plans. “It’s harrowing for some folks trying to run programs and more scary for kids caught in the crosshairs.”

CHP+ insures children age 18 and younger and pregnant mothers 19 and older who don’t qualify for Medicaid but come from households that have an income of less than 260 percent of the federal poverty level. The program covers primary care, hospital and emergency room visits, dental, prescriptions and immunizations.

Enrollment costs and co-pays vary depending on the household’s income.

While Congress can still act to continue funding the program before the end of the year — there is a draft for a bill that would fund the Children’s Health Insurance Plan for the next five years in the energy and finance committee — local health providers and doctors are concerned for the patients in the program.

Dr. Katherine Price, a pediatrician with Western Colorado Pediatric Associates in Grand Junction, has been directing CHP+ families to patient advocates about their options and noted that about 5 percent to 10 percent of the children treated at her facility are in the program.

Price said Western Colorado Associates sees about 50 percent of the children in the Grand Valley and she’s concerned for the patients in the program.

“I think this program really is essential. It has had historical bipartisan support and fulfills the needs of families,” Price said. “I think we value that patient-provider relationship and we’ll be here and find a way to give them the care they need. But the challenges are real.”

In Durango, Dr. Cecile Fraley at Pediatric Partners of the Southwest has been following the issue closely and serves on the Medical Services Board in the Department of Colorado Health Care Policy and Financing, which manages CHP+.

Her practice, where she serves as CEO, sees approximately 13,000 children with 720 in the CHP+ program.

During the past few weeks, the practice has been reaching out to families with children in the program who are due for a checkup before the end of the year to make an appointment to come in before the funding runs out. Colorado has enough money to run the program through the end of January, according to the Health Care Policy and Financing.

“We just want people to get in while they still have coverage,” Fraley said, adding that the office has been texting families through a HIPAA-compliant system.

She’s also been reaching out to lawmakers as she hopes the program will be refunded as soon as possible and noted her feelings on the importance of pediatric care and the financial hardships that some families could soon be facing.

“To go from that to paying for insurance on the exchange is going to be a big hit for some families,” she said

The state’s exchange, Connect For Health Colorado, serves as a marketplace for individuals in need of health insurance. If CHP+ is not refunded, many of the families who lose coverage for their children could end up there for their health insurance.

Connect For Health Colorado Director of Communications Luke Clarke said the organization is preparing for an influx of inquiries and believes that many would qualify for tax credits for their coverage.

“We are working with (Health Care Policy and Financing) in anticipation to enroll a significant amount of people coming off of that program. That means being prepared to communicate with them.”

He also encourages CHP+ families to talk with their doctor’s offices to make sure they can select a good plan for them that allows them to keep seeing their current doctor.

Meanwhile, the sooner Congress acts, the better it will be for both patients and providers, according to Rocky Mountain Health Plans CEO Steve ErkenBrack.

“I am hopeful that the issue is so significant that it’s on the radar screen,” he said. “The good news is there seems to be bipartisan realization of the need to address this.”


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