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A family support program of Parent to Parent of Vermont advocates for system change and provides health care information to families. |
Recently, parents may have been wondering about news stories regarding
debates in Congress and proposed federal administrative changes in the
State Children’s Health Care Program (SCHIP) and the children’s
Medicaid program.
Vermont ranks first in the country in providing
health care coverage for children. In our state, federal SCHIP funds
are used along with state funds to cover over 3,000 children in
families with incomes from 225% to 300% of the federal poverty level,
as part of the Dr. Dynasaur Program. Our national Congress is currently
debating whether and to what extent to continue the SCHIP funding. As
of press time for this newsletter, Congress passed the Children's
Health Insurance Program Reauthorization Act of 2007 (CHIPRA) and
waiting for Presidential action. (We now know that President Bush
vetoed CHIPRA. If it were enacted into law, the Congressional Budget
Office estimates CHIPRA would have provided insurance coverage to
almost four million children nationally. )
The good news for Vermont families is that Vermont’s
Governor and Legislature have committed to continuing Dr. Dynasaur
coverage at current levels, regardless of Presidential action. However,
it would be more costly to the state.
More alarming are three recent Bush Administration
proposals to administratively change children’s SCHIP and Medicaid.
Unlike changes in law, these proposed administrative changes are not
subject to public debate, but become policy through a re-writing of
program rules. Even though Congress is in the middle of debate on what
are proper SCHIP income levels, the federal Centers for Medicaid and
Medicare Services (CMS) has administratively proposed restrictions on
SCHIP funding for children in families with incomes over 250% of
poverty.
Additional administrative rules under consideration
would prohibit Medicaid reimbursement for school or contracted
administrative services that support children with Medicaid. Examples
of services that would not be funded include specialized
transportation, substance abuse professionals, prevocational or
vocational specialists, after school programs, nutrition, guidance
counselors, school nurses, and dental hygienists. Vermont schools would
lose about $3 million.
Services for individual Vermont children might not
be immediately or directly impacted, as payment for these services
should revert to the schools and Vermont state and local education
funding. However, by putting additional financial pressure on our
schools, it would likely become even harder for families to advocate
for comprehensive, coordinated services for their children with special
needs – and harder for schools to provide them.
Most frightening for families of children with
special needs, rule changes are being considered to prevent Medicaid
from paying for some services provided for children with special needs
in schools. These changes specify that Medicaid funded “rehabilitation
services” cannot include services furnished by other (non-school)
programs that are focused on social or educational development goals.
It is unclear whether these services would be picked up by schools, or
simply not provided by either schools or Medicaid. Family Voices
(Parent to Parent is Vermont’s Family Voices Chapter) maintains that
this rule change would be a violation of federal law which requires
comprehensive Early Periodic Screening, Diagnosis and Treatment (EPSDT)
benefits for all children covered by Medicaid.
VT’s Congressional delegation – Senator Bernie
Sanders, Senator Patrick Leahy, and Representative Peter Welch – have
all voted to support SCHIP funding. Further, all oppose the
Administration’s proposed rule changes that would cut back eligibility
for SCHIP and reduce EPSDT benefits. Governor Jim Douglas has also been
working very actively (directly, and through the National Governor’s
Association) to make sure no Vermont children will lose coverage or
benefits due to reversal of federal policies.
We are fortunate to live in a state that has a long
history of ensuring health care coverage for children. Vermont families
hope the federal government will continue to be a good partner in that
effort! ©
