WASHINGTON - Maryland was one of only three states that showed a big decline over the last six months of 2003 in enrollment in a national program to cover uninsured children, according to a report released yesterday by the Kaiser Commission on Medicaid and the Uninsured.
The state health department said what has happened is mostly a bookkeeping change, not a cutback in coverage; most of the children kept the same insurance, but had it financed by a different program.
Advocates, however, said even if the numbers are small, changes in state policies had denied coverage to some children, causing problems for those families.
The Kaiser report tracked enrollment trends in the State Children's Health Insurance Program, known as SCHIP. Nationally, the report found, enrollment dropped 1 percent over the last six months of 2003 - the first dip in participation since the politically popular program was launched in 1997 as a supplement to Medicaid, the state-federal program for the indigent.
Diane Rowland, executive director of the private commission, said, "The economic downturn and rising state fiscal problems" had led some states to cut back on SCHIP, interrupting "a steady march" to cover more uninsured children.
SCHIP allows states to get federal matching funds to extend coverage to children just above the poverty line. Each state can set its own income and eligibility rules, within broad federal guidelines.
In Maryland, enrollment in SCHIP dropped from 112,758 at the end of June 2003 to 89,811 by the end of the year - a decline of nearly 23,000 children, or 20 percent.
Texas (down nearly 75,000, or 17 percent) and New York (down more than 23,000, or 5 percent) were the other states showing large declines. New York, like Maryland, shifted many children to Medicaid, while Texas cut back on benefits and made enrollment more difficult. On the other hand, enrollment increased in 41 states, the report found.
John G. Folkemer, executive director of the Office of Planning and Finance in the state health department, participated in a panel discussing the report at the commission's Washington office. He said most of the drop came last fall as the state reviewed eligibility for participants.
More than 14,500 children were moved from SCHIP to Medicaid, Folkemer said, because the state review showed their families' incomes had dropped (or had remained steady while the poverty guidelines were adjusted for inflation). That meant their health coverage continued unchanged, but was financed from a different line in the state budget. There are about 150,000 low-income children in Maryland covered by Medicaid.
Another 2,300 were removed from the rolls because their families had health coverage provided by employers.
Also, Folkemer said, 1,600 children lost coverage because their families couldn't or didn't pay a $37-a-month premium imposed by the state for children with family incomes between 185 percent and 200 percent of the federal poverty line. (For a family of four, 200 percent of the poverty level last year was $30,320.)
The General Assembly ended the premium for that income range, effective this month. Folkemer said 14 percent of those dropped for nonpayment of premium returned to the program before premiums were dropped; figures from this month aren't available.
Although not challenging the state's numbers, when coverage is dropped, "for an individual family, it can be devastating," said Carol Fanconi, health policy director for Baltimore-based Advocates for Children and Youth.
"Maryland is one of the wealthiest states," she said, yet has high rates of infant mortality and other indicators of health problems. "We should do better."
Rachel Klein, deputy director of health policy at Washington-based Families USA, said the Kaiser Commission report reflected that a number of states had taken action to trim budgets, "and when you undo policies, it has a direct impact on enrollment."
Vernon K. Smith, a consultant who was the author of the commission report, said it's unclear whether states are continuing to cut back on coverage to solve budget problems.
"The drop in the last half of '03 may have been a bump in the road, but until state budgets are in better shape, it will still be a bumpy road."