The Child Health Insurance Provisions section of the Balanced Budget Act of 1997 earmarked $24 billion to expand coverage and services for low-income and uninsured children. One of the three models listed in the Act is Florida’s Healthy Kids, a school enrollment-based insurance program that currently serves 35,000 children.
Medicaid responses to uninsured children crisis
Although state-based Medicaid programs have expanded, the number of uninsured children has continued to rise. Nearly 10 million children 18 years and younger are uninsured. In the past four years, the number of US children covered under their parents’ group plans declined by 5.6%.2
Responding to this health care crisis, Congress recently approved funding for states to expand Medicaid enrollment of eligible children, create new state programs for children’s health insurance, or both. One model program is Healthy Kids, a public-private partnership between school districts and licensed insurers created in 1992 to offer comprehensive health insurance to Florida children. To date, 38,638 Florida school children have enrolled in Healthy Kids. Healthy Kids Project sites currently exist in 17 Florida counties, 11 counties have Healthy Kids planning sites, and Healthy Kids project sites are projected in three counties.3
Texas, Iowa, Georgia, New Hampshire, and Louisiana are planning and implementing insurance programs based on the Florida model. The Robert Wood Johnson Foundation recently awarded a grant to fund a Healthy Kids National Program Office to aid other states in replicating the insurance program. The National Program Office, which is located in Tallahassee, will award $3 million in grants to approximately seven states for planning and implementing similar insurance programs.4
Healthy Kids concept
Healthy Kids is based on the concept that school systems can create large groups of school children who qualify for group insurance benefits and premium packages. The coverage is subsidized on a sliding scale based on family income so that lower-income families can afford health insurance for their children.
The Healthy Kids benefit package currently is contracted with eight private managed care organizations: AVMED Health Plan; HIP Health Plan of Florida; Health Option, Inc.; Humana Health Care Plans; Florida 1st Health Plans, Inc.; Florida Health Care Plan, Inc.; JMH Health Plan; and Physician Corporation of America Family Health Plans.5 A long-term program goal is to ask these managed care organizations to open service sites at participating schools.6
Healthy Kids offers a comprehensive basic benefits package and other preventive services. The benefits package includes well-child care visits, immunizations, primary and specialty care, physician office visits, laboratory tests, inpatient hospital care, surgical procedures, emergency services and transportation, prescriptions, vision screening and eyeglasses, hearing screening and hearing aids, physical therapy, mental health services, prenatal care and delivery, transplants, a $1,000,000 life-time maximum, and no limitation on preexisting conditions.7
Premiums have decreased to the current average of $51 per month per child. These premium decreases are based on data that demonstrate appropriate utilization of services–in part due to school health programs and education of children and parents about health consumer roles–and the relative good health of children. For example, during the 1995-1996 school year, children in Healthy Kids had more than 113,000 physician office visits, while hospitals in the participating communities reported a 30% decrease in pediatric charity work and a 70% decrease in pediatric emergency department visits. This appropriate utilization of services saved the state of Florida more than $13 million in health care costs in one year.8
Funding arrangements
Florida schools serve as the conduit between Healthy Kids and the children who need insurance coverage. School districts file program requests, obtain school board approval, distribute applications and marketing materials to families, and verify student eligibility for the programs. Family eligibility for the national school lunch program confirms eligibility for reduced health insurance premiums through Healthy Kids programs.
An important principle of Healthy Kids is parental responsibility for their children’s health care. Parents pay part of the monthly $51 premiums based on sliding scales developed by each project site. For example, in Volusia County, parents pay $10 or $25 per month depending on whether their child qualifies for free lunches or reduced lunches, respectively, and $48 per month if their child is not on the lunch program. Parents also are charged co-payments for some services (e.g., three dollars for office visits, $25 for emergency room visits). At the present time, families with children enrolled in Healthy Kids contribute 35% of medical costs for the program.9
Local funding (e.g. hospital taxes, private philanthropy, county taxes) contributes a 5% minimum contribution during the start-up period and increases to a maximum of 40%. During the 1996-1997 fiscal year, local funds contributed 16% of the total funding for medical premiums.10
In fiscal year 1996-1997, the state of Florida appropriated $13 million (49% of the funding for medical services) for Healthy Kids. Last year, the Florida legislature doubled the previous year’s appropriation, which allowed Healthy Kids enrollment figures to increase by more than 100% by the middle of 1997.11
In 1989, Congress authorized a demonstration grant through the US Health Care Financing Administration to launch the first Healthy Kids pilot project. This grant was completed in 1995, and the federal government currently does not provide funding for the Healthy Kids program.
Healthy Kids as part of Florida PediatriCare
The state of Florida plans to use a mix of existing insurance programs to expand health care coverage for Florida children with the new federal funds, and the Florida Healthy Kids Corporation will be one of several conduits to channel these funds. Currently in Florida, Medicaid funds health care for eligible children between the ages of birth and 18 years; Children’s Medical Services (i.e., Title V) provides medical services for special needs children; and Healthy Kids Corporation provides health care coverage for children who are not eligible for Medicaid and have no other health care coverage.
The Institute for Child Health Policy, which is located at the University of Florida in Gainesville and provided the blueprint for Healthy Kids, has proposed a unified agency (Florida PediatriCare) that would consist of two programs: a healthy children program and risk pool (i.e., Healthy Kids Corporation and Medicaid), which would have agreements with standard managed care networks, and a separate program and risk pool for children with special health care needs (i.e., Children’s Medical Services and Title XXI), which would have agreements with specialty pediatric managed care networks. Florida PediatriCare would be responsible for operations, contracting, eligibility determination for subsidy, and case management for children with special health needs.12
References:
1. Background
Material for New Program on Children’s Health Insurance, Children’s
Defense Fund,
Washington, DC, 8/97.
2. Ibid.
3. Healthy Kids Annual Report, Florida Healthy Kids Corporation, 2/97.
4. Ibid.
5. Ibid.
6. S Freedman, personal communication, 14 Aug 1997, Gainesville, Fla.
7. Healthy Kids Annual Report.
8. Ibid; E Shenkman et al, "The school enrollment-based health insurance program: Socioeconomic factors in enrollees’ use of health services," American Journal of Public Health 86 (December 1996) 1791-1793.
9. Healthy Kids Annual Report
10. Ibid.
11. Ibid.
12. Health Care for Children: An Integrated Access and Financing Proposal, Institute for Child Health Policy, Gainesville, FL, 8/97.
Additional references:
Crafting a Children's
Health Insurance Plan: Design and
Implementation Issues, National Health Policy Forum Issue Brief
No. 701, The George Washington University, DC, 5/98.
S A Freedman et al, "Coverage of the uninsured and underinsured: A proposal for school enrollment-based family health insurance," New England Journal of Medicine 318 (March 31, 1988) 843-847.
Office
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University of Colorado Denver
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