Inadequate and inconsistent Medicaid policies are leaving an increasing number of Utah children without access to basic health care, according to a report released Tuesday by Primary Children's Medical Center.
The comprehensive report by the National Association of Children's Hospitals and Related Institutions examines the status of the largest publicly funded health program and its consequences for children and children's hospitals.Utah officials warn that the local consequences are serious.
"Medicaid revenue accounts for 35 percent of all inpatient days, and 25 percent of patient revenue at Primary Children's Medical Center," said administrator Don Poulter. "Medicaid funding is one of the most pressing issues we face. We are presently reimbursed only an average of 60 percent of charges."
Based on its status as a high Medicaid provider, Primary Children's is entitled to somewhat greater reimbursement. Yet Poulter said Primary still anticipates $8 million in Medicaid write-offs in 1989.
"We continue to be reimbursed in inadequate amounts that don't fulfill the original intent of Medicaid legislation. The intent was to medically support indigent families and reimburse hospitals at a reasonable cost," Poulter said. "This is not being done. Our state Legislature simply doesn't provide enough money for Medicaid."
Designated as the national health program for the poor and medically indigent, health officials say Medicaid has evolved in two competing directions. While it is the primary source of access to health care for millions of poor pregnant women and children, Medicaid has also directed a growing share of its resources towards the elderly, blind and disabled.
"This generational tug-of-war over diminishing resources has resulted in fewer dollars used to help children today than in 1978, in spite of a large increase of children living in poverty," the report says. From 1975 to 1985 the percent of Medicaid outlays spent on children in low-income families declined from 17.9 percent to 11.8 percent.
In Utah, Medicaid funds are picking up more nursing home care. But more children are going without care.
"Only about half of poor Utah children (those below 100 percent of the poverty level) are covered by Medicaid, and the coverage is not continuous," said Dr. Peter C. van Dyck, director of the Family Health Services Division of the Utah Department of Health. "Eligibility changes from month to month depending on family income, so maintaining preventive or acute-care services is difficult. Even when eligible, access to care is a problem. Of the 32,000 eligible children in Utah, only about 8,000 are making regular preventive visits."
Van Dyck said special services - eyeglasses, orthodontia, wheelchairs, hearing aids - for handicapped children are also being reduced "because of the rush to serve the elderly."
To help solve the Medicaid crisis, Primary Children's Medical Center - which has provided more than $2.7 million in donated charity care to more than 1,600 children - has joined with the National Association of Children's Hospitals and Related Institutions in proposing reforms (see box) in Medicaid eligibility. Officials said the goal is to ensure equal access to care for all children.
"The broad set of reforms are intended to fill the gaps in private financing of health care for children," officials said. "It is expected that these reforms will be phased into the current Medicaid program, complementing reforms which are needed to enhance the effectiveness of private insurance."
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(Additional information)
Proposed reforms
-Establish more uniform eligibility for children
-Separate Medicaid from welfare
-Ease enrollment procedures
-Establish more uniform and broader service packages for children
-Ensure adequate reimbursement
-Commit adequate resources