Money -- or the lack of it -- is no reason for children to go without the medical care they need, including immunizations.
Utah's Children's Health Insurance Program bridges the gap for those 18 and younger whose parents can't provide private insurance because they can't get it through work or they can't afford it.There are no monthly premiums, and preventive services don't have co-payments, which are assessed for other services as they are used.
"We're hoping to show that it's fiscally efficient to insure the uninsured if we can treat them up front with prevention, so they don't end up in the emergency room, which costs much more," said Chad Westover, CHIP administrator.
Westover and Terry Lange, director of reimbursement for Utah Valley Medical Center in Provo, will be featured on the Deseret News/Intermountain Health Care Health Hotline Saturday. The two will help people who don't have insurance learn about different programs that help cover medical expenses.
The importance of preventive health care can't be exaggerated, Westover said. Even a cold, left untreated, can turn evolve into something serious that requires hospitalization. That costs a lot of money.
In severe cases, Westover said, a family may be able to turn to Medicaid, a federal-state partnership program with stringent income guidelines. But it makes more sense to get early or preventive care so the child doesn't have to suffer through an illness.
CHIP is available to families up to 200 percent of poverty -- $32,900 gross annual income for a family of four. It began when Sen. Orrin Hatch, R-Utah, and Sen. Ted Kennedy, D-Mass., teamed up to find a way to insure needy children. States were given the option of expanding Medicaid or developing their own programs, which Utah opted to do.
The program contracts with three health maintenance organizations in the Wasatch Front and with a different provider in other counties. It's available statewide, but half of the children now enrolled live in rural areas.
The program is funded by Utah hospitals, who agreed to continue paying an assessment that was set to sunset last year.
In an emergency, care would be provided without CHIP. But "that's not where we want to focus our efforts. I think everyone -- the insurance companies, hospitals and physicians -- would all like us to concentrate our efforts on getting people into care before a situation becomes acute," said Westover. "And if you have a condition that's chronic and manifests over a long duration, you're going to suffer over a long period of time if you never go in to get treatment."
People who fall through the health-care cracks eventually and inevitably end up in acute care, he said.
Currently, 4,300 children are enrolled in CHIP. That's a small number, compared to the 60,000 children who don't have insurance. Half of those would be eligible for the program. Of the other 30,000, parents either earn too much (meaning they could afford insurance but don't buy it) or the children are eligible for Medicaid but aren't enrolled. If a child who applies for CHIP qualifies for Medicaid, the family will be sent to that program. CHIP can't enroll them.
As for the copayments, they're modest. They're based on income, divided at 150 percent of poverty. It costs someone below that level $5 to see a doctor. Those who are above that level pay $10 for a visit.
A family that could get employer coverage and could afford it won't get CHIP. "We have to make sure they're not able to enroll in a private plan," Westover said.
Anyone who has a higher income, but can't get insurance from an employer, will be directed to an individual policy or the state's high-risk pool, which has steeper premiums but is there for people without other options.
Westover believes in CHIP. He will never forget the woman who broke down. She told him it was the first day she was able to make an appointment for the doctor and the dentist for her kids.
"She's able-bodied and wants to do the best for her kids but couldn't afford the insurance," he said. "If we can keep people off the welfare rolls and help so that illness will not put them onto welfare, we're helping people stay self-sufficient. It makes the job worthwhile."
To learn more about CHIP, call 1-888-222-2542.