State program helps children lacking health coverage

When you're behind on your mortgage, and your health insurance has lapsed, the last thing you want to hear is a cough in the night.

For Sara Phelps, it can mean her 10-year-old son's cold has deepened into an asthma attack. Does the Chesapeake mother have the cash to pay for an urgent care center? Is it serious enough for her to take Zackary to the emergency room?

For Robin Lacy of Portsmouth, the nighttime questions go more like this: Should the single mom go back to working two jobs instead of one to pay for the insurance for Travis, her 5-year-old son?

Thankfully, Phelps and Lacy don't have to wake with those questions anymore. Zackary and Travis recently qualified for a health insurance program for children whose families make too much money to qualify for Medicaid but not enough to afford private insurance.

In Virginia, it's called Family Access to Medical Insurance Security, and it's part of a federal children's health insurance program that was reauthorized by President Barack Obama and Congress earlier this month. That reauthorization is expected to bring $176 million to Virginia for the 2009 fiscal year, an 81 percent increase from the previous allocation.

In 2008, the state program covered about 150,000 children in Virginia and 3,000 pregnant women. It's estimated there are still 120,000 uninsured children in the state who are eligible for FAMIS or Medicaid programs.

The slumping economy is likely to add to the enrollments. In South Hampton Roads, for instance, the number of children on FAMIS increased by 5 percent during the past seven months. The number of people qualifying for Medicaid is edging up as well but at a slower pace.

Government insurance such as Medicaid, which covers the poor and disabled, and FAMIS have been central issues before both state and federal legislators. Virginia has struggled to balance Medicaid needs with dwindling state revenue.

According to Families USA, a national health-consumer organization, half the states in the country have either made or proposed cuts to Medicaid, such as restricting the number who qualify, trimming benefits and reducing payments to providers, mostly hospitals and doctors.

In response, Congress included $87 billion in the federal stimulus package to help states meet their Medicaid obligations, along with money to subsidize health insurance of the recently unemployed.

Virginia is expected to receive $1.47 billion in Medicaid funding during the next two years from the stimulus package. State legislators will now re-examine some of the Medicaid cuts that had been on the table this session, such as reductions in reimbursements to hospitals, nursing homes and doctors as well as cuts to some programs for the disabled.

Local outreach workers say they see the need for a health safety net in the faces of the families who come before them for help. Denise Parker works for the Southeastern Tidewater Opportunity Project and recently helped the Phelps family apply for FAMIS.

Phelps' husband is a self-employed painter whose income once covered private insurance. But the lull in construction cut the family budget, so for the past year, they've gone without health insurance.

Phelps used to worry about her youngest son's health, in particular, because Zackary has asthma. She has a nebulizer, a machine that turns liquid medicine into a mist. That usually helps, but when it doesn't, she has to take him to an urgent care center or the emergency room.

She found out last week that Zackary and her 12-year-old son, Cameron, qualify for FAMIS.

Now those nighttime coughs aren't so scary. "It's like a weight off your shoulders," Phelps said.

Parker also signed up Lacy for her son, Travis, last fall. For a while, the Portsmouth mom worked two jobs. One job had insurance for her, but she needed the extra money from a part-time job to add her son to the policy.

When her son started school, she wanted to cut back on work hours. She found a full-time job with the STOP organization, where Parker works. There she also learned about the FAMIS program.

The newly authorized state children's health insurance program has some new features that will expand coverage. For instance, it eliminates a five-year waiting period during which legal immigrant children and pregnant women were not able to qualify after they came to the United States. New funding and incentives are also included to boost outreach efforts.

Meanwhile, Medicaid enrollment is going up at a slower rate.

Earl Ford, financial assistance director at the Virginia Beach Department of Human Services, said Medicaid applications can lag behind other social programs like food stamps. "There's a hierarchy of needs," Ford said. "As long as everyone is healthy, there's no urgency for them to apply for Medicaid, but they have to eat."

Harry Cromer, chief benefits program supervisor at Chesapeake Department of Human Services, said many laid-off employees have 401(k) accounts, unemployment benefits, bank savings or a spouse's income that keep them from qualifying.

Jill Hanken, staff attorney for the Virginia Poverty Law Center, said another reason for a slower rise in Medicaid could be Virginia's qualifications, among the most stringent in the nation.

She hopes the federal stimulus money will help restore proposed state cuts to the Medicaid program so the commonwealth can draw down as much federal health funding as possible. For every $1 the state kicks in to Medicaid, it receives $1 in federal funds; for every $1 in FAMIS money, it receives $2.

"Virginia has one of the leanest Medicaid programs in the country, and in a recession, more people depend upon it," Hanken said. "This is just not the time to cut the program."

Elizabeth Simpson, (757) 446-2635, elizabeth.simpson@pilotonline.com