Senator Eliot Shapleigh - El Paso, Texas

McALLEN, April 13 - The Children’s Defense Fund-Rio Grande Valley is concerned that the Texas House version of the 2010-2011 State Budget will fail to include funding for 12 months coverage for Children's Medicaid.

The group learned this through viewing the preliminary House Appropriations Committee’s recommendations on health and human services spending.

“Right now, state leaders can decide the fate of 56,000 uninsured Rio Grande Valley children and 250,000 throughout Texas by making a very simple but effective change in our law,” said Luisa Saenz, director of Children’s Defense Fund-Rio Grande Valley.

“Twelve months coverage for Children's Medicaid is essential to reducing Texas' number of uninsured children and fixing the state's overburdened eligibility system.”

Saenz said a change to 12-months eligibility has wide support in business, medical and policy circles. She said it would help children who already qualify for Medicaid get the check-ups they need to stay healthy and see the doctor when they get sick or injured. She said it also offers a net gain for Texas taxpayers.

Saenz pointed to states estimates which show that by simply covering enrolled children for a year instead of six months, more than 250,000 additional Medicaid-eligible children would get and keep health coverage.

According to the Children’s Defense Fund, providing 12-month Children’s Medicaid coverage will bring more than $450 million in federal funds into Texas because for every $1 the state invests, the federal government kicks in $1.47. There would also be a decrease of about $250 million in health care burden on local communities. The change would also lead to the creation of 24,400 new jobs, with $2.84 billion in new business activity and $1 billion in additional salaries and wages for Texans.

“We urge lawmakers to make the smart choice – the right choice – right now to cover these uninsured children,” Saenz told the Guardian. “All it takes is changing a single word in state law that has created a sea of red tape for Texas families.

The “problematic” word is “six,” Saenz said. This describes the number of months a child is covered by the Medicaid program before the application process for his or her family starts all over again. By changing the word to “12” and keeping families in the program for a full year, Texas can produce enough of any efficiency to insure 250,000 more already-eligible children, Saenz said.

Saenz explained why one word makes such a difference. In recent years, the Texas system that processes enrollment applications has been under-resourced and overrun, without the staff and the technology to meet the needs of Texas’ growing population, she said.

“As a result, while our neighboring states are able to process applications for programs like Medicaid in mere days, many Texas families wait months to hear back about their children’s applications. And through that wait, vulnerable children who qualify for coverage go uninsured,” Saenz said.

With once-a-year enrollment, Texas would “lift the burden” on its enrollment system, cutting its paperwork load in half to help applications move efficiently and keep children insured, Saenz said.

“We know this, because the state has already provided children covered by the CHIP program with once-a-year enrollment, resulting in fewer gaps in coverage and more children renewing and staying insured from one year to the next,” she said.

For the neediest children, however, those eligible for Medicaid, their odds of losing their health care because of paperwork errors and delays is twice that of kids covered by CHIP, Saenz explained.

“Those losses happen with surprising frequency. Our state’s error rate in processing Medicaid applications is eight times as high as the level at which the federal government first recommends taking corrective action to fix the problem,” Saenz said.

“These errors and delays put real Texas children at risk, including the 72,000 who nearly lost coverage altogether in the wake of Hurricane Ike last year, simply due to processing errors and delays.”

Saenz pointed out that the state’s laws allow for these children to see a doctor. Their families meet the economic qualifications, and they follow the application rules to the letter so that their kids can have things like vaccines, check-ups, and doctor’s visits when they are sick or hurt.

“Giving kids access to a doctor is both right and affordable, and that’s why we have a Medicaid program: to serve these kids for a much lower price through their regular doctor instead of leaving them to seek far costlier emergency room care,” Saenz said.

“What’s keeping these children from getting the insurance they need is red tape that we can and must eradicate.”

Saenz said there has “never been a better time” to cut out the red tape, with federal stimulus funding providing ten times the health dollars Texas needs to cover more than 250,000 children affected when it moves the enrollment period to once a year.

“It’s wrong to exclude children whose families play by the rules, and it is costly to our state to leave those children to seek care in the emergency room,” Saenz concluded.

“Texas should make this simple and smart fix to our law: do away with that problematic ‘six’ and ensure eligible children can keep Medicaid coverage for twelve months instead, just like children under CHIP. We urge state leaders to make the right choice for Texas right now.”

Saenz urged Valley residents to not only contact their local House representatives, but also the Capitol offices of Speaker Joe Straus, Appropriations Committee Chair Jim Pitts and House Appropriations Subcommittee on Health and Human Services John Zerwas.

Guardian reporter Steve Taylor contributed to this report from Austin.