Senator Eliot Shapleigh - El Paso, Texas

Izzy Mendoza, pre-teen, has had to miss visits with heart doctor.

A high-profile proposal to expand the Children's Health Insurance Program divided lawmakers this spring before fizzling out at the last moment and reignited sore feelings when it didn't make Gov. Rick Perry's agenda for the just-wrapped special session.

But that doesn't mean the Legislature didn't pass laws that aim to reduce the number of uninsured. One new law has the potential to insure more than twice as many children as the failed CHIP expansion.

Another adds a program that, while small, would help children with major medical needs. And lawmakers set money aside to make two insurance programs more affordable for low-income Texans.

One change creates a health insurance program called ChildLink for children in the state's child-support collection system. Texas Attorney General Greg Abbott, who floated the idea in 2008, says the program — which will be run by a to-be-named private company — could reach about 200,000 children within a few years. The CHIP proposal would have added 80,000 children to that program.

There are 5.8 million Texans without health insurance, including 1.5 million children.

ChildLink is "the perfect blend of getting many more children in Texas covered by health insurance without costing taxpayers any money," said Abbott, who wouldn't reveal his political plans but is widely expected to run for lieutenant governor if Lt. Gov. David Dewhurst runs for higher office.

ChildLink takes "cash medical support" that parents already pay and redirects it to the new health insurance program. It doesn't cost the state money because parents pay the premiums, Abbott said.

But some of the state's most ardent supporters of expanding health insurance programs for children aren't celebrating ChildLink. State Rep. Garnet Coleman, D-Houston, said he's not opposed to the program — he just doesn't think it will have the impact that Abbott envisions.

"He's not insuring 200,000 kids," Coleman said. "He's putting a mechanism in place trying to bring medical support orders to one company."

Another new program approved by lawmakers this spring will allow certain families of children with disabilities to pay to join Medicaid even if they earn more than the limit for that federal-state health insurance program.

"This is going to be a huge help to a lot of families that have been struggling with whether to pay their mortgage or get health care for their child," said Colleen Horton, public policy director at the Texas Center for Disability Studies at the University of Texas.

Anne Dunkelberg, associate director of the Center for Public Policy Priorities, said the new programs "are some helpful notes."

"But 1.5 million uninsured kids is a lot, and I don't think we've done more than just whittled around the edges," she said. Those uninsured children represent about 22 percent of children in the state.

Dunkelberg's group, which is an advocate for low- and middle-income Texans, pushed for the CHIP proposal as well as a failed measure to add 258,000 children to Medicaid by changing the enrollment period from six months to a full year.

"We've still got a lot of work to do," Dunkelberg said.

Linking kids with care

Not all children whose parents pay child support are in the state's child-support system. The state tracks families who apply for cash welfare and those who ask for help setting, enforcing or modifying a child support order.

Overall, the families in the state's system tend to have lower incomes than the general population.

There are about 1.2 million children in the system, and about 500,000 of those have no health insurance, Abbott said. He's not counting on all of those children to join the new program, he said. Some have parents who are unemployed and don't pay child support, and some are in Medicaid or CHIP.

The group he said he's expecting to enroll are the children of noncustodial parents who follow orders to pay cash medical support to the custodial parent. Now, he said, that doesn't always lead to health insurance. The money sometimes is used for emergency room visits rather than preventive care.

With ChildLink, parents would have the option of joining, or they could choose employer-based or private health insurance.

"This is a program that will not be forced upon parents," Abbott said.

He expects the plan to cost parents around $100 a month in premiums. The state will seek bids from private companies to run the insurance program, he said.

Dunkelberg said she's concerned that the plan might offer only bare-bones coverage. "In order for it to be both affordable and unsubsidized, it would have to be pretty limited," she said.

Abbott said he envisions that the plan will include:

• About five doctor visits per year, plus more for a co-pay.

• Generic prescription drugs for a co-pay.

• Access to a 24-hour nurse line.

• Abbott said he expects ChildLink to be in place by early next year.

Help for greatest needs

The new Medicaid buy-in program for children with disabilities comes four years after lawmakers created a similar one for adults. That one serves only 64 people statewide, said Geoff Wool, a spokesman for the Health and Human Services Commission. He said the state is stepping up its outreach efforts to let potential applicants know that through the program, they can work and stay on Medicaid.

The children's program — which would cost $19 million over two years in state dollars — could serve nearly 5,000 people by 2012, according to a state estimate.

That's a small percentage of the state's uninsured children, but the bill's authors, Sen. Bob Deuell, R-Greenville, and Rep. Eddie Lucio III, D-San Benito, say these children have some of the greatest needs.

"These people have no alternative," Deuell said.

Twelve-year-old Izzy Mendoza of San Antonio might qualify. Izzy, who has mental disabilities, was born with heart murmurs and is supposed to see a cardiologist periodically, said his mother, Monica Garcia.

But he missed last year's visit, Garcia said, because they don't have health insurance.

"We can't afford a regular doctor, let alone a heart doctor," said Garcia, a legal assistant who said she takes her son to the emergency room when he gets sick.

Her husband, Mike Garcia, has health insurance through his job at a dental office, she said, but the family can't afford to add Izzy to the plan.

The Garcias earn too much to qualify for Medicaid and for CHIP, which is designed for families who can't afford private health insurance but earn too much to qualify for Medicaid.

"I don't know how to explain not being able to take your child to get the regular care he needs," Garcia said. "It's frustrating to sit in the ER for 10 hours, 12 hours and hope to be seen."