Illinois makes big strides in covering all kids

Washington -- The 11-year-old boy is 4 feet, 9 inches tall and weighs 140 pounds. His single mother, who does not speak English, is worried that he might be having seizures while he sleeps.

His mother takes two buses to get him to Carrie Nelson, MD, a North Aurora, Ill., family physician and associate director of the Family Medicine Residency Program at the Rush-Copley Medical Center.

"He's a real at-risk child," said Dr. Nelson, an Illinois Academy of Family Physicians board member.

The 11-year-old is one of the 155,000 previously uninsured children in Illinois getting health care through All Kids. The $45 million insurance program, passed in November 2005, targets uninsured children who don't qualify for Medicaid or the State Children's Health Insurance Program. The state estimated that 200,000 to 250,000 children lacked insurance when All Kids launched in mid-2006.

The program is a leading attempt to connect all children to primary care doctors through sliding-scale subsidized health insurance. The plan includes hospital, physician, dental and vision care, and prescription drugs. Children are eligible no matter their citizenship status or income, but families earning more pay higher premiums and co-pays.

Dr. Nelson has been seeing more children lately. Though they're not always economically disadvantaged, All Kids is giving their families access to immunizations and other well-child care they didn't have before, she said.

At least 18 states are considering proposals or bills to expand access to health care for children in some form. Some are increasing eligibility for Medicaid or SCHIP, some are creating All Kids-like subsidized insurance plans with buy-ins for higher-income families, and some are considering a combination, according to the National Conference of State Legislatures and the BlueCross BlueShield Assn.

The adoption of All Kids kick-started many of these state discussions, said Robin Rudowitz, principal policy analyst at the Kaiser Commission on Medicaid and the Uninsured. "Illinois has been a leader in taking on the issue of universal coverage for kids."

Payments coming in regularly

More than 2,485 primary care physicians have agreed to participate in All Kids in Cook County and the adjacent northeast Illinois counties, where the state is concentrating its efforts first. Add 324 who have enrolled in other parts of Illinois as of March 1 and the state is nearing its goal of 3,000 primary care physicians, said Amy Rosenband of the Illinois Dept. of Healthcare and Family Services.

This level of participation might not have been reached if Illinois Gov. Rod Blagojevich hadn't addressed the state's dysfunctional Medicaid payment system, said Steven Knight, MD, president-elect of the Illinois Academy of Family Physicians.

Until recently, Illinois began each new fiscal year by paying doctors on time but then delayed Medicaid payments as the state budget ran out of money. Physicians cared for patients for up to six months without getting paid. Then, when the next fiscal year began, the state would catch up, and the cycle would repeat.

Consider this example of a payment difficulty: The state was only paying Dr. Knight, the nine other physicians and five allied health professionals in his Harrisburg practice on a limited basis for their Medicaid patients between November 2005 and mid-2006. The bill was at least $1.2 million.

The problem was ultimately resolved when an Illinois State Medical Society colleague communicated with the proper state contact on Dr. Knight's behalf. This step eventually led to follow-up from the state, improved payments and the debt dropping below $200,000 by last fall. "Basically, I think we finally ended up pretty well even," Dr. Knight said.

The state says it's paying error-free All Kids bills within 30 days for children and within 60 days for adults in a related parallel program, FamilyCare. All Kids primary care physicians also receive $2 per month per child they treat as a way of offsetting the costs of coordinating care.

Dr. Knight said the speed of payments has improved greatly. Other Illinois physicians agreed.

"There is no question you have to give the governor credit concerning the payment cycle," said Peter Eupierre, MD, president of the Illinois State Medical Society and an internist in Melrose Park, near Chicago.

But they're still low payments

But Illinois still isn't a leader in Medicaid payment rates, Dr. Eupierre said. Doctors are paid the same for All Kids patients as they are for Medicaid and SCHIP enrollees.

Illinois is tied with Maine, ranking 42nd in Medicaid payments to primary care physicians, according to a 2003 analysis conducted by the Kaiser Family Foundation. More recent statistics were not available.

The state doubled rates for 12 types of Medicaid services to pediatricians in January 2006, according to Scott Allen, executive director of the Illinois Chapter of the American Academy of Pediatrics. The state also has raised rates for preventive dental services for children nearly to private insurance rates, Rosenband said.

But Dr. Eupierre said there is still work to be done. "The major problem is still the amount of payment."

It could take years to judge the impact All Kids has on physicians and the health of Illinois residents.

Like Dr. Nelson, Dr. Knight has noticed more children in his practice, although he isn't sure if his new patients already were Medicaid patients or had recently enrolled in All Kids. Both are billed to the same system.

Dr. Nelson said it can be difficult to find specialists to see her patients, including those in All Kids. It took her two months to get that 11-year-old boy an appointment with a neurologist who accepts public aid.

All Kids' specialist referral system will not be in place until the fall at the earliest, said Edward Pont, MD, president of the Illinois Chapter of the American Academy of Pediatrics.

Illinois officials are listening to physicians, though, Dr. Pont said.

"The state is doing a very good job involving providers in the decision-making process as the program rolls out," Dr. Pont said.

Illinois is expecting All Kids premiums and savings from its new Medicaid primary care case management system to cover All Kids' $45 million cost, Rosenband said.

While physicians don't have total confidence in the state's public programs and payment rates, many said they are willing to give the program a chance.

"I like to believe [All Kids is] feasible," Dr. Nelson said.

Said Dr. Knight, a self-described conservative: "I'm normally not optimistic when it comes to dealing with the state. We'll see."