Mo. Law Glitch Leaves Thousands of Children Without Insurance

Thousands of Missouri children have been dropped from the state Medicaid program because of a little-known law that denies coverage if their parents’ employers are deemed to offer “affordable” insurance.

Private insurance qualifies as affordable if the policy covers doctor visits and hospitalization for children for less than $342 a month. Yet some parents must pay as much as 20 percent of their income for that private insurance.

In the past six months, the law has forced nearly 5,000 children from the Children’s Health Insurance Program, an extension of Medicaid for lower- to middle-income families, according to the Associated Press account.

The state has used an affordability test for years but never applied it to so many families, including those with incomes slightly above the poverty line. The change was part of last year’s law tightening Medicaid eligibility standards and reducing benefits.

The affordability test is based on what state employees and legislators pay under the Missouri Consolidated Health Care Plan. Insurance is deemed affordable if it costs no more than 133 percent of the average cost for children in the state workers’ plan. Because the change took effect Sept. 1, the test is triggering four times as many rejections as before.

The Republican sponsor of last year’s Medicaid-cutting legislation said the change was inadvertent and may need to be reviewed.
“It was an unintended consequence,” said Sen. Chuck Purgason, R-Caulfield.

Gov. Matt Blunt’s spokeswoman said the governor would defer to the Legislature on the issue.

Meanwhile, some families are worrying about how the affordability test will affect them.

Matthew and Kathy Kitrel have been paying the state $105 a month to insure their three children in the Medicaid plan. First-grader Timmy Kitrel, 7, has cerebral palsy, and has received occupational, physical and speech-language therapy through Medicaid, said his mother.

But the Kitrels expect to be kicked out of the state plan because Matthew Kitrel’s employer offers children’s coverage for $220 a month. The Kitrels say the insurance won’t cover all their needs.

For example, Medicaid sends an aide to the Kitrels’ home three times a week to help with Timmy’s bathing and personal care, as well as every morning to get him ready for school. Private insurance will cover a maximum of 100 visits a year.

Because it is difficult for Timmy to eat, Medicaid covers his liquid nutrition, called Pediasure. Seven cases a month cost $350. His mother doubts the private plan will pay any of that. Plus, co-payments for his medicine and equipment will be higher, and his diapers won’t be covered.

The affordability test isn’t the only change pushing children off Medicaid. Overall, the number of children covered by Medicaid has dropped by 45,697 in a year, down from a high of 556,514 in February 2005.

Some families lost coverage because they failed to send in documentation of income, moved out of state or could not be located. Blunt’s administration says it is aggressively enforcing a law that requires families’ eligibility to be re-evaluated annually. Others failed to pay new premiums imposed by the Legislature.