Health program for kids assailed
By Berny Morson, Rocky Mountain News (Contact)
Published June 9, 2008 at 7:47 p.m.
The state program that delivers health care to more than 53,500 needy children and pregnant women is in administrative disarray, state auditors said Monday.
A report on the Children's Basic Health Plan found that 10 percent of patients were classified incorrectly - either as eligible when they weren't or as ineligible when they were entitled to services.
Hundreds of people were kept on the program after their eligibility expired - for up to two years in some cases.
The report to the Legislative Audit Committee did not estimate a total cost of errors in the $106-million-per-year program.
However, a sampling of 203 patients in seven counties produced errors valued at $48,300 in determining eligibility.
The Department of Health Care Policy and Financing, which oversees the program, has no controls to detect fraud and abuse in the 64 county offices that perform most of the task of enrolling patients, the report found.
Nor does the department monitor the counties as they determine eligibility.
The report stunned lawmakers. "That's huge," House Minority Leader Mike May, R-Parker, said of the 10 percent error rate in qualifying participants.
If the wrong people are being enrolled, "then the whole program doesn't work," said May, who was appointed as a temporary member of the audit committee.
Rep. Dianne Primavera, D-Broomfield, said she was "distressed" by the report.
She cited a lack of communication among the counties and various private contractors that operate the program.
"It seems like kind of a mess," said Primavera, who has worked in health care administration.
Program administrators did not dispute the findings, but said they are working on the problems, which pre-date the administration of Gov. Bill Ritter.
"We can do a better job with respect to how we organize our eligibility enrollment activities and we're doing that as we speak," said Sue Williamson, deputy director of the Health Care Policy Department.
The Children's Basic Health Plan is the Colorado agency that carries out the federal program called State Children's Health Insurance Program, or SCHIP.
The program serves a population that is not poor enough for Medicaid, but falls below 205 percent of the federal poverty level.
Children must be under age 19 to be eligible. Pregnant women receive care for up to 60 days after delivery.
Federal funds cover 62 percent of the cost. Eighteen percent comes from tobacco companies under the settlement of a lawsuit based on claims of smoking-related diseases.
Patients are treated under contracts with numerous health maintenance organizations around the state.
The auditors found 831 women who remained in the program after their eligibility should have expired. The cost associated with them is $104,000, the auditors said.
A bigger problem may be that the program is not spending enough by failing to identify thousands of kids and pregnant women who are eligible for services.
The department claims current enrollment represents more than 55 percent of those who are eligible.
But auditors found the department engaged in a series of untested assumptions in estimating the number of eligible women and children.
"These problems seriously compromise the reliability of the estimates and the penetration rates calculated and reported by the department," the auditors wrote.
Delays by counties - sometimes several months in processing applications also are a problem. Federal law sets a 45-day limit.
Members of the audit committee told the agency to report by November on progress in remedying the problem.
A separate audit is being conducted of Anthem Blue Cross and Blue Shield, which processes claims and performs other administrative services.
That audit is scheduled for later this year.
morsonb@RockyMountainNews.com or 303-954-5209
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June 9, 2008
5:27 p.m.
Suggest removal
nicktaste writes:
yeah the gov health care in CO
needs to be replaced with a better version of itself
the current system is total garbage
here's an idea:
100% overhaul the existing crap POS in place now
and then
make it an shining example to the rest of the states as to how a state run health care system
cmon we want to see a 180 on this
because the way it is now is a dismal failure
June 9, 2008
5:50 p.m.
Suggest removal
BrianSchwartz writes:
Hmm. If the Children's Basic Health Plan were a non-government charity people would stop donating money to it. But since it's government-run, the "doners," i.e., taxpayers, would become criminals for choosing to donate the money they earn to a charity that actually deserves their donation.
A tax credit for charitable donations is one way to do this. You donate, say, $100 to a charity that helps out with kids' health care, and two things happen:
1. You get a $100 tax credit, which means you pay $100 less in taxes.
2. The Children's Basic Health Plan *loses* that $100. This will give the administrators incentive to do a good job.
I cannot imagine how defenders of government-run charities can oppose this idea. Do they think government-run charities cannot compete with other charities? Do they think taxpayers are too dumb to know which charity should receive their hard-earned income?
For more on charity tax credits, see:
http://www.patientpowernow.org/2008/0...
http://www.patientpowernow.org/2008/0...
June 9, 2008
8:07 p.m.
Suggest removal
gary writes:
This is the State that wants to have a one carrier health system and make it mandatory for everyone.
I do not know about the rest of you, but this shows me how bad they can mess things up.
Cheaper better health care from the State of Colorado.....
Not very likely...
Count me out!
Nuff Said
June 9, 2008
8:12 p.m.
Suggest removal
Heidioftherockies writes:
When will people learn that government has no role in running health care! Just look at the UK, France, Canada, for example. Wealthy people go to private doctors - or to the US. The rest of the population has to accept the mediocrity (at best) the systems offer. The result of universal health is mass exodus from the system of physicians. In Canada there are so few OBs who deal with high risk pregnancies that the Canadian health care system sends these patients south to the US for treatment. Let's face it, we have a sickcare system, not a healthcare system and it will only get worse if the government becomes the sole provider of sick insurance.
June 9, 2008
8:40 p.m.
Suggest removal
mytwosense writes:
Seems like a lot of programs under Gov. Owens' watch went astray. Now Ritter has to clean up the mess.
Of course, I can see this article has some of the privateers licking their chops. They literally advocate throwing the baby out with the bathwater, or in this case, scrapping a program that despite its current problems, provides badly needed health services to expectant mothers.
June 10, 2008
7:19 a.m.
Suggest removal
HolierThanThou writes:
The only thing SCHIP has in common with Canadian-style national health provisioning is that they both provide health care services.
Colorado relinquished administration to various private contractors and big HMOs. Then the state's audit found that they're not doing it right.
Try reading the article before inserting foot in mouth.
The fact is that the Canadians and Europeans laugh at American health care. Our private system is much more expensive and serves fewer people. The care that insured Americans need is frequently denied by bean counters. Or they make the procedures to get treatments and medicines so onerous that people simply give up, endure their pain, get sicker and die young.
Governor Bill Owens was negligent and incompetent. He bent to the will of anyone who offered to be his crony and turned SCHIP into a for-profit scheme. That's what the audit shows and it's now a big mess for Gov. Ritter's people to clean up.
Ironically, if we were smart enough to adapt a modern national health care system for everyone then SCHIP would be redundant and unnecessary. But the only people smart enough to enjoy government administered health care in America are the president, congress persons, and their staff.
Where does that put you on the intelligence scale?
June 10, 2008
11 a.m.
Suggest removal
JluvDC writes:
I tried to use that program once for my son when we were struggling financially and needed to find inexpensive health insurance for him. It was by far the biggest bureaucratic mess I've ever encountered. The forms were confusing and they required excessive amounts of documentation (hand written notes from employers in addition to pay stubs and regular tax information). The people who were supposed to help with questions about the forms and documentation didn't fully understand the forms and requirements themselves. In the end I gave up on it. I would not recommend it to anyone.
June 10, 2008
12:21 p.m.
Suggest removal
Heidi writes:
It sounds as though they didn't care how the money was spent, just that it was spent. That means the program's working, right?
June 10, 2008
3:59 p.m.
Suggest removal
mytwosense writes:
This is similar to what's happening in Iraq, where we are handing out contracts left and right to private companies to manage what government employees used to do. In both cases, our taxpayer dollars are going straight down the drain.
I am not saying that in all instances private contractors screw up like this when working on government-funded projects, but when these contracts are given out under Republican-dominated governments (at both the state and federal levels), the goal seems to be this:
Destroy our government programs, then cry "they don't work at all!"
Meanwhile, our tax dollars have made their cronies rich for doing nothing more than systematically undermining our government programs. It's disgusting and citizens need to call out these grafters for what they are.