Changes in Rules and Regulations

Aired July 21, 1999

This is INFOhio After Nine, I am David C. Barnett, bidding you greetings on this July 21st, 1999. We start off with the consideration of rules and regulations and how changes in those rules and a lack of communication are affecting Northeast Ohioans trying to navigate the transition from public assistance to self-sufficiency. This summer, the state of Ohio has made some changes in welfare law that will let thousands get access to affordable health care through Medicaid. The program, which lets low-income Americans enroll in managed care plans through the government, has just been expanded, but the struggle to continue to let welfare client know exactly what they and their children are entitled to continues to be a problem. As part of 90.3 WCPN®'s ongoing series, "The Changing Face of Welfare," 90.3's April Baer has this report.

April Baer–Ohio law states that every child here at Harvard Community Service Center is entitled to health care. But not every child's mother knows that. Amonica Davis is a counselor who works with welfare clients.

Amonica Davis–I don't think that they truly understand the language that the writers of the different health care plans have implemented or have introduced. Most of these women, they haven't been accustomed to listening to the terminology associated with health care and HMOs. How do they know how to choose? I don't think they truly understand what the health care plan, how it could truly benefit them, so they can make an informed choice.

AB–Many outreach workers like Davis say that clients of Ohio Works First, the state welfare reform program, are dealing with a complex and often-changeable system of government rules, and a dozen different HMO-style plans to choose from. Seemingly slight violations of state or county regulations can often cause big problems or delays in benefits. Recently, there have been Ohio's system of providing health care through Medicaid, and Davis and others are trying to make sure clients understand the new system. Often times, she says, people simply aren't aware of what they're entitled to under the new welfare laws. That means less parents and children are getting the medical care that they need.

AD–I think an entire family definitely needs to be covered. If you ask any middle class American who lives in inner-ring suburbs, they wouldn't expect not to be covered as a mother. They would expect coverage for the entire family, and children pattern their behaviors after their mothers and their fathers, and if they don't see their parents taking advantage of health care, then they don't see the benefits on a day-to-day basis for not only when an illness occurs, but in terms of preventative care.

AB–State lawmakers have been working on ways to extend coverage to as many working families as possible. While the state legislature doesn't have unlimited power to expand Medicaid, it does have a a little more flexibility these days in spending the federal dime. When Ohio's general operating budget was passed in June, its wording included an expansion of health insurance for the state's children. Currently, parents making up to 150% of federal poverty guidelines can enroll their children in Medicaid. Beginning next year, that requirement will be loosened to parents making 200% of the poverty level. State senator Eric Fingerhut is the author of the Children's Health Insurance Program, or CHIP, expansion.

Eric Fingerhut–The 200% of poverty level that has been established for the Children's Health Insurance Program was arrived at because that is the maximum allowable under federal law, so Ohio now fully utilizes the power we have under federal law, and fully utilizes the federal money to insure children.

AB–There's also another change written into the budget that will allow more adults to be covered. Beginning January 1st, parents who have successfully found a job and entered the workforce can keep their Medicaid coverage for up to two years, as long as they are making 100% of the poverty level. Fingerhut says he thinks there's a need to stretch Medicaid coverage even further, but, at this point, he's pleased that some expansion was voted in.

EF–The 100% level for working adults was really just frankly a compromise. Most of us believe that we do need to have a higher level of health insurance benefit available for low-wage workers, but it is an expensive benefit to provide and it does need to be implemented gradually, so frankly that was just simply the best we could do in this budget process.

AB–Welfare officials hope that the expansion of benefits will make clients more likely to seek preventive care for themselves and their children through programs like Healthy Start, an initiative that aims to curb infant mortality by addressing the educational and nutrition needs of low-income mothers and their families. Jackie Davis, with the Cuyahoga County Department of Health and Nutrition is a coordinator for welfare caseworkers. Davis says the county's coverage is specifically targeted to welfare's women and children.

Jackie Davis–The CHIP program itself is administered through our Healthy Start program here in Cuyahoga County, so we talk about Healthy Start as the program benefit for medical coverage available to children. The change would be that we've gone from 150% of poverty to 200% of poverty. For a family of four, it would be $33,400. We've actually looked at estimates of how many people fit into those poverty bands, we have some idea of what the potential impact will be.

AB–The county's figures indicate that under the state expansion, up to 4,000 more children will be eligible for Medicaid next year. That much is known. What is not know is why there are still a large number of people who are eligible for Medicaid, but who have dropped out of the program. About four years ago, an estimated 100,000 people in Cuyahoga County were enrolled in the program. Last year, the list of Medicaid clients was down to about 24,000. Jackie Davis says the county has begun to research this phenomenon, making calls to families who haven't taken advantage of their Medicaid benefits over the past six months in hopes of understanding where the gaps in knowledge lie. For INFOhio, I'm April Baer in Cleveland.