DHW hits billing goal for co-pays on Medicaid plan for children

It looks like lawmakers and department officials have met a goal set for achieving a cost-savings within a children’s Medicaid program, but federal intervention might spell trouble for plans to keep up collections of payments.

In early 2010, the Idaho Department of Health and Welfare (DHW) asked the Legislature to approve a co-pay for a service known as the Katie Beckett program, which provides in-home care for disabled children.  At the time, agency officials projected that instituting co-pays would save Medicaid about $200,000 annually, which is funded jointly by the state and the federal government.

According to a report obtained by IdahoReporter.com Tuesday the department has exceeded that goal.  Between May 1, 2010, when billing commenced, and the end of April 2011, the department took in $214,542 from co-pays, which are entirely optional for participants.

But future billings may drop off due to intervention by the federal government. In January, the Centers for Medicare and Medicaid Services required DHW to conduct a survey about the option nature of the co-pays among program enrollees.  The agency sent surveys to 928 enrollees, and of the 213 responses received, about 40 percent of respondents said they were unaware that co-pays are optional and said they planned to opt out of future payments to DHW now that they know.

About 42 percent of respondents said they will continue to pay, even though they know payments are optional.

In all, of the 1,285 families that are co-pay eligible, only 175 families are paying premiums, while 395 families have specifically asked DHW to prevent future billings from being sent.  Another 715 families are sent bills by the department but simply don’t pay them.

The annual cost for the Katie Beckett program hovers around $37 million.  The aim of the program is to give disabled minors access to in-home care, regarded as a cheaper alternative to institutionalization.

Jim Baugh, a member of the Idaho Council on Developmental Disabilities, told IdahoReporter.com that because the payments are optional, they haven’t necessarily harmed any program enrollees.  “So there hasn’t been any drastic effect on families since the ones who would have been harmed the most simply don’t pay the premiums.”

Co-pays are assessed on a progressive income scale. For those families making $2,500 a month or less, the average bill from DHW is about $10. For those making $10,000 or more each month, DHW asks for about $473.  Co-pays are reduced for those families providing private insurance for their kids enrolled in the Medicaid program.

One lawmaker on the House Health and Welfare Committee, Rep. Steve Thayn, R-Emmett, said that even though the $200,000 savings is small relative to the total $37 million bill for the program, it’s a move that saves taxpayers money and cuts down on the redistribution of wealth through health care entitlements.  “It’s important that they met their goal,” said Thayn.

The chairman of that panel, Rep. Janice McGeachin, R-Idaho Falls, said that even though only a small portion of money is coming back to Medicaid, it helps.  “Everything adds up,” she said.

McGeachin said there are no plans to further alter the billing for the program in the near future.