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Volume 16, Issue 3
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Spring 2004 |
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| published quarterly by: The New Hampshire Challenge, Inc. P.O. Box 579, Dover, NH 03821-0579 |
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| In This Issue |
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Kathy Schwartz said, speaking at a forum in Concord about proposed changes to Home Care for Children with Severe Disabilities (HC-CSD), the Katie Beckett Medicaid program.
She voiced the frustrations of many parents in New Hampshire who are caring for their children with disabilities while chasing after the moving target of health insurance. Schwartz' previous insurance company (Cigna) paid for half of the nursing costs for her child but her new carrier (Anthem Blue Cross Blue Shield) refuses to cover in-home nursing services. She sought the assistance of Senator Gatsus with her insurance coverage problems but he was unable to help her and she had to rely on HC-CSD.
According to federal law, the HC-CSD program must be the "payor of last resort" for medical expenses incurred by children with disabilities who live at home. So families are sometimes forced to wait months for approval of an expenditure from their private insurance company only to have it denied and have to begin the Medicaid approval process. Judy Kuczwara's story is a case in point.
Eight years ago she gave birth to triplets, two of whom have varying degrees of medical need including 24 hour nursing care, durable medical equipment and special formula. A wheel chair request took 8 months to be approved by her insurance carrier after being denied twice. She pursued her private insurance even though her sons are on HC-CSD because, like many parents, she doesn't want to use state funds if she doesn't have to.
But the constant battles have taken their toll on her own health. Last summer she was diagnosed with post-traumatic stress syndrome and is on medication to help her sleep. "All we want to do is to live in our own home, lead our life and not have to fight all the time," she said.
Health and Human Services (DHHS) Commissioner John Stephen sympathizes with parents who care for their children at home while constantly struggling with insurance companies to provide for even the most basic medical needs. He agrees that the practice of cost shifting from private insurance to Medicaid is a problem.
At a forum in Concord on January 14, 2004 he stated his intention to meet with health insurers and hold them accountable for paying their fair share of health care costs. A few weeks later at a hearing on House Bill 1428, he suggested that the state might recoup $500,000 over the next two years by collecting money owed by health insurance companies for services paid by Medicaid.
Representative Peter Burling responded to these concerns by adding a section about health insurance to HB 1428. (See accompanying article.) The bill establishes a position at the Department of Health and Human (DHHS) to help families recover health care costs from private insurers for home care services. It goes on to set up an information sharing arrangement between health carriers and the DHHS to identify HC-CSD Medicaid recipients whose services may be covered by private insurance.
This information would allow the DHHS to collect from the insurers for covered services. Federal Medicaid law encourages states to pursue insurance companies to recoup funds, according to Alex Feldvebel, assistant commissioner, New Hampshire Insurance Department. Feldbevel also mentioned that the new federal medical privacy law might be problematic for the information-sharing clause in HB 1428.
Written By: Jamie Stephenson |
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