Additional children are eligible for health insurance coverage

Some parents may not be able to provide regular health insurance coverage for their children because they have lost their jobs or simply cannot afford it. However, their children may be eligible for free or low-cost government-provided health insurance.

Approximately seven million youngsters nationwide now receive low-cost medical care through the Children’s Health Insurance Program. The program can provide eligible children with free health insurance even if their parents’ income level is too high to be eligible for Medicaid. Oklahoma operates its CHIP program as a Medicaid expansion program called SoonerCare.

SoonerCare is a health coverage program jointly funded by the federal and state government. It is administered by the Oklahoma Health Care Authority, which also determines financial eligibility for the program. SoonerCare serves children in households earning up to 185 percent of the federal poverty level.

“The federal and state program has been a lifeline for children 18 and younger whose parents don’t qualify for Medicaid but, through no fault of their own, don’t have or can’t afford private health insurance,” said Dr. Renard L. Murray, Dallas regional administrator for the Centers for Medicare & Medicaid Services. “The youngsters get regular check-ups, dental care, shots and prescription drugs. They’re less likely to miss class and fall behind.”

The state uses a statewide, managed care system and contracts directly with primary care providers. Through a waiver granted by the federal government, Oklahoma has developed a “Medical Home” system in which every SoonerCare Choice enrollee has a primary care case management physician coordinating all medical care for that child, including referrals for additional care. OHCA officials said this system has worked remarkably well for families.

Oklahoma is poised to increase eligibility to households earning up to 300 percent of poverty. SB 424, which became law on June 4, 2007, requires the OHCA to increase eligibility on or before Jan. 1, 2011. The agency already has begun working on the implementation process.

“A year ago, President Obama and Congress added money to the CHIP program to expand children’s health coverage,” Murray said. “The goal now is to find and sign up each of the five million eligible youngsters who aren’t enrolled. Children deserve good health care to reach their full potential. Parents shouldn’t have to choose between paying for groceries and affording a doctor’s visit.”

Oklahoma’s SoonerCare(Medicaid and CHIP) Facts
Funding: The total program cost is $139,969,434

Participation: As of August 10, 2010, there were 466,628 children enrolled in SoonerCare, of which approximately 70,000 receive benefits paid for under CHIP. Because SoonerCare operates as a Medicaid expansion program, there is no discernible difference between the benefits package for children whose health insurance is funded by Medicaid and those whose insurance is funded through CHIP dollars.

Eligibility: Children 18 years of age or younger in households earning 185 percent or less of the Federal Poverty Level ($40,700 for a family of four) qualify for SoonerCare.

Cost sharing: Oklahoma has instituted a limited cost sharing system for SoonerCare. Participating families do not pay premiums. However, some adults do pay nominal co-payments as allowed by Medicaid. For example, depending on the service the co-payment can be $1 to $2 dollars and maybe $5 in some cases, but the provider cannot deny service for lack of co-pay if the member demonstrates insufficient funds. Oklahoma plans to institute a different cost sharing system for higher income families earning between 185 and 300 percent of poverty once it has expanded eligibility to these households.

How to apply: In an effort to increase participation in the program, the state has simplified its application process and eliminated the requirement for face-to-face interviews and an asset test for determining eligibility. Applications for SoonerCare are available at locations including the Oklahoma Department of Human Services county offices, county health departments, WIC offices, public libraries and school systems.
Parents may also call toll free (877) 543-7669 to talk to a representative to determine if their children are eligible for low-cost health insurance or visit www.insurekidsnow.gov. Families can usually complete their applications over the phone, online or through the mail, without taking time off from work.