DRCNH Home > News > 11-13-2003 audit

Program supporters worried families will pay price

From the Concord Monitor:

By DANIEL BARRICK
Monitor staff

A program that allows severely disabled children to qualify for Medicaid could be pared down significantly as the state Department of Health and Human Services trims its budget.

Families with children in the Katie Beckett program, which provides financial assistance to families that would not normally qualify for Medicaid, say they're worried that hundreds of disabled children could be dropped from the program's rolls in an effort to save money. Health experts say the cuts could face strong opposition in both the Legislature and the health community.

"This could be one of the most controversial cuts of all those proposed in the department's budget," said Dr. James Squires, president of the Endowment for Health and a former state senator.

The Katie Beckett program is designed to provide the same level of care at home that the children would get if they were in a medical institution. It also helps schools cover half the cost of therapy and medical equipment it has to provide for these children. The program applies to children up to the age of 19.

Many of the families enrolled in the program are already covered by private insurance. The special Medicaid funds apply to exceptionally high costs that private insurance won't cover. The children covered under the program typically suffer from severe disabilities, such as muscular dystrophy, cerebral palsy and cystic fibrosis.

In a report released last week, Health and Human Services Commissioner John Stephen said he would save $500,000 next year by changing the program's eligibility rules. He did not indicate what those changes would be, and he did not respond to a request to be interviewed for this article. Several legislators interviewed for this article said they had not heard what eligibility changes might be proposed. But two people close to the department said Stephen's goal was to reduce the number of children in the program from 1,200 to around 250.

In a memo to the legislative audit committee dated Oct. 31, Stephen requested an audit of the Katie Beckett program. He noted that the program had expanded from 400 children at a cost of $4 million in 1994 to 1,200 children at a cost of $20 million in 2003.

But since much of the funding for Katie Beckett comes from matching federal dollars, it is not clear how much of that $20 million was state money. Several lawmakers said they were unsure of how much of the program's costs were actually incurred by state taxpayers and expected Stephen to provide those figures.

In the same memo, Stephen said he also wanted to compare New Hampshire's program to those in neighboring states. But Michelle Winchester, a health policy analyst with the Institute for Health, Law and Ethics at Franklin Pierce Law Center, said state-by-state comparisons were not the best way to evaluate the program's effectiveness. Massachusetts, for instance, offers a broader range of insurance programs for severely disabled children. New Hampshire has offered Katie Beckett coverage since 1989.

Winchester added that studying the program from an economic perspective was not the best way to assess its worth.

"We have to remember why we created this program in the first place," Winchester said. "It wasn't because it was the most cost-effective thing to do. . . . It was part of a push to bring children out of institutions and bring them back to their families and their communities."

In fact, she added, the cost to the state of institutionalizing many of these children would actually be higher than extending Medicaid benefits to their families under Katie Beckett.

Mary Trinkley, of Concord, enrolled her son Ryan in the program 11 years ago. Ryan, who just turned 18, suffers from seizures and requires 24-hour care. His mother said when she first inquired about the program at the Concord district office in 1992, nobody had heard about it. Trinkley said the program's recent expansion was because of increased awareness on the part of parents.

She said she was worried about the health department's goals in conducting its audit.

"We're hoping they will talk to families that are using the program, and not just look at figures," Trinkley said.

Amy Messer, an attorney with the Disabilities Rights Center in Concord, said tightening the eligibility requirements was "bad health care policy as well as bad fiscal policy."

"Cutting back this program would result in more cost-shifting," Messer said. Public health institutions would pick up the costs of caring for the children denied coverage under the Katie Beckett program. New Hampshire schools could also potentially lose tens of thousands of dollars in federal money if students are dropped from the program, she said. Schools would still be legally obligated to provide therapy to the disabled children, but without the financial backing of Medicaid.

Several lawmakers welcomed the opportunity to examine the program. Sen. John Barnes said he was glad Stephen had requested an audit of the program. He said the program had "ballooned" since being introduced 14 years ago, and he expected an audit would provide a better sense of how it was being administered.

Sen. Sylvia Larsen said she hoped any changes to the program's eligibility requirements would come after, and not before, the audit was finished. She said she wanted any changes to look beyond financial ramifications.

"I'm concerned about the effect (eligibility changes) will have on the families," Larsen said. "I seriously doubt if there's a large number of wealthy families with kids with disabilities who are getting a free ride on the state through this program."
--------------------------------------------------------------------------------
(Daniel Barrick can be reached at 224-5301, ext. 322, or by e-mail at dbarrick@cmonitor.com.)

Thursday, November 13, 2003