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Insurance benefits untapped in W.Va.

September 01, 1998|By KERRY LYNN FRALEY

MARTINSBURG, W.Va. - It may be West Virginia's best-kept secret.

A family of four can have an annual income of nearly $25,000 and still qualify for a new insurance program that provides medical, dental and vision benefits to children ages 5 and younger.

Meant to fill the gap for families who make too much to qualify for Medicaid but not enough to afford private insurance, the two-phase program went into effect July 1, said Kathy Boylan, of the West Virginia Department of Health and Human Resources.

But it looks like the agency will have to fill a communication gap to get things off the ground, said Boylan. A disappointingly low response made it clear an aggressive outreach effort was needed, she said.

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She estimates 500 to 600 qualified families in Berkeley, Jefferson and Morgan counties are missing out on the comprehensive insurance plan, mandated and jointly funded by the federal government and the state.

"This is a way families don't have to worry about hospital bills and doctor bills and how they're going to pay them," said Boylan, community services manager for the agency's Bureau of Children and Families.

The outreach effort started in the Eastern Panhandle on Monday with an informational seminar in Martinsburg targeting people who work with children and families and can help get the word out.

Additional seminars will be held Thursday at the Bardane Public Service Center in Jefferson County and Sept. 8 at the First United Methodist Church in Morgan County.

Based solely on family income, the West Virginia Children's Health Insurance Program - known as CHIP - provides full medical, dental, vision and prescription medicine coverage to children in families making up to 50 percent more than what's allowed to qualify for Medicaid, Boylan said.

Children up to 18 years old will be covered by the second phase of the program, which should be in place by January 1999, she said.

All it takes to participate is filling out a simple form, much simpler than what's required for Medicaid, without any questions about assets, Boylan said.

Families can make up to 150 percent of the poverty level income, which depends on the size of the family, she said.

For example, a single parent with one child could make a gross income of up to $1,357 a month, or $16,284 a year, according to the program's eligibility chart.

A family of four could have a gross income of up to $2,057 a month, or $24,684 a year, according to the chart.

Working in billing at City Hospital in Martinsburg, Kathy Fletcher has seen the insurance gap in action too many times.

The parents of a sick child are working, making too much to qualify for Medicaid or other public assistance but not enough to afford medical insurance.

"Normally, these types of people end up making small payments for a long time," said Fletcher, who attended the seminar with co-worker Debbie Minghini.

The program sounds like it will benefit those families and decrease the number of lawsuits the hospital will have to file to collect outstanding bills, said Minghini, billing and reimbursement supervisor at the hospital.

The Rev. Tom Hartshorn, pastor of Christ Reformed Church in Martinsburg, said he thinks low response to the program so far may have more to do with the age restriction on the first phase.

"It seems like with the little ones, other ways are found. It's when they get older, it gets harder," Hartshorn said.

The second phase, which will be bid out for a private company to administer, should provide coverage as close as possible to what the first phase offers, he said.

It should include children up to age 5, who are now covered under an expansion of the state's Medicaid program, said Hartshorn, who thinks the program's association with public assistance could hurt response.

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