Vermont is a national leader in Medicaid coverage of children. In 2001 only 4 percent of our state’s children were without health insurance, compared to a national rate of 12 percent. However, in late 2003, new legislative policy replaced co-payments with monthly premium payments for children in families earning 185 percent of the federal poverty line or more. This change resulted in reduction in enrollments, which, as of June 2004, had not reached prior levels for children whose family incomes are 225 to 300 percent of poverty. (1) The premium system has left some children without coverage when their families cannot afford it.
Vermont faces a growing deficit in its Medicaid fund. According to the Joint Fiscal Office, expenditures are far outstripping revenues and will only get worse during the next four years. Vermont’s Medicaid deficit cannot be blamed on the state’s commitment to coverage of children. Though children are the highest number of enrollees in the Vermont Medicaid system, they require the lowest expenditures. Pharmacy and nursing home providers receive the highest percentage of public financing. It is necessary to advocate passionately for Vermont to continue its current coverage of children.
Transitioning Youth and Support
There is one group of young people who may be on the outside of our public health care coverage; a group who needs every kind of support available. Unless they are eligible for the health insurance program for low-income adults without children called the Vermont Health Access Program (VHAP), young people transitioning out of the custody of the state do not have access to health insurance. This group of young people, one of the most at-risk in our state, needs access to publicly funded health care. The legislature is working hard currently to provide health care coverage for all Vermonters, either as a universal system or one that covers the previously uninsured. Until that day Medicaid coverage should be expanded to make sure that this group receives coverage up to 200 percent of the federal poverty line or less.
Access Not Guaranteed
Even though children are covered for health care, they may not be able to receive the care they need in Vermont. In rural areas especially, there are shortages of child psychiatrists and other mental health providers, pediatricians, specialists, and dentists who accept Medicaid.
* Only 4% of our state’s children were without health insurance in 2001. That compared to a national rate of 12% and was the best rate in the country along with Rhode Island and Wisconsin.(2)
* Access to medical care is a major problem for rural Vermont families. Rural families have less access to specialists, mental health care, home health care and dental care. They also have significant problems transporting their children to care. (3)
* For every 10,000 residents in rural Northern New England, there is, on average, one pediatrician, or half as many pediatricians as are available in nonrural areas. (4 )
* Vermont faces a growing deficit in its Medicaid fund. (5)
* Though children are the highest number of enrollees (46.18%) in the Vermont Medicaid system, they require the lowest expenditures (16.69%). Most costs to our state’s health care budget do not come from coverage of children. Pharmacy and nursing home providers receive the highest percentage of public financing. (6)
* Advocate for no cuts to eligibility or programs and no increase in premiums for children’s Medicaid.
* Advocate for Medicaid coverage for single nineteen- to twenty-two-year-olds who are transitioning from state custody.
* Investigate ways to improve access, especially for rural families, to health care providers.