Advocates help enroll children in health plans

An advocacy initiative in North Georgia is filling a health insurance hole for hundreds of kids who had fallen through the system's cracks.

Over the past year, the Northwest Georgia Healthcare Partnership has enrolled hundreds of children in either Medicaid or PeachCare -- a program for those who make too much to qualify for Medicaid but not enough to afford private insurance -- through its new child advocacy program.

Run by Reyna Peinado, the program works directly with families, helping parents wade through the often-confusing process of applying for coverage. Since January 2009, the program's advocates have enrolled more than 600 children in a publicly supported health care program.

"It can be rewarding, and it can be stressful at the same time, but I love my job," Ms. Peinado said.

When families have to delay preventive or routine medical care because they lack insurance, an easy-to-fix health problem can become an urgent -- and expensive -- emergency, said Nancy Kennedy, executive director of the Northwest Georgia Healthcare Partnership. The organization estimates that the effort has saved the community more than $1 million in avoided medical costs by getting timely and routine care to children, she said.

That calculation was based on an estimate that communities save $2,331 for each child they insure or keep insured, published in the journal Pediatrics, Ms. Kennedy said.

The enrollment assistance program came about at the request of Whitfield County pediatrician Dr. Martin Michaels, who last year was experiencing a steady flow of uninsured children into his office, many of whom he knew could qualify for either Medicaid or PeachCare.

"I just decided to ask them if I could come and talk to them about the problem I was seeing," he said.

Although some of his patients just didn't know about the programs, others actually believed they were enrolled but fell victim to small oversights that resulted in gaps in their coverage, Dr. Michaels said.

Kids who were missing early treatments for conditions such as pneumonia ended up in the emergency room, he said.

Parents who couldn't afford asthma maintenance medicines for their children took them to the hospital with severe asthma attacks, resulting not only in decreased quality of life, but significant financial costs, he said.

"The money that we spend on coverage like Medicaid and S-CHIP (PeachCare) for children is actually a lot less than what the complications would cost if the kids are uninsured," he said.

Some failed to go through Medicaid's regular recertification process, required every six months for children over 1. Other families found themselves shuffled throughout the system, applying for Medicaid after a lost job or cut work hours, then having to switch gears and apply for PeachCare if their income ended up increasing or they got a new job.

"We call it the yo-yo effect," Ms. Peinado.

That was the situation for Dalton resident Genevieve Sanchez, 23, who last year was struggling to get coverage for her children, Fidel and Sherlyn Hernandez, who are 4 and 3. She earns about $16,000 a year working at Mohawk Industries, but her pay varies widely from week to week.

She was told she earned too much to qualify for Medicaid (the cut-off level for a family of three is $2,300 a month) but her income had dropped by the time she applied to PeachCare, and she was sent back to Medicaid.

Ms. Peinado helped her figure out which program to apply for and got the kids covered by Medicaid in November.

"I'm really thankful for Reyna and the program because I don't know what I would have done," Ms. Sanchez said.

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