Families Seeking Insurance For Kids
Downturn Forcing Parents to Get Aid

By Chris L. Jenkins
Washington Post Staff Write
Wednesday, January 14, 2009

Rising unemployment and the sinking economy are driving sharp increases in the number of Washington area families seeking state health insurance for their children, and more of these families are qualifying for coverage, records show.

The increases are particularly pronounced in the region's largest and wealthiest jurisdictions as employers cut benefits and eliminate jobs. In Fairfax County, for instance, requests for the state's insurance program for children, Family Access to Medical Insurance Security (FAMIS), were up 16 percent between November 2007 and November 2008. In Alexandria, caseloads increased 20 percent, and in Loudoun, they were up 16.5 percent.

Overall, caseloads in Northern Virginia shot up 18 percent during that period, from 19,299 to 22,692, compared with 7 percent for the rest of the state.

In Maryland's Washington suburbs, caseloads for the state's insurance plan for children have increased about 4 percent, from about 45,000 to 47,000.

Not only are caseloads up, but the number of people applying for such coverage has increased substantially too. Last week, the Virginia Department of Medical Assistance Services reported that the number of people applying for

FAMIS increased an average of 24 percent a month in 2008 over 2007, from 5,073 a month to 6,291. This included a 40 percent increase in applications in September and October 2008 over the same two months in 2007. In addition, the number of applications approved increased 10 percent statewide from 2007 to 2008.

In Maryland, where eligibility levels are more generous than in Virginia, officials in Montgomery, Prince George's and Howard counties said they have seen an increase in applications for the Maryland Children's Health Program (MCHP) as well. For instance, the number of people applying for the program in Montgomery County increased almost 16 percent in October 2008 from a year earlier, from 3,977 to 4,599.

The District does not keep separate statistics on the number of children enrolled in its program, officials said.

"These generally seem to be people who, when times were good, didn't need this kind of help, but now with the economic downturn and loss of a job, now they may need it," said Sandy Ovuka, public assistance program manager for the Fairfax County Department of Family Services.

Social services officials and advocates for the poor say the numbers reflect the worsening recession and the larger problem of millions of uninsured Americans. There is a direct correlation between the increase in the number of children seeking state-sponsored coverage and the number of adults who lose their jobs or can no longer afford employer-sponsored coverage, national studies have found.

Although more families are finding that they qualify for coverage for their children, many of the parents still make too much money to qualify for government-sponsored coverage, such as Medicaid, for themselves. The increase in requests for assistance also burdens already stretched state budgets.

Each state runs a children's health insurance program paid for by a combination of local and federal dollars that covers families whose annual income is too high to qualify for Medicaid. Generally known as the State Children's Health Insurance Program (SCHIP), the eligibility requirements are usually much more generous than publicly financed health insurance for adults who are not elderly or disabled. In Virginia, a family of four making less than $42,400 a year -- or 200 percent of the federal poverty level -- is eligible for the insurance, although some states add money to expand the coverage to a broader group. In Maryland, a family of four making up to $63,600 qualifies for some health care aid for their children.

Expanding SCHIP is a top priority of president-elect Barack Obama. And with an Obama administration, congressional Democrats hope to succeed in expanding SCHIP where they failed with President Bush; they begin today by taking up debate on whether to expand the program from 6 million children to 10 million. Congress passed a program expansion twice, only to have the bills vetoed by Bush, who said that the measures expanded coverage to families that made too much money.

Caseworkers and advocates for the poor said that in many cases the new enrollees are children in families where one parent has lost a job, decreasing the family's income to a level that qualifies them for state help.

"We also get a lot of cases where people can no longer afford their health plans," said Meredith McKeen, a program manager for Northern Virginia Family Service. "Circumstances are changing very quickly."

For years, Fawn Miller's family received health insurance through her $31,000-a-year job at a financial services company near Tysons Corner. Her husband, Richard, makes $36,000 a year as a contract truck driver but doesn't receive health benefits. So when she lost her job as an administrative assistant in October, the family lost her income and benefits. The couple's three children, ages 9, 11 and 14, have qualified for FAMIS, although neither adult has coverage. The parents don't qualify for Medicaid, and Miller cannot afford COBRA coverage, the federally sponsored insurance program for the recently unemployed.

"When I walked in, I still didn't think I'd be eligible, I thought we would make too much," said Fawn Miller, 38, referring to the FAMIS program. She said this was the first time she or Richard, 45, had ever been on public assistance. "We're hoping things look up in the coming months, but I admit it's been an odd situation. We're not really poor, but we kind of are."

Nationally, experts have raised concerns about the rising unemployment rate's impact on health-care coverage. On Friday, the Kaiser Family Foundation released a report estimating that now that the unemployment rate has reached 7 percent, an additional 2.6 million people nationwide might become uninsured. The report estimated that Medicaid and SCHIP enrollment could increase by 2.4 million. If the unemployment rate hits 10 percent, the report estimates, Medicaid and SCHIP enrollment would increase by 5.4 million.

"We found that people who are getting SCHIP for their children are people who have never had any public assistance before and never dreamed that they would ever have to do that," said Diane Rowland, executive vice president for the Kaiser Family Foundation.

Joe Antos, a researcher in health-care and retirement policy at the American Enterprise Institute, said that the number of families needing public health-care coverage if they become unemployed depends partly on how long the recession lasts. An increase in public health-care enrollees "is certainly plausible, but many of them are going to have to figure out how to apply," he said. "In many cases, people who have never looked for these kinds of services don't even know they exist or that they would be eligible."