BUREAUCRACY FRUSTRATES HEALTH CARE; NEEDY FAMILIES AND EVEN AGENCY OFFICIALS SOMETIMES FIGHT A PAPERWORK JUNGLE

Families, health care providers and even agency officials often fight a paperwork jungle when trying to access health care programs available for needy children.

In the past five years, steps have begun to offer more health care services to more children. Gaps still exist, but a panel of local child health experts said Friday bureaucracy associated with state and federal programs can be a significant barrier.

The four spoke Friday at a forum of the Cape Girardeau chapter of the Missouri Association for Social Welfare.

It can take weeks, sometimes months, for children and families to receive services, said the officials. Payment to doctors and other health care professionals can be just as slow. And social workers trying to access services for clients spend much of their time filling out forms.

Other troubles listed include a lack of health care providers, lack of transportation and parents who don't get services available to their children.

Dennis Reagan, director of the Cape Girardeau County Division of Family Services, said his office administers 17 different programs, serving thousands of needy people.

And the number is growing.

The number of families receiving Aid to Families with Dependent Children jumped from 484 in 1987 to 1,196 in 1992.

And food stamp recipients rose from 3,452 in 1987 to 5,332 in 1992.

Reagan said things are improving. In 1987 and again in 1988, Medicaid was expanded to include more children.

In 1989, Medicaid coverage was extended to automatically cover eligible newborns. Prior to that, parents had to apply for the program after the child was born.

Now, the program has changed to offer temporary Medicaid coverage to pregnant women who meet a simplified income guideline form. The coverage begins quickly and continues while the more in-depth application process takes place.

Medicaid was also expanded to cover some low income families who are working through a program called transitional Medicaid. Medical coverage is offered for six months to a year.

"If people find employment it is more or less a minimum wage job," Reagan said. "And a lot of employers don't have medical coverage."

If a child became ill, the parent would quit the job and reapply for assistance in order to receive Medicaid coverage.

Reagan said the Division of Family Services screens Medicaid applicants for eligibility. It does not administer the program.

But he sees the bureaucracy in his own division and those he deals with as a significant problem.

"For everything we do, we have to fill out a form. For almost everything we say, there is a form," Reagan said.

The bureaucracy applies to providers also, Reagan said. "It's additional paperwork for them, and I think that's a major barrier for them."

He added that four or five years ago, doctors were waiting up to two years for payments from Medicaid. The time lag in payment has improved since then.

"A real barrier has been a lack of providers," Reagan said. "The number of providers in Cape Girardeau County is limited by specialities and also many physicians are limiting the number of Medicaid patients they see."

Trish Codding, regional director with the Bureau of Special Health Care Needs in Jackson and Poplar Bluff, is involved in a new program called Healthy Children and Youth.

It officially started in 1989 and is designed to cover more treatment for children. The state had been covering the cost of medical screenings. But as health professionals identified problems, no money was available to treat those problems.

Health Children and Youth covers things like physical therapy, occupational therapy, speech therapy and nursing services.

Paul Schniedermeyer, director of children's Services for the Community Counseling Center, said while the Healthy Children and Youth program can help provide health care to children, the bureaucracy still reigns.

"The Healthy Children and Youth program started in 1989. You know when we heard about it? Last summer," he said.

Under the program, services for children must be preauthorized before payment begins.

Schniedermeyer's worst case example of delays in preauthoritzation involved a child who was diagnosed as needing a service in August. The case was reviewed in Jefferson City in October and he received the authorization back on Feb. 18.

In the meantime, any treatment that has been done is not paid for.

"The only preauthorizations we have ever had rejected were because the paperwork was not done properly," he said.

Regulations are complicated, he added. "It is supposed to have a provision for transportation, but nobody is doing it yet."

In response to some of these access problems, the Cape Girardeau Health Department initiated a Primary Care Clinic for low income children in November, explained Charlotte Craig, director of the health department.

"The doctors were caught," she said. "They had all this paperwork and no money for the treatment. I know of one physician who spent an entire weekend with a sick child at the hospital, from Friday through Sunday, and got $21."

The clinic operates with a pediatric nurse practitioner who is supported by 15 local physicians.

Children ages two weeks through age 18 who are on Medicaid may receive treatment there. The clinic provides well-child care as well as minor sick-child care.

From Nov. 9, when the clinic opened, to Feb. 23, Craig said 617 children had been seen at 1,047 visits.

The health department also offers childhood immunizations at no cost and without income guidelines.

It administers WIC, a supplemental nutritional and educational program for pregnant women and children. Craig said the program provides food for these low-income persons and also provides a chance for education.

But, she said, children in the community have no access to health care. Income guidelines don't catch everyone. Many families don't have transportation to take children for treatment, or parents just don't get their children where they need to be.

Craig said her clinics have about a 37 percent no-show rate. Parents make appointments for the Primary Care Clinic or for immunizations, but never bring their children in.

"There is no single problem and no single answer," she said.