MEDICAID COVERAGE STILL SCARCE FOR AREA CHILDREN

Scarcity of participating providers in the region could mean no real change in health care services to Southeast Missouri children, despite recent legislation signed by Gov. Mel Carnahan that expands Medicaid coverage for some 90,000 Missouri children.

Carnahan signed Senate Bill 632, also called The Children's Health Initiative, this month. The legislation allows the state to access about $51 million in federal funds to provide affordable medical coverage to children who don't have health insurance or cannot get it.

The expanded coverage would mean more preventive services for children whose primary health care provider to date has been the nearest emergency room, said Brad Keatcher of Carnahan's office.

Children, especially those in working families struggling to make ends meet, would not have to wait until an emergency situation arises to seek medical attention and would have coverage for immunizations, dentistry, optical care and many other services, he said.

"This provides the mechanism to cover kids and allows parents to have peace of mind," said Keatcher. "We're confident while there may be a few minor snags here and there, for the state as a whole it's something that's very workable."

The "snags" include a lack of health providers who accept patients with Medicaid coverage in Southeast and Northeast Missouri. Dr. Lanis Hicks, an associate professor of health management informatics with the University of Missouri at Columbia, said these regions have a distinct lack of providers who accept Medicaid, especially in the areas of dentistry and specialized medicine.

Some 468 physicians and eight hospitals provide services to Medicaid patients in Bollinger, Cape Girardeau, Scott, Mississippi, New Madrid, Stoddard, Butler, Pemiscot and Dunklin counties. That includes providers in many health and mental health areas.

Hicks said children in other regions of the state have benefited from MC+, a managed care program that creates networks of providers who accept Medicaid patients. However, partly because of the lack of providers accepting Medicaid reimbursement, the northeast and southeast regions have not been able to implement similar systems of providers.

"It's been more difficult to get in place in these regions because Medicaid people want to make sure it can be implemented effectively before it's developed," said Hicks. The program is "a start in trying to expand coverage to people that need it, but it's not a total solution. The next step is trying to figure out how to get providers into that system."

In the meantime, Southeast Missouri providers who do accept Medicaid patients find themselves frustrated with the lack of referral options, inadequate payback and slow reimbursement issues they must deal with.

Debra Rau, a clinical psychologist in Sikeston who accepts Medicaid patients, often has to refer young patients to mental health providers as far away as Dyersburg, Tenn. This week alone it took her two days before she finally referred a patient to a provider in Poplar Bluff -- the nearest one who accepted Medicaid reimbursement.

Quite often these families have few financial resources and can't afford the additional expense of this sort of trip, she said.

"We keep hearing constantly more and more people won't accept it, but you never hear about people who will start taking it," she said. "Rate of reimbursement is an issue. Also, paperwork is an issue because when you're dealing with the government there's a lot of additional paperwork."

Rau said a 3 percent reimbursement increase recently approved for Medicaid providers may offer some incentive for health care providers to accept Medicaid patients, but much more will be needed. "If the increased demand for service could increase the number of providers that would be a positive thing, but I don't know if that's going to happen or not," she said.