Keiki health care umbrella unfolds
The Hawaii Medical Service Association will begin enrolling eligible children today for free health coverage under a Keiki Care program forged last year by the Legislature, the administration, health advocates and HMSA.
"I am very excited about Hawaii actually achieving universal health care for all children," said Sen. Suzanne Chun Oakland (D, Kalihi-Liliha), chairwoman of the Senate Human Services and Public Housing Committee. "I do hope families take advantage of this opportunity to make sure their children are covered with health care insurance."
The Keiki Care legislation was drafted last year to resolve concerns of Gov. Linda Lingle, who vetoed an earlier version in 2006. One concern was that families might drop employer-paid or private coverage to take advantage of the free plan.
A safeguard was written into the bill requiring that children must be uninsured continuously for at least six months and ineligible for any other state or federal coverage to qualify for the Keiki Care Plan.
HMSA, the state's partner under contract for the three-year pilot program, will begin coverage April 1. Children must be between 31 days and 19 years old and live in Hawaii to be eligible.
"It truly is a great thing for our state," said Rep. John Mizuno (D, Kalihi), House Health Committee vice chairman. "We'll be the second state in the nation to do this (after Illinois)."
He said it is a great example of public-private collaboration. "What a worthy cause to make sure every keiki from birth to age 19 is covered by health insurance."
The plan is intended to help as many as 3,500 children who are in a gap group that is not eligible for other government health coverage, HMSA said. Most are in families with income at or more than 300 percent of the federal poverty level.
Without access to preventive care, these children often end up in an emergency room with critical health problems, HMSA said. "Such care is often uncompensated and places a growing financial burden on Hawaii's hospitals and physicians."
The health carrier and state will share costs of premiums for each child, estimated annually at $1 million for each partner if 3,500 children are enrolled.
HMSA said it was directed by its board of directors to use health plan reserve funding for the coverage so employers and HMSA members will not be paying for the program with membership dues.
Basic health benefits will be provided, including doctor visits, immunizations, diagnostic tests, certain preventive services, emergency care, mental health and dental services and some prescription drugs.
HMSA and legislators began working in 2005 on a program to provide universal health coverage for children.
"This is more than just a family problem," HMSA Senior Vice President Cliff Cisco said in a news release. "It's a community problem, and it requires a community-based solution where public and private sectors work together to cover our children."
Comprehensive program covers children
Coverage under the Keiki Care program includes:
» Office visits: Up to 12 outpatient visits per calendar year, with $7 co-payment per visit; well child care, immunizations and hospital visits for no co-payments; and mental health and substance abuse services for $7 co-payment per outpatient visit.
» Hospital stays: Up to five days per calendar year for a semiprivate room and care for $100 per day co-payment; laboratory and X-rays for no co-payment.
» Prescription drugs: A 30-day supply of drugs on the HMSA formulary; generic antibiotics and oral contraceptives provided for $5 co-payments.
» Dental services: Two examinations per calendar year with no co-payment; X-rays with one set of bite-wing tabs per calendar year, no co-payment; cleaning and polishing, two per year, no co-payment; fluoride treatment, one per calendar year, no co-payment.
For more information, call HMSA at 948-5555 on Oahu.
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