Health Choice divides leaders

Senate wants enrollment cap

Uncertainty over federal funding for children's state health insurance has opened a breach between the state House and Senate over allowing more to sign up.

The House wants more than 10,000 additional children to be covered on the government-sponsored insurance N.C. Health Choice and adds $10.4 million to its proposed budget to pay for the expansion. Under the Senate budget proposal, no more children would be able to sign up between Sept. 1, 2008, and March 31, 2009. Children could begin enrolling again April 1, but only if Congress has renewed the program or put up more money to pay the costs.

The Senate budget, which members will vote on today, caps the program's enrollment growth at 2.4 percent and includes $1.7 million for the expansion.

The federal government pays for most of the 122,379 children enrolled in Health Choice, but the state shares the cost.

Sen. Tony Rand, a Fayetteville Democrat, said the state does not have enough money to cover costs through the end of the year if the federal government doesn't agree to send more money. It's better to freeze enrollment than take children's insurance away, he said.

"Having to disenroll people would be a disaster," he said.

North Carolina is one state where spending exceeds federal estimates. Despite warnings of federal shortfalls, Health Choice has grown in the past three years.

Gov. Mike Easley recommended adding the $10.4 million, same as the House. Dan Gerlach, Easley's senior budget adviser, said that Congress has come up with money in the past for North Carolina and other states that had shortfalls and that that practice is expected to continue.

"Congress intends to cover children who are eligible," Gerlach said.

State Rep. Mickey Michaux, a Durham Democrat and House budget writer, said Congress isn't going to stiff the state. Expanding the insurance is particularly important in touchy economic times, he said.

Health Choice is for children in families with incomes at or below 200 percent of federal poverty level, or $42,400 a year for a family of four. The program is meant for children whose families earn too much to qualify for Medicaid but cannot afford private insurance.

Kimberly Endicott, whose husband runs a business in Youngsville, could not enroll her children in Health Choice before 2005 because the family made too much money. The family struggled to pay medical bills for her eldest son, who has a brain injury, and her three youngest children, who have cystic fibrosis.

It took shutting down the business during a medical crisis for the Endicotts to lower their income enough to qualify for Health Choice, she said.

Most of the children were able to go from Health Choice to disability insurance, Endicott said, but her 16-year-old daughter, who is healthy, lost the insurance when the family income went up again.

"One year, we made a mistake and earned a little bit too much," Endicott said. The state needs to keep letting children enroll in Health Choice and support a new program that would allow parents with incomes up to 300 percent of poverty level to buy insurance on a sliding scale, she said.