Proposed changes to Children with Medical Handicaps program causes concern among local families

March 12--COLUMBUS GROVE -- A state program that benefits more than a thousand local children with medical conditions is undergoing a major overhaul, causing concern among area families and public health officials who worry that less people will be covered if the changes are accepted.

The Bureau of Children with Medical Handicaps program, or BCMH, pays for health care services for children with special needs who are uninsured, underinsured or whose insurance does not cover the services they need.

It is run by the Ohio Department of Health, but a state budget proposal would transfer BCMH services to the Ohio Department of Medicaid in 2018.

Because there is no limit to the number of people who can take advantage of the program, the number of enrollees has skyrocketed in recent years. Additionally, while these services already exist in the Medicaid system, BCMH essentially spends taxpayer dollars twice on similar services for BCMH-enrolled children who are also enrolled in Medicaid.

As a result, BCMH has consistently run over budget, and is operating on an $11 million deficit.

According to state health officials, the move to a Medicaid-run program would streamline services under one department, thereby eliminating unnecessary expenditures. But the proposal also raises the financial eligibility requirement for families who enroll after July 1, which would likely cause fewer people to qualify -- especially middle class families with two sources of income.

Saving the safety net

Casey Zimmerly is an 11-year-old from Columbus Grove who was born with a genetic abnormality that causes medical conditions such as asthma, epilepsy, low muscle tone, and global delays, which hinder his ability to walk, talk and feed himself.

His mother, Katie Zimmerly, enrolled her son in BCMH soon after he was born, and has benefited from the program ever since.

Though she and her husband work full time, the medical bills would become too overwhelming without help from the program. Casey's epilepsy medication alone costs between $300 and $600 a dose, and it is sometimes administered multiple times a day. Her family has private insurance, but it denies coverage for some services Casey needs.

"For middle class families like ours, [BCMH] provides that extra safety net to help purchase a lot of those medications and things," Zimmerly said. "Without BCMH, our family wouldn't have been able to afford to help Casey grow and develop. We might not even have been able to stay in our home or pay the bills."

In Ottawa, Nikki Kuhlman's 15-month-old son was born with a form of Down syndrome called Trisomy 21, which caused congenital heart problems that required two open heart surgeries. She calls him her "million-dollar baby" because his medical conditions cost $1 million before he was 6 months old.

She also enrolled her son in BCMH, and it has been especially helpful because she had to take a significant time off work to care for him. Her fear is that when she goes back to work, she may not meet the financial eligibility requirements set forth by the new BCMH program.

"If I go back to work full time, I'll be making too much money and he might be off the program," Kuhlman said. "The changes to BCMH are going to hurt working families more than anyone."

Allen County Health Commissioner Kathy Luhn agreed that working class, middle-income families would be most affected by these changes.

"Our concern is that families that are working but have a child with major medical issues will have a drain on their income," Luhn said. "It's important for them to be able to qualify for the program."

Eligibility changes

The new BCMH proposal grandfathers current participants into the program until they reach age 21, or their medical or financial eligibility changes. The Medicaid BCMH program maintains the same medical eligibility criteria, but raises the financial requirement from 185 percent of the federal poverty line to 225 percent.

State health officials said while current enrollees will not be affected, raising the financial requirement will hurt some families, especially upper-income households, but project that 80 percent of future applicants will still qualify under the 225 percent level.

Officials maintained that altering the financial eligibility structure will establish clearer guidelines for people who are unsure if they qualify. They also said that, because the majority of enrollees are between 185 and 500 percent of the FPL, raising it to 225 will not affect the majority of children on the program.

Losing the local connection

One of the more significant concerns for county health departments is the transition from working with local health care providers to Medicaid officials who may be disconnected from community resources.

"Our BCMH nurses form a special bond with the families they see, so I think that is very important," said Brenda Eiting, nursing director at the Auglaize County Health Department. "It's hard to tell how [Medicaid BCMH providers] will understand local resources, and if there will be any consideration for contracting with local health departments who may be more aware of these resources.

"I hope they do the best they can with the resources they have, but we also hope they take advantage of local resources."

Sherri Recker, director nursing at the Putnam County Health Department, agreed that the local connection is important.

"Our public health nurses are familiar with the community and what services are available, as well as knowing who to contact to help make those connections on a local level," Recker said. "Losing that local perspective is more of a handicap for the family."

A Medicaid official said the care each family receives will be looked at on a case-by-case basis. This means that some children may stay with their public health nurse, while others will gain a new nurse or case manager. Some may even have a combination of care from local public health nurses and Medicaid case managers.

Additional resources

The ODH has established several resources to help families learn more about the proposed changes to BCMH.

These resources include an overview of the BCMH program and how it will impact families, along with a list of frequently asked questions and medical eligibility requirements for treatment. Parents who have questions concerning coverage or the proposed changes may also send an email to [email protected].

A Facebook page created by parents of BCMH children is available, and can be found at http://bit.ly/2mUyKGC. According to the group's administrators, it is meant as a support system for BCMH parents to share information and resources.

Those wishing to express their questions or concerns about BCMH are also encouraged to contact their state representatives, senators and members of Congress.

Reach John Bush at 567-242-0456 or on Twitter @Bush_Lima.

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