Michigan has made great strides in increasing the opportunities for children to receive health care. The recently implemented MIChild program may provide health care insurance to as many as 156,000 children, based on estimates by the Administration. Yet a question remains regarding the health care of those children not yet enrolled in a program or ineligible for Medicaid and MIChild.

It is estimated that as many as 69,000 uninsured children (Kids Count in Michigan Data Book, American Academy of Pediatrics) are not eligible for Medicaid or MIChild, and thus do not have access to needed primary and preventive health care services. Strategies to provide health care insurance to these children should build on the model of MIChild and benefit from the lessons of the transition of Medicaid to managed care.

One issue affecting the enrollment of children in MIChild is the slow pace at which applications have been processed. While the state is moving quickly on several levels, it acted very slowly to add the personnel to process newly generated applications due to MIChild and Medicaid case findings. The result has been long delays in enrollment and access to care. The delays are angering those in the community helping to find eligible families and delays access to primary and preventive health care services. The state must quickly remedy this situation and assure that the safeguards are in place to accommodate the application needs in the future.

Of those families applying to MIChild, approximately half are being found eligible for Medicaid, but may not wish to enroll. The reasons for this vary by family, reflecting the stigma associated with Medicaid and the negative experiences by themselves or those around them. The state should take responsibility for improving the status of Medicaid, and subsequently the access to services within the program (see briefing paper on access). The state can rename Medicaid as part of its 'no wrong door' approach and ending the welfare image of this insurance program.

Recommendations:

• Expand opportunities to insure more children in Michigan.
• Pursue the eligibility of additional pregnant women through a federal waiver of MIChild.
• Rename the Medicaid program as part of its 'no wrong door' approach
• Assure adequate state personnel are available to process Medicaid and MIChild applications in a timely fashion, now and into the future.

Additional Resources:

Ann Marston
Michigan League for Human Services
517/487-5436

Gerard Breitzer, D.O., M.S., F.A.A.P.
MI Chapter, American Academy of Pediatrics
517/353-3100

Jane Zehnder-Merrell
Kids Count in Michigan
517/487-5436

Gail Martin
March of Dimes of Southeast Michigan
248/359-1550

Sharon Claytor Peters
Michigan's Children
517/485-3500