A Remedy for Sick Kids

Powerful health care interests are now lobbying state legislators for what they regard as their fair share of the public health insurance benefits the state cut drastically in the early 1990s. On Wednesday several hundred doctors marched in the state capital, carrying signs saying, “Shame on California, 47th in Medi-Cal spending.” They ask better reimbursement for their services, saying underpayment in the long run harms patients. They are right.

However, in even more dire straits are the the 150,000 children whose health care is overseen by California Children’s Services (CCS). A relatively obscure state agency, Children’s Services provides specialty medical care and case management for disabled or chronically ill children in low-income families. Its ability to provide care effectively is increasingly compromised by its rock-bottom reimbursement rates, which have led many specialist physicians to stop seeing its patients.

The shortage of physicians has led to painfully long waits for treatment, which now average four months for diabetes cases and eight months for rehabilitative therapy, according to the California Children’s Hospital Assn.

California’s two other public health insurance programs, Medi-Cal and Healthy Families, pay doctors a flat fee per year per patient, which can prove financially difficult for doctors with high caseloads of patients with challenging problems. In these cases, Children’s Services takes over and pays physicians for each procedure. But a special report prepared for the state Senate shows that because of low reimbursement rates the program no longer works as intended. Gov. Gray Davis and his administration should at least agree to increases of 15% to 20% to equal the most pinched managed care rates.

At the same time, the Davis administration should straighten out a payment system that gives an oncologist who spends an hour explaining treatments to the parents of a toddler with cancer the same $18 to $30 accorded the pediatrician who spends 10 minutes on an ear infection.

Another challenge is streamlining the complex enrollment procedures for CCS, which vary county by county. What’s really needed is a unified and simplified application for all three state health programs--Medi-Cal, CCS and Healthy Families.

Before legislators get tangled up in long debates over sweeping health policy changes, they should implement these modest CCS reforms to aid very ill children of the working poor.