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Published January 12, 2011, 07:51 PM

ND Advocates Want Broadened Child Insurance Access

Supporters of broadening access to North Dakota's subsidized health insurance for children said Wednesday that its coverage standards are among the nation's most difficult and could afford to be loosened.

By: Dale Wetzel, Associated Press

BISMARCK, N.D. (AP) — Supporters of broadening access to North Dakota's subsidized health insurance for children said Wednesday that its coverage standards are among the nation's most difficult and could afford to be loosened.

"I come from an oil county, and there's lots of money out there. I think we can afford to spend, and share, just a little bit of that wealth insuring a few more children," said Bryan Quigley, social services director in Mountrail County, one of the state's leading oil producers.

Budget analysts say oil production is a major contributor to North Dakota's budget surplus, a rarity among state governments that is expected to reach $1 billion by June.

A group of the Legislature's minority Democrats has introduced legislation to raise the income threshold to qualify for the Children's Health Insurance Program from $35,280 for a family of four to $55,125.

The change would increase the income limit from 160 percent to 250 percent of the federal poverty guidelines. The U.S. Department of Health and Human Services, which publishes the guidelines, plans to update them in late January.

The North Dakota Senate's Human Services Committee held a hearing on the legislation Wednesday. The committee will later recommend whether the full Senate should approve or defeat the measure.

North Dakota's insurance program is called Healthy Steps. It subtracts a number of expenses from a family's gross income before determining whether the family qualifies for coverage, including taxes, child care expenses, any family child-support payments and the parents' costs for their own health insurance.

Maggie Anderson, the medical services director for North Dakota's Department of Human Services, presented an example showing that if the income maximum were lifted to 250 percent of the federal poverty guidelines, a family of four with $7,300 in monthly gross income — or $87,600 a year — could enroll their two children in Healthy Steps.

Anderson said her example included $2,760 in allowable monthly deductions, including taxes, job training allowances, child care expenses, $400 in monthly child support payments by the father, and the mother and father's own health insurance bills.

Previously, North Dakota lawmakers have been dubious about raising the income limit because of examples about how relatively high earners could qualify for taxpayer-financed health insurance for their children.

The Healthy Steps plan covers hospital and clinic visits, prescription drugs, mental health counseling, substance abuse treatment, dental and vision checkups and immunizations. No payment for the coverage is required, although many participants must make co-payments for some services, including $2 for a drug prescription and $5 for an emergency room visit.

Two years ago, then-Gov. John Hoeven, a Republican, was rebuffed by the GOP-controlled Legislature when he asked the income limit to be raised to 200 percent of the federal poverty guidelines.

Sen. Tim Mathern, D-Fargo, the primary sponsor of legislation to raise the threshold to 250 percent, said the change would cost relatively little and provide future medical cost savings by making treatment more easily available to young people.

"I believe it's morally correct to assure all children have health care coverage," Mathern said. "I believe it's fiscally prudent to use this Healthy Steps program to accomplish that."

The Department of Human Services estimates the change will raise state spending by $1.75 million during the 2011-2013 budget period. The sum will rise to $3.15 million in the following two years, the agency said.

About 3,700 children were covered by the program in November, and the higher income threshold would bring in another 1,320 children, the agency estimates. Its cost analysis assumes children who are added to the rolls gradually from 2011 to 2013 will remain enrolled in the following two years.

Paul Ronningen, North Dakota coordinator for the Children's Defense Fund, said South Dakota and Wyoming set their income limits at 200 percent of poverty for the program. In Montana, it is 250 percent. The national average is 245 percent, Ronningen said.

At 160 percent of poverty, "North Dakota has the lowest eligibility in the nation," Ronningen said.

Anderson said the state would have to ask the federal government to increase North Dakota's allocation of childrens' health insurance funds if the state's coverage threshold is raised. An increase in the state's federal allotment would not be automatically granted, she said.

The Department of Human Services now has $21.6 million, including $5.6 million in state funds, set aside for Healthy Steps during the 2009-2011 budget period, which ends June 30. Gov. Jack Dalrymple has recommended that the Legislature increase that amount to $28 million, including $8.7 million in state funds, during the 2011-2013 period.