TexCare Partnership Become a CHIP provider and help children

by Shellie Pruden, DCMS director of medical practice relations

Assistance soon will be available for many of the 218,000 uninsured children in North Texas. The Children's Health Insurance Program will begin accepting eligibility applications April 3. The program builds on the Texas Healthy Kids Corp, implemented in 1997, and the Medicaid program. Together, these three programs will be marketed as TexCare Partnership and will extend child health insurance to low-income families.

Although CHIP may be viewed as the greatest advancement for low-income children's health coverage since the introduction of Medicaid in 1965, this program should not be confused with Medicaid. The families that participate are supporting themselves without state-assisted programs, such as welfare. The program models other commercial plans with insurance premiums with cost-sharing copays and deductibles. Entitlement programs such as Medicaid guarantee benefits to all eligible individuals, regardless of program budgets. CHIP-eligible children (up to age 18, from families whose income falls below 200 percent of the federal poverty level and whose income prevents participation in Medicaid) will receive benefits on a first-come, first-served basis and may be placed on a waiting list if funds are expended.

To promote public awareness, the Community Council of Greater Dallas received a two-year grant of $535,000 from the Health and Human Services Commission for CHIP outreach activities. More than 80 agencies and civic organizations have partnered with the CHIP Outreach Coalition to increase availability of information and provide application assistance to increase enrollment.

CHIP covers physician visits and preventive services such as regular checkups, immunizations, radiology services, prescriptions, hearing and vision tests, and limited dental exams. Hospitalization, surgery, and services for children with disabilities and special healthcare needs will be covered.

Three health plans have contracted with the HHSC to offer services in North Texas. Parkland Community Health Plan's KIDSfirst, Americaid Community Care's AmeriKids, and Cook Children's Health Plan will offer this commercial insurance product. The Parkland and Americaid programs will cover children in Dallas, Collin, Ellis, Hunt, Kaufman, Navarro, and Rockwall counties. In addition, Americaid will offer service in Grayson County. The Cook Children's Health Plan will cover children in Tarrant, Denton, Hood, Johnson, Parker, and Wise counties. These plans are negotiating contracts to complete their panel of providers before enrollment begins.

As with any new program, guidelines will be introduced to physician offices. To prepare for implementation, TMA will conduct seminars to familiarize physicians and their staffs on CHIP eligibility and enrollment, health plan benefits, continuity of care, outreach, reimbursement, and coordination among CHIP, Medicaid, and Texas Healthy Kids Corp. The Dallas seminar will be April 20. For more information contact TMA's Practice Management Department at 800-880-1300, ext. 1411.

Families interested in purchasing this insurance can call 800-647-6558 to request an application. Applications will be distributed in April for a May 1 effective date. To be listed in the first printing of directories, physicians must have completed contract negotiations and applications by mid-March. To become a CHIP provider in the Dallas area, contact Randy Jones with KIDSfirst at 214-590-0979 or Donna Wright with AmeriKids at 214-678-5503. All specialties are needed.