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Utah makes temporary fix to gap in coverage for kids on CHIP

Published November 15, 2010 6:24 am

Health • Swtich to Molina aims to address shortage of pediatric care in Emery, Carbon.
This is an archived article that was published on sltrib.com in 2010, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

For the foreseeable future, kids in Carbon and Emery counties who sign up for the Children's Health Insurance Program will be automatically assigned to Molina Healthcare, instead of Intermountain Healthcare's SelectHealth.

It's a temporary fix ordered by the Utah Health Department after CHIP families in that region complained they no longer have access to pediatric care. SelectHealth, which inherited about 61 percent of the area's 379 CHIP enrollees in July, has no primary-care providers there.

Molina, on the other hand, has a central Utah network of 13 providers, including three pediatricians.

The state's remedy helps only new enrollees. Existing customers are on their own.

"Our network is adequate and we can help," said Paul Muench, president of Molina Healthcare of Utah. "But if they're not our members, we can't contact them directly."

But the health department sent letters to clients, explaining their right to switch plans or petition SelectHealth to pay for an out-of-network provider, said an agency spokeswoman Kolbi Young.

Federal regulators require states to provide CHIP families a choice of more than one network. Historically, about half chose the quasi public agency overseeing health benefits for state employees, the Public Employee Health Plan.

SelectHealth inherited those customers last year after lawmakers passed legislation to privatize CHIP.

"We had 20,000 clients to move. So instead of requiring them to call and select a plan, we decided it would be most efficient to auto-assign them to SelectHealth and send them a letter saying they had 90 days to switch to an alternative, in this case Molina," said Young.

Meanwhile, SelectHealth is wooing rural doctors.

Yvonne Jensen, executive director of two federal health clinics in Helper and East Carbon, wants families to know she has three nurse practitioners and two physician assistants who accept CHIP. Like doctors, they can order tests and fill medications, she said. "We're here to serve everybody, even the uninsured."

Low-income advocates, meanwhile, are urging the state to review its "provider map" for other possible coverage gaps.

"This is probably a temporary problem," said Lincoln Nehring at Voices for Utah Children. "We just didn't do our homework."

kstewart@sltrib.com