MEDICAID CHILDREN WORRY DOCTORS

Some children aren't welcome at the doctor's office, says Dr. Scott Weiner.

It has nothing to do with picking on little ones who bite dentists' fingers or howl at the sight of a needle. These children are covered by Missouri's fastest growing health insurance, Medicaid. But since physicians lose money on Medicaid patients, many are unwilling to treat them.

"We enroll these folks in Medicaid, and they end up having a card they can't use," said Weiner, a pediatric hospitalist with Southeast Missouri Hospital and St. Francis Medical Center.

Since 1998, when Missouri widened the parameters for those eligible for Medicaid, participation in the program has grown by approximately 23 percent, according to statistics from the Missouri Hospital Association. Participation by children has increased about 20 percent.

Dwight Fine of the Missouri Hospital Association calls this good news.

"There is no reason to have an uninsured child in Missouri, other than the parents don't know what's available," said Fine, senior vice president of governmental relations.

The fastest growth in Medicaid is occurring in Southeast Missouri, and particularly in the Bootheel, he said.

But with increased demand, doctors and dentists who still accept Medicaid are overburdened, while some have closed their practices to Medicaid, Weiner said.

Costs not covered

The lack of acceptance is mostly because physicians' costs for treating Medicaid patients are poorly reimbursed by the state. Currently, Missouri Medicaid pays 55.6 percent of the allowed Medicare reimbursement for Medicaid children. This means that if an examination or procedure costs $1,000 and Medicare reimburses this at 100 percent, Medicaid would only pay a doctor $556.

In many cases, Weiner said, the reimbursements don't cover a doctor's overhead.

Finding a dentist who accepts Medicaid is much harder than getting a physician in Southeast Missouri, said Dr. Jake Lippert, executive director of the Missouri Dental Association. The reason is twofold: Low reimbursement and a declining number of dentists.

The state has attempted to inch dentists' rate of reimbursement up since 1998. Presently, it amounts to about 50 percent of what is billed, Lippert said.

But when overhead costs amount to 65 to 70 percent of billing, the dentist ends up paying at least 15 cents from every dollar billed for serving a Medicaid patient, Lippert said.

Considering that most physician's overhead amounts to 40 to 50 percent of what is billed, dentists bear a larger burden under Medicaid, he said.

Asking for state help

Both doctors and dentists are asking the state to increase their levels of reimbursement.

If $22.5 million were taken from Missouri's general revenue fund to support children's Medicaid, the state would pay all of a doctor's Medicaid expenses, allowing children to get care anywhere, Weiner said.

But in Gov. Bob Holden's proposed budget announced last Tuesday, the idea forwarded by the Missouri Medicaid Reform Coalition was absent.

President pro tem of the Missouri Senate Peter Kinder, R-Cape Girardeau, believes the proposal by the coalition, a network of medical associations and pediatricians across the state, is the right answer.

The group, which includes Weiner, advocates using $22.5 million in state money to draw federal matching funds of $35.5 million. This would allow for 100 percent Medicaid reimbursement of doctors, Weiner said.

The point is not to save doctors money as much as increase children's medical access, he said.

Even though both Cape Girardeau hospitals and the county Public Health Center see Medicaid children, Weiner doesn't think it's good enough.

Trips to emergency rooms involve different doctors on different visits who seldom get to know a child's health history well, Weiner said. It can lead to wrong diagnoses and more expensive care over time, he said.

The county health center already carries a large burden, with two nurse practitioners and a part-time physician handling a caseload of more than 9,000 children last year.

Kinder said he was aware of the load at the health center. His father, the late pediatrician James Kinder, spent the last three and a half years of his life working there.

Kinder said he would do his best to find the money through the legislature to support the reform.

"I have my father's example in my mind every day," he said.