I was pleased to read your plea for improved Medicaid dental coverage for adults (“Dental coverage needs more teeth,” Editorial, May 29). You detailed the need well, and I hope your words provoke an appropriate response. I wonder if your readers also have any idea of the extensiveness of another serious shortfall in the state’s Medicaid program and the potential it has for continuing harm to the future of this state. This problem is the unconscionably low Medicaid reimbursement for pediatric services in Illinois, a state in which children account for 55 percent of the enrollees of the Medicaid program, yet receive only 18 percent of the expenditures from that program. Medicaid is a safety net for our children, the largest single insurer of children, paying for nearly 30 percent of all our patient visits and for more that 40 percent of all births.
Averages, however, only tell part of the story. At major medical centers, Medicaid may be the insurer for 50 percent or more of patient visits. That happens because we, too, are a safety net for children. In Illinois physicians in private practice often cannot afford to provide care for large numbers of these children because reimbursement for care is among the worst in the nation.
In Illinois Medicaid always reimburses less than Medicare, often less than one-third of what Medicare pays for comparable services to the elderly. It pays less than both the U.S. average and the regional average for many of the services required to preserve the health of children or restore them to health when they are ill. A new patient visit for preventivehealth care will be reimbursed a little more than $30 through Medicaid, while a comparable visit for an adult in the Medicare program will be reimbursed over $100. Similarly a sick child with a serious problem will have a visit reimbursed at $50 by Medicaid compared with $99 for an adult in the Medicare program, and almost $130 in some Blue Cross/Blue Shield plans.
Children are seriously discriminated against in state-insured health care, despite the fact that in the standard Medicaid program, 50 percent of the funds come from the federal government, and in the more recently enacted Title XXI portion of the program, 65 percent of the dollars are federal. Even worse, the discrimination seems likely to continue. Witness the fact that the Illinois budget is projecting almost $700 million in tobacco settlement money over the next two years, with very little of that money dedicated to health services for children, and not a single pediatrician among the 14-member task force proposed to address how money from this settlement should be allocated.
Illinois’ children, who make upless than a third of our population, are destined to be 100 percent of our future. They deserve the best of health care, delivered in a cost-effective way. They deserve preventive medicine in a pediatrician’s or other primary-care physician’s office. They deserve prompt treatment of their illnesses in that same setting, with the frightening and very expensive emergency rooms reserved truly for emergencies.
When we look to getting adults to the dentist, let’s also make sure that all of Illinois’ children have financial access to the health care they need and deserve.
