Nevada Check-Up is providing an ounce of prevention

"An ounce of prevention is worth a pound of cure." Whoever said that must have had children. As a parent there are few things as scary and daunting as a sick child, unless it is a sick child when you don't have the money to pay for the child's medical care.

The Nevada Check-Up program is designed to help. Established in October of 1998, the State of Nevada began providing health insurance to uninsured children of low-income working families. Nearly 10,000 Nevada children are now enrolled to receive health care benefits either through health maintenance organizations or under fee-for-service. Children are covered through age 18 by this low-cost insurance program. And for every 35 cents Nevada spends, the federal government matches with 65 cents.

Depending on income and family size, premiums range from $40 to $200 per year per family. The coverage includes medical, dental, vision, prescriptions, and more. Preventive services include immunizations and a Healthy Kids screening exam. Benefits include medical and mental health services with no co-payments.

For some families, Nevada Check-Up has made all the difference. But many other families have not discovered this wonderful option. An ongoing challenge for Nevada's Division of Health Care Financing and Policy, which runs the program, is marketing. Most outreach that has occurred so far has been through schools and social service agencies.

Efforts are being made to get the word out about the low cost medical insurance program through youth groups, tribes and businesses.

One advocate who's worried about the outreach of the program is Roger Volker, executive director of Great Basin Primary Care Association in Carson City. He testified in April before members of the Legislative Committee on Health Care about "presumptive eligibility."

Presently the only children who can be covered by the program are those whose families' applications have already been approved. Right now, an uninsured low-income child not covered by Medicaid, with no insurance coverage, would not be presumed eligible for the program. Mr. Volker argues that the Nevada Check-Up program could serve more of its target population if a preliminary determination is allowed to be made that the child is eligible based on a declaration of family income, without supporting documentation, which would be obtained later.

Mr. Volker is also pushing for the program to allow non-governmental workers to conduct eligibility interviews. With the distances of Nevada, and scarce staff resources, school health nurses, hospitals, mental health providers, and other community based organizations that serve these families should be trained to conduct screening interviews in addition to the state's eligibility workers.

At the same meeting, Jon Sasser of Legal Services stated that in March of 2000 there were over 800 pending Check-Up applications. "The chief advantage of adopting presumptive eligibility in Check-Up is that it captures kids when they're sick," said Sasser. It also provides the incentive to sign up at the time when the services are needed, and coverage that lasts for a year before it is renewable.

Roger Volker's group estimates that there are about 345,000 people in Nevada who are uninsured. It estimates that 70,000 would qualify for Nevada Check-Up or Medicaid.

Having uninsured children covered by medical insurance is a win-win proposition. Children's health needs are covered and paid for. Parents

can take their children for medical care on a preventive basis, not just in emergencies. Medical personnel know that they'll be paid for the services being provided. And counties aren't left holding the bill.

Parents won't be choosing between the power bill and the penicillin bill. And most importantly, children will receive the medical care that they need when they need it, not after it's too late.

Let's hope that lawmakers and leaders will expand the Nevada Check-Up program to permit presumptive eligibility, and will continue to provide adequate funding so that the medical needs of all children in Nevada will be met.

Abby Johnson consults on rural community development, grant management and nuclear waste issues. She is married and has one middle school-age child.