DOVER, N.H. — Bree Messier has found everything she needs for her children through Maine’s health care program.
The Berwick, Maine, resident moved from Somersworth in 2006 and says she remains in Maine for the health care coverage, with all three of her children currently on MaineCare.
Messier has a 13-year-old son, a 10-year-old girl, and a 4-year-old son. Her daughter, she said, is behind cognitively, her son suffers from suicidal ideation, and both have received helpful services through MaineCare.
“The services Maine provides for her are outstanding,” Messier said of her daughter.
A counselor is provided through the school as part of a mental health program, which a child can use whether they are covered by MaineCare or another provider.
MaineCare also has provided Messier with a counselor who comes to her home to work with her son as well as someone who comes to her home to help her daughter if more work is needed in addition to school counseling.
“There is in-home support where you have a clinician that helps you deal and cope with difficult parental things with your children,” Messier said.
Messier is also covered by MaineCare because she fits the guidelines for a family of four. The program covers physical health, dental and mental health.
When she was living in Somersworth, Messier recalls feeling as though she didn’t get much help through the state. Her two older children were covered by Healthy Kids, but Messier was unable to receive coverage unless she was pregnant, and the benefits for her children were not as extensive, she said.
Maine “seems to have a lot more services,” she said.
Each state contracts for different benefits packages, and states have some flexibility in how much funding they put into Medicaid, what they choose to cover and what eligibility they would like to institute, according to Holly Connor, director of Application Assistance at New Hampshire Healthy Kids.
Healthy Kids administers a silver plan and a buy-in plan. The Medicaid program — the Gold Plan — is handled through the Department of Health and Human Services.
Each plan has income-related eligibility requirements based on the federal poverty level. Those on the Silver Plan fall between 186 to 300 percent of the poverty level and those in the buy-in plan fall between 300 and 400 percent of the poverty level. The buy-in is a non-subsidized program in which the family pays the whole premium.
“It’s all about eligibility and whether they meet that eligibility,” said Gail Garceau, president and CEO of Healthy Kids. “Children that are deemed eligible for a specific program go into the program.”
Garceau explained that Healthy Kids provides access to affordable, quality health care and signs children up for coverage. Once they’re signed up, Healthy Kids defers the family to their vendor, Harvard Pilgrim Health Care, for specific questions about benefits.
MaineCare, that state’s Medicaid program, requires a poverty level of up to 200 percent of the federal level, which works out to about $44,000 in annual income for a family of four.
MaineCare covers children up to the age of 18 and adults with children who are eligible for the program.
John Martins, communications director for the Maine Department of Health and Human Services, said Maine’s poverty level requirements are on the high end compared to other states, adding that Gov. Paul LePage is hoping to put Maine’s guidelines more in line with the federal requirements.
“Our program is probably more generous than some others,” Martins said.
MaineCare covers medically necessary services, including for children with intellectual disabilities, in the most appropriate settings, according to Sarah Stewart, acting director of Program Management at the Maine DHHS.
Services in a school setting include physical therapy, occupational therapy, speech therapy, behavioral health services and services known as habilitation services for children with cognitive impairments and functional limitations, which are only available for children who have had a comprehensive assessment, with such services authorized before they are administered.
The recent budgets set for New Hampshire and Maine didn’t make many changes to the health care programs.
Garceau said one thing that has affected Healthy Kids is Gov. John Lynch’s announcement that the state would no longer be contracting with Healthy Kids to administer the Children’s Health Insurance Program, or CHIP, which is the same as the Silver Plan. Those children in the Silver Plan would be transferred to Medicaid Managed Care.
Garceau said those children would still have coverage, but the major difference would be they would no longer have access to the same health care plans with Harvard Pilgrim Health Care and Delta Dental.
“Will there be difficulty accessing the same care?” she asked, adding Medicaid Managed Care will come into effect July 2012, at which time “tens of thousands” of children covered by Healthy Kids will no longer be able to use that program. “We do outreach, education and assistance, renewal and retention. One would hope the state would do its customer service.”
Martins said most proposed cuts to Medicaid were shot down in the Legislature, and overall, MaineCare came out of the budget process “really well.”
Messier said she does have concerns about whether eligibility requirements will change in Maine, as the health care has been a top benefit of her having moved to the state.
“New Hampshire should follow Maine, because the services are great,” she said.
Copyright (c) 2011, Foster’s Daily Democrat, Dover, N.H.
Distributed by McClatchy-Tribune Information Services.