Healthier kids, less red tape

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Scenic Rivers Health Services is a commendable example of how far the nation’s health care safety net stretches.

Along with the nation’s 1,300 other nonprofit “community health centers,” the Cook, Minn.-based medical provider is delivering care to places often left unserved by big brand-name health systems.

Scenic Rivers’ coverage area spans roughly 8,500 square miles in the state’s far north. Primary care clinics are located in Cook, Tower, Floodwood, Northome, Big Falls, Big Fork and Eveleth. Of the more than 14,000 patients served annually, 14% are uninsured and 29% are enrolled in medical assistance.

Extreme weather, remote locations and patients struggling to make ends meet are among the challenges Scenic Rivers faces. But in January, a smart, pioneering new statewide health reform gave it a boost by reducing red tape for its staff and, more importantly, helping ensure that its very youngest and neediest patients get regular checkups and other care so critical for their future.

That’s a double health care win, one deserving both a spotlight and applause.

The new policy, which was signed into law by Gov. Tim Walz in 2023 and just took effect this year, regrettably doesn’t have a catchy name. The best shorthand I’ve come up with is descriptive: continuous enrollment in the state’s Medical Assistance (MA) program for eligible kids age 0-6.

Wonkish, yes, but bear with me because this is a big step forward for children’s health. It accomplishes this by protecting kids from the downstream consequences of a longstanding problem: the so-called “churn” of enrollees in and out of the MA program.

Income and household size are key criteria for MA eligibility. MA parents’ income, for example, tops out at 133% of the federal poverty guidelines. That translates to $2,265 a month or $27,185 annually for a household of two, such as a single mother. Note: There are different income thresholds for children or those with disabilities.

Many MA enrollees become eligible for the program because they struggle to find or hold onto a steady, good-paying job. Among the reasons: poor health, mental illness, housing instability, lack of transportation or day care, with the last two especially challenging in remote rural areas like those Scenic Rivers serves.

Efforts to find employment, such as seasonal jobs, or a run of overtime, can create another problem: temporarily elevating pay above MA income eligibility, causing a loss of coverage.

What the new state program does is ensure that young children’s coverage continues during key developmental years across the state even if their parents or caregivers are cycling in and out of MA.

“All children under age 6 who qualify for Medical Assistance will have up to 72 months of uninterrupted coverage,” the Minnesota Department of Human Services (DHS) announced at the year’s end. ”The new law makes it easier for kids to stay covered.”

About 600,000 children are expected to benefit from the change, DHS said.

DHS Assistant Commissioner John Connolly said the change puts Minnesota in the national “vanguard.” It is one of five states that received federal approval late last year to implement continuous enrollment for eligible kids 0-6. The other four states are New York, Colorado, Hawaii and Pennsylvania.

Minnesota’s cost for this coverage-during-tender-years policy is estimated at $24.6 million for the current biennium and $83.5 million for the 2026-2027 biennium.

What Minnesota gets for this investment, Connolly noted, is regular care during a critical time. Vaccinations, well-child checkups and developmental screenings provide the foundation for education and career success. Care for routine illnesses is vital as well. Timely treatment of ear infections, for example, can prevent hearing loss.

Uninterrupted coverage is also a pragmatic step to address the state’s stubborn pediatric health-outcome disparities affecting minority children.

Coverage lapses can prevent parents from bringing kids into a clinic, a reality that the new policy takes a dramatic step to fix. “Black and Hispanic children [are] more likely to experience gaps in health care coverage. Data shows these groups are at greater risk of losing their health insurance because of paperwork and administrative barriers,” the DHS statement said.

The Minnesota Medical Association understandably backed this move. “The Minnesota Medical Association and the rest of Minnesota’s physician community support this law in the ongoing effort to close enrollment gaps and ensure Minnesota’s children are covered. The state’s Medical Assistance (MA) program is critical to ensure that all Minnesotans have access to healthcare coverage,” the organization said in a statement.

The new policy has a common-sense provision. If the parent obtains private coverage covering children, that plan becomes the primary insurer for the child’s medical claims, though MA would provide wraparound coverage.

Walz also weighed in, citing the continuous coverage as progress toward making Minnesota a family-friendly state.

“We’ve set a goal of making Minnesota the best state for kids to grow up, and health care is a critical piece of that,” Walz said this week, noting it was a top priority in the last budget.

Amber Jola, Scenic Rivers’ director of clinical operations, noted another benefit. The continuous coverage reduces paperwork and the administrative burden on staff, who often play a critical role in helping families navigate MA eligibility. That’s a welcome change, especially during a pressing workforce shortage.

Less red tape. Healthier kids. Even in an age of deep political divisions, there ought to be agreement about the value of an innovative state reform that accomplishes both.