WV to Use SCHIP Administrative Funds to Screen Children; A "Central Fill" Pharmacy

WV TO USE SCHIP ADMINISTRATIVE FUNDS TO SCREEN CHILDREN; A “CENTRAL FILL” PHARMACY

Volume 29, Issue 509 February 19, 2008

Matthew Gever

The Mountain State has just launched two programs aimed at improving the health status of poor residents; both would minimize the use of state dollars.

A proposal by West Virginia Governor Joe Manchin would use administrative funds from the state’s SCHIP program to help pay for comprehensive wellness screenings for all uninsured kindergartners. “By encouraging this early connection to a medical home, we can ensure that children are healthy and ready to learn when school begins,” said the Governor in his State of the State address. About 5 percent of West Virginia children do not have health insurance, according to the Department of Health and Human Resources.

Called Kids First, the program will use federal administrative matching funds from the state’s SCHIP program. Normally, administrative funds must be used for functions such as outreach or information technology. But the Centers for Medicare & Medicaid Services (CMS) approved a state plan amendment that will allow West Virginia to use the administrative dollars for screening children who do not have either private or public coverage.

Kids First would broaden the measures used in the school entry exam. In accordance with Medicaid’s Early Periodic Screening, Diagnosis, and Treatment (EPSDT) protocol, kids would have everything from hearing and vision, to risks for obesity and diabetes checked. Children also would be examined by physicians, rather than by school personnel who have varying degrees of training.

“Providing for our children to have good health and healthy habits early is not an expenditure but an investment, and one that offers a great return,” said Senator Ron Stollings, a practicing physican.

The state will spend $160,000 of state/federal SCHIP funds on the program. Additional public dollars will come from Medicaid and the Public Employees Insurance Agency. Also, Mountain State Blue Cross Blue Shield has agreed to contribute $1.5 million over the next five years to help screen uninsured children.

Exam results will for the first time be shared with the child’s parents and regular provider. Children also will receive follow-up screening in the second, fifth and eight grades. “With this program, we hope to identify health problems otherwise overlooked among our youngest West Virginians and help them be better learners from the first day of school,” said Senator Stollings.

Rx for Those in Need

The private sector also figures into the state’s second initiative—West Virginia Rx. This public-private partnership will provide free prescription drugs to uninsured residents whose incomes fall below 200 percent of the federal poverty level.

Launched February 1, the program establishes an almost paperless “central fill” pharmacy. Providers may e-mail their patients’ prescriptions to the central fill pharmacy, which will fill and mail the prescribed medications to patients within a day or two. The state plans to combine $140,000 from its general fund with donations from the Benedum Foundation and Heinz Family Philanthropies to create the system. Drug manufacturers will donate the medications. “It has been estimated that the $100K investment will save about $350 million in future health-care costs,” said Senator Stollings.

WVRx will not make available any controlled substances. Two community health centers will administer the program—Beckley Health Right will process the applications and West Virginia Health Right in Charleston will ship the medications. Patients must fill out an application, provide proof that their income falls below 200 percent FPL and pay a to-be-determined application fee, but no co-pays.

Senator Stollings hopes that the central fill pharmacy will help patients avoid paperwork and get their medications more quickly. “In my office we have a person who spends about one-third of her time helping individual patients get their meds,” he said.

The idea for WVRx came from the 2004 West Virginia Pharmaceutical Availability and Affordability Act (HB 4084). The bill established a database for low-income and uninsured residents to help them connect to public and private drug assistance programs. It also created a pharmaceutical cost management council, which recommended that a central fill pharmacy be created. Implementation of the pharmacy was delayed until this year due to drawn out debates between the parties involved.