The Kansas Department of Social and Rehabilitation Services today issued a Request for Proposal (RFP) asking private companies to bid to provide health insurance to currently uninsured Kansas children.

The release of the RFP is another step in the creation of HealthWave, the name selected for a health insurance program for Kansas children and adolescents. The program would cover children up to age 19 in families at or below 200 percent of the federal poverty level, or $27,300 for a family of three.

Aimed at providing affordable health insurance to children in low-income working families, it is estimated that up to 60,000 Kansas children will become eligible for HealthWave. The program will become available January 1, 1999, although families may begin making application in November of this year. The insurance program will have a simplified application process, limited to two pages. A toll-free number will be set up by October 1 to provide information to families about the program.

SRS Secretary Rochelle Chronister said the long term savings that will result from HealthWave will be tremendous. She said getting children regular, preventive health care pays off as the children move to adulthood.

"A healthy child is more apt to be successful in school and become a productive member of society," she said.

HealthWave is made possible by a combination of state and federal funds. Under federal legislation, Kansas will receive $31 million a year for five years to provide health insurance coverage for children in families with low incomes. That was matched by $12 million in state funds appropriated by the 1998 Kansas Legislature; the total amount of funding available to the program for uninsured Kansas children is about $43 million.

The RFP includes three parts: physical health insurance coverage (including prescription drugs), dental insurance coverage, and behavioral health insurance coverage (including mental health and substance abuse services). Companies could bid to provide health insurance in all three of the coverage areas or limit their bid to one or two of the coverage areas.

In addition, the RFP divides the state into three regions using SRS management areas, and companies may submit proposals to cover one of more of the three regions. Companies could bid to provide the health insurance in eastern Kansas (the Kansas City, Lawrence, Olathe and Chanute SRS management areas); central, south central and northwest Kansas (the Emporia, Topeka, Manhattan, Salina and Hays SRS management areas); or southwest and south central Kansas (the Hutchinson, Wichita, and Garden City SRS management areas).

Under the RFP, the state will reimburse companies on a per-member, per-month basis.

SRS is hopeful that a managed care entity will bid to provide HealthWave insurance coverage statewide on an HMO capitated basis, meaning the state would pay in advance for the coverage to be provided through a health care network. SRS is also hopeful more than one company will win bids to provide health insurance in all areas, giving families a choice of health plans.

In geographic areas where a contractor will not be providing services under an HMO model, a plan for increasing the availability of such managed care services is expected to be included in the bids.

Under HealthWave, the state would pay the premiums for eligible children up to 150 percent of the federal poverty level. Families who have incomes between 150 and 200 percent of the federal poverty level will pay a small portion of the premium for the coverage, with the state picking up the rest. The family payments for children in families in this income range would be $10-$15 per month.

Benefits included in the health insurance coverage for children will emphasize prevention, including health screenings and immunization. It will also include all medically necessary services. A key provision in the RFP calls for mental health parity, meaning insurers who win the bid to provide mental health services must treat mental health needs the same as physical medical needs. There will be no limit on medically-necessary in-patient or out-patient mental health services.

Companies who win the children's insurance bid must show how they will meet certain performance-based health outcomes. Certain health measures such as providing access to services, effectiveness of care and utilization of services are included in the contract expectations. In addition, specific health status outcomes for children will be monitored such as the incidence of low birth weight, the rate of hospitalization for asthma, and the incidence of vaccine-preventable disease.

A pre-bid conference on the RFP is scheduled for June 26 in Room 481 of the Docking State Office Building, 915 SW Harrison, Topeka, 9 a.m until 12. Bid proposals are due August 3.

Page Last Updated: May 29, 2001