Health-care Model: Little Rock Insures For Drug Treatment

By Jonathan Weisman — September 11, 1991 6 min read

When the 26,000 students in the Little Rock, Ark., public schools began classes this month, they became the first students in the nation to be automatically covered by a free district insurance policy for the often unmanageable costs of drug- and alcohol-abuse treatment.

The unique program, coordinated by city officials, the Little Rock school district, and Blue Cross and Blue Shield of Arkansas, may have wide-ranging implications, not only for substance-abuse programs but for national efforts to pull uninsured children under the health-care umbrella.

“If you look at what’s going on nationally, everyone is looking at revamping health insurance,’' said Gil Buchanan, a former Arkansas chapter president of the American Academy of Pediatrics. “This is a good way to take a particular problem and address it comprehensively through the schools.”

Nationwide, nearly one-fifth of all children are uninsured, and one-third of the more than 30 million uninsured Americans are children, child advocates say. Under the plan, Blue Cross and Blue Shield of Arkansas issued a single plan covering all children in grades K-12 at a cost of $10 per student. Rather than charge the students, the organizers will raise the $267,000 for the premiums through private donations, according to Jo Evelyn Elston, director of pupil services for the district.

Blue Cross and Blue Shield have waived all administrative fees, and the city’s treatment providers have pledged to work at or below cost to thwart escalating medical costs.

“It is truly a community-based effort,” Ms. Elston said.

Students will be referred through school nurses or clinicians. Parents must consent to treatment, and participation is voluntary.

One previously uninsured student has already enrolled in substance-abuse treatment, school officials say.

Four Levels of Cure

The policy, which pays 100 percent of all treatment costs, is broken out into four levels of care targeting the gamut of drug problems, from experimentation to addiction.

The initial level consists of education and counseling services. Students are eligible for two counseling sessions a week for up to four weeks, one hour-long private session with a counselor, and up to three two-hour group therapy sessions.

The highest level of care covers 24-hour supervised treatment for up to 90 days; three-hour group-therapy sessions throe times a week or one weekly individual session for up to six months; three one-hour private sessions for family members; periodic drug screening; and throe days of inpatient drug detoxification.

The total cost of such intensive care could reach $30,000, Ms. Elston said, and the city has no public substance-abuse treatment programs for uninsured and indigent minors.

Even students who already are covered by health insurance will benefit from the program, school officials say. Most health policies cover, at most, half of the costs of rehabilitation. For insured students, the school-district policy will cover whatever the primary insurance does not.

The program, called “Fighting Back! Insure The Children,” is part of a national “Fighting Back” effort launched last year by the New Jersey-based Robert Wood Johnson Foundation to develop and fund community-based substance-abuse-prevention programs. Of the 15 community projects funded, the effort in Little Rock has received perhaps the most attention.

“It gets to the heart of our nation’s two-tiered system” of drug rehabilitation, said Gregory Dixon, Fighting Back’s deputy national program director.

“For underprivileged young people, once they start getting into trouble with drugs and alcohol, the next place you’re apt to see them is in the back of a squad car,” he said. “But if they come from well-to-do families, the youngsters can get help virtually immediately.”

Health-Insurance Model

The Little Rock effort has been lauded as one of the few to provide health insurance for students.

Later this fall, the Elaine and Eudora districts in Arkansas will begin a program to provide free, limited health insurance to all students in grades K-12 who have not been covered by Medicaid or private insurance for at least six months, according to Charles Nickerson, the program’s director.

The project, funded by a $l-million, one-year grant from the U.S. Department of Housing and Urban Development, is expected to cover up to 450 of the 1,700 students in the districts.

Volusia County, Fla., which includes Daytona Beach, also began a pilot program this month with $2.2 million in state funds channeled through the quasi-public Healthy Kids Corporation.

Under the plan, students who qualify for the federal free-lunch program receive free comprehensive health coverage through a health-maintenance organization. Students eligible for reduced-price lunches pay 28 percent of the premium, and all other children may purchase coverage at a group rate of $60 per child per month, Ms. Kilgore said. A comparable policy at an individual rate would cost $100 per child per month, she said.

So far, the parents of about 5,800 children have signed on for free or subsidized policies, she said, and another 9,000 have bought coverage at the group rate.

Spreading the News

The Florida program also was developed with the help of a two-year planning grant from the Robert Wood Johnson Foundation. (See Education Week, Oct. 17, 1990.) Now the nation’s largest health-care philanthropy is seeking to spread the Little Rock and Volusia models throughout the country.

In 1990, more than 300 communities competed for a total of $27 million in grant monies allocated through Fighting Back, and to do se, they all had to form broad-based community consortia, according to Amy Mone, a foundation spokesman.

The foundation is now going back to the consortia to try to peddle the winning models, Ms. Mone said, and Little Rock’s effort is receiving top billing. This June, at a workshop for the 15 grant winners, foundation officials pushed the Little Rock plan. Officials in Santa Barbara, Calif., already have begun negotiating with their local Blue Cross and Blue Shield agency to develop their own version.

In addition, the Institute for Child Health Policy has seized on the Little Rock and Volusia County schemes as market-driven answers to the problem of uninsured or underinsured children. Institute officials say they will try to sell the efforts as politically palatable models for replication.

But Dr. Buchanan, now chairman of the pediatric group’s annual forum committee, warned that school-based insurance should be seen not as a solution, but as a stopgap measure until a more comprehensive national insurance plan can be implemented.

“Obviously, schools are where the kids are, and it makes sense to go through them,” he said. “But if you had comprehensive third-party coverage, you wouldn’t have to find 16 different ways to cover them.”

“The problem here is trying to do an educational and social revolution in the same arena,” he added. “And that’s going to be tough.”

The A.A.P. will look specifically at the interface between education and medicine at its national forum in Chicago on Sept. 20, he said.

Mr. Dixon also cautioned that there are several unanswered questions that will have to be dealt with this year in Little Rock. For example, he said, the awareness campaign now under way and targeted at parents, educators, and administrators may not be enough to ensure proper care referrals. Also, the program could be abused by students using the coverage for psychological problems not related to substance abuse.

There is also a fear that the community’s financial largesse could dry up, and Ms. Elston of Little Rock pupil services stud there are no moves underway to place the program under more steady public sponsorship.

Indeed, this summer the district raised only $68,728, nearly missing last month’s deadline for the first of two $133,500 payments. Only an $80,000 interest-free loan from a local bank kept the effort from ending before it began.

School officials blamed the summer break for fundraising problems, and said they were confident that local P.T.A.'S would easily raise the premiums during the school year.

A version of this article appeared in the September 11, 1991 edition of Education Week as Health-care Model: Little Rock Insures For Drug Treatment