New policy allows parents to keep health insurance

Imagine a parent who's plunged so deep into drug addiction or mental illness she's no longer fit to take care of her children. Then take away her health insurance as she tries to recover. This was a common practice in Rhode Island until about three months ago. Rhode Island Public Radio's health care reporter Megan Hall explains how the state did away with a long standing but counter intuitive policy.

On a warm afternoon, Holly Cekala walks through the kitchen of her home in West Warwick, shooing away the lost dog she discovered wondering around the neighborhood this morning.

Cekala's life is good right now, but it wasn't always this way. About five years ago, she was separated from her daughter, addicted to cocaine, and just finishing a prison sentence.

When Cekala lost custody of her daughter, she also lost her health insurance. That's because Rhode Island's RIte care program only offers medical coverage to low income families, not individuals. And without a child, Cekala no longer qualified. Suddenly, she had no way to get the mental health services she needed.

I'm diagnosed with bi-polar and PTSD, some frightful things happened along the way," She says. "I couldn't get any counseling or anything like that. They had me on all sorts of medicine, I couldn't get any of those."

Cekala also couldn't get into a drug treatment program, one of the major requirements for reuniting with her daughter. So instead of entering a residential rehab center, Cekala spent her first week out of prison living on the streets, waiting for one of the scarce "public beds" to open up.

Stephanie Terry is the child welfare director at the Rhode Island Department of Children, Youth, and Families. She says she's seen this happen over and over again to both mothers and fathers.

"Typically what they're expected to do is call every day to see if there's a bed," she says. "It's very discouraging, it's more one thing to do, obviously the person is impaired at that point. It's a lot to expect."

Rhode Island officials have talked about changing the policy of kicking parents off Rite care when they lose custody for more than a decade. In a letter dated September of 1998, an official from the Department of Human Services said he'd support continuing health insurance coverage for women like Cekala. But nothing happened. Deb Florio with the Department of Human Services says money was a major factor.

"I remember having this conversation," she says. "And I think one of the stumbling blocks was, how are we going to figure out how to finance this?"

About two years ago, Rhode Island College's Institute for Addiction Recovery started talking to women who'd lost custody of their children because of drugs or alcohol. Director Sandra Del Sesto says there was an obvious pattern.

"We'd say to them, what was the most difficult part? And then they go back to I lost my health care I wasn't able to get the medications I needed it was so hard for me, I relapsed as a result," she says.

So the Institute formed the Women's Task Force and made changing Rhode Island's Rite Care custody policy its central goal.

"We decided to take this on and then one step at a time do what we needed to do," she says. "First to get the attention of the people we knew who were decision makers and then persist at it."

Something else changed too. Through the state's so called Global Medicaid waiver, Rhode Island gained the ability to spend federal money on a new range of services, including health care for parents who lost custody of their children. Deb Florio with the department of human services says that created a rare opportunity.

"I've been with the state for about 12 years now and things do reappear and there are windows that open and they're not often, but there are times," she says.

On July 1st, the state started allowing parents to keep their health insurance for three months after they lose custody of their children. So far, only about five families are taking advantage of the policy change, but Florio estimates as many as 200 people may eventually qualify.

The program still has its bugs- officials have to manually change each parent's status in the state's computer records. And the Women's Task force thinks three months of health care aren't enough for mothers and fathers in recovery, but the members still celebrated the policy change with a party and a big cake.

But the changes didn't come fast enough for Holly Cekala (sha-ka-la), the woman who lived on the street before she could get into a drug treatment program. It took applying for social security disability benefits to get the drug treatments she needed to reunite with her daughter. Other parents weren't as lucky.

"I knew two women that had the same thing happen to them, but they're both dead, they both overdosed," she says. "Maybe if they did that years ago, she'd be able to find some direction."

Cekala points to the lost dog she took in on this morning The Shepherd/Husky mix looks well cared for, but doesn't have any tags. She worries that if she calls the police the unclaimed dog will get locked up and eventually put down. That's a situation all too similar to her time in prison, struggling with addiction.

"You know what I mean? They fine you, they put you in a bed, in a cell, and if somebody comes to claim ya, you might get a ride out of there," she says.

Cekala says she'll let the dog stay for a little while, offering the kind of compassion she would have wanted for herself.

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