- The Washington Times - Sunday, January 29, 2006

RICHMOND — Educator Foney Mullins has noted a shift in rural Washington County: Youths once toned and fit from farm work are sporting middle-aged waistlines in middle school.

Mr. Mullins has spent years promoting health surveys and exercise programs to battle the scourge of burgers and fries. Now the state’s pitching in.

Former Virginia Gov. Mark Warner’s $72 billion budget proposal includes $400,000 dedicated to slimming overweight children in southwestern communities — funds providing everything from guidance on preparing nutritious meals to healthy shopping tips in a region where little people aren’t so little anymore.

“FAMIS-ly Fit” — a play on the name of the state insurance program — would target children receiving “fee-for-service” coverage through Medicaid. The funds would be directed to 115 children.

The program would include things such as education on proper exercise habits, psychological counseling to combat weight-related issues and even rewards for children who stay on a healthy path, said Karen Lawson, policy and research manager with the state Department of Medical Assistance Services.

Health officials are still determining specifics, such as how services would be delivered, which children would be enrolled and in which localities would the program be set up.

Anthem, the state’s largest health insurer, will add $250,000 to the proposed government funding. The program would start in September and, if successful, could spread across the state, officials said.

It’s part of the Healthy Virginians initiative, a year-old Warner effort that has so far focused on things such as encouraging state workers to walk during breaks.

Medicaid officials have been looking to trim costs and have zeroed in on obesity-related illnesses, said Wayne Turnage, a Warner policy director who has surveyed health conditions among Medicaid enrollees.

Virginia’s Medicaid program costs about $5 billion a year, taking up about 16 percent of the state budget. The federal-state program helps pay for health care for needy, disabled and low-income people.

Data led officials to fee-for-service children. In a study last year, Mr. Turnage found that 59,523 showed signs of being overweight. There are 152,624 fee-for-service children statewide.

Fee-for-service enrollees differ from Medicaid patients on managed care plans.

Medicaid pays a managed care plan provider a set fee to cover all of an enrollee’s medical expenses as well as providing perks such as checkup reminders and obesity prevention plans.

But fee for service is a more pay-as-you-go plan, with patients left to figure out for themselves when to visit a doctor. The result: Patients tend to go only for emergencies, skipping checkups that could identify a burgeoning weight problem, Mr. Turnage said.

It hits hardest in rural areas, where fewer patients and a lack of doctors willing to enroll in care plans means most Medicaid enrollees depend on fee-for-service care, Mr. Turnage explained.

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