Reegan Karice Oxendine was a toddler when she died in September 2013 from undiagnosed Type 1 diabetes.
She became noticeably sick beginning at 14 months of age, and her parents took her to the doctor numerous times. Reegan was given the diagnosis of acid reflux disease. When a prescription to treat the reflux didn’t work and her distress worsened, she was taken to the emergency room, where her blood glucose levels were checked. The test came back with a reading of 1,100 mg/dL, and she was airlifted to the Children’s Hospital at UNC in Chapel Hill. An A1C test showed that her blood sugar had been elevated to near fatal levels for three months. She died two months later.
North Carolina legislators introduced identical bills in the state’s House (HB 20, January 28, 2015) and Senate (SB 27, February 3, 2015) to require medical practitioners who provide well-child care to ensure that diabetes screening is performed upon each child at birth, and then at ages one and two. The measure has the vigorous support of the Test One Drop advocacy group and a Facebook page launched by Oxendine family friends and relatives.
A fasting blood glucose sugar test and hemoglobin A1C test can be had at a laboratory service in the mid-Atlantic region for about sixty dollars. Why, then, should it take a legislative act to mandate a simple on-the-spot test that could save a child’s life?
The answer is as complicated as the health insurance marketplace in the United States. State legislators and insurance commissioners have the power to determine what must be covered under a policy issued by a health insurance carrier in the state. This was a powerful apparatus for public health policy makers back in the days when health insurers were competing for business. Now the tables have turned and state officials are having trouble keeping health insurers in the state.
Medicaid, the federal program that pays for benefits for uninsured and low-income children, doesn’t always cover infant and child diabetes screening, however. A state must opt in to add that specific benefit to its Medicaid reimbursement program. Obamacare established tiers of optional Medicaid coverage for states, but the states must put up matching funds to opt for specific tiers of coverage. An optional “Medicaid Expansion” plan supported by the American Academy of Pediatrics includes diagnostic, screening, and preventive care procedures not covered under the basic mandatory benefits portion of the Medicaid program. North Carolina is one of 18 states not participating in the Medicare Expansion Plan.
Insulin Nation contacted state senator Jane Smith, a co-sponsor for the bill, for a phone interview. She said the Senate version of Reegan’s Rule bill has progressed to the state legislature’s Committee on Rules and Operations, where it has been determined that the measure would have no effect on North Carolina’s Medicaid budget. In the House, the identical version of the bill is in the Committee on Health, and would next go to the Appropriations Committee.
Along the way, medical practitioners in North Carolina have suggested that the screening occur at one month’s age, rather than at birth, to reduce the possibility of inaccurate initial readings. Smith says lawmakers also might be amenable to an amendment to relieve well-child practitioners of the obligation to perform follow-up one-year and two-year tests if parents don’t reply to reminders or can’t be located. She believes a legislative fix to this problem can, and must, be passed.
“We’re not talking about a lot of money. A test strip costs a dollar or less,” she says. “We just don’t want what happened to that little child to ever happen again.”
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