Five months ago, the state's Blue Cross health insurance companies reached out to thousands of lower-income families to tell them how to get free coverage for their children. Such a shift would save them the $50 per month they were paying for the insurers' low-cost plan -- and would provide superior coverage because the Children's Health Insurance Program includes prescriptions as well as dental, vision and hearing care.

Alyssa Cwanger, Post-Gazette Lisa Rajakovich with three of her four children, Mark, 7, left; Kristina, 4; and Emily, 10, at their home in Swissvale. Rajakovich switched her children to the state's Children's Health Insurance Program after reading a Post-Gazette story in January about CHIP-eligible children in Special Care. Click photo for larger image. More information For more information about CHIP, call the state at 1-800-986-5437 or Highmark at 1-800-543-7105.

But from February through April, more children still enrolled in the Blues' low-cost plan, called Special Care, than switched into the free state plan.

It's an irony that has raised hackles and suspicions among consumer advocates, who cannot conceive why any family would opt for a higher-cost plan with less coverage when CHIP was available.

"No one in their right mind, knowing the facts, would ever choose Special Care, which is costly and gives so little, over CHIP," said Jonathan M. Stein, general counsel for Community Legal Services Inc. in Philadelphia. "We can only assume that the consumers of Highmark and other companies are just not being well informed."

Officials at Highmark Blue Cross Blue Shield maintain that they are doing all they can to educate consumers but say they can't force people to switch.

Highmark spokesman Aaron Billger said a variety of factors could influence the decision, such as parents deciding to keep their children in the Blue Cross program just because it covers the whole family. He also said Highmark was developing a questionnaire to generate data on why Special Care parents hadn't switched their CHIP-eligible children.

Pat Stromberg, the deputy commissioner for the state Insurance Department, agreed that it was still not clear what was motivating parents' choices. She is convening another meeting with the companies on the subject this month.

"We have tried a variety of tactics and will focus on others," Stromberg said. "It is important to really understand a parent's motivation and point of view. Are they lacking information, or are they making informed choices? And if they are choosing another program over CHIP, why is that?"

Highmark and three other Blue Cross plans administer CHIP in Pennsylvania on a contract with the state.

Billger stressed that his company had educated consumers about CHIP for years and expanded the effort in mid-January. Highmark sent a letter and CHIP application with a postage paid envelope to Special Care families informing them about the state program, Billger said.

All new families with children in Special Care now receive a welcome letter that promotes CHIP. The company has followed up on each letter with at least two phone call attempts, Billger said.

The Highmark letter stresses that youngsters can be switched from Special Care to CHIP without any gaps in coverage.

But that message didn't get through to Lisa Rajakovich, 37, of Swissvale, who made several calls to Highmark about CHIP beginning in summer 2003.

When she asked Highmark customer service representatives about CHIP, she was told switching would create a gap in coverage for her children. That answer didn't sound right to Rajakovich, but she got the same response whenever she called Highmark about the situation -- including in last summer when the family switched its coverage from Highmark's CompleteCare program to lower-cost Special Care.

"I was told that they had to be without insurance coverage at the time of application" to CHIP, said Rajakovich. "For fear of not wanting my kids going without coverage, we opted for Special Care."

Special Care and CHIP are meant to help a similar group of Pennsylvanians -- people who make too much money to qualify for Medical Assistance, the state Medicaid program for the poor, but can't afford private insurance.

People eligible for Special Care must earn less than 185 percent of the poverty level, or $35,798 for a family of four. CHIP benefits, which cover children under age 19, are available to families earning slightly more.

Rajakovich finally switched her four children after reading a Post-Gazette article in January about CHIP-eligible children in Special Care. After contacting the Downtown-based Consumer Health Coalition about her situation, she learned from Highmark that her children would be enrolled in CHIP, there would be no gap in coverage and that the family would save about $50 per month in premiums, not to mention other reduced out-of-pocket health care costs.

Rajakovich can attest to the fact that in the past several months Highmark has tried to get people to switch their kids.

"After I did switch them, it seems like a bunch of people were calling me saying, 'We recommend you switch your kids to CHIP,' " she said.

Billger said the company apologized for any repeat calls, but noted that Highmark was taking the problem seriously.

While not commenting on Rajakovich's situation directly, Billger said customer service representatives at Highmark read from scripts that clearly stated there was no gap in coverage for children switching from Blue Cross coverage into CHIP.

Although numbers shared with the Insurance Department about enrollment between February and April did show the number of new CHIP-eligible enrollees in Special Care was greater than the number of youngsters switched out of the programs, Highmark has had great success switching youths out of Special Care during the past month, he said.

"The results of our outreach efforts to families from the beginning of the year through the end of April have resulted in 227 children moving to CHIP and 141 children being referred to Medicaid," Billger said.