Focus Groups Give Healthy Families High Marks, Say Medi-Cal Program Carries Stigma

Most California families whose children are covered by Healthy Families report high levels of satisfaction with the program, according to findings from several focus groups conducted in the state. Most parents with children in Healthy Families said that they did not experience "difficulty" obtaining care for their children; parents, however, reported some problems with administrative "hassles," such as renewing enrollment and experiencing frustration with care providers' administrative staff. The focus group study is the result of a collaboration among HHS' Office of the Assistant Secretary for Planning and Evaluation, Health Systems Research and Lake Snell Perry and Associates, which conducted a series of 52 national focus groups to evaluate policy issues concerning CHIP and Medicaid enrollment and factors affecting low-income children's health coverage. California was one of nine states selected to participate in the focus groups. In August, the research organizations conducted five focus groups in Southern California and four in Northern California. Focus groups consisted of families with children eligible but not enrolled in Medi-Cal or Healthy Families; families with children enrolled in Medi-Cal; Spanish-speaking Hispanic families with children who have special needs and are covered by Healthy Families and California Children Services; families who have incomes above 200% of the federal poverty level and children in Healthy Families; Spanish-speaking Hispanics with children disenrolled from Medi-Cal; families with children disenrolled from Healthy Families; and families with incomes between 200% and 250% of the poverty level who have private insurance. From meetings with those groups, the researchers determined:

• Medi-Cal has a "considerable" amount of stigma, and many beneficiaries said that they received "poor treatment" from providers' administrative staff. Beneficiaries also found the in-person enrollment process "degrading." Families with private insurance said that even if they qualified for Healthy Families, the program's association with Medi-Cal would keep them from applying.
  
• Medi-Cal's managed care option is "unpopular" with "all income and enrollment groups," with many beneficiaries reporting negative experiences with such plans. Participants said their dissatisfaction is related to delays in getting referrals or lack of access to brand-name prescription medications.
  
• Participants favor extending Healthy Families coverage to parents.
  
• Participants preferred outreach materials that included specific information on income limits and premium costs and favored television advertisements that display a toll-free telephone number throughout the ad. Medi-Cal beneficiaries and those disenrolled from Medi-Cal preferred informational material with "bright colors and simple text," but the privately insured group said such material was "offputting."
  
• Spanish-speaking participants expressed concern that Healthy Families and Medi-Cal outreach might "ignor[e]" new and undocumented immigrants. Those participants suggested distributing outreach materials in Spanish and conducting door-to-door campaigns ("State Children's Health Insurance Program Focus Group Study: California Summary," September 2001).