At a time when its services may be more needed than ever, the state Managed Risk Medical Insurance Board is considering halting enrollment in Healthy Families, California’s version of the State Children’s Health Insurance Program.
Healthy Families is the largest SCHIP in the country with enrollment greater than the second- and third-largest state programs combined.
The Managed Risk Medical Insurance Board, which administers the program designed to make sure children of low-income families have health coverage, said something will have to give because of the state’s budget shortage. Rather than reduce services or drop currently covered children, MRMIB is considering freezing enrollment at current levels.
It would be the first time in the program’s 10-year history that enrollment has ceased. The move would come in the midst of what many economists say is the worst financial downturn this country has faced since the Great Depression.
“This is exactly the wrong time to be thinking of something like this,” said Ted Lempert, president of Children Now, a national advocacy organization based in California. “If anything, we should be thinking about ways to expand these kinds of programs in hard financial times. That’s when people need the help.”
In a memo to MRMIB’s board of directors two weeks ago, executive director Lesley Cummings said “the only tool in the board’s control to manage costs in the current year is to limit enrollment.” She also said “the number of children to be waitlisted is significant.”
Lempert called it “a very dangerous announcement” and other children’s advocates echoed the sentiment.
“After all the years of making strides forward on children’s health insurance, it would be just devastating to be going backwards. Funding for children’s health insurance, which is relatively inexpensive and more than pays for itself by keeping kids healthy and out of the emergency rooms, should not be one of the things on the chopping block,” Lempert said.
Numbers Expected To Increase
Healthy Families provides health, dental and vision coverage to more than 900,000 kids, a milestone reached last month. For the past several months, the program has been enrolling more than 27,000 new beneficiaries each month. If enrollment in the program is frozen, it means as many as 162,750 kids would be denied coverage over the next six months, Cummings told board members.
“The part that’s chilling about this is that this is exactly the time when families are going to be struggling to just stay afloat and when they most need to know that their kids will have health coverage,” said Wendy Lazarus, founder and co-president of the Children’s Partnership, a national advocacy group with offices in California and Washington, D.C.
“It’s clear from the numbers of new enrollments every month that there’s a need and the need is only going to grow with the kind of economic climate we’re facing,” Lazarus said.
The Children’s Partnership and Children Now, along with the Children’s Defense Fund, are part of the statewide 100% Campaign working to provide health coverage for every child in California.
The 100% Campaign argued against the enrollment freeze last week at a public meeting of the MRMIB board.Â The board invited public comment at its meeting this month and plans to make a decision at its Dec. 17 meeting.
MRMIB staff predicts a $17.2-million deficit for healthy Families if the board takes no action.
“If the board does not cap enrollment, it would have to take other, more drastic actions later,” Cummings wrote. “Capping enrollment, rather than eliminating coverage that a child currently has, seems the preferable path.”
Healthy Families is open to children from families whose incomes exceed Medi-Cal eligibility guidelines but still do not exceed 250% of the federal poverty level.
Help May Be on Its Way
Children’s health advocates urge the board to postpone decisions until a much-anticipated federal stimulus package takes shape. Congress is considering several options to help the ailing economy, including new money for Medi-Cal and SCHIP.
“There is a very good likelihood California will be getting as much as $2 billion in the stimulus package,” Lazarus said. “And that could happen as soon as December but probably not until after (President-elect Barack) Obama takes office. We’re urging the board not to make any drastic decisions until we see what comes from Washington. Compare the $17.2 million MRMIB says it needs to that $2 billion before we do anything we’ll all regret,” Lazarus said.
The California Legislature also has yet to weigh in on the issue. Lawmakers are in special session to deal with the state’s growing budget gap and could authorize more money for Healthy Families.
Help might come from other fronts as well. The California Endowment, a private health foundation that provides grants to community-based organizations, announced a new round of grants last week totaling $7.75 million to 20 Children’s Health Initiatives in 23 counties. One of the goals for the grants was to provide help in enrolling newcomers in the Healthy Families program.
Robert Phillips, senior program officer for California Endowment, urged MRMIB to consider alternatives to an enrollment freeze.
“I think Healthy Families considering closing its doors at a time like this is a little shortsighted,” Phillips said. “This is actually the time to be a little more creative, a little more daring. It feels like they’re erring on the side of caution rather than actually trying to engage the problem and try to solve it.”
Phillips said it’s a question of setting and keeping sight of goals.
“It’s ultimately a question of what the policy goals are,” Phillips said. “MRMIB has to ask itself, at the end of the day, ‘What is our ultimate goal?’Â If it’s to provide coverage for as many kids as possible, this is not the right way to move toward that goal,” Phillips said.