Four years after the first Healthy Kids program sprang up in Santa Clara County, homegrown health insurance programs have spread to almost half the counties in California, covering children who fall through the cracks in state and federal programs.
Healthy Kids programs are either in place or in the works in 27 of the state’s 58 counties.
“If there is the political will to make it happen, county-run programs can be infinitely more effective than state and federal programs,” Robert Sillen said. Sillen is the executive director of Santa Clara Valley Health and Hospital System, which runs the county’s Children’s Health Initiative, a three-pronged effort promoting Medi-Cal, Healthy Families and Healthy Kids.
County governments are finding a need for such programs because many children are not being helped by Medi-Cal or Healthy Families. Estimates of the number of uninsured children in California range from 800,000 to one million. Many such children are eligible for state or federal insurance but are not getting it for one reason or another.
About two of five uninsured children in California (37.4%) went without any medical care for an entire year, according to a report released this fall by the Robert Wood Johnson Foundation. The report also found that 55% of uninsured children in California do not have a usual source of care.
Many uninsured kids are eligible for, but not enrolled in programs that provide low- or no-cost health care coverage. In Los Angeles County, the state’s most populous, more than 235,000 kids have no health coverage and 87% are eligible, according to a study by the University of California-Los Angeles Center for Health Policy Research.
The numbers aren’t as high in other counties, but county health officials up and down the state agree that government-subsidized health programs for kids are underutilized in California.
Although Healthy Kids programs differ county to county — especially in how they are funded — the basic county-run Healthy Kids program operates with a combination of private money and local government support using similar guidelines, including that beneficiaries must:
- Be younger than age 19;
- Be residents of the county;
- Live in a household whose annual household income does not exceed 300% of the federal poverty level, or about $56,000 for a family of four; and
- Not be eligible for health care coverage through Medi-Cal or Healthy Families.
In addition, beneficiaries must pay monthly premiums usually on a sliding scale determined by family income. Premiums range from a few dollars monthly to the mid-$20s per child, and most counties set a maximum limit that any family would have to pay.
Healthy Kids programs go two important steps further than Healthy Families. For one, Healthy Families covers children in households with incomes that do not exceed 250% of the federal poverty level. Families that sign up for Healthy Kids can have incomes up to 300% of the poverty level. That means a family of four can have a monthly income of $4,838 and still qualify for Healthy Kids.
The second, and perhaps most important, difference between Healthy Kids and other programs is that Healthy Kids does not require applicants to prove that they are documented immigrants, a stipulation for coverage through Medi-Cal and Healthy Families.
Healthy Kids programs’ approach means “you know you won’t have ‘La Migra’ looking over your shoulder,” Sillen said.
La Migra is a catch-all Spanish term for U.S. government officials and agencies dealing with immigration issues. It used to specifically refer to the Immigration and Naturalization Services, but in 2003 that agency was absorbed by the newly formed U.S. Citizenship and Immigration Services, which is part of the Department of Homeland Security.
State and federal money used for Medi-Cal and Healthy Families comes with immigration strings attached. Beneficiaries are required to show documentation of legal status in the U.S. to qualify.
Not Healthy Kids.
“Our program is intended for any kid whose family qualifies, regardless of documents or legal status in this country,” Sillen said. “We’re able to do that because we don’t take state or federal money. We don’t have to deal with La Migra.”
Santa Clara health officials estimate that 85% of the families involved in their Healthy Kids program over the past four years have had some cause for concern over issues with “La Migra” and might not have sought health coverage without the “no-strings-attached” Healthy Kids program.
A big part of the Healthy Kids campaigns in most counties is outreach, trying to get low-income families to take advantage of any and all government subsidized health care — not only Healthy Kids, but Medi-Cal and Healthy Families, as well. Just being eligible is not enough. Families actually have to enroll and sometimes pay premiums to get children health care coverage. Getting them signed up is a major task.
“That’s an enormous part of what our program is all about — outreach, marketing, trying to get people to give it a chance,” Sillen said. “We have ads in three languages (Spanish, Vietnamese, English) on radio and buses and other places, and we’re careful not to stress the government connection” to Healthy Kids, Sillen adds.
None of this is free.
Santa Clara’s Children’s Health Initiative, including its often-copied Healthy Kids program, costs roughly $13 million annually and is funded with private grants and county money. Santa Clara County officials say the 103,000 new applications since the program started in 2001 fell about evenly — one-third in Medi-Cal, one-third in Healthy Families and one-third in Healthy Kids.
Some counties — Fresno, Tulare and others — plan to use money from the statewide First Five ballot initiative approved by voters in 1998. First Five funds, from a 50-cent per package tax on tobacco products, can be used only for programs for children ages five and younger.
San Luis Obispo County matched funds from First Five to help provide coverage for older kids, and private groups are donating the balance. The program started last month with $250,000, enough to cover about 400 kids for one year. The county’s goal is to raise $1.2 million to cover 1,000 children by 2008.
In Solano County, supervisors voted to provide as much as $300,000 to match funds donated by local businesses and community members to the Solano Coalition for Better Health’s Children’s Health Initiative. Solano County’s Healthy Kids program, initially aiming to cover 4,000 uninsured children, kicks off Nov. 1.
Two bills approved by the Legislature this fall would have created a statewide Healthy Kids program. Both were vetoed by Gov. Arnold Schwarzenegger (R). Modeled largely on the Santa Clara plan, a bill (AB 772) by Assembly member Wilma Chan (D-Oakland) would have raised the income eligibility guideline for state health insurance programs for children. Monthly premiums for qualifying families were set no higher than $23 per child with a maximum of $69 per family. A second bill (AB 1199) would have created the California Healthy Kids Fund to handle public and private financing.
The two bills put the governor in a difficult situation. Although he has long maintained that all children in California should have health coverage, he said these bills were too expensive. The program would have required about $300 million from California’s general fund next fiscal year and as much as $500 million the year after.
Schwarzenegger might see the same bill on his desk before the next legislative session ends. An identical bill by Sen. Martha Escutia (D-Montebello) awaits on the Senate floor. Escutia, chair of the California Latino Legislative Caucus, and Chan, chair of the Assembly Health Committee, worked in tandem to have a second piece of legislation ready should the first be vetoed.
“We didn’t start from scratch,” Chan said. “We looked at what counties had done — Santa Clara, Los Angeles and others — and went from there.”
“It’s very hard for counties to pull these programs off on their own,” Chan said. “It’s hard to say whether more counties will try. Many current programs have had to reduce what they’re doing because of funding.”
The California HealthCare Foundation offers a market overview to help Californians obtain health insurance.
The California Department of Health Services offers information about Medi-Cal eligibility and coverage.