Report Highlights Importance of Calif.’s Social Safety Net for Children’s Health

About 2.3 million California children live in poverty — but that number would go up by 1.28 million if the state’s social safety net programs were not available, according to a report from the Public Policy Institute of California.

Although government assistance is available for so many, wide variations in enrollment from county to county have led to disparities, according to the PPIC report released earlier this year.

With a budget calling for more coverage for children and a special legislative session on health care spending, the state’s safety net for children is getting new attention this summer.

The state last month passed a fiscal year 2015-2016 budget that expands Medi-Cal coverage to undocumented children and increases funding for child care services. Medi-Cal is California’s Medicaid program. In addition, a legislative special session on health care spending called by Gov. Jerry Brown (D) could focus more attention on programs for children in the state.

The Affordable Care Act has made some progress toward expanding enrollment, but researchers say state policymakers must do more to build on those advances.

Safety-Net Program Participation Varies ‘Widely’

More than 50% of California children participate in at least one nutrition assistance or public health insurance program, such as:

  • CalFresh;
  • Medi-Cal;
  • School lunches; and
  • The Women, Infants and Children program.

That rate goes up to 85% among low-income children in the state, according to the PPIC report.

However, despite increased enrollment statewide, participation in safety-net programs “differs widely” among counties. Enrollment rates ranged from 52% to 100% among the state’s 58 counties.

“Despite the importance of safety-net programs, there is evidence of under enrollment in Medi-Cal and CalFresh relative to the size of California’s eligible population,” the PPIC report noted. The report highlighted several reasons why eligible residents might not sign up for safety-net programs, including:

  • The cost of applying for and maintaining eligibility, including taking time off of work, finding child care and other factors;
  • A lack of familiarity with the programs or their benefits; and
  • Public perception of the programs.

The study found that outreach activities “do not seem to affect” enrollment.

Such programs are supervised by the state, but administered by local agencies. Because safety-net programs for low-income California children “serve overlapping populations,” PPIC noted that “integrating administration across them can increase participation, improve the client experience and lower administrative costs.”

How the ACA Is Helping

“The ACA is expanding opportunities to make enrollment in one program a gateway for accessing others,” according to the PPIC report. “This ‘horizontal integration’ — eligibility determination and enrollment across multiple safety-net programs — can increase participation, improve the client experience and lower administrative costs.”

While integration of programs among children already was a priority for the state before the ACA was passed, PPIC found “there is room for improvement in integrating programs and increasing enrollment, particularly among school-aged children.”

Despite state efforts to disseminate data on crossover enrollment, the PPIC report noted that “data on multiple program use are not routinely made available or examined” and “[a]dministrative data also lack information on unenrolled family members who may be eligible.”

The authors of the PPIC report wrote, “To build on the positive momentum brought about by the ACA and to move toward full enrollment across counties, state policymakers can make use of our findings in several ways,” including by:

  • Allocating funding for program administration in a way that keeps pace with changes to the state’s low-income population;
  • Considering boosting resources to counties with low enrollment in low-income children’s programs; and
  • Using ACA funding to invest in information technology to better integrate such programs.

Brief Outlines Strides, Shortfalls in Childhood Health

Meanwhile, a UCLA Center for Health Policy brief released in May outlines gains the state has made in childhood health, as well as shortfalls that stakeholders still need to work on in improving.

Using data from the California Health Interview Survey, researchers examined trends over a decade for several key indicators, including:

  • Children being overweight for their age;
  • Health insurance coverage status;
  • Source of medical care; and
  • School readiness metrics.

They found “improvement in health insurance coverage and access to dental services for low-income children over the 10-year period” from 2003 to 2012, but the “percentage of children who were overweight for their age remained unchanged among those in households with incomes below 200% of the federal poverty level.”

The researchers noted that “[c]losing the income gap in the percent of children who had at least one dental visit in the past 12 months was significant,” but increasing the rates for children in all income groups should be the focus moving forward.

Meanwhile, they noted that “overweight rates among young children are now higher in California than the national average, and the rate of overweight-for-age did not improve” during the research period, with low-income and Latino children more likely to be overweight than others. “Renewed efforts are clearly required to reduce these disparities,” the researchers wrote.

The researchers wrote that the findings “can help guide policy and planning efforts to best meet the health … needs of young children in California.”

According to the brief, “[C]ontinued monitoring of uninsured rates and of disparities within particular communities and income groups will remain important.”

“In addition, tracking demographic trends in usual sources of care among young children will help in state and local planning and policy efforts.”

During a seminar on the policy brief, CHIS Director David Grant said, “Public coverage has replaced private coverage as the most common type among [California] children,” adding, “The state has stepped up to the table … public insurance really saved the day in California.”

However, Grant said that progress on children’s health coverage as a whole — along with rates of being overweight and having usual sources of health care — has remained flat for California kids up to five years old. Grant noted, “We can change things like health insurance rates with policy much more quickly than we can change obesity and eating behaviors and physical activity by either legislation, social messaging or other interventions.”

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