A First Step to Providing Health Care for All Kids

On Wednesday morning, hundreds of thousands of California’s children will wake up with something many of them have never had before: access to health insurance, thanks to Healthy Families, California’s new children’s health insurance plan.

California’s effort to provide health insurance to more uninsured children was made possible last year when Congress passed and President Clinton signed the state Children’s Health Insurance Program, the largest expansion of children’s health coverage since the adoption of Medicaid in 1965. CHIP is a $4-billion-a-year national initiative for states to provide health insurance for uninsured children in low-wage working families. California is using the new CHIP funds to make insurance available to more than 400,000 children. It’s a good start with the potential to help California achieve the goal of providing health insurance for all children.

Healthy Families offers health coverage to children 18 and under whose family incomes are too high to qualify for Medi-Cal, but lower than $27,300 a year for a family of three, which is twice the federal poverty level. The state has already committed $21 million a year for the recruitment and enrollment of eligible children. Now the hard work of making sure that every child is enrolled begins.

Difficult challenges lie ahead. Healthy Families’ success requires getting the word out to the families of more than 1 million uninsured children--11% of all children in the state--who are eligible for Healthy Families or Medi-Cal but are not enrolled.

It is especially vital to reach out to the vast number of eligible children in Southern California and in particular to the Latino children who represent most of those eligible for both Medi-Cal and Healthy Families. Success will require the hard and innovative work of community-based organizations, employers, faith-based organizations, schools and health agencies.

Even if these efforts are successful, there are obstacles to overcome:

* Applying for Healthy Families needs to be simpler. Unlike Connecticut, where the application packet and instructions are less than six pages, California’s Healthy Families application is 28 pages long.

* Medi-Cal’s quarterly registration process is a real burden. Children should be covered for a full year before families need to file more paperwork. Children in Healthy Families will receive a year of coverage; lower income children in Medi-Cal need the same sustained coverage. There also needs to be continuity and cohesion between the two programs so that children’s coverage will not be interrupted.

* The program needs to be made more affordable. Healthy Families requires that families contribute a monthly premium and copayment for each doctor visit and prescription. A recent Children’s Defense Fund report found California’s program charges some of the highest premiums in the nation.

* Affordable health insurance needs to be made available to all uninsured children. More than one-third of California’s currently uninsured children are ineligible for Medi-Cal or Healthy Families. One way to meet this goal is to expand the program to cover children whose families earn up to three times the poverty level, or $40,950 for a family of three, while requiring parents to pay what they can. Additional federal funds are available to extend coverage to these children. Another way is to provide incentives for employers and health insurance plans to ensure that all children obtain the coverage.

Our goal should be to become the first state to provide 100% of its uninsured children with the health coverage they need and deserve.