Simplify Health Programs for Poor, Study Says

Nearly 40% of the low-income children enrolled in the state’s publicly funded health insurance programs drop off the rolls within a year of joining, but such attrition is avoidable, says a new report by health policy experts released Wednesday.

The renewal process should be simplified for both the Medi-Cal and Healthy Families programs, and premium payments for Healthy Families should be flexible if households have financial emergencies, the report urges.

It was prepared by the 100% Campaign, a consortium of child health care advocacy groups that hopes to get coverage for all eligible youngsters.

Such “common sense and cost-effective” reforms can help reduce the number of children who fall through the cracks of the system and wind up with no insurance coverage, the study says. “Stable coverage means children get needed care and are healthier. Conversely, the revolving door in and out of insurance wastes taxpayer dollars,” a report summary says.

Mindful of the state’s current budget problems, the report says it costs the state an extra $72 each time a child is mistakenly dropped from Medi-Cal and reenrolls within six months of the initial enrollment.

Even with such churning, more than 3 million children are in the free Medi-Cal program for the poorest families and nearly 600,000 are in Healthy Families, a low-premium insurance plan for those whose incomes are somewhat higher but still are unable to afford private insurance.

Premiums for Healthy Families range from $4 to $9 a month per child, with a family cap of $27. The 100% Campaign group urges more leniency in payments and lower premiums for families who can’t afford those rates.

And for both programs, it suggests that annual renewals be handled mainly by telephone instead of the paperwork now required; if there are changes in eligibility, those should be handled with easy postcard notification, the group recommends.

Russ Lopez, spokesman for Gov. Gray Davis, said the Healthy Families program has implemented several of the campaign’s suggestions, including simplifying some of the application and renewal forms, since research for the report began in June 2002.

Premium statements are now sent monthly in five languages -- English, Spanish, Chinese, Korean and Vietnamese. Phone calls, in addition to mailers, are made in those languages to remind people to fill out annual eligibility forms.

Not all of the group’s suggestions have been implemented, but none have been ruled out.

“We welcome the engagement of the group,” said Leslie Cummings, executive director of the Managed Risk Medical Insurance Board, which administers Healthy Families. “The issue is there [are] a number of families who want to retain enrollment in the program, but haven’t.”

Jamila Zatar, 29, of Anaheim discovered that her 7-year-old son no longer had Healthy Families coverage six months ago when she rushed him to the emergency room after he hit his head on the bathroom sink and suffered cuts.

She was told later that his coverage had been canceled for more than two months; it turned out that the child was mistakenly listed in a computer system as being enrolled in a Medi-Cal account even though he wasn’t.

“I never applied for Medi-Cal for him,” said Zatar, a certified application assistant who works for an Orange County agency that helps people enroll in Healthy Families or Medi-Cal.