State Offers Health Coverage for Needy Children

They have no family physician, so the children are rushed to hospital emergency rooms and walk-in clinics with fevers climbing, ear infections raging, stomachs aching.

Their parents earn too much money to sign the children up for Medi-Cal. Still, the parents’ jobs--as food servers, custodians, retail clerks, temp workers--pay too little for them to afford private health insurance.

Consequently, their kids go without regular medical care, dental checkups or eye exams. The parents’ paychecks barely stretch to cover food and shelter; preventive and well-child health care is a luxury.

But come July 1, these children--numbering perhaps 30,000 in Orange County--could qualify for that kind of health care under a state program called Healthy Families.

Designed for children of the “working poor,” the $500-million undertaking sets up an insurance program in which parents pay monthly premiums ranging from $4 to $27, depending on family income and number of children, in exchange for medical, dental and vision care, often for $5 a visit.

Healthy Families is the state’s way of carrying out a mandate by Congress last year to improve health care for uninsured children. Two-thirds of the program’s price tag is covered by federal funds.

But with the start date looming, local and state officials are scrambling to get workers trained, applications sent and a new bureaucracy in place, even as some wonder whether the working poor will embrace the complex program.

“There is a lot that still needs to be worked out. Is it too complicated? Will the outreach effort be successful? Will the co-pay requirement be a barrier?” asked Orange County Supervisor William G. Steiner, who appointed a task force to oversee the county’s participation.

“But by the same token, all of us realize that this is such a great opportunity for us to fill a gap in providing health care.”

The first barrier could be the Healthy Families application itself. At 16 pages, enclosed in an 28-page workbook, it is as daunting as a long tax form.

The state has hired a firm to train community-based organizations, insurance agencies, schools and other groups, so they can help the needy fill out the forms.

Although the help is free to families, the organizations providing assistance will be paid $25 for each family signed up, as an incentive to bring people into the program.

The application is so complex partly because it allows families to apply for either low-cost Healthy Families or no-cost Medi-Cal for Children. The latter is for children in families that earn up to the federal poverty level, or $16,050 for a family of four, while Healthy Families generally covers those who earn up to twice that amount.

However, when computing income, there are different deductions allowed for the two programs. That’s a recent change, promoted by Gov. Pete Wilson, which resulted in disqualifying up to 25% of the 562,000 uninsured children statewide previously targeted for Healthy Families, according to a UCLA study.

The application requires proof of income and papers showing that the children are U.S. citizens or legal residents.

The Healthy Families applicants also must choose from among a dozen health plans in Orange County. The two cheapest, with monthly premiums ranging from $4 to $18, are offered by CalOPTIMA Kids, a newly created division of CalOPTIMA, which won a “community provider” designation from the state, entitling it to charge discounted premiums. Ten other plans are offered by Blue Cross, Blue Shield, Kaiser Permanente, UHP Healthcare, United HealthCare and Universal Care, with premiums ranging from $7 to $27.

Children enrolled in Medi-Cal are covered solely by CalOPTIMA.

Parents can apply for both Medi-Cal and Healthy Families and, if rejected by one program, have their applications forwarded to the other.

To help with this complex system, a countywide coalition called First Things First is helping community organizations receive training and spread the word about the new program. The coalition, made up of numerous health and community organizations, was originally created in May to reach families of the estimated 50,000 to 85,000 Orange County children who are eligible for--but not enrolled in--Medi-Cal.

“We want to make sure that those people who can participate in Healthy Families get signed up, but at the same time, we realize we might also reach people who should be on Medi-Cal,” said Alan Woo, coalition leader.

On July 1, the state will begin its advertising blitz for Healthy Families, using radio and television spots, billboards, bus signs, even ads on grocery bags, said Sandra Shewry, executive director of the state’s Managed Risk Medical Insurance Board, which oversees the program.

In Orange County’s nonprofit community clinics, workers are being trained to help with applications and will inform their patients about the program. Some community groups will send workers door to door to tell families about this and other health programs, such as immunization clinics.

Despite outreach efforts, many activists are concerned that the poor will not flock to the program. The monthly premium, small as it is, might be too high for some families, they say.

“When you’re at the bottom of the economic barrel, sometimes you barely have enough money for food and shelter,” said Felix Schwarz, executive director of the Health Care Council of Orange County. “These people are struggling. No way will some of them be able to afford the premium every month.”

Schwarz and other advocates also are concerned that illegal immigrants whose children are eligible will be loath to apply, despite assurances that the Healthy Families administration will not turn over information to immigration or other authorities.

“Their parents are terrified they’ll be deported,” Schwarz said.

And what will happen, he wonders, when families’ incomes fluctuate, which is common in households dependent on seasonal employment or multiple part-time jobs?

“They will flop in and out of eligibility, from one program to another,” he said.

Despite his criticism of the program, Schwarz is committed to making it work.

“When we’re in as bad shape as we are [regarding uninsured children], anything you do is going to help,” he said.

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HOW TO APPLY

* Low-income residents who wish to apply for Healthy Families low-cost health insurance can receive more information and order applications--available now--by telephone or over the Internet: Call toll-free (888) 777-1222. Information is available in English and Spanish and soon will be offered in more languages. On the Internet, the home page is https://Healthy Families.ca.gov/. Applications also will be available at Orange County’s social service offices.