State to Cut Red Tape in Health Plan for Children of Poor

With enrollment badly lagging, state health officials said Tuesday that they will revamp aspects of California’s $500-million Healthy Families insurance program for children of the working poor by streamlining the bulky application and improving community outreach, especially among Latinos.

Three months after start-up, the state has enrolled only about 20,000 children--10% of the first year’s target. About 60% of the eligible children in the state are Latino.

Subsidized by the federal and state governments, the program is geared toward working families who are too well off for Medi-Cal but too poor to afford private insurance. More than 400,000 children in California are believed to be eligible.

The announcements came amid a drumbeat of complaints from some consumer and health care advocacy groups that the application process was too cumbersome and the outreach campaign poorly focused. In addition, many Latino families have steered clear of the program, fearing that it might hurt their prospects for citizenship or legal admission of other family members to the country.

Hoping to ease such concerns, health officials said Tuesday that the U.S. Immigration and Naturalization Service recently assured state health officials that participation of children who are citizens will not affect the status of other family members applying for citizenship.

State health services director Kim Belshe called for dramatic reductions in the unwieldy application packet for Healthy Families and Medi-Cal, which some consumer advocates have compared to the Internal Revenue Services’ 1040 long form. Under a draft proposal she unveiled, the Healthy Families forms would be cut from 12 to three pages. Medi-Cal forms would be cut from 10 to five pages. Final revisions are expected by the first of next year.

“This draft is a starting point in making the joint application as user friendly as possible,” she said.

In addition, Belshe proposed doubling to $50 the fee the state pays to certified assistants who help successful applicants with the paperwork, and allowing applicants to pay first month premiums by personal check as well as money order or cashier’s check.

She pledged that the state would work more closely with school officials in areas of high eligibility, offer application assistance to people who make telephone inquiries and target the Latino print media, supplementing radio, television and billboard campaigns. It also will expand efforts to train application assistants in Spanish.

Belshe said enrollment of Latino children is the state’s “highest priority”--especially in Los Angeles County--because of the large numbers of working poor.

Many critics of the program Tuesday welcomed the reform but remained cautious about the state’s approach. “The devil is in the details,” said Lourdes Rivera, a staff attorney for the National Health Law Program.

Rivera, like many advocates, said she was concerned that the state is not relying enough on the expertise of community-based organizations in signing up applicants. In raising the assistance fee, she fears the state may be encouraging a cadre of inexperienced helpers, who will file unsuccessful applications.

Rivera and others continued to voice concerns that Healthy Families and Medi-Cal are not meshing well. Some critics believe that families should not have to sort through the packet and calculate for themselves which program they are eligible for; the state ought to do that for them, they say. Others believe the campaign for Healthy Families is eclipsing Medi-Cal outreach--at a time when more than 600,000 children are believed to be eligible for Medi-Cal but not signed up.

Several said that Healthy Families shares the same “welfare” stigma that Medi-Cal has--even though it is based on a private insurance model and requires low-cost premiums.

“They don’t know what it is,” said Dawn Harris, president and chief executive of Managed Care Connection, which held a Healthy Families sign-up in South-Central Los Angeles on a recent weekend.

Working people “don’t want a handout,” she said. “I still think there needs to be more positive outreach efforts to let people know what this is, without the stigma.”