Insuring Low-Income Children

Children from poor families have a better chance of getting free medical insurance in California these days, but health care advocates say the challenge is getting that help to all the kids who need it.

Insurance pays for injections, checkups and treatments that children need to grow up healthy. And it gives parents relief from the terrible guilt that burdens them when they can't afford to take a sick child to the doctor or get a prescription filled.

There are 1.1 million children eligible for free medical coverage under either Medi-Cal or the Healthy Families program. Los Angeles County, which has more poor and working-class uninsured people than any other area in the state, is home to huge numbers of these kids--more than 500,000.

The challenge is getting them enrolled.

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Healthy Families, a program started a year ago with federal and state dollars, signed up 134,000 kids in its first year. The quick start "is very good news," said Patricia Freeman, senior health associate at Children Now, an Oakland-based advocacy group involved in a coalition whose aim is to get coverage for all of California's poor kids.

Major expansions are expected for Healthy Families within the next few weeks, when Gov. Davis signs legislation implementing the new state budget. An additional 140,000 children will become eligible for the program, boosting the statewide potential pool to 460,000.

The income ceiling will be boosted from 200% to 250% of the federal poverty standard. Under this measurement, the income limit for a family of three, now $27,760 a year, will climb to $34,700. For a family of four, maximum income climbs from $33,400 a year to $41,750.

And children who have arrived in the United States as legal immigrants since Aug. 22, 1996, will now be eligible if their families meet the income standards.

The program will write to families whose applications were rejected because of income or date of arrival to inform them they may be eligible under the new rules, said Sandra Shewry, executive director of the Managed Risk Medical Insurance Board in Sacramento, which runs the Healthy Families program.

Healthy Families helps children whose parents are still relatively poor but make too much money to qualify for Medi-Cal. There is an often bewildering array of rules for Medi-Cal, with different income standards for the family depending on the age of the child.

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The discouraging news for those who want to see all children covered by health insurance is the reluctance of many families to get involved with Medi-Cal because they fear it has the stigma of welfare or complain that it is excessively bureaucratic and unresponsive. And health advocates say that among immigrants, Latino families in particular are hesitant to get involved with any government program because they fear it may cause them immigration problems. But Medi-Cal does offer children access to quality managed care plans, advocates say.

Because of varying income and age-related eligibility rules between the programs, a family might have one child eligible for Medi-Cal, while another is enrolled under Healthy Families. Many of the same HMOs participate in both programs, so it should be possible for a family to keep the same doctor for all children. The state is moving to make things easier with a single, simplified application for both programs.

Among immigrant families, there has been great fear that participation in one of the programs could hurt the parents' chances to become citizens. If a person is likely to be a "public charge," dependent on taxpayer-funded programs, that could be viewed by federal authorities as a potential obstacle to citizenship.

But the Immigration and Naturalization Service has just ruled that enrolling immigrant children in Medi-Cal or Healthy Families will not be viewed as a "public charge" issue.

"This is a very important clarification," said Wendy Lazarus, director of the Children's Partnership, a research and advocacy group with offices in Washington and Santa Monica. "The real work now is in getting the word out in local communities through groups trusted by immigrants."

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If a family has too much income to qualify for either Medi-Cal or Healthy Families, there is another source of free insurance coverage for children. Kaiser Permanente Cares for Kids makes help available to those with annual incomes up to $45,900 for a family of four.

There are "so many different options, people are confused as to what they should apply for," said Linda Kotis, the Kaiser program's director. "Our commitment is to provide additional coverage, not to duplicate what is already out there."

Kotis is puzzled because most of the applications she receives are from people whose incomes are low enough to make them eligible for Medi-Cal or Healthy Families.

"We are trying to do an analysis to understand this," she said. "Are people applying to us because they do not understand the process of these other programs, or are they worried about immigration, or about some stigma about government activities?"

All government programs are limited to legal immigrants. For those children who are undocumented, there is another source of help, the California Kids Health Care Foundation, a private charity based in Encino. It provides aid without questioning immigration status. The hard part is persuading people that their identity will be kept confidential. "For most families, it is the first time any of them have insurance," said Michael Koch, the program's director. "This is all about trust. They have to trust us. We have to trust them."

Joint applications for Healthy Families and Medi-Cal may be requested by calling (888) 747-1222. Operators can handle calls in English, Spanish, Vietnamese, Cambodian, Hmong, Armenian, Cantonese, Korean, Russian and Persian. Information on local community organizations that will help families fill out the application is also available at this number.

Applications for Healthy Families are available from the Managed Risk Medical Insurance Board in Sacramento. Call (800) 880-5305.

Information on Kaiser Cares for Kids is available by calling (800) 255-5053.

California Kids Health Care Foundation has information and applications at (800) 374-4543.

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Some people who have brought their parents from abroad to live with them are now worried about how to pay for their medical expenses. There is no easy answer. Medicare covers people age 65 or over. But a legal immigrant has to be here five years to be able to participate in the program.

And there is a lack of affordable insurance for this group. There are policies, called international temporary health benefits, the kind of coverage travelers can buy when visiting another country. The policy can be purchased for periods of up to one year, but it can be renewed only after a one-day break in coverage. And if the person develops a health problem, a company might reject him when the renewal comes up. These policies are costly, about $1,800 a year.

Some clinics provide free medical services, and some doctors offer discounted or free care. Sources of information include the Center for Healthy Aging, (310) 576-2550, and Jewish Family Services' Freda Mohr Center, (323) 937-5900.

I'd also welcome any letters or e-mail about your suggestions and experiences in finding care and coverage for your elderly relatives who can't qualify for Medicare.

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Question: I'm a 53-year-old male, married, and I am at the tail end of a COBRA program with my former employer. I teach part time at several colleges. I learned that converting my old Blue Cross group policy to an individual policy would run about $900 per month. That is way too much. Is there an independent broker who can help me find good health insurance for us at a reasonable rate? Am I eligible for a Medical Savings Account?

Answer: COBRA (the Consolidated Omnibus Budget Reconciliation Act) allows a worker to continue health insurance for up to 18 months after leaving a job, provided she pays the full cost of the insurance, both her share and the company's share. Converting or switching a COBRA policy is costly.

A better choice is to ask a health insurance agent to find out what's available in the market for individual policies. Major firms such as Blue Cross of California, Blue Shield of California and Kaiser offer individual products. Jim Armitage of Arroyo Insurance Services in South Pasadena says policies for an individual in good health are available for about $180 a month.

Prices rise for those with health problems.

A state-backed program for those with serious ailments who can't get insurance otherwise costs about $600 a month. The Medical Savings Account combines high-deductible insurance with a tax-free savings account. It is available for the self-employed and for workers at small companies without health insurance.

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We welcome your suggestions, questions and tips about the fast-changing world of health care. Write to Bob Rosenblatt, Health, Los Angeles Times, Times Mirror Square, Los Angeles, CA 90053. Or e-mail to bob.rosenblatt@latimes.com.

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