Confusion Over Coverage Frustrates Families in Need

Low-income working families in California confront a crazy quilt of public programs as they seek subsidized and free health benefits. Federal and state programs provide insurance or medical care for more than 5 million people statewide. And some health-care experts say at least 1 million more would take advantage of the programs if they were consolidated and simplified.

“People experience enormous frustration in trying to figure out the system,” said UCLA professor E. Richard Brown, director of the Center for Health Policy Research.

But government officials are pushing to streamline operations, making it easier for people to determine if they qualify and to apply. In the meantime, toll-free telephone numbers are available so people can find out if they or their children are eligible for free or low-cost medical help.

Health-care workers and government leaders say they need to reach low-income wage earners, particularly those in immigrant neighborhoods where residents often go to unlicensed storefront operations for illegally imported prescription drugs.

In the last year, two Latino toddlers in Orange County died after receiving injections of allegedly smuggled medicine from unlicensed practitioners. The children, born in the United States, were likely covered by public medical benefits.

Too often, health officials say, immigrants and their children avoid government programs, fearing repercussions from the Immigration and Naturalization Service.

“We have thousands of children of undocumented parents who receive medical benefits,” said Robert A. Griffith, chief deputy director of Orange County’s Social Services Agency. “The status of the parents is not an issue as long as the parent isn’t applying for benefits for themselves.”

But going through the myriad rules and program variations can be daunting--even when parents aren’t pressed for time because a young child is sick and needs care in the middle of the night.

Medi-Cal, which provides medical care to the poor, has more than 100 categories under which a family may be eligible. The Healthy Families program, a federal- and state-subsidized insurance program for children of the working poor, has a 28-page application. A four-page version is expected sometime in April, said Peter Anderson of the state Department of Health Services.

How to sort it out?

Call or “come in and apply, because we have so many categories and we are instructed to make the programs available wherever and whenever possible,” said Barry Bonin, manager for Orange County’s Medi-Cal program.

There are more than two dozen medical insurance or subsidized health-care programs available in the state, ranging from free counseling services for pregnant teens to the comprehensive medical benefits under Medi-Cal.

The three largest programs providing full health services--mainly to children--are Medi-Cal, Healthy Families and Access for Infants and Mother, which offers perinatal, birth and infant care to uninsured pregnant women.

Of the 1.85 million children without insurance in the state, about 1.1 million are eligible for coverage under one of the big-three programs, according to a 1998 report by the UCLA Center for Health Policy Research. Figures are not available for uncovered eligible adults.

In the last year, health-care officials have tried to improve access by offering mail-in applications for some programs and setting up toll-free phone numbers so that people can find out what programs they should apply for and where they can get help.

While politicians work on ways to improve the programs, public officials are pressing the INS to guarantee that receiving medical benefits will not affect naturalization, visa renewal or reentry into the U.S.

A ruling on the issue is “in the works,” said Maria Cardona, an INS spokeswoman in Washington. Immigrant parents of children who are citizens because they were born here, as well as permanent legal residents, “have no exposure with the INS” in seeking medical benefits, she said.

Here are some general eligibility rules, contact numbers and other criteria for the big-three programs:

* Medi-Cal is the comprehensive medical, dental and vision care program that is free for the poorest of California residents and workers. It can be reached toll-free at (888) 747-1222.

The program covers citizens and certain categories of qualified immigrants, including lawful permanent residents and others who have satisfactory immigration status. To be eligible you must meet income guidelines and either be a child, in a family with children, or be blind, disabled or age 65 or over.

The program’s eligibility is most generous for pregnant mothers or families with infants under age 1. That family is covered as long as its annual income is less than 200% of the federal poverty level, or $32,904 annually. A family with children age 1 to 5 can be covered if annual income doesn’t exceed $21,888. For ages 6 to 19, families can’t top $16,452 in earnings a year. Up to $90 a month in income can be excluded for each working family member.

Pregnant women are covered for prenatal, birth and one-month postnatal care regardless of immigration status, as are people needing emergency care. The federal and state governments split the cost.

* Healthy Families is a subsidized health-insurance program for children ages 1 to 19 of working families. Information is available by calling (800) 880-5305.

The program covers citizens and certain categories of legal immigrants. The child must have been in the country prior to Aug. 22, 1996, unless the child qualifies for an exception.

The program’s income eligibility maximum is 200% of the federal poverty level. Unlike Medi-Cal, there are no exclusions for earned income. A state lawmaker has proposed raising the ceiling to 250% of the poverty level.

The program offers free preventive dental and health care and has a co-payment of $5 for other services. In addition, families pay between $4 and $9 per child up to a maximum of $27 per month to cover all siblings.

The federal government pays 65% of the cost of the program, the state 35%. So far, about 90,000 of the state’s estimated 328,000 eligible children are enrolled, Anderson said.

* Access for Infants and Mother is a subsidized insurance program that provides prenatal and maternity services for pregnant women, including 60 days postpartum care, and infant care for two years. For information, call the program at (800) 433-2611.

The program covers people who live in California for six months prior to application with a family income no greater than 300% of the federal poverty level, or $49,350 for a family of four--the pregnant woman counts as two. The program requires a contribution of 2% of gross income, with an initial payment of $50 and the balance due in 12 months.

The program, which enrolls about 355 new mothers a month, is paid for with state tobacco taxes. In six years it has covered about 35,000 pregnant women.

In addition to these programs, individual counties offer medical care assistance. Eligibility rules vary, and residency status may be a factor in qualifying for the programs. The programs cover poor people with urgent medical problems, certain chronic illnesses and medical emergencies.

Los Angeles County serves almost 1 million people in its public system, which includes six county public hospitals and more than 150 outpatient clinics. Information is available at (800) 427-8700.

The Ventura County Medical Center operates the Ventura County clinic system, which cares for about 250,000 people a year. There are 36 clinics throughout the county, including 10 acute-care primary clinics. Information is available at (805) 641-5700.

Orange County does not operate a county hospital but pays for care to indigents and others in need of urgent care. The services are provided by hospitals, 15 community clinics and private physicians. Information is available at (714) 834-6249.