Benefits Can Be a Tough Sell

Candidates across the country already are scoring political points on the health-care issue by offering sympathy for the millions of Americans who can’t afford good medical insurance.

About 44 million people have no health insurance at all, and others with coverage have a hard time finding the cash to make the co-payments and deductibles required by their policies.

But before the nation gets into another big political fight over health care--Democrats against Republicans, business against labor--Americans should make full use of the laws already on the books.

Millions of people could get help tomorrow paying for health care: Getting them enrolled in current state and federal programs would make a big dent in the ranks of the uninsured.

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Consider the numbers: About 8.5 million people on Medicare, the federal program for those older than 65 and the disabled, are eligible for additional financial help, but just 4 million have signed up. In California, more than a million of the 1.85 million uninsured children could be covered immediately, either through Medi-Cal (the federal-state health program for the poor) or Healthy Families (a program aimed at kids from modest-income working families).

There are lots of reasons people don’t enroll. In this state, for example, less than 30% of parents with uninsured kids know about programs like Healthy Families.

Perhaps they’ve heard of Medi-Cal but don’t want to be involved with a government program. “Once people are off welfare, they often don’t want to have anything to do with the welfare department,” said Lucy Lynch, who runs the Medi-Cal program in Los Angeles County. “They want to stay away and not get involved.”

Most of the people who left welfare and found work are now in low-paying jobs without health benefits, and they probably don’t realize that their income levels may still make them eligible for Medi-Cal.

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Welfare reform has made the system all the more confusing. The old system gave Medi-Cal benefits automatically to anyone getting welfare. That system is no longer in place. Now, to be eligible for Medi-Cal, people must meet complex income requirements.

Lynch likens the Medi-Cal application process to “trying to refinance your house.” As people’s job and family circumstances change, “you are constantly having to update your documents and records to see if you are eligible. It becomes a very cumbersome process.”

In many households, parents don’t want any connection with a government program, no matter what benefits it promises for their children.

Many of the state’s uninsured children are members of families with mixed immigration status. Some of the kids may be citizens because they were born in the U.S, while their older siblings and parents might be immigrants, perhaps legal, perhaps not.

These parents are afraid to enroll their children in Healthy Families, said Dr. Mark Smith, president of the California HealthCare Foundation, an Oakland-based nonprofit group that works on health education issues.

Sadly for the children, the development of health policy has been a “one step forward, two steps back” process, according to a report by Families USA, a Washington, D.C.-based health advocacy group.

Children’s enrollment in Medi-Cal, for example, dropped by about 270,000 in the past three years, presumably reflecting the combination of a stronger economy and welfare reform, the Families USA study said. Healthy Families, meanwhile, has provided low-cost coverage for 210,000 kids previously without insurance.

Enrollment in programs such as Healthy Families is “moving up nicely,” said Ron Pollack, executive director of Families USA. But the impact of welfare reform on health-care coverage is “a negative story,” he said. “We need to find and enroll more of these kids.”

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The children can be easily located and enlisted through an “express lane” approach using existing programs, such as food stamps, school lunches and Head Start, which have already identified eligible families, according to a proposal by the Children’s Partnership, a Santa Monica advocacy group. The school lunch program, for example, has a simple one-page application, with verification of eligibility after the child has enrolled. And it’s only necessary to enroll once a year. “We’re willing to feed the kids, and we use a lot less red tape than we use in giving them medical care,” said Lynch, the Medi-Cal manager. “It would make sense to have one application for both programs.”

But these are separate programs, involving different federal and state departments, and it would take a special effort to surmount the bureaucratic barriers.

Persuading more people to sign up for health benefits is going to be a tough selling job, as any campaign will need to address people’s indifference, ignorance or fear. Yet a country in which kids spend $150 for a pair of Air Jordan sneakers or adults drop $3 for a caffeine jolt at Starbucks should be able to find a way to persuade the customers--elderly low-income people and poor families with children--to take advantage of programs already in place.

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Here’s a short guide to finding out about the benefits:

Medicare beneficiaries can get help depending on their incomes. A single person with income of up to $947 a month and a married couple with income of up to $1,265 may qualify. (The limits can be higher if some of the monthly income includes earnings from work.) There is also a financial assets test--things such as bank accounts, stocks and bonds. Individuals are eligible with assets up to $4,000, and a couple can have up to $6,000. The home, furniture, a car, a burial plot and some life insurance are not counted as assets.

A free booklet called “Medicare Savings for Qualified Beneficiaries” explains the different levels of benefits and is available from the federal government at (800) 633-4227.

The programs are run through county social services agencies. The Los Angeles number is (877) 597-4777. Applications can be handled by mail without the need for a personal visit to the county office.

Medi-Cal provides free health coverage for children through age 18 and for pregnant women. Household income, children’s ages and family size will determine which particular program and benefits apply. Information in Los Angeles County is available at (877) 597-4777.

Healthy Families provides low-cost insurance coverage for children through age 18. Premiums range from $4 a month per child to a maximum of $27 a month per family, regardless of the number of children. Income eligibility limits were boosted in November, and benefits are now available for families with incomes up to 250% of the federal poverty level. For a family of three, that level would be $34,703.

A statewide, toll-free line, (888) 747-1222, provides applications and the names of neighborhood groups offering assistance in filling out the forms. Another toll-free link, (800) 880-5305, offers help in completing the applications, with assistance available in English, Spanish and other languages. Web site information is available at https://www.mrmib.ca.gov.

Medi-Cal and Healthy Families do not gather information on the immigration status of parents or guardians who are seeking coverage for children. Social Security numbers are required for children seeking Medi-Cal benefits. But no number is required for children enrolled by Healthy Families.

Tip of the Month: Medicare now pays for men to get an annual prostate examination and a PSA test to detect prostate cancer.

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