Close 'Baby Gap' in Public Health

Lucy Quacinella is a consultant with Maternal and Child Health Access.

Suffer the little children. Make that the youngest children. California should be proud of its recent progress in insuring more children in working-poor families through Medi-Cal and Healthy Families. But the very youngest have been bypassed. Worse, current state plans for implementing the governor's new "gateways to health insurance" clang the door shut on babies.

New data from a UCLA study show that 95% of uninsured infants under 1 are eligible for either Medi-Cal or Healthy Families. That means nearly all of our low-income uninsured infants eligible for publicly funded health insurance are not covered.

Children without health insurance are less likely to get the medical care they need; this can begin a cycle of missed opportunity. Sick children have a tough time in school. Some die or are disabled by treatable diseases. The tax base also takes a hit when we fail to support the health of the next generation.

The disappointing news about infants' health coverage comes after five years of policies aimed at making it simpler for low-income working families to sign up their children and expanding coverage to more kids with federal matching funds.

For older children, real gains have been made. So it's especially upsetting that infants have not benefited nearly as much.

What went wrong? Infants were overlooked in the reforms because everyone assumed they were covered. While infants are eligible for insurance, red tape has kept them unenrolled.

Since the late 1990s, infants have been eligible for Medi-Cal in families with income up to 200% of the poverty level. (The poverty level for a family of four in 2002 was $18,102).

Infants have long been eligible for Medi-Cal up to their first birthdays if the mother had Medi-Cal for the delivery. However, the state's rules for infant enrollments aren't automatic at birth, or even particularly user-friendly, and some of the rules for this group are even more Byzantine. The result is the baby gap.

The red tape persists in the flawed design of the "gateway" program, which goes into effect in July. It aims to enroll uninsured children through certain health-care providers. This is disappointing given the governor's written promise that he would "automatically" enroll eligible infants into Medi-Cal from "gateway" pediatricians' offices and health clinics. Instead, many of the infants may lose coverage the month after their first visit because of more red tape to continue coverage.

The state is facing record budget deficits. But the fiscal and other costs of not doing anything are far greater than the small sum needed to fix the baby health-insurance gap.

Two simple strategies would help to close the insurance gap. First, fix the glitches in the existing infant enrollment process and in the "gateway" plan for pediatricians' offices and clinics. Then, open a gateway from hospitals so that when the mother is discharged, she will have her newborn's insurance in hand.

Let's close the baby enrollment gap as we move forward to covering all uninsured children and adults.

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