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Benefits Bob

State Plan Extends Helping Hand to Thousands of Uninsured Kids

July 13, 1998|Bob Rosenblatt

Now comes the children's hour. California is beginning the biggest expansion of public health insurance programs since Medi-Cal was created a generation ago.

Working families of modest incomes without health insurance for their children became eligible July 1 for a new state program offering coverage for doctor visits, hospital care and prescription drugs.

The Healthy Families program aims at finding and covering many of the 400,000 uninsured children in the state.

"We want to provide low-wage families with access to comprehensive systems of care," said Sandra Shewry, head of the state's Managed Risk Medical Insurance Board, which runs the Healthy Families program. "We are trying to model this after the commercial insurance market in California," she said.

The benefits are identical to those in the health insurance package offered to members of the state Legislature and to state government employees.

Healthy Families is California's version of the legislation approved by Congress in 1997, providing $24 billion, a major expansion of federal health spending. Two-thirds of the money comes from Washington.

At the same time, the state will be trying to find more low-income families whose children qualify for Medi-Cal, a program for the poor.

A single application will help families enroll their kids in either Healthy Families or Medi-Cal.

Healthy Families is designed for children 18 or younger. They must be U.S. citizens or qualified legal immigrants who entered the U.S. before Aug. 22, 1996. (There are some exceptions for refugees.)

The cost will vary, depending on family income and the type of health plan selected. The payment can be as little as $4 a month for each child, and the maximum for any family, no matter how many children, would be $27 per month.

There is a co-payment of $5 for an office visit. There are no further charges once a family makes a total of $250 in co-payments for the year.

Applications are available through community organizations, schools, PTAs, day-care centers, county health programs, insurance agents, churches and synagogues, and state government offices. A drive to enroll all eligible children, called the 100% Campaign, is being run by the Children's Defense Fund, a national Washington-based group; Children Now, based in Oakland; and the Children's Partnership, based in Santa Monica.

The goal of Healthy Families is to find uninsured children whose families have incomes between 100% and 200% of the federal poverty level, which is $16,450 for a family of four. The income limit for participation in Healthy Families is 200% of that figure, or $32,900.

Typically, these children come from households in which parents work full time but don't have health insurance through work. Many low-wage workers have no insurance at all. Others have coverage for the worker only.

Employers cannot use Healthy Families to reduce their own costs if they already provide health insurance for children to their workers. Under California law, it is an unfair business practice to cancel the coverage at work for children of workers whose income would qualify them for the public program.

Healthy Families essentially uses federal and state dollars to subsidize the cost of private insurance. The care will be provided through the same standard health organizations that provide coverage for millions of Californians through the private health care market.

In Los Angeles County, the participants are: American Family Care, Blue Cross (HMO), Blue Shield (HMO), Community Health Plan, Health Net, Kaiser Permanente, L.A. Care Health Plan, UHP Healthcare, and United Health Care.

Orange County choices are Blue Cross (HMO), Blue Shield (HMO), CalOptima Kids, Kaiser Permanente and UHP Health Care.

Health plans that have been successful in serving low-income families have been designated "community providers." They will be allowed to offer the lowest premiums, $4 a month. Community Health Plan is listed as a community provider for Los Angeles County, and CalOptima Kids has the designation for Orange County.

For Riverside County, the community provider plan is Inland Empire Health Plan, and the other plans are Blue Cross-EPO, Blue Shield--HMO, Health Net, Kaiser Permanente, American Family Care, UHP Healthcare, United HealthCare and Universal Care. In San Bernardino County, the community provider plan is Inland Empire Health Plan, and the other plans are Blue Cross-EPO, Blue Shield-HMO, Health Net, Kaiser Permanente, American Family Care, UHP Healthcare, United HealthCare, and Universal Care.

Ventura County has Ventura County Health Care Plan as the community provider plan, and the other participants are Blue Cross-EPO, Blue Shield-HMO, Health Net, United HealthCare and Universal Care.

Families can fill out a single application to determine eligibility for Healthy Families and for Medi-Cal. If a family qualifies for both, there are certain times when Medi-Cal may be preferable, according to Patricia Freeman, a health policy analyst with Children Now:

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