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Health Dollars & Sense

Insuring Low-Income Children

July 12, 1999|Bob Rosenblatt

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.

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