SACRAMENTO — A state program that provides health care coverage for uninsured children would be expanded, with money from California's tobacco settlement, to include 300,000 parents under a proposal submitted to Washington this week by Gov. Gray Davis' administration.
Details of the proposed expansion of Healthy Families, outlined in the request to U.S. Health and Human Services Secretary Donna Shalala, were received warmly by health care experts and activists for the uninsured.
They said it would help reduce the number of Californians without health insurance, even if it would not cover as many families as they had hoped.
"This is a very important step and I really applaud it," said Rick Brown, director of the UCLA Center for Health Policy Research. "It's going to mean a lot for many thousands of families in California who are working really hard and right now have nowhere to turn to get the health care that the rest of us take for granted."
Under the expansion proposed by state Health and Human Services Secretary Grantland Johnson, California would extend the program to include many, but not all, parents of children who qualify.
Davis, who initially resisted efforts to use the tobacco money for health care, sought to reassure the public Thursday that widening its scope will not come at children's expense.
"The governor's priority, first and foremost, has been to ensure that every child eligible for coverage in the Healthy Families program is enrolled before we expand coverage to parents," Johnson said in a statement. "The governor's budget will continue to include the necessary funding to cover the maximum number of eligible children."
Despite its name, the Healthy Families program was initially intended solely for children. But enrollment, currently estimated at 360,000, has failed to meet expectations in a state with a massive uninsured population.
As a result, California nearly had to give back $590 million in unused federal money recently. Only last-minute legislation championed by Sen. Dianne Feinstein this fall prevented that from happening.
So to use all the money in the future, and reach more children, state officials are proposing to include some parents. The program will retain children, however, as its primary focus.
If the expansion is approved by the federal Health Care Financing Administration, as is expected, parents making from the poverty limit of $17,050 for a family of four up to twice that amount would be able to receive coverage.
But parents making just a little more would not, even though children are eligible if their parents' income does not exceed 2 1/2 times the federal poverty limit. Most families earning less than the poverty limit are already eligible for the state's Medi-Cal program.
Furthermore, parents would have to pay a monthly premium based on the family's income, not to exceed $25 per parent per month. To cover their children, parents now pay a slightly lower premium, between $4 and $27 per month, based on their income level and number of children.
The activists who had been pushing for the expansion had hoped that all parents whose children qualified would be included.
"There are many parents whose kids are eligible for Healthy Families that will not be eligible for this," said Jim Keddy of the Pacific Institute for Community Organization. "But without a doubt, it's a significant step forward."
Davis spokeswoman Hilary McLean said restricting the number of parents who can qualify was the only way to extend the program without asking the federal government for more money.
"That was a way to use the amount of funds available, while living within our means," McLean said.
Brown and Beth Osthimer, a senior attorney at Neighborhood Legal Services at the Health Consumer Center of Los Angeles, said the expansion should include simplification and better coordination of the Medi-Cal and Healthy Families programs.
The proposed expansion includes an outreach component to assist families in learning about Healthy Families and participating.
"Any expansion is great," Osthimer said, but the programs are "too complex and too confusing. . . . We need to make it so that people can easily get on and stay on the programs."