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California and the West

Children's Insurance Program Mired in Bureaucracy

Policy: Parents call application process for state-run Healthy Families confusing. A study shows that only about half the eligible children are enrolled.


Bruce Bertrand lost his job last fall, stranding his wife and two young sons--one of them autistic--without health insurance.

The children, Michael and Ryan, appeared to be perfect candidates for the state's Healthy Families program, California's version of a state- and federally funded insurance plan for children whose parents make too much money to qualify for Medi-Cal but too little to afford private coverage.

Despite rosy promises about the program in state-funded ads, and a continuing barrage of upbeat press releases from Gov. Gray Davis, it would require nearly three months of excruciating back-and-forth negotiations with state workers and the intervention of a Riverside County supervisor before the Bertrand children had coverage.

In the meantime, the Bertrands were forced to cancel a $3,000 autism evaluation for 8-year-old Michael, and had to pay $250 out-of-pocket for a neurological exam for him, said Patricia Bertrand, the boys' mother.

When Ryan, who is 5, developed what appeared to be a bronchial infection, the Corona couple treated it with over-the-counter drugs because they couldn't afford to go to the doctor, Patricia Bertrand said.

"My experience with this organization," she wrote the state in December, "has been disastrous."

Statewide, about half the children eligible for Healthy Families are actually enrolled, according to figures to be released next week by the UCLA Center for Health Policy Research.

According to the center, which gathered its information between December 1999 and March 2000, about 741,000 children qualify for the program. But as of last month, the state had only enrolled 375,000.

Indeed, so few children had been brought into the program by last summer that the federal government threatened to take back $590 million that had been allocated to help pay for it. Ultimately, the state was allowed to keep $360 million of that.

The Davis administration defends its handling of the program, pointing out that enrollment has increased exponentially since Republican Pete Wilson left office in 1998.

"Anybody who thinks that in a state like California you can do this overnight is simply failing to appreciate the challenge," said Grantland Johnson, California's secretary for health and human services. "You can't just wave your hand with a magic wand."

Still, many families and health care advocates say the system is unnecessarily difficult to navigate.

"I know how to work through the system, and I thought it was pretty difficult," said Anne Stephens, the aide to Riverside County Supervisor John Tavaglione who eventually found someone to help the Bertrands. "If I didn't know how to work the system, it would have been even worse."

Nationwide, the Children's Health Insurance program--of which Healthy Families is a part--has had mixed results. The federal government, which reimburses 65% to 84% of the cost of the program, allows states to administer it themselves.

Some states, including Wisconsin and Connecticut, have done well, integrating several programs aimed at helping families obtain health insurance and making the application process quick and easy. New York had signed up 530,000 children as of last month--a quarter of those enrolled in the entire nation--and was among the few states allowed to keep all of the money that had been allocated for the program.

But other states, including California, have struggled to sign up families. Despite efforts to simplify the cumbersome enrollment process, the state has been forced to train hundreds of workers to walk people through it.

Because eligibility is determined by age as well as income, children in the same family may be placed in different programs--some on Medi-Cal and others in Healthy Families. The mother may be in yet another program, aimed at assisting women, and the father may not be eligible for aid at all.

California and Texas, which have large immigrant populations, also must contend with powerful cultural barriers: Many eligible residents come from countries where it is customary to go to a public clinic or pharmacy. Private doctors are used as a last resort.

Some immigrants fear that they will be deported if they apply for public assistance, or that their own immigration status will be questioned if they apply on behalf of their children.

The state's ability to attract and enroll eligible families will be tested even further over the next six months, as officials prepare to roll out a new arm of the program aimed at covering parents. This expansion, endorsed by Gov. Davis in December and slated to begin in July, is awaiting federal approval.

"Overall, it's a wonderful thing," said Lynn Kersey, director of the advocacy group Maternal and Child Health Access in Los Angeles, of the expansion. "But there are concerns about covering more people in a broken system."

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