Children s Health Insurance Programs. facts and figures

Transcription

1 Children s Health Insurance Programs facts and figures June 2006

2 Introduction California has seen a more than 20 percent drop in the number of uninsured children over the past five years. Still, almost 800,000 children in the state still lacked health insurance coverage as recently as California policymakers and children s advocates have worked hard to reduce the number of uninsured through statewide programs (Medi-Cal and Healthy Families), as well as county-based coverage efforts known as Children s Health Initiatives (CHIs) locally managed and financed programs to cover low-income children ineligible for state programs. Introduction California has made progress covering children and is now at an important crossroads. For all the work done to date, California is at a crossroads on children s health insurance. A ballot initiative planned for November 2006 proposes to make insurance accessible to all California children. At the same time, the federal legislation authorizing Healthy Families must be renewed next year, and little is known about the Bush administration s plans. This graphic summary provides an overview of California s existing children s health insurance programs public and private and where those programs may be headed California HealthCare Foundation 1

3 Major Milestones Affecting Medi-Cal and Healthy Families Coverage 1965 President Johnson signs Medicaid into law on July 30, creating Title XIX of the Social Security Act 1966 Governor Edmund Pat Brown signs Medi-Cal into law, California s version of Medicaid Introduction Federal and state programs for children s coverage have evolved over the years Medi-Cal expands coverage for certain low-income families 1990 Medi-Cal further expands coverage for pregnant women and children 1997 Federal government establishes State Children s Health Insurance Program (S-CHIP) through Title XXI of Social Security Act 1998 California creates: Healthy Families Program under the S-CHIP legislation Joint Medi-Cal/Healthy Families application Enrollment Entities and Certified Application Assistants (CAA) Medi-Cal eliminates face-to-face application for children/families; creates 1999 Single Point of Entry for Medi-Cal and Healthy Families applications Medi-Cal eliminates assets test for children; institutes 12-month continuous 2000 eligibility for children and reduces documentation requirements (SB 87) California launches Health-e-App (Internet-based application) to enroll children in 2001 Medi-Cal and Healthy Families; Medi-Cal eliminates quarterly status reports for families California creates CHDP Gateway to enroll eligible children into Medi-Cal and Healthy Families; community-based outreach and CAA funding eliminated due to the state budget crisis 2003 Notes: Specific program details are explained throughout this document. Other milestones are presented in the timeline on page 3. Sources: California HealthCare Foundation, Medi-Cal Facts and Figures, California HealthCare Foundation, Healthy Families Program Facts and Figures, California HealthCare Foundation 2

4 Other Milestones Affecting Children s Coverage 1973 California creates Child Health and Disability Prevention (CHDP) program 1992 CaliforniaKids (CalKids) Healthcare Foundation launches limited insurance package of primary and preventive services for uninsured children California launches Access for Infants and Mothers (AIM) insurance program Introduction The recent past has seen more public and private efforts to expand children s health insurance coverage Kaiser Permanente launches Child Health Plan Santa Clara County launches first Children s Health Initiative to cover low- to moderate-income children who are ineligible for Medi-Cal and Healthy Families and develops Healthy Kids insurance product 2001 Express Lane Enrollment laws enacted expediting Medi-Cal/Healthy Families 2003 enrollment from School Lunch and Food Stamp program applications Private foundations fund school districts as pilot sites California restores funding in state budget for CAA payments 2005 Eighteen counties have Children s Health Initiatives with Healthy Kids insurance programs offering coverage to uninsured children; 13 additional counties are in various planning stages for such initiatives and seven offer CalKids coverage 2006 Notes: Specific program details are explained throughout this document. Major milestones affecting Medi-Cal and Healthy Families are presented in the timeline on page 2. Sources: California HealthCare Foundation, Medi-Cal Facts and Figures, CaliforniaKids Healthcare Foundation at Kaiser Permanente at California HealthCare Foundation, Healthy Families Program Facts and Figures, Santa Clara Health Plan at California HealthCare Foundation 3

5 Sources of Coverage California Children Under 19 Healthy Families (6%) Uninsured (8%) Private/ Other (7%) Total 10 million Sources Employers are the primary source of insurance for children, but one-third receive coverage through Medi-Cal and Healthy Families. Employer (53%) Medi-Cal (26%) Source: California Health Interview Survey (CHIS), 2003, UCLA Center for Health Policy Research. Note: CPS and CHIS employ different methodologies to estimate the number of uninsured. For a thorough comparison of different methods to estimate the uninsured, please see CHCF s California s Uninsured and Medi-Cal Populations: A Policy Guide to the Estimates at California HealthCare Foundation 4

6 State Comparison of Sources of Coverage for Children PERCENT OF COVERAGE SORTED BY HIGHEST PERCENTAGE OF UNINSURED NUMBER OF UNINSURED CHILDREN Employer Individual Other Coverage Market Medicaid Public Uninsured Texas ,395,090 Florida ,790 California ,324,040 Georgia ,330 New Jersey ,690 Illinois ,310 Pennsylvania ,300 New York ,580 Ohio ,660 Michigan ,000 United States ,037,120 Sources Of the 10 largest states, California has the secondlowest rate of employer coverage and the secondhighest rate of public program enrollment. Notes: While most statistics in this document use data from the UCLA Center for Health Policy Research s California Health Interview Survey (CHIS), 2003, this slide uses source data from the U.S. Current Population Survey (CPS) in order to allow a comparison of California to other states. CPS and CHIS employ different methodologies to estimate the number of uninsured. For a thorough comparison of different methods to estimate the uninsured, please see CHCF s California s Uninsured and Medi-Cal Populations: A Policy Guide to the Estimates at Sources: U.S. Census Bureau, Health Insurance Coverage of Children ages 0 to 18, states ( ), U.S. (2004), Kaiser Family Foundation s California HealthCare Foundation 5

7 Rates of Uninsured Children by State Sources Of all states, California OREGON WASHINGTON MONTANA NORTH DAKOTA MINNESOTA VT NH MAINE ranks ninth highest in the percentage of uninsured IDAHO WYOMING SOUTH DAKOTA WISCONSIN MICHIGAN NEW YORK MASS CONN RI children. CALIFORNIA NEVADA UTAH COLORADO NEBRASKA KANSAS IOWA MISSOURI ILLINOIS INDIANA KENTUCKY OHIO WEST VIRGINIA PENNSYLVANIA DC VIRGINIA NEW JERSEY DELAWARE MARYLAND TENNESSEE NORTH CAROLINA ARIZONA NEW MEXICO OKLAHOMA ARKANSAS SOUTH CAROLINA MISSISSIPPI ALABAMA GEORGIA TEXAS LOUISIANA FLORIDA ALASKA HAWAII < 8% 8% 9 to 12% > 12% Notes: While most statistics in this document use data from the UCLA Center for Health Policy Research s California Health Interview Survey (CHIS), 2003, this slide uses source data from the U.S. Current Population Survey (CPS) in order to allow a comparison of California to other states. CPS and CHIS employ different methodologies to estimate the number of uninsured. For a thorough comparison of different methods to estimate the uninsured, please see CHCF s California s Uninsured and Medi-Cal Populations: A Policy Guide to the Estimates at Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimate based on Census Bureau s March 2004 and 2005 Current Population Survey, Kaiser Family Foundation s California HealthCare Foundation 6

8 Overview of Insurance Programs by Launch Date LAUNCH DATE GEOGRAPHIC COVERAGE PURPOSE ENROLLMENT LEVEL Medi-Cal 1966 Statewide State-federal partnership to cover low-income persons under federal Medicaid program. AIM 1992 Statewide State program to cover mothers and infants who do not qualify for Medi-Cal. As of July 2004, infants born to AIM mothers are enrolled in Healthy Families. Kaiser Permanente Child Health Plan 1998 Selected service areas Not-for-profit program offers limited coverage to children ineligible for other public programs. Enrollment open in selected counties. Not-for-profit health plan subsidizes coverage for children ineligible for other programs due to family income or immigration status. Healthy Families 1998 Statewide State-federal partnership to cover low- to moderate-income children in families under federal S-CHIP program. Healthy Kids 2001 in Santa Clara; dates vary by county CalKids 1992 Countyspecific Countyspecific County-specific plans covering low- and moderate-income children not eligible for Medi-Cal or Healthy Families. 3,481,556 age 20 and under as of October ,241 infants as of April ,529 ages 2 through 18 as of April ,561 under age 19 as of April ,336 under age 19 as of March ,397 under age 19 as of May 2006, with many counties holding waiting lists Program Comparison Medi-Cal is the longest running public insurance program for California children. Sources: California Department of Health Services, Medi-Cal beneficiaries by Zip Code, October 2005, Managed Risk Medical Insurance Board, April 2006 enrollment report, CaliforniaKids Healthcare Foundation, Kaiser Permanente, California HealthCare Foundation 7

9 Administration and Funding of Insurance Programs Medi-Cal AIM ADMINISTRATION California Department of Health Services under federal rules California Managed Risk Medical Insurance Board (MRMIB) under federal rules FUNDING SOURCES Federal government pays 50%, state General Fund, county dollars State General Fund, federal Title XXI funds, state Proposition 99 funds, premiums paid by family CalKids CaliforniaKids Healthcare Foundation Donations from foundations, corporations, non-profit hospitals, First 5 Commissions, premiums paid by family Kaiser Permanente Child Health Plan Kaiser Permanente Kaiser Permanente income, premiums paid by family Healthy Families California MRMIB under federal rules Federal government pays 65%, state General Fund, premiums paid by family Healthy Kids Varies: Health Departments, First 5 Commissions, community-based organizations Varies: First 5 Commissions, public health plans, foundations, non-profit hospitals, tobacco settlement, premiums paid by family, private donations Program Comparison A variety of administrative structures and funding sources are used to support children s health programs. Sources: California Department of Health Services, Medi-Cal beneficiaries by Zip Code, October 2005, Managed Risk Medical Insurance Board, April 2006 enrollment report, CaliforniaKids Healthcare Foundation, Kaiser Permanente, California HealthCare Foundation 8

10 Benefits and Cost Sharing in Insurance Programs BENEFITS OFFERED PREMIUMS PAID BY FAMILY CO-PAYS Medi-Cal Comprehensive None required to receive service AIM Comprehensive 1.5% of household income None CalKids Kaiser Permanente Child Health Plan Primary and preventive care, behavioral and dental health, vision, prescription drugs (no inpatient coverage) Comprehensive None required to receive service $0 to $20 PCPM $5 to $25, varies by service $8 or $15 PCPM for first three children in a family; additional children are free Healthy Families Comprehensive $4 to $15 PCPM Capped at $45 PFPM Healthy Kids Comprehensive $4 to $12 PCPM, varies by county Capped at $12 to $18 PFPM $5 for most services Capped at $250 for one child and $500 for two or more children $5 for some services and $0 for preventive services Capped at $250 PFPY $5 to $15 for most services Program Comparison The majority of children s insurance programs have comprehensive benefits and low cost sharing. Notes: Comprehensive care includes inpatient, outpatient, lab tests, and other care. PFPM: per family per month; PFPY: per family per year; PCPM: per child per month. Sources: Institute for Health Policy Solutions, California, Overview of Local Children s Coverage Expansions, May 9, TableDocument% pdf. Kaiser Permanente: California HealthCare Foundation 9

11 Eligibility Requirements of Insurance Programs for Children Medi-Cal FAMILY INCOME REQUIREMENTS AS PERCENT OF FPL Infants: less than 200% FPL Age 1 to 5: less than 133% FPL Age 6 to 19: less than 100% FPL OTHER MAJOR REQUIREMENTS Residency/citizenship AIM 200% to 300% FPL No other health insurance or deductible over $500, 6 month resident, pregnant, infants of AIM moms can stay in Healthy Families up to 2 years CalKids Kaiser Permanente Child Health Plan Less than 250% FPL (300% FPL in three counties) Less than 300% FPL Ages 2 to 18, not eligible for public insurance Under age 19, not eligible for public insurance, and if there is no employer contribution toward insurance Healthy Families Less than 250% FPL Under age 19, uninsured previous 3 months, ineligible for Medi-Cal, residency/citizenship Healthy Kids Less than 300% FPL (less than 400% FPL in San Mateo County) Under age 19, county resident, currently uninsured, not eligible for public insurance Program Comparison Determining eligibility for children s insurance programs is complex. Notes: Not an exhaustive list of eligibility requirements. Children must be without employer-sponsored coverage to be eligible for each of these programs, with the exception of Medi-Cal. Federal poverty level (FPL) for a family of three is $16,600 in Medi-Cal also provides coverage to others, including seniors and people with disabilities. Seven counties (Del Norte, El Dorado, Humboldt, Imperial, Marin, Mendocino, and Orange) continue to enroll children in CalKids. Sources: Medi-Cal beneficiaries by Zip Code, October Managed Risk Medical Insurance Board, March 2006, April 2006 enrollment report. Managed Risk Medical Insurance Board, January 18, 2006 board minutes, March Institute for Health Policy Solutions, Overview of Local Children s Coverage Expansions, May 9, California HealthCare Foundation 10

12 Income Eligibility for Public Insurance Programs Program Comparison Program eligibility varies Medi-Cal Healthy Families AIM County CHI Programs by a variety of factors, Children < 1 year* Children 1 5 years Children 6 19 years including income. Healthy Kids, CalKids, and Kaiser Permanente Child Health Plan eligibility are all contingent on ineligibility for other public programs. Pregnant Women Children All Ages 0% 50% 100% 150% 200% 250% 300% Federal Poverty Level (FPL) *Infants of AIM mothers eligible for Healthy Families up to 300 percent FPL. San Mateo income eligibility goes to 400 percent FPL. Notes: AIM is Access for Infants and Mothers. Reflects Full-scope Medi-Cal only. FPL for a family of three is $16,600 in Individuals must also meet other eligibility requirements. Medi-Cal provides coverage to others, including seniors and people with disabilities California HealthCare Foundation 11

13 Children s Health Initiatives (CHIs) throughout California Program Comparison CHIs have developed county Del Norte Humboldt Trinity Siskiyou Tehama Shasta Modoc Lassen Plumas Implemented Planned CalKids by county. Eighteen counties offer Healthy Kids coverage, and seven offer CalKids Mendocino Lake Glenn Colusa Butte Yuba Sierra Nevada Placer coverage. Enrollment into Napa Sonoma Sutter El Dorado Yolo Sacramento Amador Alpine Medi-Cal and Healthy Marin San Francisco San Mateo Santa Cruz Solano Calaveras San Contra Joaquin Tuolumne Costa Alameda Stanislaus Mariposa Santa Clara Merced Madera San Benito Monterey Fresno Kings Mono Tulare Inyo Families significantly increases in counties with CHIs. San Luis Obispo Kern San Bernardino Santa Barbara Ventura Los Angeles Orange Riverside San Diego Imperial Sources: Institute for Health Policy Solutions, California, Overview of Local Children s Coverage Expansions, May 9, WebsiteTableDocument% pdf. Gregory Stevens D. et. al. Monitoring the Expansion of Children s Health Initiatives in California, Keck School of Medicine, University of Southern California. May Trenholf C. Expanding Coverage for Children, The Santa Clara County Children s Health Initiative California HealthCare Foundation 12

14 Eligible but Not Enrolled in Public Programs Enrollment The number of uninsured 2001 Total Uninsured: 997, Total Uninsured: 779,000 children decreased by 22 percent between 2001 and 2003 (the last year for which Exceeds Income Limits (16%) Not Eligible Non Citizen without Green Card (18%) Medi-Cal (36%) Eligible Exceeds Income Limits (20%) Not Eligible Non Citizen without Green Card (19%) Medi-Cal (26%) Eligible CHIS data are available), and the number of uninsured who are eligible but not enrolled in Medi-Cal or Healthy Families has fallen Healthy Families (30%) Healthy Families (29%) by 35 percent. County CHI Programs* (6%) *These county programs are funded with both public and private dollars, and are not available statewide. There were seven operational county CHI programs with Healthy Kids insurance products at the time of the 2003 CHIS survey. Sources: E. Richard Brown, et al., The State of Health Insurance in California: Findings from the 2001 California Health Interview Survey, UCLA, E. Richard Brown and Shana Lavarreda, Children s Insurance Coverage Increases as a Result of Public Program Expansion, UCLA, California HealthCare Foundation 13

15 Eligible but Not Enrolled in Public Programs by Region Northern/Sierra Central Coast Sacramento Greater Bay Area San Joaquin Valley Enrollment Los Angeles County and the five other southern counties are home to almost three- Medi-Cal Healthy Families quarters of the children 1% 4% 8% 4% 5% 6% eligible but not enrolled in Medi-Cal, and two-thirds of those eligible for but not Other Southern (40%) 13% Other Southern (37%) 11% enrolled in Healthy Families. 8% Los Angeles (30%) Los Angeles (29%) Notes: Does not reflect eligibility for CHIs. Given small sample sizes, statistical anomalies may exist. The base number for the Medi-Cal eligible is 204,000; for Healthy Families is 225,000. Other Southern includes: Orange, San Diego, San Bernardino, Riverside, Imperial Counties. Sources: California Health Interview Survey, 2003; UCLA Center for Health Policy Research California HealthCare Foundation 14

16 State Program Enrollment Process Enrollment 1. Mail-in Application 2. Internet Health-e-App One-e-App* There are several options for parents to enroll their children in Medi-Cal and New illustration coming in round In-person County eligibility worker Healthy Families. Healthy Families Family should be notified within 10 days of receipt SINGLE POINT OF ENTRY IN SACRAMENTO COUNTY SOCIAL SERVICES Medi-Cal Family should be notified within 45 days of receipt *The Center to Promote HealthCare Access ( was established by the California HealthCare Foundation and The California Endowment to promote the adoption of One-e-App and to manage its implementation and operation throughout California. Notes: For complete applications, the Healthy Families program must make an eligibility determination within 10 days. Incomplete applications are evaluated within set timeframes for follow-up California HealthCare Foundation 15

17 No Wrong Door Approach Enrollment Many counties are building No Wrong Door approaches to enrollment, though the participating Community Clinics Public Health Agencies Hospitals Schools Physician Offices County Clinics organizations and tools may be different from county to county. ENROLLMENT SUPPORT OPTIONS Each organization uses a mix of professionals and tools to assist families with applications, enrollments, and re-enrollments. THE GOAL: No matter which organization a family Certified Application Assisters Call Centers at Enrollment Entities One-e-App Health e-app Outstationed Eligibility Workers Outreach Children s Health Initiative (CHI) chooses, they can enroll all eligible children in coverage. STATE PROGRAMS Healthy Families Medi-Cal LOCAL PROGRAMS Healthy Kids CalKids Kaiser Permanente Child Health Plan Available programs vary by county California HealthCare Foundation 16

18 Local Efforts to Improve Enrollment and Retention Using One-e-App COUNTY PROGRAMS INCLUDED* LOCAL PARTICIPANTS LAUNCH DATE Alameda Fresno Los Angeles San Mateo Santa Clara County Indigent Program, Healthy Families, and Medi-Cal Healthy Kids, Healthy Families, and Medi-Cal for Children and Pregnant Women Child Health and Disability Program (CHDP), Healthy Kids, Healthy Families, and Medi-Cal for Children and Pregnant Women Healthy Kids, Healthy Families, Medi-Cal, San Mateo County Adult Indigent Program (the WELL Program), and San Mateo County discounted health program Healthy Kids, Healthy Families, and Medi-Cal for Children and Pregnant Women Alameda County Social Services, Alameda Health Care Services Agency, and the Alameda Alliance for Health Fresno County Employment and Temporary Assistance, Clovis and Fresno Unified School Districts, numerous community health centers and county-based organizations, Fresno County Office of Education, California Health Collaborative, Health Net, and Fresno Healthy Communities Access Partners L.A. County Department of Health Services, L.A. County Public Social Services, the County s CAO and CIO offices, L.A. Care Health Plan, L.A. Children s Planning Council, and several community-based organizations San Mateo Health Services Agency, San Mateo Human Services Agency, and the Health Plan of San Mateo Santa Clara Family Health Plan and Santa Clara Social Services Department August, 2005 September 2005 November 2006 (planned, first phase of development underway) November 2003 Fall 2004 Enrollment One-e-App is a Web-based system that supports No Wrong Door enrollments with a single application for multiple local and state programs. It electronically transmits enrollment data to the appropriate systems for final eligibility determination. Santa Cruz Healthy Kids, Healthy Families, and Medi-Cal Santa Cruz County Health Services Agency, Central Coast Alliance for Health, and Santa Cruz County Human Resources Agency June 2004 San Joaquin Healthy Kids, Healthy Families, Medi-Cal, the county s Adult Indigent Program (MAP Program), and Child Health and Disability Program (CHDP) First 5 San Joaquin, Health Plan of San Joaquin, San Joaquin County Health Care Services, and San Joaquin County Human Services Agency September 2006 (planned, requirements phase underway) *The Child Health and Disability Program (CHDP) will be available in the fall of Medi-Cal for adults and the county indigent care program (Medi-Cruz) will be available in the fall of California HealthCare Foundation 17

19 Enrollment Trends Enrollment Public Programs 5,000,000 Private Programs 100,000 After a rapid increase between 2000 and 2002, TOTAL (includes private programs) the enrollment rate for 4,000,000 80,000 Healthy Kids children in California s Medi-Cal public insurance programs 3,000,000 60,000 has slowed in recent years. From 2000 to 2005, the 2,000,000 40,000 Kaiser Permanente Child Health Plan number of children enrolled in Medi-Cal, 1,000,000 Healthy Families 20,000 Healthy Families, and AIM has increased by nearly 0 0 CalKids 43 percent Note: All enrollment data are from the end of the calendar year. AIM enrollment is dropping off as the program began enrolling infants born to AIM mothers in Healthy Families in Enrollment figures for AIM are too small to fit on this scale, having fallen from 7,744 in 2000 to 6,499 in Medi-Cal data is for ages 0 to 20. Sources: Medi-Cal beneficiaries by Zip Code, October Managed Risk Medical Insurance Board, December 2005, January 2006 enrollment report. Author correspondence with CaliforniaKids Healthcare Foundation, Kaiser Permanente, individual CHIs, and MRMIB California HealthCare Foundation 18

20 Enrollee Profile: Race and Ethnicity Enrollee Profile Asian (7%) White (non-hispanic) (17%) Black (11%) Medi-Cal Hispanic (65%) Native American/ Alaska Native (<1%) 3% Asian (12%) White (non-hispanic) (13%) Healthy Families Other (12%) Hispanic (61%) Medi-Cal and Healthy Families have similar racial and ethnic distributions. All enrollees are legal residents. Note: Medi-Cal under 18 for the 3,010,148 beneficiaries with a known ethnicity. Healthy Families population under age 19 for the 633,717 beneficiaries with a known ethnicity. Due to data limitations, Medi-Cal only offers child enrollment by race for age under 18. Medi-Cal data does not offer an Other category. Totals may not add to 100 percent due to rounding. Healthy Families and Medi-Cal were selected for this comparison as they are the two largest public health insurance programs in the state. Healthy Kids and CalKids programs do not collect race/ethnicity data in a comparable manner. Sources: Medi-Cal beneficiaries by Zip Code, October Managed Risk Medical Insurance Board, March 2006, April 2006 enrollment report California HealthCare Foundation 19

21 Enrollee Profile: Age Medi-Cal Ages 0 to 20: 3,481,556 Healthy Families Ages 0 to 18: 747,336 Enrollee Profile Medi-Cal has a greater 18 to 20 years (9%) 6 to 17 years (54%) 0 to 5 years (38%) 18 years (3%) 6 to 17 years (71%) 0 to 5 years (25%) portion of child beneficiaries under age six than Healthy Families. CalKids Ages 2 to 18: 10,529 Healthy Kids San Mateo County Ages 0 to 18: 4, to 18 years (44%) 6 to 12 years (46%) 2 to 5 years (10%) 13 to 18 years (37%) 0 to 5 years (17%) 6 to 12 years (47%) Note: Totals may not add to 100 percent due to rounding. Sources: Medi-Cal beneficiaries by Zip Code, October Managed Risk Medical Insurance Board, March 2006, April 2006 Enrollment Report. CalKids enrollment May 2006 from program office. Healthy Kids San Mateo County 2004 enrollment from Howell et al, Evaluation of San Mateo Healthy Kids Initiative: Second Annual Report. August 2005 available at California HealthCare Foundation 20

22 California Children s Services (CCS) Other Public Programs Provides specific medical services and equipment provided by CCS-approved specialists for qualified persons under age 21 who have conditions that are physically disabling or require medical, surgical, or rehabilitation services. Supports those children with family income up to $40,000, or whose out-of-pocket costs for the CCS condition would account for at least 20 percent of annual income, as well as children with Medi-Cal or Healthy Families coverage that have a CCS condition regardless of income eligibility. CCS offers services to children under age 21 with serious conditions and is operated by the Department of Health Services. County CCS staff conduct eligibility determinations that include residency, income, and condition-related requirements. Serves approximately 39,000 children each month. COVERED CONDITIONS INCLUDE: Cancer Diabetes Serious birth defects Injuries due to accidents or violence Sources: 2005 California Children s Services (CCS) Status Report, Managed Risk Medical Insurance Board, January Lasting Returns: Investing in Coverage for California s Children. California Budget Project, February California HealthCare Foundation 21

23 Child Health Disability and Prevention (CHDP) Program CHDP: Provides periodic preventive health services and other care. Is open to children under age 21 with Medi-Cal, as well as any child under age 19 with family income up to 200 percent of the Federal Poverty Level. Other Public Programs The CHDP Gateway is designed to be a vehicle for increasing enrollment in public insurance. Serves approximately 7,500 children each month using state funds. THE CHDP GATEWAY: Allows CHDP providers to electronically and immediately pre-enroll children into temporary Medi-Cal (up to 60 days) for all covered benefits. During the pre-enrollment process, families can elect to receive a joint Medi-Cal/ Healthy Families application in the mail to apply for continuous coverage. Between November 2004 and October 2005, approximately 600,000 children pre-enrolled into temporary Medi-Cal through the CHDP Gateway. Of the these children pre-enrolling, 14 percent successfully enrolled in continuing coverage through Medi-Cal or Healthy Families. The CHDP Gateway also identifies infants under one year old born to mothers on Medi-Cal and automatically enrolls them into Medi-Cal. Source: Lasting Returns: Investing in Coverage for California s Children. California Budget Project, February California HealthCare Foundation 22

24 Major Issues to be Addressed in Children s Coverage ELIGIBLE BUT NOT ENROLLED: Over 400,000 California children are eligible for Medi-Cal or Healthy Families but are not enrolled. U.S. CITIZENSHIP DOCUMENTATION REQUIREMENTS FOR MEDI-CAL: Under a new federal law, the documentation requirements for all those applying to Medi-Cal are significantly more stringent, and may reduce enrollment levels of legal residents. Looking Ahead Significant hurdles remain to covering the 800,000 uninsured children in California. CHI EXPANSION AND FINANCIAL SUSTAINABILITY: Existing CHI counties are estimated to have a funding shortfall as large as $163 million for maintaining operations and fulfilling existing waiting lists, particularly when serving the population of 6 to 18 year olds. NO WRONG DOOR ENROLLMENT AND RE-ENROLLMENT STATEWIDE: While several counties have improved their outreach and streamlined the application process, families in most counties still face confusing bureaucratic hurdles. DECLINING EMPLOYER-SPONSORED COVERAGE: Between 2001 and 2003, children s coverage linked to parental employment declined by nearly 4 percent. Sources: Monitoring the Expansion of Children s Health Initiatives in California. Stevens, Gregory D., et al. Keck School of Medicine, University of Southern California, May E. Richard Brown and Shana Lavarreda, Children s Insurance Coverage Increases as a Result of Public Program Expansion, UCLA, California HealthCare Foundation 23

25 Pending Actions Looking Ahead The following pending actions will impact children s insurance coverage: GOVERNOR S OUTREACH/ENROLLMENT INITIATIVE: To promote outreach, enrollment, and retention of children s health coverage programs, including the county CHIs, the budget calls for $72 million in new spending. Children s coverage policy is constantly evolving. LEGISLATIVE ACTION: Democrats are promising to introduce legislation in the summer of 2006 to expand children s health insurance coverage. SB 437 is under legislative consideration and would streamline operations in Medi-Cal and Healthy Families to help children enroll and stay enrolled. The bill also supports CHIs. FEDERAL MEDICAID REFORM: To limit federal financial liability in Medi-Cal, these changes to federal rules made in 2005 for funding California s safety net hospitals could have a negative impact on health care access for children. S-CHIP REAUTHORIZATION: To continue the S-CHIP program, the federal government must reauthorize the program s legislation, which runs out of allotted funds in September TOBACCO TAX ACT OF 2006: This initiative would raise an estimated $2 billion in annual revenue to support hospitals, health services, and tobacco control. Over $400 million would be made available annually to cover low- to moderate-income children who do not qualify for Medi-Cal and Healthy Families, with most of the operational responsibility for expanded insurance programs going to MRMIB California HealthCare Foundation 24

26 Acknowledgments Much of the information and data for this presentation was provided by Len Finocchio of the California HealthCare Foundation, along with Peter Harbage as assisted by Sarah Arnquist. Harbage, a former assistant secretary with the California Health and Human Services Agency, is an independent consultant based in Sacramento, California. In addition, the following people provided expert reviews: Mike Koch, CalKids Jodi Leslie, Kaiser Permanente Rene Mallow, DHS Bonnie Midura, The California Endowment Patty Mintz, independent consultant Appendix GIVE US YOUR FEEDBACK Was the information provided in this report of value? Are there additional kinds of information or data you would like to see included in future reports of this type? Is there other research in this subject area you would like to see? We would like to know. Click to complete our survey at and enter Report Code #1078. Thank you. Ernesto Sanchez, MRMIB Bobbie Wunsch and Tim Reilly, Pacific Health Consulting Group FOR MORE INFORMATION California HealthCare Foundation 476 9th Street Oakland, CA California HealthCare Foundation 25