Action Alliance for Children is no longer creating new content for Children's Advocate and Defensor de los Niños.
We encourage the continued use and distribution of the magazine and online articles archive.
Permissions guidelines: Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Public License.

Kids Move from Healthy Families to Medi-Cal

February 27, 2013
By
Original Author: Jessine Foss

DSCN1541

Don't panic! Children are still going to be covered.

Kelly Hardy

Director of Health Policy

100% Campaign

California eliminated its low-cost health insurance program, Healthy Families. An estimated 875,000 children are being shifted from Healthy Families to Medi-Cal.

“Don’t panic! Children are still going to be covered” by health insurance, said Kelly Hardy, director of health policy for the 100% Campaign, a collaboration of children’s advocacy organizations.

However, some families will need to find a new doctor or dentist because their current provider does not accept Medi-Cal—a challenge in areas with a shortage of Medi-Cal providers. Advocates, health providers and state officials are reaching out to inform parents about the transition. As families go through this transition, many parents have questions.

Maria Lopez in Yolo County worries about whether her children will receive the same quality of care. Can the family find a new doctor who speaks their native language? Will they still pay premiums?

Community organizations answer questions

If families have questions about the transition, they should contact their health plan or community organizations (see resources).

When Lopez did not understand the letters her family received, she asked Dalila Martinez to explain the process. Martinez is a Yolo County Children’s Alliance (YCCA) certified application assistant (CAA) who helped the Lopez family enroll in Healthy Families. CAAs are certified by California to help families enroll in state and county health insurance programs.

Organizations like YCCA are helping to get the word out to families about the Healthy Families transition.

“We’re already seeing a lot of confusion as kids start,” said Maria Romero-Mora, program coordinator for YCCA’s Community Health Initiative. In October, YCCA provided information about the changes in multiple languages at health fairs across Yolo County.

YCCA is working with community clinics and the health department to inform families, particularly if children have chronic conditions. Nonprofit health center Clinica Sierra Vista is also hearing from families and training their CAAs to answer questions.

“We want to make sure families don’t get lost,” said Ana Velasquez, the primary contact for Healthy Families at Clinica Sierra Vista, which serves Kern, Fresno and Inyo counties.

The 100% Campaign is working with the state to increase outreach to communities of color. The majority of families receiving Healthy Families are Latino, many of whom are monolingual Spanish-speaking or enrolled with the help of a community organization.

Children will receive same quality of care

Many children will see few changes—and even some benefits—from the transition.

“Children transferring to Medi-Cal will receive the same quality of care,” said Norman Williams, deputy director of public affairs for the California Department of Health Care Services.

Children will have health, dental and vision coverage through Medi-Cal. They will also have more comprehensive mental health services and better access to immunizations than they did under Healthy Families. In addition, children will have access to health programs not covered by Healthy Families. These include non-emergency medical transportation, 24-hour shift nursing and the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program. EPSDT aims to minimize children’s health problems by providing early screening and treatment.

Many parents will see positive changes after the transition. Families will no longer have to pay premiums if they make under 150% of the federal poverty level ($28,635 for a family of three). If families make a higher income, then they may pay monthly premiums of $13 for each child, up to a maximum of $39 for all children in a family. They will also find it easier to enroll children, by applying at county offices, by mail or online.

Are there enough providers?

A key concern is whether there will be enough Medi-Cal providers—doctors but also dentists. Some doctors are unable to accept Medi-Cal because they receive lower reimbursement rates. The state has cut reimbursement rates repeatedly in past years. In many rural areas, as well as high-density urban areas, there is already a shortage of Medi-Cal providers.

The Lopez family will need to find a new doctor because their Healthy Families provider, Kaiser Permanente, does not accept Medi-Cal. Lopez is concerned because most of her children have had the same doctor since birth. Also, few doctors speak the family’s native language.

Families looking for new doctors and dentists who accept Medi-Cal, can check with their new health plan for a list of providers. They can also contact their county medical society.

However, state officials believe the transition will not reduce children’s access to health care.

“The goal is to ensure children are able to stay in the same plan and see the same provider,” Williams said. “90% of health plans contract with both (Healthy Families and Medi-Cal), so children will continue to receive the same high level of access to quality primary and specialty care.”

The state is also reaching out to encourage additional health care providers, including Kaiser Permanente, to begin serving Medi-Cal families. These providers would benefit from higher reimbursement rates in 2013 and 2014, thanks to the Patient Protection and Affordable Care Act. The federal law, also known as Obamacare, aims to provide access to health care for the uninsured and decrease the cost of it.

Advocates are calling on the state to make sure all children have timely access to care.

“We are pushing the state to strengthen access to services and slow down the transition if necessary,” Hardy said.

State sends transition letters

The state is sending out letters with information in multiple languages about children’s transition from Healthy Families to Medi-Cal.

Families should pay attention to the letters. These provide important details about what parents should do during the transition and any changes in children’s health plans. The letters also answer questions about premiums as well as dental, vision and mental health services. Parents should also watch for a beneficiary identification card and a new health plan card, sent separately.

Currently, children are eligible for Healthy Families or Medi-Cal if they live in families that make roughly $46,000 per year (for a family of three) and are U.S. citizens who live in California. The state is expected to save about $70 million annually starting in 2014-2015 when the transition from Healthy Families to Medi-Cal is fully implemented, according to the Legislative Analyst’s Office, a nonpartisan fiscal analyst.