Cutting off kids for Christmas?

Wednesday, November 19th, 2008

* Could California close doors to coverage at time children need it most?
* Over 900,000 kids now on program; Coverage for over 160,000 children at stake
* Advocates make the care against waitlist; Decision pending for June board meeting

Click for What’s New on the Health Access WeBlog: Daschle at HHS!; Open (Enrollment) Season; Keeping Obama’s Promise(s); Senators Step Up for Health Reform; Health Wonk Review; Response to the Baucus Plan; A Health Access Homecoming…

Last Reminder: Health Access’ 20th Anniversary Forum & Reception with Sen. Steinberg, Assemblyman Jones, and an All-Star Panel:Thurs, November 20th, 2pm-6pm, Sacramento Convention Center.

Advocates and enrolled families flocked to the Managed Risk Medical Insurance Board (MRMIB) meeting today in Sacramento (it was literally “standing room only”) to give testimony to the Board in support of California’s State Children’s Health Insurance Program. The health insurance program covers children of working families of modest means who do not qualify for Medicaid, known as Medi-Cal in California . The MRMIB board believes they must decide whether to impose a freeze on enrollment to California ’s program, known as Healthy Families, in response to the state’s budget shortfall and uncertain federal funding.

Although the board did not take a vote on imposition of a freeze at their meeting today, they are planning to render their decision at December’s board meeting. The Board is considering placing eligible children on a waiting list for up to six months, or possibly even longer until the financial picture in the state and federal funding commitment is clearer. This contemplated action is particularly unfortunate because it coincides with increased enrollment to Healthy Families of approximately 27,125 children each month and reaching a milestone with its highest enrollment ever, exceeding 900,000 children. In fact, California has the highest enrollment in the nation; more children are enrolled in California ’s Healthy Families Program than the second, third, and fourth states combined.

Unfortunately, the worsening financial situation nationally and the state’s budget problems make the continuation of enrollment in Healthy Families essential for families during any economic downturn. Families are facing the loss of jobs and health insurance, increased out-of-pocket health insurance costs, and many families face loss of their homes and retirement savings due to mortgage and credit difficulties. Consequently, they should not also face a freeze on enrollment in Healthy Families during this same period of time.

In addition, President George Bush twice vetoed the extension of the State Children’s Health Insurance program nationally, despite strong bi-partisan support in the U.S. House and Senate. However, President-elect Obama and the new Congress indicate that they would support re-authorization of the S-CHIP program nationally early in the new administration.

Every single speaker at the MRMIB Board hearing today urged the board to explore other alternatives, and to delay any freeze in Healthy Families enrollment and impose it if necessary only as the very last resort. Many argued that the harm to the program could be irrevocable because of the gap in health insurance coverage has real health consequences for children.

Also, the confusion surrounding off-and-on-again enrollment in the program does not convey the stability and accessibility of treatment for chronic conditions such as asthma, diabetes, and obesity. One community clinic advocate described how Florida never returned to their previous enrollment level attained before freezing enrollment because of the uncertainty it created for families even after lifting their waiting list requirement.

The most compelling testimony at the Board Meeting by far came from families enrolled in Healthy Families. They spoke about the impact the program had had on the lives of their children and the piece of mind it gave them to have a stable health resource and access to diagnostic tests and specialty care.

Advocates, providers, associations, and families all implored the Board not to take this action at all or at least not prematurely Here is a sampling:

* Cliff Sarkin, representing the Children’s Defense Fund, PICO, and the 100% Campaign, spoke on behalf of California ’s children and many children’s organizations. He emphasized the importance of maintaining a strong safety net like Healthy Families during a period of an economic downturn. He urged the Board to explore other scenarios and not to let California become the only state to establish a waiting list.

* David Ford from the California Medical Association argued that the Board should explore other options during the remaining month before they feel they have to make a decision. He predicted that families without health insurance coverage would either go without care until their health status worsened or would go to emergency rooms (either of which are more costly alternatives.)

* Leona Butler representing the Local Health Plans of California urged the Board to explore unconventional funding sources such as the possibility of using First Five funding to cover costs for Healthy Family enrollees up to age 5 to defer some costs. She also said that the Healthy Family providers she represents might even be willing to take a 5% cut in reimbursement to avoid the cap on enrollment.

* Bonnie Ferreira from the Children’s Health Care Initiative also counseled about the negative spillover effect and confusion that the waiting lists would have on this and other public health programs.

* Dr. Richard Penn, representing The Academy of Pediatrics, testified that many families would not seek care without health coverage and we would lose any of the gains we have made in health status by taking advantage of opportunities for preventative care.

* Al Hernandez from Latino Coalition for a Healthy California also emphasized the huge impact this program has for the largest ethnic group of enrollees, Hispanic children.

* Elizabeth Abbott from Health Access stressed the importance of the higher federal funding match rate for Healthy Families—which should make this the very last program that should be frozen. She also highlighted the efforts in the U.S. Congress to temporarily increase the federal matching share payments to the states and the hopeful signs that there would be a stimulus package that would provide some additional money to fill the state funding gap. These actions at the federal level might make freezing enrollment unnecessary, delay the implementation of a freeze, or cause any cap on enrollment to be in effect for a shorter period of time.

It is anticipated that the board will vote on this at their next board meeting on December 17, 2008 in Sacramento .

ACTION: Please contact your state Assemblymember and state Senator and urge them to support finding money in the state budget to fund Healthy Families, one of the most successful health programs for children in the nation. We cannot think of decision less in keeping with the holidays to freeze enrollment for Healthy Families in December.

For more information, contact the author of this article, Elizabeth Abbott, at

Health Access California promotes quality, affordable health care for all Californians.
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