State’s Budget Cuts Jeopardize Children’s Healthcare Program

Healthy Families California from New America Media on Vimeo. SAN FRANCISCO -- Last November, Michelle Mandujano was dreading her son’s upcoming 6th birthday.

On that day, she was warned by state health care officials, her child Anthony, stricken with asthma since he was an infant, would “age out” of the Medi-Cal program he and his mother had been on since 2005.

“I freaked out when I heard that that was the cutoff age,” the 32-year-old, Hispanic single mom said. “Luckily, they also told me about the Healthy Families program.”

Nearly one million children and teens in California depend on Healthy Families, a federal-state partnership for working poor families. The program was launched in 1998 for parents who earn too much to receive MediCal coverage but who are priced out of the private insurance industry.

Healthy Families is the name under which California operates the federal Children’s Health Insurance Program (CHIP) created by Congress in 1997 for low-income families.

For every $1 a state spends on the program, the federal government puts in $2. Of the roughly $1.1 billion dollars spent on the Healthy Families program annually, $225 million comes out of California’s budget.

In the budget proposal unveiled Jan. 8, Governor Arnold Schwarzenegger has threatened to pull the plug on the Healthy Families program entirely if he does not receive $6.9 billion in new federal funds he says the state is owed. The governor said getting that money would be the only way the state could keep many programs alive, including Healthy Families.

“It’s a reckless move,” asserted Kelly Hardy, associate director of health with Children Now, a California-wide program that aims at ensuring that children’s issues are a top public policy priority. “He’s turning back the $800 million the state gets from the federal government to fund Healthy Families.”

Under the proposed national health care legislation Democratic leaders hope to pass this year, it appears that there is no place for CHIP within the framework of comprehensive health care reform.

The House bill would eliminate the program by the end of 2013, forcing millions of kids whose parents make incomes below 400 percent of poverty –- or $88,000 for a family of four -– to either transition to Medicaid or shift into private plans contained on a proposed health insurance marketplace, dubbed the exchange.

The Senate bill on the other hand continues CHIP through 2019, but does not include authorization of funding beyond 2013. As it stands now, the program expires Oct. 1, 2013.

The Senate bill, too, has the exchange provision, and children whose parents make less than 150 percent of the poverty level will move into Medicaid.

Both bills require the Health and Human Services Department to provide Congress with a cost and benefit analysis of CHIP plans versus those on the exchange by 2011.

Lawmakers want “to ensure that the exchange will be as good before they transition,” noted Hardy.

In her current job with the Salvation Army in San Francisco, Mandujano’s $1,300-a-month salary is just enough to take care of her car payment, the one room she rents in the Excelsior District, food and utility bills.

She cannot afford to put Anthony on her employer-sponsored health insurance program, she maintains, even though she realizes how risky it is to keep him uninsured.

“He has already been hospitalized twice for his asthma,” said Mandujano. “What if he has to go to the hospital again?”

The program has been a lifeline for families like Mandujano’s, which is why there was widespread panic earlier last year when Gov. Schwarzenegger and lawmakers, facing a severe budget crisis, put it on the chopping block.

But a last minute reprieve in September, thanks to a concerted push by some Democrats -– Assembly Speaker Karen Bass of Los Angeles, Senate President pro Tem Darrel Steinberg of Sacramento and Chairman of the Assembly Health Committee Dave Jones among them -– saved it from elimination.

“It’s the sole source of health care coverage for low- and moderate-income families,” said Jones. “That’s why the legislature felt it should be saved.”

Shared contributions from the State First 5 Commission, which will contribute $82 million to cover the state’s share of premiums for children 5 years and younger, premium increases from $4 to $7 per child per month, and increases in co-payments for emergency room visits and brand name drugs, have kept the program alive until December 2010.

“We found a bipartisan way to keep the Healthy Families program alive, without adding a new burden to the state’s general fund,” Steinberg said, noting that the state could “not afford to kick vulnerable children off of health care.”

Leslie Cummings, executive director of the state’s Managed Risk Medical Insurance Board (MRMIB), which runs the program, said that in mid-July, the state’s budgetary distress forced her agency to close enrollment, resulting in placing nearly 93,000 children on a waiting list within two months.

“We had to make those adjustments,” Cummings maintained.

If you look at the home where Emily To, her mechanic husband and two children –- Kyle, 11, and Chloe, nine months -– live in Alameda, Calif., you will not think they need any government handouts. But actually they do, and the pretty two-story home in a cul-de-sac is actually To’s parents’ home.
“We’re staying with them because we can’t afford to live on our own,” said To, 36. Her husband’s gross annual salary is $30,000.

When she first enrolled Kyle in Healthy Families five years ago, To was paying a monthly premium of $4. But that has gone up each year. She is currently paying $26 for each child. In addition, she has a co-payment of $10 for each hospital visit, twice what she was paying until the state budget was passed.

Kyle requires expensive inhalers and other medications to keep his asthma in check. He needs regular counseling for his attention deficit hyperactivity disorder.

A few months ago, the clinic she had been taking her son to all these years told her they could no longer provide him counseling sessions because they no longer get reimbursed for them by Healthy Families. If she wanted counseling for Kyle, she would have to pay with cash.

And when she took her son for a tooth extraction, the dentist told her the Healthy Families’ plan doesn’t cover general anesthesia. That would mean an out-of-pocket expense of $800.

“That’s a lot of money for us,” To said. “Still, having Healthy Families is better than not having any insurance.”

Called for a comment, MRMIB’s Cummings asserted that the Healthy Families program includes mental and dental health services for its clients and that there must have been some “miscommunication” between To and her health care providers.

Darlene Thomas, who works as a maintenance assistant for the city of Pasadena’s Public Works Operations Department, makes just a little over $10 an hour. Her three youngest children – ages 8, 7 and 5 -- are enrolled in Healthy Families. Her husband cannot work because of a disability, she said.

Because families earning less that 150 percent of the federal poverty level don’t have to pay premiums or co-payments, Healthy Families is working out well for Thomas. Just having her three children on the program makes her feel “secure,” said the 40-year-old African American woman.

“Knowing that they have somewhere they’ll be taken care of makes me feel good,” Thomas said. “We never know what health issues come up.”

The high number of layoffs California has seen since the onset of the recession two years ago has made hundreds of thousands of families turn to state-subsidized health care programs. Enrollment in Healthy Families has averaged around 27,000 a month during the past year, but enrollment figures “have been fairly constant in the last few years,” insisted MRMIB’s Ernesto Sanchez, deputy director for eligibility.

Children Now’s Hardy speculates that many low-income families don’t even know they are eligible. She said there are some 225,000 eligible children who are not enrolled.

“The state is not opening all the doors and doing enough outreach,” Hardy asserted, noting that the situation could worsen because California has cut outreach funding by $20 million from its budget.
Fabiola Magdaleno, a resident of Orange County, said she didn’t know her children qualified for Healthy Families even when her husband, Gilbert, was employed full-time.

Gilbert was laid off from his $30,000-a-year job last January. He and his family didn’t qualify for Medi-Cal because they had too many assets: a retirement account and two cars. And he couldn’t draw unemployment because he still had a part-time job.

Their youngest daughter, Eva, now 3 ½ years old, was born with craniosynostosis, a congenital condition in which the sutures of the skull close too early. Children afflicted with that condition require a series of surgeries. Three of them were done while Eva, her older sister and mother were on Gilbert’s employer-sponsored health plan.

“We were paying $400 a month for the three of us to be on his plan,” Magdaleno said. “Somehow, we managed to make those payments.”

When her husband was laid off, Magdaleno worried about how she would be able to pay for the surgeries Eva still needed, until one day she received a call from Children’s Health Initiative (CHI), a non-profit dedicated to providing California’s children access to health care. Before long, Magdaleno’s children were on the Healthy Families program.

Concerned about the financial future of California, last September Assembly member Jones succeeded in getting the legislature to pass a bill that would draw about $2.3 billion in federal funds to support the state’s health care programs, including Healthy Families.

AB 1383, which has the governor’s approval, requires California hospitals to pay a provider fee for each Medi-Cal admission, and could generate more than $2 billion a year. That amount would be eligible for enhanced federal matching funds. California’s Healthy Families would stand to receive as much as $320 million annually.

“The beauty of my bill is there is no share from the state,” Jones said, noting that while his legislation has a shelf life of three fiscal years, “we’re looking to place an initiative on the ballot to make permanent the hospital provider fee.”

California is still awaiting approval of the legislation from the federal government. But in the meantime, people like Magdaleno are thinking short term. They worry whether cash-strapped California will be able to continue to financially support the Healthy Families program next year. Even if national health care reform goes through, it will take at least four years before it is implemented.

“My daughter has a pre-existing condition, and she is considered uninsurable,” Magdaleno said. “We would be devastated if we couldn’t get health coverage for her.

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