When the breadwinner of a Hmong family in Merced, Calif., lost his employer-sponsored health insurance coverage when he got laid off from his job last year, he didn’t think to find a public insurance program for his 5-year-old son.
So when his son got sick a few months later and had to be taken to hospital, the family had to turn to the boy’s grandparents to pick up the treatment costs.
The father believed that public health insurance programs were not as good as private ones, a commonly held belief among many members of the Hmong community, noted Palee Moua, director of cultural services at Healthy House in Merced.
Many immigrant families have an innate distrust of children’s public health care programs, or a lack of understanding of how to enroll in them, she said.
“Some families are scared; some are confused,” observed Odella Recio, health program specialist with Cover the Kids, a direct service organization in Sacramento. Recio spoke during a Feb. 27 legislative briefing in Sacramento organized by the Greenlining Institute that focused on the implementation of health care reform in California’s diverse communities.
This fear and confusion have resulted in at least 404,000 of the state’s eligible children not taking advantage of Medi-Cal or Healthy Families, two of the better known health insurance programs in the state for low-income children under 19, according to a recent UCLA study that analyzed data gathered by the California Health Interview Survey. According to another survey, this one based on an Urban Institute analysis of American Community Survey, the number of uninsured children who are eligible for coverage could be as high as 695,0000.
Whatever the number, “two out of three children in California are eligible for public health insurance programs but not enrolled in them,” observed Mike Odeh, health policy associate with the non-profit, Children Now.
Medi-Cal is California’s health care program for the state’s low-income children – adults can enroll in it too — while Healthy Families is the state’s health program for children whose parents earn too much to qualify for Medi-Cal but don’t make enough to afford private coverage.
Of the children eligible for Medi-Cal or Healthy Families, 285,000, or 70.6 percent, are Latino, while 65,000, or 16.1 percent, are white, according to the UCLA study. Figures are not available in the study for African American and Asian American and Pacific Islanders.
Almost 60 percent of Latino children are not eligible for either program, the UCLA study shows.
Half of those children who are currently not enrolled in either Medi-Cal or Healthy Families once were, said Jessica Rothaar of PICO California (People Improving Communities through Organizing), a faith-based, grassroots advocacy organization.
“The focus and emphasis historically has been on enrollment,” said Cover the Kids executive director Kelly Bennett-Wofford. “It’s easier to get a funder interested in enrollment. The retention work is not as well funded.”
There are two myths that keep parents who are undocumented, or who are waiting to get permanent residency, from enrolling their children in public health programs, according to health care advocates. The first is that parents believe they would have to reveal their own immigration status on the application form.
The second myth is the fear that by making their children “public charges,” the parents are jeopardizing their own pathway to citizenship.
“There is an incredible lack of knowledge among parents on coverage options,” asserted Suzie Shupe, executive director of California Coverage & Health Initiatives, which works to help children in California get access to quality, affordable health insurance.
Another reason for low enrollment is that many parents mistakenly think their child’s health insurance card doesn’t have an expiration date. In fact, for a child to stay on Medi-Cal or Healthy Families, parents have to renew enrollment every year.
“Medi-Cal is a complex program, and there are a lot of questions to be answered,” Shupe said, noting that the process can be “extremely intimidating,” especially for those with language barriers.
In 2003, as a cost-cutting measure, Gov. Gray Davis eliminated funding for California’s Certified Application Assistors (CAA) program that had been launched in 1998. The program, provided by trained community members, assured that outreach was local, in-person and linguistically appropriate and culturally sensitive.
The funding was reinstated in 2005, but was eliminated again by Gov. Arnold Schwarzenegger in 2009.
“Obviously, it was not a state priority,” Shupe said.
Now, “most of the services like outreach are not reimbursable, so there’s not much incentive,” Oscar Gomez, chief executive officer of Health Outreach Partners, said at the Sacramento briefing.
“Getting that funding reinstated” is crucial to bringing the enrollment figures up in Medi-Cal and Healthy Families, Shupe said.
When the Affordable Care Act (ACA) is fully implemented in 2014, she added, the application process in public health care programs will be simplified, and Health Benefit Exchanges will have to generate revenue to hire “navigators” to help people get health insurance.
Meanwhile, despite lack of financial assistance from the state, organizations such as Cover the Kids continue to help enroll kids and – the real challenge — keep them enrolled.
For more information about Healthy Kids and Medi-Cal, call 1-877-KIDS-NOW (543-7669). People can also apply online at www.healtheapp.net.