Fifteen years after it was created, the state program that provides health insurance to 880,000 children from low-income working families fell victim to the state’s budget crisis.

Lawmakers on Wednesday voted to eliminate the Healthy Families program, sending the bill to Gov. Jerry Brown, who was expected to sign it Wednesday night.

Now the state hopes to move all of those children into the Medi-Cal program instead, with Yolo County being one of the first counties to make the transition.

“We’re pretty nervous about it,” said Katie Villegas, executive director of the Yolo County Children’s Alliance, which oversees outreach and enrollment in both Healthy Families and Medi-Cal.

“We’re not really sure how it’s going to play out,” she said, “but it’s going to be a big change for our families.”

Currently, 4,331 children in Yolo County are enrolled in Healthy Families, Villegas said.

The program was created in 1997 to provide health insurance to children whose families earn too much to qualify for Medi-Cal, but too little to pay for private health insurance.

The program provides medical, dental and vision care to children whose parents earn up to 250 percent of the federal poverty level, or about $46,000 a year for a family of three. Families are given private insurance and pay premiums and co-pays on a sliding scale based on income.

Medi-Cal, on the other hand, serves adults and children living at or below the poverty level and families are not required to pay any premiums for their coverage.

Under federal health care reform, 200,000 children in the Healthy Families program — those whose families earn up to 133 percent of the federal poverty level — were scheduled to be moved into Medi-Cal in January 2014.

Now Medi-Cal’s income guidelines will be raised further and all Healthy Families children will begin moving over in 2013, with Yolo County among the handful of counties to make the transition first, Villegas said, because the program here is a geographic managed health care plan and those programs will lead the way.

“It will be a big impact for Yolo County,” she said, adding that, “we don’t have the staff to process those changes.”

The state expects to save millions of dollars through the move since reimbursement rates for Medi-Cal are lower than the state now pays doctors and managed health care plans for Healthy Families.

But opponents of the move note that many doctors currently treating children in the Healthy Families program don’t accept Medi-Cal patients, which could leave those children without access to care.

That’s the fear in Yolo County, said Villegas, where “clients have a hard time finding a doctor who will accept Medi-Cal.”

Increasing the number of children in that situation, she noted, just “adds another barrier for families to get health care.”

Others agree.

James Hay, president of the California Medical Association, said the move will be “devastating for the some 900,000 children and teenagers throughout California who depend on (Healthy Families) for medical care.”

“(It) will undoubtedly ensure that those kids now have a harder time getting access to care,” Hay added.

Suzie Shupe, executive director of California Coverage & Health Initiatives, called the move “reckless.”

“Shifting children out of a popular, successful program, with no guarantee that they’ll have access to health providers, is an unprecedented and reckless experiment with the health of our children,” Shupe said. “The shift will also have a disproportionate impact on Latino children, who make up nearly half of Healthy Families children.”

Children’s advocates were joined by Republicans in the Legislature in opposing the elimination of the program. Democrats had initially resisted the move during budget negotiations with Brown, but agreed to the program’s elimination late last week.

During floor debate in the state Senate on Wednesday, Sen. Darrell Steinberg, D-Sacramento, told critics, “I don’t love this proposal but it’s not as bad as many of you are making it out to be.”

Healthy Families, he said, will not go away until every child is transferred and has a provider.

“The issue of provider access is very real and we have to watch this implementation like hawks,” he added.

Sen. Lois Wolk, D-Davis, joined 20 other Senate Democrats in voting for the plan — the bare minimum required for passage. Her colleague in the state Assembly, Mariko Yamada, D-Davis, also voted in favor of the proposal.

“No one is pleased with the elimination of Healthy Families, a privately based health care program that serves nearly 1 million California children in a cost-effective manner,” Yamada said after the vote. “However, unlike the elimination of the adult day health care benefit last year, Healthy Family patients will be moved over to an existing network of service through California’s Medi-Cal system, moving us closer to a single-payer structure. Without the hope of new revenue for our state, this shift is painful but necessary to ensure continuity of care for hard-working California families.”

Both Wolk and Yamada, noted Villegas, are great friends of the Yolo County Children’s Alliance and have long worked on behalf of low-income families and children, “but their hands are tied… the state is in a fiscal crisis and trying to save money any way they can.

“I don’t know that it will save money,” she added. “Yeah, there will be fewer people (in the system), but is that really what we want?

“Healthy Families is a low-cost health insurance program that has worked incredibly well for low-income wage-earners,” she said. “We’re very sad to see this program go away.”

The good news in Yolo County is that under the Children’s Alliance, a centralized system is already in place to help with the transitions.

Still, said Villegas, “We’re preparing for a big mess.

“I think our families are in for a rude awakening.”

— Reach Anne Ternus-Bellamy at [email protected] or (530) 747-8051. Follow her on Twitter at @ATernusBellamy.

Comments

comments