So Long, Healthy Families Program

October 24, 2013

Next month, following a 15-year run, the curtain will go down on California’s Healthy Families Program (HFP), which has provided low-cost health, dental, and vision coverage for children in low- and moderate-income families. As part of the 2012-13 state budget deal, lawmakers adopted Governor Brown’s proposal to transfer children enrolled in the HFP to Medi-Cal, California’s largest publicly funded health coverage program for low-income residents. In addition to providing coverage for children transitioning from the HFP, Medi-Cal now covers all newly enrolling children who were previously eligible for Healthy Families, up to 250 percent of the federal poverty line ($48,825 for a family of three in 2013).

The shift of children from Healthy Families to Medi-Cal began this past January 1 — when about 850,000 kids were enrolled in the HFP — and has proceeded in several stages. By the end of September, nearly 730,000 children had been transferred to Medi-Cal, although tens of thousands of children did not make the transition because they lost eligibility for Healthy Families prior to their scheduled transfer date. (Children can be removed from the HFP for a number of reasons, including if their families do not pay monthly premiums or they reach their 19th birthday and “age out” of the program. It’s likely that at least some of these children found — or eventually will find — their way onto Medi-Cal by applying for coverage through their county human services offices.) The final group of children — more than 20,000 — will transfer from Healthy Families to Medi-Cal on November 1.

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Once the transition from Healthy Families is complete, nearly half of all California children will be enrolled in Medi-Cal, according to state estimates. Ultimately, the success of this transition will hinge on whether children in Medi-Cal are able to access the health care services they need. In this regard, state officials have more work to do. For example, many children with autism lost access to critical behavioral health services when they were shifted from Healthy Families to Medi-Cal. Another concern: Doctors, dentists, and other Medi-Cal providers are bracing for — or have already felt the impact of — a 10 percent provider payment cut that the state has begun implementing, although primary care doctors will be largely shielded from this reduction through 2014 due to a provision in the federal Affordable Care Act. It’s too early to tell whether these payment changes will, on balance, have a positive or negative impact — or no impact — on provider participation in Medi-Cal and thus on children’s access to care. State officials should closely monitor the situation in the months ahead to ensure that all of the more than 8 million Californians enrolled in Medi-Cal — children and adults alike — have timely and adequate access to needed care.

— Scott Graves


Why Isn’t Healthy Families Enrollment Higher?

August 6, 2010

Enrollment in the Healthy Families Program (HFP) has dropped by 5.4 percent, or about 50,000 children, since June of last year. The HFP provides access to low-cost health, vision, and dental coverage for children in families with incomes up to 250 percent of the federal poverty line – $45,780 for a family of three. As of June 30, 2010, 871,467 were children enrolled in the program – down from a peak of 922,429 in July 2009.

There are a number of possible reasons for why enrollment in Healthy Families has fallen. First, fewer families are applying for coverage. In 2008-09, the HFP received 316,365 applications. In contrast, in 2009-10, the HFP received 273,427 applications – a drop of 13.6 percent. It is worth noting that in August 2009, the state eliminated payments to individuals certified to help families fill out Healthy Families applications, thereby reducing the incentive for some entities to aggressively recruit and enroll qualified children.

Applications submitted with assistance generally account for around one-quarter of all applications processed. Other budget reductions may also be depressing enrollment. The state imposed a waiting list from July 2009 through September 2009, and since then, enrollment has hovered below 885,000 children.

The recession may also be playing a role by increasing the share of children who no longer qualify for Healthy Families because their family income has dropped. These children become eligible for Medi-Cal. In April 2007, just prior to start of the recession in California, 7.9 percent of children were dropped from Healthy Families because they qualified for Medi-Cal. In April 2010, the most recent month for which data are available, 16.6 percent of children were dropped from Healthy Families because they qualified for Medi-Cal – more than double the rate three years earlier. Finally, between one and two out of five children leaving Healthy Families each month do so because families have failed to pay premiums. Part of the drop in enrollment may reflect a rise in the number of families who cannot afford even the modest cost of coverage through the HFP.

Healthy Families remains an important source of health coverage for children. But like other state programs, it has been a frequent target of budget-saving measures, such as cost-sharing increases that resulted in some children’s premiums increasing by as much as 77 percent. The Governor’s May Revision, which would nearly triple premiums compared to pre-recession levels, would only make it more difficult for families to afford health coverage at a time when families are struggling to make ends meet.

– Hanh Kim Quach

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Vision for Tomorrow

May 28, 2010

Nearly 1 million children would lose coverage for eye screening and eyeglasses under Governor Schwarzenegger’s May Revision, which maintains his January proposal to eliminate vision benefits for children enrolled in the Healthy Families Program, a reduction that budget committees in both houses have so far rejected. This cut would reduce General Fund spending by $7 million – less than one one-hundredth of 1 percent of estimated 2009-10 General Fund spending. But as with many proposed budget cuts, the dollar savings do not take into account the human costs that may exceed the impact on the budget’s bottom line.

Left undetected, vision problems can hinder a child’s ability to reach his or her full potential because inadequate vision interferes with children’s ability to learn. Children with vision problems may experience eye strain, affecting their ability to focus. Vision problems can lead to delayed or slowed reading, which affects reading comprehension or ability to do math. The impact can snowball in the long term. Special attention is required from teachers, therapists, or other school aides to keep children with disabilities from falling behind in school. The additional help increases school spending – not just for special education classes, where students have access to specialized teachers and resources, and for before- and after-school services, but also for visually impaired students who are in regular classes with students who do not have vision problems. Nationally, visually impaired or blind students required an average of $2,422 in additional spending in the regular classroom environment in 1999-2000, according to a report prepared for the US Department of Education.

Research has shown that approximately 2 percent of children entering first grade and approximately 15 percent of adolescents entering high school are nearsighted. Detected early, eyeglasses or surgery can help improve children’s vision. Experts say children should have their vision screened at ages six months and 3 years and upon entry into school. But for lower-income families, paying for even one screening before a child enters school may be too costly. This is especially troubling because research shows that children from families with incomes below the poverty line are nearly twice as likely to be visually impaired as children in higher-income families.

As we strive, as a state and nation, to improve students’ performance in school, it is important to remember that encouraging children to excel requires an investment in the basics – their vision.

— Hanh Kim Quach

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On the Docket: Health and More Health

May 25, 2010

Two more important budget hearings are coming up.

Tomorrow (Wednesday) at 9:30 a.m. in Room 4203, the full Senate Budget and Fiscal Review Committee will take up the Governor’s proposed reductions to mental health, the Healthy Families Program, and Medi-Cal.

On Thursday at 9:00 a.m. in Room 4202, Assembly Budget Subcommittee #1 on Health and Human Services will be hearing and closing out all health-related issues. Most of the issues will be “vote only.” Topics to be discussed include proposed cuts to Medi-Cal, Healthy Families co-pays and premium increases, and cuts to mental health.

For more information on these proposals, see our summary of the Governor’s May Revision proposals.

As always, you can follow these hearings through The California Channel or the Senate and Assembly websites.

— Lisa Gardiner

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On the Docket: The Toll Cuts Have Taken

March 23, 2010

Mark your calendars; here’s one not to be missed. Tomorrow at 1:30 in room 4202 at the State Capitol, Assembly Budget Subcommittee #1 will have a hearing titled, “Toll on Californians of Adopted and Proposed Health and Human Services Cuts.” The hearing will examine the impact of last year’s health and human services cuts on Californians, as well as the toll of the Governor’s proposed 2010-11 budget cuts.

There will be no public testimony, although the committee will take written comments. The Governor’s administration, its department directors and staff, as well as the Legislative Analyst’s Office, are expected to testify.

If you’re not in Sacramento, you can follow audio of the hearing from the Assembly website. It might also be televised on The California Channel.

You can, of course, find a multitude of CBP work on these issues. Our recent fact sheets document the impact of the Governor’s proposed cuts to CalWORKs by county and legislative district; to SSI/SSP by county and legislative district; and to the Healthy Families Program by county and legislative district.

Last year, the CBP also examined the impact of cuts to the safety net.

— Lisa Gardiner

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