Healthy Families Provides Health Insurance for California's Children
California’s version of CHIP is called the Healthy Families Program (HFP). Children up to age 19 are offered health, dental and vision coverage if their family earns more than Med-Cal allows, yet cannot afford private insurance premiums. For a family of four, for example, they could earn up to $4,954 per month and qualify for HFP. Premiums for income levels from 150 to 200 percent of federal poverty guidelines (family of four earning $2,758 to $3,675 per month) cost $13 per child each month with a community provider or $16 per month if the parent opts for HFP thru a private insurer like Blue Cross, Blue Shield or Kaiser. The maximum premium per family is capped at $39 monthly with the community option or $48 per month with the private insurer in that income bracket. Each county offers a variety of plans. Currently, more than 900,000 children are enrolled in the program statewide.
Effect of State Fiscal Crisis
With California’s budget in tatters Healthy Families Program has become a target – even though two-thirds of its cost is paid for by the Federal government. As the budget deficit deepened last year, there were calls to reduce or even eliminate HFP and eventually $124 million was trimmed from the program. The Managed Risk Medical Insurance Board (MRMIB) that administers HFP in California closed enrollment from July to September 2009. In fact, the Board was preparing to disenroll children from the program, leaving them uninsured.
In addition, 50,000 applications for 93,000 children were put on hold until funding was reestablished when the California’s First Five Commission contributed $80 million to keep the program going. (The Commission was established in 1998 by Prop 10. The initiative instituted a 50 cents/pack tax on cigarettes designating the funds to help pre-kindergarten children.)
AB 1422, an insurance industry tax on policies (voluntarily agreed to by the insurance companies), contributed additional funding, so HFP eligibility was maintained for families making up to 250 percent of federal poverty guidelines and unfreezing enrollment for those on wait lists by December 2009. These two funding sources were temporary measures for HFP’s viability.
Individual Premiums
Monthly premiums for parents increased in November 2009, by $4 per child or a max of $12 per family earning 150 up to 200 percent of federal poverty guidelines. Families earning from 200 to 250 percent of the federal poverty standard saw premiums increase $7 per child or a max of $21 per family each month. Proposals for 2010/2011 budget seek to almost double monthly premiums. A parent paying $16 monthly per child could see that increase to $30 and a family max of $48 monthly could become $90.
Families are now eligible to participate in the Healthy Families Program if their monthly income is up to 250 percent of the federal poverty guidelines. There have been proposals to totally eliminate HFP for over 900,000 California children, but a more likely option is to make the program available for families 200 percent of federal poverty limits. This would reduce budget expenditure by $10.5 million this year and $63.9 million in 2010-11 -- but 200,000 to 300,000 children would join the ranks of the uninsured. Another revision would be to eliminate vision benefits in July 2010, for a $21.7 million 2010/2011 budget reduction.
Constant Changes Cause Confusion
With continuous changes in Healthy Families Program, it is hard for parents to understand eligibility requirements. Like a new regulation enacted in November 2009 that restrict dental coverage for children not in HFP for two consecutive years. Currently, there are 180,000 children eligible for HFP, but they are not enrolled. A UCLA Center for Health Policy Research study found 25 percent of the eligible families did not know about the program and another 20 percent thought they were not eligible. To secure long term funding for HFP and stabilize eligibility requirements would make the program more accessible.
Overall, 8 million Californian’s are uninsured and 1.5 million are children. The state’s uninsured population has increased 28 percent since 2007. As one or both parents lose their job and family health benefits, it means more children are becoming eligible for the Healthy Families Program, but funding is not available even though early medical care will result in long-term costs savings.
The unmet needs of childhood illness and asthma, for instance, can turn into chronic life time illness and limit their educational opportunities and future employment. Illness that could be treated in a doctor’s office instead of an emergency room provides lower patient costs and continuity of care, if the children have affordable insurance and can access a local physician. Mental health issues addressed and treated in adolescence could prevent chronic psychological problems persisting into adulthood.
Poverty impacts one in five children in our state and counties. In Fresno, for instance, more than 37 percent of children live in poverty. The Healthy Families Program is a viable health care option for California’s children that helps battle poverty in the state and provides for the care of vulnerable children.