Coverage for Almost Every California Child

Coverage for Almost Every California Child


On May 1, California children can be eligible for Medi-Cal regardless of their immigration status. The income threshold is 266% of the federal poverty level ($53,626 for a family of three or $75,650 for a family of five). California joins four other states and Washington DC. We are nearly at universal coverage for every California child.

The projections are that 175,000 of the estimated 250,000 eligible children will enroll.

This is the culmination of 15 years of efforts, based initially in local health plans in Santa Clara, Alameda and San Diego and generated by local advocates, such as Working Partnerships. San Mateo, San Francisco and Los Angeles started a year or two years later. A great deal of credit is due to the very earliest pioneers: Leona Butler of Santa Clara Family Health Plan, Irene Ibarra of Alameda Alliance and Joel Diringer of The California Endowment. Senator Ricardo Lara (SB 4) completed the journey with landmark legislation (SB 75 and SB4) signed by Governor Brown in the summer of 2015.

In Los Angeles, the LA Care Health Plan, the Los Angeles First Five Commission, The California Endowment and the Los Angeles County Department of Health Services convened and led the local effort. Within a very short time after its launch, nearly 45,000 Los Angeles children had enrolled – clear demonstration of how much immigrant families valued coverage for their children. Some of the key findings from program evaluations were that there was enormous satisfaction with dental and vision coverage enabling children to do better at school where they could see the blackboard and their teeth were not in constant pain. Program costs were far less than for traditional coverage, reflecting the effective use of primary care and prevention and the vital roles of the local community clinics. Enrollment was easy with a short two-page application form, and families were very loyal to the program – turnover rates were very low.

On May 1, about 120,000 children on restricted scope Medi-Cal will be automatically eligible for full scope coverage. They will need to pick a local health plan and select their own primary care doctor. About 13,000 children in local Healthy Kids programs will be eligible, but they must first apply to Medi-Cal through their local county social services offices. About 73,000 children in Kaiser Permanente Child Health Programs will be eligible, they need to apply for Medi-Cal as well. There may be some enrollment overlap with local efforts and restricted scope Medi-Cal (also known as emergency Medi-Cal.

Some families will be concerned about the potential impacts on their immigration status as they live in the shadows with fears of deportation. Their information is private and will not be shared with the Department of Homeland Security or the Immigration and Naturalization Service.

Some families will be confused about how managed care works. This is confusing to many newly enrolled English speaking US citizens as well. Hopefully the plans, the providers, the promatoras and advocates will play a special role in explaining the program to the newly insured.

Some families will be concerned about maintaining continuity of care with their child’s existing family doctor. It will be vitally important to guide families on how to keep their doctor in their new Medi-Cal managed care program.

All of us should work to assure that all the newly eligible children have prompt and reliable access to a family doctor and good information in the right languages about how Medi-Cal managed care works.

What children will remain uninsured in California? 1) Those whose parents don’t hear about this new coverage. 2) Those whose family incomes exceed 266% of federal poverty level, but cannot afford the premiums in the Covered California program. 3) Those whose families fear or do not believe in public programs. The numbers will be very small. Congratulations and thanks to all who have worked so hard and so long to make this a reality.

Prepared by: Lucien Wulsin

Dated: April 29, 2016

Henry Stern in Senate District 27

Lucien’s Farewell to ITUP