The Children's Agenda for California
Defining the goals of
The Children's Movement
Goal 7:
Providing every California child with affordable health coverage and access to quality care.
Specific policy components to consider:
- Maximizing the number of eligible children enrolled in state health insurance programs.
At least 700,000 of the roughly 1.5 million uninsured California children are currently eligible for existing Medi-Cal or Healthy Families coverage. California should lead the national challenge recently issued by the Obama administration to enroll all eligible children in health insurance. To meet this challenge, the state needs to focus on:
» Streamlining the eligibility and enrollment system for children. The state needs to expand and improve the entry points to applying for coverage by continuing to pursue a “no wrong door” system and developing a single application for all available coverage options. The state could achieve this by capitalizing on new opportunities in the federal Affordable Care Act (ACA) and directing state agencies and the new California Health Exchange to develop eligibility and enrollment standards across all programs.
» Aligning eligibility levels for children in Medi-Cal so that all of the children in a family are in the same program. California should align eligibility levels at 133% of the federal poverty level (FPL) for all children ages one to 19. Currently, children ages one to five are eligible for Medi-Cal if their families earn up to 133% of the FPL, while their older siblings, ages six to 19, are only eligible up to 100% of the FPL. The ACA requires that Medi-Cal eligibility be simplified by 2014 to include all children and adults up to 133% of the FPL.
» Reducing "churn" in health coverage programs by making it easier for children to stay covered. Keeping children covered continuously would reduce state administrative waste and improve children’s access to uninterrupted health care. California should follow Louisiana’s example of automating a large portion of coverage renewals.
» Supporting efforts by local programs, providers and community-based organizations (CBOs) to educate families about new coverage opportunities under the federal law and connect children to coverage. Leading up to and after 2014, there is a need to inform families and connect them to the new coverage options available to them through the ACA. California should leverage federal “navigator” and outreach grants to support CBO efforts in this regard, giving strong, experienced organizations a preferential role. Strengthening local programs and safety-net providers will help ensure that all California children, even those not covered under the new federal law, will be able to access critical health services. - Prioritizing funding for existing children’s health coverage programs, vis-à-vis other state budget items, accounting for increased need during the economic downturn.
The state needs to prioritize the funding of public health insurance programs to fully cover the increased demand for them in the down economy. This should be done by providing stable, ongoing General Fund dollars. Recent cuts in funding have led to enrollment in Healthy Families dropping by over 50,000. - Expanding access to pediatric care providers, including supporting the development of new pediatric care delivery models.
California needs to ensure an adequate supply of pediatric care providers for children. A first step is to identify the highest-need areas and review provider reimbursement rates. In addition, the ACA provides an opportunity for California to develop new pediatric accountable care organizations as an innovative way to deliver coordinated care to more children. The state should apply for a federal demonstration grant and strategize with pediatric providers and other stakeholders about how to develop a successful model. - Increasing access to preventive screenings and services.
California should leverage federal dollars from the ACA’s prevention and public health fund to increase the availability of preventive services. In addition, the state should educate the public about the ACA provision that allows for no-cost preventive services. - Improving the delivery of mental health services to children.
To help fight the growing and costly epidemic of poor mental health, the state should demand improvements in the delivery, coordination with primary care networks and providers, and follow-up of mental health services provided by the health plans that contract with Healthy Families. The state should work expeditiously with counties to effectively leverage newly available funds generated by the Mental Health Services Act of 2004 and emphasize early intervention programs. - Preserving vision services for children so they can read and learn.
Providing vision screenings and eyeglasses to low-income children is often threatened by budget cuts, but is vital to ensuring children can see, read and learn. The state should strengthen children’s vision care by ensuring that Healthy Families coverage preserves vision benefits and that school health screenings include vision screenings. - Increasing the percentage of children who receive evidence-based immunizations.
Immunization rates fell in California from 2008 to 2009. The state should bolster its immunization programs, including developing an outreach campaign to educate and inform parents about the importance and availability of immunizations and screenings. The state also should apply for grants available through the ACA to improve immunization rates and support community public health. - Reducing infant mortality rates, especially for African Americans.
In addition to supporting existing programs like Access for Infants and Mothers (AIM), the state should re-establish programs that have been cut recently, such as the Black Infant Health Program. While the overall infant mortality rate in California (5.2 deaths per 1,000 live births) is lower than the national average (6.8 deaths per 1,000 live births), the state’s African American infant mortality rate is more than double the average, at 12.4 deaths per 1,000 live births.
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