Citation URL: http://www.urban.org/LouisePalmer

In early 2003 San Mateo County, California launched the Children's Health Initiative (CHI), to ensure that all children have access to comprehensive health insurance coverage. Healthy Kids covers uninsured children below 400 percent of poverty and primarily serves poor, undocumented Latino children. A survey of parents of Healthy Kids enrollees found that in the first year of enrollment, children experienced improvements in access to and use of medical and dental care; a reduction in missed school days due to health problems; reduced unmet need; increased parent confidence in getting care and satisfaction with quality; and reduced financial worries. Moreover, use of preventive and dental services continued to improve during the children's second and third years of continuous enrollment.

A large number of California counties have taken bold steps to extend health insurance to all poor and near-poor children through county-based Children's Health Initiatives. The Los Angeles Healthy Kids program extends coverage to uninsured children in families with incomes below 300 percent of the federal poverty level who are ineligible for Medi-Cal (California Medicaid) and Healthy Families (its SCHIP). A four-year evaluation of Healthy Kids finds the program has improved access for more than 40,000 children, most of whom are immigrant Latinos, who have almost no access to employer coverage. However, sustaining this program has proved to be challenging.

A longitudinal survey of parents of enrollees in the Los Angeles Healthy Kids Program has found that the program had significant positive impacts on children’s health and access to care. Children experienced improvements in access to and use of ambulatory, specialty and dental care; reduced unmet need; increased parent confidence in getting care and satisfaction with quality; and reduced financial worries. Most important, children’s health status improved, as perceived by parents and according to several measures. Healthy Kids covers uninsured children below 300 percent of poverty who are ineligible for Medicaid or SCHIP, and primarily serves poor, undocumented Latino children.

This brief presents data on mental health coverage benefits and enrollees' access to and use of mental health services through the Healthy Kids program in San Mateo County, California. The prevalence of mental health conditions among enrollees is similar to national levels, but despite the generous mental health benefits offered under the program, only a small fraction of enrollees with mental health conditions receive care. Reasons why more children do not use mental health services are explored. The brief also shows that enrollees with mental health needs have higher use of other health services compared to all Healthy Kids members.

Even though most low income children in the U.S. are entitled to public health insurance, many children are still uninsured. One reason for this problem is that when insurance expires (after, for example, one year of enrollment) parents may fail to re-enroll their child. This report examines rates of renewal in three public health insurance programs in San Mateo County, California: Healthy Families, Healthy Kids, and Medi-Cal. Renewal rates were low in all three programs; only about 50 percent of children renewed coverage after a year. The report provides recommendations regarding improving monitoring systems for tracking retention over time.

This report summarizes the findings from a survey of parents of Healthy Kids enrollees aged 1 to 5 in Los Angeles County. The Los Angeles Healthy Kids program was implemented in July 2003 and provides insurance coverage to low income, uninsured children, who are ineligible for Medi-Cal or Healthy Families. This report is one of a series evaluating the Healthy Kids program in L.A. and analyses the demographic characteristics of enrolled children, their health status, health care access and use experiences, parental impressions of the enrollment and renewal processes, among other topics. One year from now, a second survey report will provide results from the longitudinal follow-up with the same parents and will assess the impact of the Healthy Kids program in L.A.

In early 2003 San Mateo County, California launched the Children's Health Initiative (CHI), to ensure that all children have access to comprehensive health insurance coverage. This third annual CHI evaluation report describes the demographic and health status characteristics of children enrolled in three public health insurance programs served by the CHI; how service use has changed over time; characteristics of high cost users of services and how they differ from other children; access to dental services and mental health services; the role of schools in outreach and enrollment; and the factors influencing employer decisions to offer insurance for dependents.

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