A Profile of Young Children in the Los Angeles Healthy Kids Program

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EXECUTIVE SUMMARY

The Healthy Kids program of Los Angeles County provides insurance coverage to low income children who do not have access to other health insurance. This report is one of a series of reports being produced under the Healthy Kids program evaluation, which is designed to provide feedback to stakeholders on the progress of the initiative. First 5 L.A. contracts with The Urban Institute and its partners to conduct the evaluation.

The report provides an analysis of data from a survey—conducted by Mathematica Policy Research for the evaluation—of the parents of Healthy Kids children ages 1 to 5. The key findings from the analysis of the survey are as follows:
Most Healthy Kids enrollees are age 3 to 5 and are in two-parent, Latino working families.

• Most of Healthy Kids parents have been in the U.S. for some time.
• The majority of Healthy Kids families are very poor, with relatively low parental educational attainment.
• Most parents are Spanish speaking, suggesting a high need for culturally- and linguistically-appropriate services. Despite this general pattern, there is diversity among Healthy Kids, which should be taken into account when planning for the best way to target services. For example, it is possible that different Healthy Kids outreach approaches could succeed at enrolling increased numbers of certain types of children, such as more younger children or higher income children.
• While most Healthy Kids are in good health, a substantial proportion are not, according to several different measures. Special attention should be paid to health access for these vulnerable children, because of their fragile health status.
• Consistent with findings from the evaluation case study and focus groups, parents reported very positive experiences about the outreach, enrollment, and renewal processes for Healthy Kids.
• Healthy Kids is not substituting for employer-sponsored health insurance to any great degree, since few Healthy Kids enrollees have access to private insurance coverage.
• Emergency Medi-Cal plays an important role in providing financial access to health services for uninsured young children in Los Angeles County, and a large number of Healthy Kids enrollees retain Emergency Medi-Cal coverage after enrolling.
• Access to care for Healthy Kids enrollees is very good for many services, particularly preventive and primary care services, and the use of preventive care is high compared to national benchmarks. Almost all Healthy Kids enrollees have a usual source of care, and the location of the usual source of care was usually close to the child's home.
• Unmet need was very low for care for urgent health problems.
• Healthy Kids provides critical access to immunizations, and four and five year olds are still being caught up on their immunizations under the program. This shows that Healthy Kids has a public health effect broader than its own program's beneficiaries.
• In contrast to preventive care, the use of specialty services is lower than national benchmarks for SCHIP enrollees, and unmet need for specialty services is relatively high. Consistent with this finding, unmet need in general was higher for children with health problems.
• In spite of this generally positive picture of access to care, some parents had difficulty getting after-hours advice for health problems, when Healthy Kids parents needed to reach a doctor after the clinic was closed. In addition, a large share of parents who reported unmet need said that the main reason that they did not obtain care was that the clinic or doctors office was not open during times that were convenient.
• In spite of the generous coverage and low cost sharing under Healthy Kids, almost 30 percent of Healthy Kids enrollees reported that obtaining needed health care for their child was creating a financial burden for the families. Understanding the origin of these financial problems requires further study.
• Only about two-thirds of parents reported having a usual source of dental care for their child, which is much lower than for medical care. One major barrier is a lack of parent awareness about the importance of needing routine preventive dental care early in life, suggesting the need for more parent education. Further expanding the Healthy Kids network of dental providers will also help to provide adequate access to dental care to all enrollees.
• Parents reported relatively high rates of developmental screening for their young children under Healthy Kids, when compared to national benchmarks.
• However, relatively few parents reported being asked about, or receiving specific information about, their own concerns, particularly ones that require more time to discuss thoroughly and more cultural sensitivity during communication (e.g., child behavior and parent/child communication issues). This frequent lack of effective communication between health providers and parents, while consistent with national patterns, is an area where the Healthy Kids program could focus more effort.
• Consistent with the data collected in evaluation focus groups with parents, most parents are very satisfied with the quality of care in the Healthy Kids program. Still, some parents expressed their need for more time with their child's provider and for better communication around the child and family's needs.

One year from now a second survey report will provide results from the longitudinal follow-up with the same parents who provided the data reported here. This analysis will provide an assessment of the impact of the Healthy Kids program on a range of indicators such as access to care, use of services, developmental status, and health status. Until that time, we hope that this interim client survey analysis, while showing important accomplishments of the program to date, will also provide useful information for improving Healthy Kids as the program grows and develops.

Note: This report is available in its entirety in the Portable Document Format (PDF).

The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

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