How Far Can the Healthy Kids Program Go in Closing Coverage Gaps for Children in Los Angeles County?

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Abstract

One in every ten children in Los Angeles County lacked health insurance coverage in 2002/2003. This brief uses L.A. County Health Survey data to assess how these children could be reached. Findings suggest that the Healthy Kids Program and L.A.'s Children's Health Initiative have the potential to substantially reduce uninsurance rates for L.A.'s children without eroding private coverage. A renewed push to enroll more children in public health programs could also reduce the uninsurance rate variations — especially with respect to citizenship status.

Introduction

According to the Los Angeles County Health Survey, one in every ten children in Los Angeles County — about 270,000 children — lacked health insurance coverage in 2002/2003 (LA Health Department of Health Services 2004). Concerns about the access problems experienced by these uninsured children and the concentration of coverage problems among undocumented children (Jhawar et al. 2004) led to the launch of the Healthy Kids program in Los Angeles County in July 2003. The Healthy Kids program was designed to cover low-income uninsured children who do not qualify for Medi-Cal or Healthy Families — i.e, undocumented children with family incomes below 300 percent of the federal policy level (FPL) and citizen and documented children with family incomes between 250 and 300 percent of the FPL. It extended coverage to uninsured children ages 5 years or younger in July 2003 and to children ages 6 to 18 ten months later in May 2004. In June 2005, however, a moratorium was placed on new enrollment in the older age category due to funding shortfalls.1 Along with the Healthy Kids program, Los Angeles County invested in new outreach and enrollment assistance efforts through a broader Children's Health Insurance Initiative (CHI) aimed at increasing participation among uninsured children who were already eligible for coverage under the existing Medi-Cal and Healthy Families programs in the state.

It has been three years since the launch of the Healthy Kids program. In that time, enrollment in the new program has grown to 42,600 (“Los Angeles Healthy Kids Evaluation, Semi-Annual Process Monitoring Report: Third and Fourth Quarters 2005” 2006). While no definitive information is available, it appears that the outreach component of Healthy Kids may be leading to higher enrollment in other programs, since 80 percent of the applications completed by outreach workers are for children who appear to be eligible for Medi-Cal or Healthy Families.

This brief uses the L.A. County Health Survey (LACHS) to examine coverage patterns in 2002/2003 prior to the roll out of the Healthy Kids Program, and to assess what would be required to dramatically reduce uninsurance among children in L.A. County. Subsequent issue briefs will examine the 2005 LACHS data to quantify the extent to which the Healthy Kids program and the broader Children's Health Initiative have begun to reduce uninsurance among Los Angeles County children. In this brief, we use the LACHS to assess how uninsured rates varied across different subgroups of children in the county, whether there appeared to be particular groups of uninsured children who appeared harder to enroll in the Medi-Cal/Healthy Families programs, which enrollment barriers limited participation in public programs, how these efforts might reduce the number of uninsured children in the county and the extent to which they may substitute for employer-sponsored coverage.

This analysis is part of the Healthy Kids Program Evaluation, a four-year effort directed by The Urban Institute, which is supported by First 5 LA and The California Endowment. The evaluation has multiple components, including case studies, focus groups and a longitudinal survey of enrollees. Read the studies already published as part of the evaluation.

(End of excerpt. The complete report is available in PDF format.)

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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