Growing Pains for the Los Angeles Healthy Kids Program

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Abstract

The Los Angeles Healthy Kids program, during its first four years, extended comprehensive, affordable coverage to over 40,000 poor and vulnerable children, and improved their access to and use of care. Yet, the program also faced serious challenges, primarily related to financing. Funding for children ages 6 through 18 ran short in spring 2005 and Healthy Kids capped their enrollment. State health reform efforts that could have stabilized funding for the program have failed. Based on interviews with over 40 stakeholders, this case study analyzes the complex challenges that the Los Angeles Healthy Kids program faces at this critical juncture.

Introduction

As the Los Angeles Healthy Kids program reached its fourth birthday, it could boast of many early successes. After a year of implementation, the program expanded from its original scope of covering children ages zero to five, to include older children ages 6 to 18. By its second anniversary, aggressive outreach efforts had resulted in the enrollment of nearly 45,000 children into coverage. A case study of program implementation found that Healthy Kids was carefully designed to meet the needs of vulnerable children in Los Angeles County, and that it was nurtured during its early development though the ongoing collaborative efforts of the Children’s Health Initiative of Greater Los Angeles (the CHI Coalition) and, in particular, the leadership of First 5 LA, the LA Care Health Plan (LA Care), the Los Angeles County Department of Health Services (DHS), and The California Endowment (Hill, Courtot, and Wada 2005). In a series of focus groups, parents with children enrolled in Healthy Kids expressed strong praise for the program, saying that the benefits covered the services their children needed, that access to care was good, that cost sharing was affordable, and that the coverage gave them a strong sense of security and peace of mind (Hill et al. 2006). Finally, a household survey of a representative sample of parents confirmed that Healthy Kids enrollment was associated with both improved access to usual sources of health and dental care, and improved confidence among parents that they can meet their children’s health care needs without financial hardship (Dubay and Howell 2006; Howell et al. 2006).

Yet four years in, the program has also been beset by serious challenges, mostly related to financing. Specifically, while funding for younger children ages 0 to 5 remains stable, resources for older children began to run short as early as the spring of 2005. By June of that year, Healthy Kids was forced to impose an “enrollment hold” for 6 to 18 year-olds and maintained a waiting list of prospective enrollees until the end of March 2006 (at which point the list was also closed). Meanwhile, even as enrollment leveled off and then dropped for these older children, it also dipped for the 0 to 5 group, as the outreach network struggled to market a program that could only serve a subset of younger children. The last year also witnessed increased public attention on issues of illegal immigration, both nationally and in Los Angeles, and residents of LA County staged one of the largest demonstrations of solidarity for immigrant rights in the nation during the spring of 2006. But stakeholders wondered whether this visibility might adversely affect enrollment in Healthy Kids, by driving the primarily undocumented immigrant families it serves underground.

At this critical juncture, the Los Angeles Healthy Kids Program Evaluation continues to monitor the implementation of Healthy Kids and assess its impacts on the target population and systems of care for children. This second case study report was developed under a four-year contract between First 5 LA and the Urban Institute. The Institute and its partners—the University of Southern California (USC), the University of California at Los Angeles (UCLA), Mathematica Policy Research, Inc., and Castillo & Associates—are conducting a broad range of evaluation activities over the course of the project, including case studies of implementation, focus groups with parents, a longitudinal household survey, and ongoing process monitoring of outreach, enrollment, retention, and utilization measures.

This report is based on information gathered during a week-long site visit to Los Angeles conducted in November 2006. During the site visit, evaluators met with over 40 key informants representing First 5 LA staff, policymakers, public and private providers, county public health officials, health plan administrators, dentists and dental plan officials, child and family advocates, health policy researchers, and community-based outreach workers. (See Appendix A for a complete list of all site visit informants.) All interviews were conducted using structured protocols by evaluation team members from the Urban Institute, USC, and UCLA.

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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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