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

This second case study of the Los Angeles Healthy Kids program analyzes the status of the maturing initiative and delves into some of the complex challenges it faces. While funding for younger enrollees age 0 to 5 remains stable, funding for children age 6 through 18 ran short in spring 2005, forcing the program to cap enrollment of older children. State health reform efforts that could have stabilized premium support for the program have failed. Beyond financing, Healthy Kids has also faced challenges related to some chronic problems in the systems of care into which the program was introduced.

This policy brief highlights the key findings from a case study based on indepth interviews conducted with more than 40 stakeholders during a week-long site visit to Los Angeles. Key informants represented 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. Background and

Prior Evaluation Findings

The Los Angeles Healthy Kids program was designed to provide health insurance to all children in the county, regardless of immigration status, living in families with incomes below 300 percent of the federal poverty level and ineligible for Medi-Cal or Healthy Families. In July 2003, the program was implemented to cover children age birth through 5; it was expanded in May 2004 to cover children age 6 through 18. Healthy Kids has achieved a great deal in its first four years. The program has provided hands-on outreach, application assistance, and support to families throughout the county, and it has extended comprehensive and affordable health coverage to more than 40,000 very poor, very vulnerable children, most of whom are immigrants. Further, according to newly released survey results, Healthy Kids has demonstrably improved children’s access to and use of care, reduced parents’ concerns about obtaining care for their children, reduced unmet need for virtually all types of services, and improved the health status of enrolled children. Since the “enrollment hold” was implemented for children age 6 through 18 in June 2005, the program has remained essentially closed for these children, and enrollment levels for all children have slipped.

Healthy Kids has achieved a great deal in its first four years. The program has provided hands-on outreach, application assistance, and support to families throughout the county, and it has extended comprehensive and affordable health coverage to more than 40,000 very poor, very vulnerable children, most of whom are immigrants. Further, according to newly released survey results, Healthy Kids has demonstrably improved children’s access to and use of care, reduced parents’ concerns about obtaining care for their children, reduced unmet need for virtually all types of services, and improved the health status of enrolled children.

Since the “enrollment hold” was implemented for children age 6 through 18 in June 2005, the program has remained essentially closed for these children, and enrollment levels for all children have slipped.

(End of excerpt. The entire brief is available in PDF format.)

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