Publications on "State Children s Health Insurance Program"

In budget policy, myths are progress's number one enemy. One silly fiction now making the rounds is that we don't know how to judge the relative value of different types of health care, so we can't control health care costs-at least not for now. Like many myths, this one contains an element of truth-there is a lot we don't know. So what? It's still a myth that we know too little to act.

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 new analysis conducted for the Kaiser Family Foundation's Commission on Medicaid and the Uninsured examines the implications of a downturn for health coverage and state programs. The authors estimate that a one percentage point increase in the national unemployment rate would increase Medicaid and SCHIP enrollment by 1 million and cause the number of uninsured to grow by 1.1 million. The analysis documents how federal fiscal relief during the last economic downturn of 2003-2004 helped to stabilize Medicaid eligibility and let states avoid deeper budget cuts. The authors also consider alternative approaches to targeted federal fiscal stimulus.

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.