Sustaining Universal Children's Coverage: Growing Pains for the Los Angeles Healthy Kids Program

We assess the ongoing implementation of the Los Angeles Healthy Kids Program, which is designed to extend comprehensive health insurance to children in families with incomes below 300 percent of poverty who are ineligible for Medi-Cal and Healthy Families. The study identifies both the program's successes in reaching, enrolling, and caring for children, as well as the challenges it has faced in securing stable financing.

Conducted as part of a four-year evaluation, this paper presents findings from the project's second round case study and focus groups, synthesizing information from over 50 interviews with county stakeholders and 10 focus groups with parents of child enrollees.

We find that, by many measures, Healthy Kids continues to be a significant success. The program enjoys the strong support of County officials, philanthropies, and the non-profit L.A. Care Health Plan. A diverse group of community-based organizations conducts intensive, culturally-appropriate outreach and assists families in applying for coverage. Focus groups with parents reveal that the program's application and renewal processes are easy, that benefits are comprehensive, that copayments are largely affordable, and that the managed care network is extending good access to care. Household survey results confirm that Healthy Kids enrollment is 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. Yet the program's ability to continue serving children is in jeopardy due to insufficient funding. In June 2005, enrollment for children ages 6-18 was frozen, and total program enrollment has since stagnated at roughly 42,000 children. Furthermore, enrollment among children ages 0-5 has also dipped, as outreach has been hampered in promoting a program that cannot serve children of all ages in low-income families. Despite strong advocacy efforts, proposed legislation that would have provided statewide funding has failed to be put into law. Hopes have recently risen, however, as Governor Schwarzenegger unveiled in January 2007 a proposal to extend health insurance to all Californians, including children, regardless of their immigration status.

We conclude that a SCHIP-like program, free of “public charge” stigma, utilizing hands-on community-based outreach and providing broad benefits through a culturally-appropriate provider network, can succeed in improving coverage and access for low-income and undocumented children. In the absence of stable and ongoing federal and state funding, however, the ability of such a local-level initiative to sustain its success is questionable.