On Friday May 13, 2016, the state Department of Health Care Services (DHCS) notified the Department of Finance that all systems are go to implement SB 75 (Medi-Cal for All Children) today.
The Medi-Cal for All Children Expansion means that low-income undocumented children will, for the first time, be eligible for full-scope Medi-Cal. Approximately 185,000 newly eligible children who do not have satisfactory immigration status will now be able to enroll in comprehensive coverage, including preventive services, specialty health and mental health services, and dental and vision care. Read more on the details of the expansion and transition of eligible children here.
Today’s milestone is the culmination of decades of state and local efforts to ensure coverage for all California children as the timeline at the bottom of this post illustrates.
California first began to emphasize covering children by allocating revenues from Proposition 99, the Cigarette and Tobacco Products Surtax ballot initiative of 1988, to a new program for middle-income pregnant women and their children not eligible for other coverage, the Access for Infants and Mothers Program (AIM).
Local and state leaders continued to move the needle on children’s coverage by implementing the landmark federal State Children’s Health Insurance Program (S-CHIP), creating the Healthy Families Program in California. California communities stepped forward starting in 2001 with the first county-based Children’s Health Initiative (CHI) to provide coverage for children regardless of immigration status. By 2007, there were 25 CHIs operating in 30 counties.
California’s commitment to cover children continued, despite setbacks when the state faced a dramatic fiscal crisis starting with the 2007 recession. During the lean years, families faced waiting lists, benefit reductions and increased out-of-pocket costs. Policymakers ultimately avoided further declines by passing the Medi-Cal managed care tax in 2009. With implementation of the Affordable Care Act, California expanded and simplified eligibility for children.
All these efforts have had an impact. Among all income levels, the percent of uninsured children in California declined from 10.3% in 2001 to 4.5% by 2014 (California Health Interview Survey). Among low-income children under 200% of the Federal Poverty Level (FPL), the rate declined from 13.4% in 1995 to 7.4% in 2012. An additional 45 million children enrolled in Medi-Cal between 2004 and 2013. Click here to see more on these stats.
The Next Challenge
The State, counties, health plans, providers, advocates and community-based organizations have been gearing up for the transition of undocumented children to Medi-Cal. It remains to be seen how successful and smooth the transition will be.
DHCS is planning to track specific indicators of the transition process but it will take vigilance and the same focus that brought California to this historic moment to ensure children have access to the care they need and deserve. ITUP will continue to reach out to its advisors and stakeholders to capture the experiences in the field as California adds nearly 200,000 children to Medi-Cal. ITUP will check in with local communities during our regional work groups in the fall. It is critical to consistently and regularly evaluate the impacts on the system as Medi-Cal continues to grow and expand to cover nearly 14 million Californians.
In addition, as remains true for the overall implementation of health reform, enrollment in coverage is just one step on the path to ensuring families have access to the health care resources needed to preserve and improve health.
Families must have access to health care services in their communities through an adequate supply of providers in all categories. Services must be timely and accessible regardless of the physical, cultural or language barriers children and families face. Services must be affordable at the point of care. We must collectively ensure that families do not encounter financial, language, literacy or cultural barriers to using the services and getting the care they need. Children and families should receive services that are appropriate for the individual and the community they live in. Services must be coordinated and integrated to meet the complexity of individual and family needs.
There is no doubt that we collectively have a lot of work to do in delivering on the promise of coverage, especially for disenfranchised children and families.
That said, putting in place the programs and systems to enroll all children in coverage is a long-awaited and essential step that we can all celebrate! Congratulations to all those who persisted in helping to realize the vision of coverage for all California children!
This blog post was co-authored by Lyndsey Nolan.