Working with Child Care Programs to Reach Uninsured California Children

Nearly one million California children were uninsured at some point in the past year. The good news is that at least two-thirds of uninsured children qualify for existing health insurance programs—such as Healthy Families and Medi-Cal and, in some counties, local insurance programs.* The challenge is connecting uninsured children with these available insurance programs. Many families don't think their children are eligible for health insurance or don't know how to enroll them. Finding these children, enrolling them in health insurance, and keeping them enrolled is key to their health, school readiness, and ability to grow into healthy adults.

One promising strategy for reaching uninsured children and their parents is through child care programs. Approximately 170,000 children in child care did not have health insurance at some point in the last year, and most are from low- and moderate- income families and would likely qualify for Healthy Families, Medi-Cal or a county program (where available). By developing partnerships between the health care and child care communities, we can make great strides in insuring every California child.

This fact sheet provides an overview of the child care and health care systems in California, and a summary of strategies for insuring more children in child care.

Child Care in California
Child care in California is a complex web of public and private programs, with differing eligibility rules, payment mechanisms, target populations, program settings and service offerings. Some children participate in organized programs, others are cared for by individual caregivers in their home, some families receive publicly-funded subsidies, others do not. Yet despite this complexity, there are many surprisingly simple ways to increase health insurance enrollment among children in child care. Government-subsidized child care programs, in particular, are a promising place to enroll children because they have income eligibility rules similar to those in publicly-funded health insurance programs.

Potential partners in the effort to enroll children in health insurance include:

• Child care providers and provider organizations
• Government agencies that administer child care programs
• The state contractors that distribute subsidies to child care providers chosen by parents (Alternative Payment Programs or APPs)
• Child Care Resource and Referral agencies (R&Rs)
• Child care health consultants, who participate in county programs to promote health and safety in child care settings
• Local Child Care Planning Councils, who assist in assessing and planning for local child care needs
• Newly developed computerized child care waiting lists (Centralized Eligibility Lists or CELs)
• Organizations sponsoring food programs for low income children in child care (Child and Adult Care Food Programs or CACFPs)

Medi-Cal provides free, comprehensive health, dental, and vision coverage to low-income parents and children up to age 21. Any child who is eligible for Medi-Cal is guaranteed by law to receive Medi-Cal coverage, if he or she enrolls.

Healthy Families offers similar coverage to children in families with slightly higher incomes. It is only available for children up to age 19. All families participating in Healthy Families pay a monthly premium. Healthy Families is also currently available to every eligible child who enrolls, although it is not guaranteed to every eligible child by law.

Families can enroll in Medi-Cal or Healthy Families by completing a four-page, mail-in application that is available in 11 languages and can be ordered through a statewide toll-free number (1-888-747-1222). California has also developed a network of Certified Application Assistants (CAAs) in most counties. CAAs have received training to help families complete the joint application form accurately.

There is also an exciting new trend among counties to develop local health insurance programs to cover children whose families cannot afford private health care coverage but are not poor enough or otherwise eligible to receive Healthy Families or Medi-Cal. These programs generally cover children in families with incomes up to 300 percent of the federal poverty line, regardless of immigration status.

Strategies for Insuring Child in Child Care
Child care providers, health care advocates, and policymakers all have important roles to play in finding uninsured children, enrolling them, and keeping them enrolled.

* A number of counties around the state have developed or are currently developing health insurance programs. Santa Clara, San Francisco, Alameda, San Mateo, Riverside, Los Angeles, Stanislaus, San Bernardino, Solano and Contra Costa counties are in the vanguard, and programs are moving forward in San Joaquin and Sacramento counties as well.