Campaign Update
Thursday, September 28, 2006

Inside This Issue:

With your tireless efforts and unwavering support, Californians for Healthy Kids has won a number of important improvements to Medi-Cal and the Healthy Families Program (HFP) in 2006--changes that will enable more eligible children in California to enroll in and retain health insurance. Achieved through Senate Bill 437 (Escutia, D-Norwalk) and the 2006-07 Budget Act, these programmatic improvements advance the goal of reducing the number of uninsured children in our state. Below you will find a summary of these improvements.

For additional information, please visit:

• A PDF version of this summary, which you are welcome to distribute this document widely and to use it in your advocacy for children's health, is available at
  http://www.100percentcampaign.org/resources/factsheets/fs-060922.htm

Sponsored by the 100% Campaign and the PICO California Project, SB 437 passed the Assembly and Senate with bi-partisan support and was signed into law by Governor Schwarzenegger on September 19th. The State Department of Health Services expects that the improvements contained in SB 437, described below, will result in the enrollment of an additional 94,000 children and 13,000 parents already eligible for Medi-Cal or Healthy Families.

Self-Certification of Income for Medi-Cal--Pilot Project
SB 437 establishes a pilot project whereby parents and children will be able to self-certify their income--both when initially applying for Medi-Cal and when annually renewing their benefits. This simplification will significantly ease the paperwork burden of applying for and renewing health insurance for children, as most families will no longer have to provide copies of pay stubs and other income documentation when they apply for and renew their Medi-Cal health insurance. The pilot project will occur in two phases: first, the state will conduct a two-year demonstration program in two counties in which roughly ten percent of the state's Medi-Cal population resides. After completion of the two-year demonstration program, the state will evaluate its efficacy and decide whether to expand self-certification of income statewide.

Self-Certification of Income for Children Renewing Their Healthy Families Coverage
SB 437 also establishes self-certification of income for families statewide who are renewing their children's Healthy Families coverage. This will make it easier for children already enrolled in the HFP to keep their coverage by reducing the paper work required at renewal.

Expedited Enrollment for Healthy Families-eligible Children Applying at Counties
SB 437 establishes immediate, comprehensive coverage for children who apply for health insurance at a county and who, upon review by a county eligibility worker, appear eligible for Healthy Families. These children will receive full coverage while counties transfer the application to the HFP to make a final eligibility determination.

Improvement upon the Medi-Cal to Healthy Families "Bridge" Coverage
SB 437 establishes a seamless coverage program to replace the existing Medi-Cal to Healthy Families "Bridge" Program. When children renew their Medi-Cal coverage but appear eligible for Healthy Families and are no longer eligible for full-scope Medi-Cal, they will be "presumptively enrolled" in Healthy Families and continue to receive health insurance coverage while their renewal application information is forwarded to the Healthy Families Program. Under this new process, children will continue to be covered while counties transfer the renewal information to HFP and until a final eligibility determination for Healthy Families is made.

Automated Enrollment Gateway from the Women, Infants, and Children Program (WIC) to Medi-Cal and Healthy Families
SB 437 calls for the establishment of an electronic "gateway" to expedite enrollment from children seen at WIC sites into Med-Cal and HFP by allowing families' information already supplied on the WIC application to constitute an application for children's health insurance, with the families consent. Eligible children who apply for health insurance at WIC sites will receive immediate coverage while their application is electronically forwarded to the appropriate entity--either Medi-Cal or Healthy Families. Children will receive this coverage until a final eligibility determination for Medi-Cal or Healthy Families is made. The electronic system will also be able to check the health insurance data files to ensure the child isn't already enrolled in health insurance to avoid unnecessary processing.

The budget eliminated the eligibility requirement that families pay the first month's Healthy Families premium with their application for children's health insurance. Under prior law, families were required to pay the first month's premium with their child's application even before knowing if they qualified for Healthy Families. When the premium wasn't paid, families experienced delays, and even denials, in their child's Healthy Families enrollment. Now, families are able to choose between submitting the first month's premium at the time of application or being billed once their child is successfully enrolled.

The budget also eliminated the requirement that families choose a health plan before their child is determined eligible for Healthy Families. Under prior law, if a family did not affirmatively select a health plan at the time of application, their child was not enrolled into coverage. With this change in this year's budget, if the completed application does not include a health plan selection, the state will try to contact the family to choose a plan. If the family does not respond and the child is determined eligible, the state will enroll the child in the lowest-cost plan available.

County-Based Outreach and Enrollment Grants
This year's budget provided nearly $20 million in grants for outreach, enrollment, retention, and utilization activities for Medi-Cal and Healthy Families. California counties, in conjunction with a broad coalition of community organizations and local stakeholders, are now eligible to receive a portion of the funds for a broad array of activities promoting these objectives. Most of the grant funding will go to the 20 counties with the greatest number of uninsured children; the rest of the counties must compete for the remaining dollars. The local coalitions will have discretion to fund strategies they know will best reach the uninsured children in their county. The program's design was built upon the demonstrated successes of local Children's Health Initiatives operating in many counties now.

Certified Application Assistant (CAA) Payment Increases
In the budget, the CAA payment for successful enrollments into Medi-Cal or Healthy Families that were submitted via electronic applications (i.e. Health-e-App or One-e-App). was increased from $50 to $60. The budget also increased the amount of CAA payments for successful eligibility renewals from $25 to $50.

Next Step--Finishing the Job of Covering All California's Children
Thanks to effective statewide advocacy and commitment to children's health by both the Legislature and the Governor, this year's budget and SB 437 made important advances in the effort to cover more uninsured children, easing enrollment and retention of children currently eligible for Medi-Cal and Healthy Families. These changes will prove even more significant in building a solid foundation for outreach, enrollment, and retention as California moves to a statewide system of affordable, comprehensive health insurance for all children--made possible by the passage of Proposition 86.

By voting for Proposition 86 on November 7th, California voters will have the opportunity to finish the job of covering all children. If passed, Proposition 86 will provide the policy framework and on-going funding to ensure that all of California's uninsured children have access to health coverage this year and in the future. Proposition 86 increases the state's tobacco tax by $0.13 per cigarette ($2.60 per pack) to reduce smoking in California and provide immediate help to some of California's major health challenges. The initiative is expected to raise $2.1 billion a year, of which $367 million will be dedicated to children's health coverage, offering California the best opportunity to secure a stable source of funding for covering all children this year and in the future. The policy improvements secured in this year's budget and SB 437 will ease enrollment for all uninsured children, including those made eligible by Proposition 86, and ensure all children keep their coverage once enrolled.

For additional information, please visit:

• The Yes on Prop. 86 website is located at
  http://www.yesprop86.org

The 100% Campaign, a collaborative effort of Children Now, Children's Defense Fund and The Children's Partnership, was created to ensure that all of California's children obtain the health insurance they need to grow up strong and healthy.
www.100percentcampaign.org

The PICO California Project is the united effort of 20 California congregation-community organizations affiliated with the PICO National Network. Collectively, we represent 350 congregations and 400,000 families statewide and are actively organizing in over 70 cities in Northern and Southern California.
www.picocalifornia.org