This article originally appeared in the May-June 2001 issue of the Children's Advocate, published by Action Alliance for Children.

Getting to health care: Tackling insurance problems

By Adrianna Khoo

More than half the California families without health insurance are actually eligible for Medi-Cal or Healthy Families, state-funded low-cost health insurance programs for low- and moderate-income families. What's keeping them from signing up?

Many families hesitate to apply for these programs because they've heard reports of problems. But community-based health advocates say those reports can be exaggerated. "Many [applications] go through without any problems at all," says Jacque Wolfram of the Solano Kids Insurance Program of the Solano Coalition for Better Health. And every community has "Certified Application Assisters" to help (see Medi-Cal and Healthy Families: Advice for parents).

Rumors of problems for immigrants are especially exaggerated, says Cindy Betancourt of Family Health Centers of San Diego. She says receiving Medi-Cal and Healthy Families should not affect a family's immigration status. However, she adds, "some people working in the [Medi-Cal] system don't know that" and may scare away potential applicants.

But sometimes the health insurance system itself makes it hard for families to get enrolled and stay enrolled, say Betancourt, Wolfram, and others who help families with health insurance. The most common problem, says Wolfram, is that things get lost—"Applications, documents, checks just don't get there for some reason." Some families experience problems.

• Getting enrolled: People often have problems documenting their income if "they have anything complicated in their situation," such as being self-employed or having several sources of income, says Wolfram. Because Medi-Cal and Healthy Families are separate programs with different rules, applications sometimes "bounce" between the two programs and may get lost, says Betancourt. And county Medi-Cal workers sometimes intimidate applicants with home visits and even intrusive searches, like looking in a woman's purse, says Lolita Torres of the Western Coachella Valley Health Partnership in Riverside.

• Staying enrolled: Medi-Cal is free for low-income families, but to remain in Healthy Families, parents have to pay a monthly premium. "I got a letter saying I needed to pay my bill by March 20 last year, but I never got a bill!" says Maria Luz Torre, a San Francisco parent organizer. Torre paid before March 20, then received two letters, one saying the payment was received and the other cutting her off for nonpayment. Many families report similar problems.

• Complaints: Torre called repeatedly to complain about being cut off. She was told to file an appeal citing the section of the Healthy Families booklet the program had violated. "They shifted the burden of proof onto me!" Torre says. Advocates report that many families have problems getting mistakes corrected. "If they make a mistake they should fix it and not make the client file an appeal," says Wolfram.

• Improvements coming: The Healthy Families program is working to fix such problems, says Richard Popper, a Healthy Families spokesperson. Soon the program will start making phone calls before rejecting applications or cutting families off for nonpayment, to see if the problem can be resolved.

• More needed: The 100% Campaign, a coalition of child advocacy organizations working for health insurance for all California children, says California should
  • Combine Medi-Cal and Healthy Families into one program with one application
  • Extend Healthy Families, which has been only for children, to parents in families with incomes up to 250 percent of the poverty level (about $37,000 a year for a family of four)
  • Streamline eligibility rules and procedures.

For more details on the 100% Campaign's legislative agenda, see Toward health insurance for all California kids.

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Medi-Cal and Healthy Families: Advice for parents

To sign up

• Get the help of a Certified Application Assister—to find one near you, call 800-880-5305 (help is available in 10 languages)

• Keep a record of all documents and payments you send.

If you have problems

• Go back to the Certified Application Assister for help

• Contact a community health advocacy center if there's one in your area
  • San Franciso Community Health Advocacy Project, 800-551-5554
  • Health Consumer Center of San Mateo County, 800-381-8898
  • Fresno Health Consumer Center, 800-300-1277
  • Health Consumer Center of Los Angeles, 800-896-3203
  • Orange County Health Consumer Action Center, 800-834-5001
  • San Diego Consumer Center for Health Education and Advocacy, 877-734-3258

To advocate for health insurance for all families

• Contact the 100% Campaign, 510-763-2444, www.100percentcampaign.org

Special section on
health care access:

Action Alliance
for Children
e-mail aac@4children.org
1201 Martin Luther
King Jr. Way
Oakland, CA 94612
(510) 444-7136