The Republican lawsuit targets reinsurance that helps insurance companies provide universal coverage without accounting for pre-existing conditions.
Jan. 20--For years, Anamaria Cisneros could take her teenage son to a specialist for his weak heart valve under a public insurance program for children whose parents make too much money to qualify for Medi-Cal but not enough to afford private insurance.
Now that the state is dissolving the government-subsidized Healthy Families program -- and moving those children into Medi-Cal to save money -- Cisneros worries about the impact on her family.
Cisneros, 52, has taken 17-year-old Derian Toscano to a specialist twice in the last four years. She doesn't know whether Derian will get to see the same specialist or what her monthly premiums will be.
"I feel worried," Cisneros said Tuesday. "I don't know if the government program is going to help me or if I'll be paying more."
The transition is under way throughout the state and expected to affect more than 20,000 Kern County children in coming months. Local families should be receiving letters in the mail about the change.
Officials generally say families need not worry. But there are patient advocates who fear some people will fall through the cracks and lose care.
"The message that we want to get out to the community is that their children will continue to have health coverage," said Edgar Aguilar, program manager for Children's Health Initiative of Kern County, which helps enroll families in Medi-Cal and previously Healthy Families.
The worry is that the transition timeline is too ambitious and that there aren't enough doctors who take Medi-Cal for payment. Medi-Cal reimbursement rates are lower than Healthy Families ones, said Anthony Wright, executive director of Health Access California, a consumer advocacy coalition.
"While Medi-Cal is a good program, in lots of ways there are real access issues that need to be dealt with," he said.
Jan Hefner, director of community wellness programs for Mercy and Memorial Hospitals, fears families will mistakenly believe their child is losing coverage.
"A lot of the families that we deal with are just doing the best they can to keep their families together and keep their kids fed and healthy," and uncertainty about a change like this can send them into a tailspin, Hefner said.
HEALTHY FAMILIES RISE AND FALL
California created Healthy Families in 1997 to plug gaps in coverage. More than 26,000 Kern kids, about 9.5 percent of the county's children, were enrolled at the program's peak in mid-2009, Hefner said. Enrollment soared statewide to more than 900,000 children then.
But that same year, the state froze new enrollment due to a budget crisis; Kern County enrollment declined to about 22,500 last November, Hefner said.
Already struggling families may drop out of a program like Healthy Families if they feel it's unstable and may disappear, Hefner said. That's one of her concerns.
"We want them to keep the coverage, that's the most important thing," she said.
Gov. Jerry Brown signed the bill to move Healthy Families children into Medi-Cal last June. It's expected to save the state's general fund tens of millions of dollars.
Healthy Families pays $106.80 per child per month to a plan for a child, while Medi-Cal pays $87.08 per child per month, according to an email from the California Department of Health Care Services.
Medi-Cal has a slightly more comprehensive set of benefits and families will also pay lower premiums for Medi-Cal than they did under Healthy Families, said Jane Ogle, deputy director for healthcare delivery systems for the California Department of Health Care Services.
Families that make up to 150 percent of the federal poverty level, $2,386 a month for a family of three, will not pay any premium, according to the Department of Health Care Services. Families that make between 150 to 250 percent of the federal poverty level, up to $3,977 a month for a family of three, will pay $13 a month per child, up to $39 a month for a family with three or more kids, according to the department's website.
Medi-Cal, unlike Healthy Families, does not have a co-pay.
Health care advocates worry not enough doctors will accept more Medi-Cal patients. But Dr. Hasmukh Amin, owner of Riverwalk Pediatrics, said he doesn't think there will be a disruption in services for most Healthy Families children in Kern County because providers who accept that program now may also accept Medi-Cal.
But local families moving from Anthem Blue Cross to Medi-Cal may have a harder time because they will have to find new health care providers, the pediatrician said.
"I think a lot of those families might be struggling to find a provider," Amin said.
On the other hand, Amin and Ogle both said more doctors may be inclined to accept Medi-Cal patients in the future because Medi-Cal reimbursement rates are planned to be raised to Medicare rates for two years for certain doctors, including pediatricians.
At Kern Health Systems, CEO Doug Hayward said the transition shouldn't be problematic for its members because most of their physicians who see Healthy Families patients also accept Medi-Cal.
"There were very few doctors who even had any questions about (the change)," he said.
But some families remain leery. Shafter resident Miriam Nevarez, a mother of four young girls, has been on both programs and prefers Healthy Families.
"Before I had Healthy Families, I had Medi-Cal and I didn't like it," she said.
She found Medi-Cal more difficult to deal with and required a lot of paperwork.
"(Healthy Families is) less of a hassle and they work with you more," she said.
Nevarez had heard about a shift from Healthy Families to Medi-Cal but she didn't know it had been scheduled. She said she would have to see how the change goes before making any decisions about her family's coverage.
Nevarez was considering talking with her husband about getting their children health insurance through her husband's job, but she worried that then the family would be at risk of losing their insurance if her husband loses his job. She said she hadn't received any letters about the upcoming change.
On Tuesday, Cisneros said she'd received the second of three letters she was told to expect about the transition but she remained concerned.
She said she had spoken with someone in Sacramento about the shift to Medi-Cal but that she was still uncertain about what will happen.
"They (Medi-Cal people) couldn't tell me anything," she said.
The change may be confusing, but Hefner urged families to reach out to their schools, doctors and the Children's Health Initiative of Kern County to find answers to their questions.
-- Staff writer John Cox contributed to this story .
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