By Aurelio Rojas -- Bee Capitol Bureau. Enrollment has slowed dramatically in California's health care program for children of the working poor, which Gov. Arnold Schwarzenegger tried to cap a year ago before yielding to vocal opposition.
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The cash-strapped state saved $38.8 million in the fiscal year that ended June 30 because enrollment in Healthy Families was below the budgeted amount.
A 15 percent staff reduction in the Managed Risk Medical Insurance Board, or MRMIB, which administers the program, has created backlogs of up to four months for families appealing denial of their applications.
In addition, program officials blame a three-year reduction in outreach programs for the drop-off. But health care advocates say administrative problems have contributed to the slowdown; complaints of lost or misplaced applications and supporting documents are common.
Janette Lopez, a deputy director of the MRMIB in charge of eligibility, conceded that a switch in January to a new contractor slowed the application process.
State officials say the contract will save the state $80 million over five years. Lopez said the contractor, Maximus Inc., is now up to speed, but that her office is not keeping pace because of the staff cuts.
About 693,000 children are enrolled in Healthy Families; frustrated advocates estimate that 300,000 more are eligible. The program provides health insurance for children in households with incomes up to 250 percent of the federal poverty level, about $36,000 for a family of four. Families make modest co-payments. The state receives $2 from the federal government for every dollar it spends.
Advocates say the cost of caring for children outside the program is passed on to other segments of the state's fragile health care system.
"When they need care, they show up at hospitals that aren't getting reimbursed," said Felicia DuPuch of Care 1st Health Plan, which serves the poor. "We're flooding emergency rooms with people who may have minor medical issues that should be addressed in clinics and doctors' offices."
Launched in 1998 during the administration of Republican Gov. Pete Wilson, Healthy Families expanded rapidly under Democratic Gov. Gray Davis.
The state aggressively expanded enrollment in the program and in Medi-Cal on the theory that insuring children would save money in the long run because they would be less likely to need costly emergency care or social services in the future.
But as enrollment rose in Healthy Families, so did costs - from nearly $212 million in 1999-2000 to $872 million in the current budget.
During last year's recall election, Schwarzenegger promised to work to provide health insurance for every child in the state.
But after inheriting a massive budget deficit, the Republican governor submitted a budget in January that proposed capping enrollment in Healthy Families at 732,000. Beyond that, those wishing to enroll would go on a waiting list, until another family dropped out.
The governor relented after Democratic lawmakers and children's advocates protested. But enrollment - 685,000 in January - has grown by only 8,000 since. Budget writers had projected enrollment to reach 774,077 by July 1, 2005.
Program officials attribute the slowdown to a dramatic drop in retention rates. Applicants are subject to annual reviews.
"Oftentimes because of language barriers and complicated procedures, these kids fall out of the system," said Jeff Okey, a spokesman for the California Endowment. "We fund outreach (programs) for enrollment and retention because the state doesn't have enough money."
Michelle Harper, a policy analyst with Consumers Union, said the millions of dollars the state spent to help applicants has been eliminated - with predictable results.
"Because there are fewer people in the field helping families get enrolled, we're missing a great opportunity to provide health care access to thousands of children," she said.
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Source: Sacramento Bee
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