A groundbreaking law now pending in California could make it easier for millions of uninsured working-poor families to get and maintain health care for themselves and their children.
The proposal would eliminate bureaucratic barriers that its sponsors say are keeping eligible families out of two government health insurance programs.
"We're losing tens of thousands of people because of these requirements," says Holly Mitchell of the Western Center on Law and Poverty in Sacramento. The center authored the bill along with the National Center on Youth Law in San Francisco. "If we mean what we say about health care being a basic right, we need to remove these."
The bill calls for streamlined application procedures and reduced reporting requirements for Medi-Cal--the state's version of Medicaid--and Healthy Families, a government program for children only.
If it becomes law, California will:
- Create a single, four-page application for both Medi-Cal and Healthy Families. Social service agencies would determine which program an applicant qualifies for, Mitchell says.
- Permit applicants to simply declare their income and other pertinent information without submitting pay stubs and other documentation, thereby drastically reducing the paper work required. "Many low-income workers might have a couple of jobs, or they don't have access to a copying machine, and it's difficult for them," says Alan Lofaso, spokesman for the bill's sponsor, Democratic assemblywoman Carole Migden. Random surveys and crosschecks with various state records would be conducted to prevent fraud.
- Eliminate the so-called asset test for Medi-Cal recipients. Proponents say it is unnecessary because so few applicants have significant resources, such as second cars and financial trusts. The state's Department of Health Services estimates that this portion of the bill would save California $4.25 million per year.
- Make all legal immigrant children eligible for Healthy Families.
- Eliminate quarterly reporting requirements and face-to-face interviews that recipients had to undergo to maintain eligibility. Many working poor families can't afford to take time off for interviews or simply balked at the "intrusiveness," Mitchell says. Families will still be required to report a change in job status, size of household and other relevant information, however.
Recent studies show the problem of the uninsured has skyrocketed nationwide since welfare reform, and that California has been hardest hit. The journal Health Affairs reported that 49 percent of women and 30 percent of children were uninsured a year after the family stopped receiving welfare.
A joint University of California at Berkeley/UCLA study found that California has more uninsured than any other state-nearly 1 in 4, many of them children, compared to 1 in 6 nationwide. Only 40 percent of Hispanics in California have coverage.
Similar legislation was vetoed by former Gov. Pete Wilson, a Republican, Mitchell says; another law was tabled last year for fine-tuning, adds Lofaso.
The state now has a Democratic governor and the bill's backers expect the measure to pass and be signed.
Hearings are expected within the next few weeks before the California General Assembly's appropriations committee, chaired by Migden. A vote is expected by the end of May on the full assembly floor; proponents expect the bill to pass, in part because of widespread media attention on the state's uninsured..
Republicans and health care plans back the bill, Mitchell says. GOP leaders realize that the state "will either pay at the front end or the back," Mitchell says, if working poor are forced to turn to expensive emergency-room care. Health plans will benefit from more patients because the state has shifted from fee-for-service to managed-care for Medi-Cal and Healthy Families, she adds.
Republican's in Carole Migden's committee recently voted against the proposal in a committee-wide vote, claiming the proposal is too expensive, said Lofaso. However, Migden's office is preparing preliminary cost estimates and expects to have them finished before a full vote on the Assembly floor.
A few states-Indiana, Massachusetts and Oklahoma-have restructured Medicaid applications to make them more accessible and have seen increases in enrollment, according to a Kaiser Family Foundation report. A Kaiser study of low-income families found that 62 percent of parents who tried to enroll their children didn't finish the process because it was too complicated andfrustrating; 72 percent cited difficulties in getting documentation; 66 percent said the "overall hassle" of the enrollment process kept them from completing it.
The Center on Budget and Policy Priorities in Washington, D.C., has recommended streamlining moves like California's and points out that the drop in welfare caseloads has led to a $7.3 billion surplus of federal funds to help poor families.