Next month, following a 15-year run, the curtain will go down on California’s Healthy Families Program (HFP), which has provided low-cost health, dental, and vision coverage for children in low- and moderate-income families. As part of the 2012-13 state budget deal, lawmakers adopted Governor Brown’s proposal to transfer children enrolled in the HFP to Medi-Cal, California’s largest publicly funded health coverage program for low-income residents. In addition to providing coverage for children transitioning from the HFP, Medi-Cal now covers all newly enrolling children who were previously eligible for Healthy Families, up to 250 percent of the federal poverty line ($48,825 for a family of three in 2013).
The shift of children from Healthy Families to Medi-Cal began this past January 1 — when about 850,000 kids were enrolled in the HFP — and has proceeded in several stages. By the end of September, nearly 730,000 children had been transferred to Medi-Cal, although tens of thousands of children did not make the transition because they lost eligibility for Healthy Families prior to their scheduled transfer date. (Children can be removed from the HFP for a number of reasons, including if their families do not pay monthly premiums or they reach their 19th birthday and “age out” of the program. It’s likely that at least some of these children found — or eventually will find — their way onto Medi-Cal by applying for coverage through their county human services offices.) The final group of children — more than 20,000 — will transfer from Healthy Families to Medi-Cal on November 1.
Once the transition from Healthy Families is complete, nearly half of all California children will be enrolled in Medi-Cal, according to state estimates. Ultimately, the success of this transition will hinge on whether children in Medi-Cal are able to access the health care services they need. In this regard, state officials have more work to do. For example, many children with autism lost access to critical behavioral health services when they were shifted from Healthy Families to Medi-Cal. Another concern: Doctors, dentists, and other Medi-Cal providers are bracing for — or have already felt the impact of — a 10 percent provider payment cut that the state has begun implementing, although primary care doctors will be largely shielded from this reduction through 2014 due to a provision in the federal Affordable Care Act. It’s too early to tell whether these payment changes will, on balance, have a positive or negative impact — or no impact — on provider participation in Medi-Cal and thus on children’s access to care. State officials should closely monitor the situation in the months ahead to ensure that all of the more than 8 million Californians enrolled in Medi-Cal — children and adults alike — have timely and adequate access to needed care.
— Scott Graves