Why Isn’t Healthy Families Enrollment Higher?

Enrollment in the Healthy Families Program (HFP) has dropped by 5.4 percent, or about 50,000 children, since June of last year. The HFP provides access to low-cost health, vision, and dental coverage for children in families with incomes up to 250 percent of the federal poverty line – $45,780 for a family of three. As of June 30, 2010, 871,467 were children enrolled in the program – down from a peak of 922,429 in July 2009.

There are a number of possible reasons for why enrollment in Healthy Families has fallen. First, fewer families are applying for coverage. In 2008-09, the HFP received 316,365 applications. In contrast, in 2009-10, the HFP received 273,427 applications – a drop of 13.6 percent. It is worth noting that in August 2009, the state eliminated payments to individuals certified to help families fill out Healthy Families applications, thereby reducing the incentive for some entities to aggressively recruit and enroll qualified children.

Applications submitted with assistance generally account for around one-quarter of all applications processed. Other budget reductions may also be depressing enrollment. The state imposed a waiting list from July 2009 through September 2009, and since then, enrollment has hovered below 885,000 children.

The recession may also be playing a role by increasing the share of children who no longer qualify for Healthy Families because their family income has dropped. These children become eligible for Medi-Cal. In April 2007, just prior to start of the recession in California, 7.9 percent of children were dropped from Healthy Families because they qualified for Medi-Cal. In April 2010, the most recent month for which data are available, 16.6 percent of children were dropped from Healthy Families because they qualified for Medi-Cal – more than double the rate three years earlier. Finally, between one and two out of five children leaving Healthy Families each month do so because families have failed to pay premiums. Part of the drop in enrollment may reflect a rise in the number of families who cannot afford even the modest cost of coverage through the HFP.

Healthy Families remains an important source of health coverage for children. But like other state programs, it has been a frequent target of budget-saving measures, such as cost-sharing increases that resulted in some children’s premiums increasing by as much as 77 percent. The Governor’s May Revision, which would nearly triple premiums compared to pre-recession levels, would only make it more difficult for families to afford health coverage at a time when families are struggling to make ends meet.

– Hanh Kim Quach

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