Posted on Mon, Jun. 14, 2004 , in the San Jose Mercury News

By Frank Sweeney
Mercury News

Santa Clara County's Children's Health Initiative has proven far more successful than expected, providing insurance coverage for more than 29,000 youngsters in its first two years, according to an analysis of the program released today.

Launched 3 1/2 years ago to extend health coverage to uninsured children, the initiative spurred large enrollment increases for two major public health programs funded by state and federal governments -- Medi-Cal and Healthy Families.

And it enrolled more than 15,000 children in the county-funded Healthy Kids program, designed to reach children who are either undocumented immigrants or whose families make too much money to qualify for the government-subsidized programs.

"It's rather extraordinary. It's a tremendous success,'' said Joseph Macrum, spokesman for the Santa Clara Family Health Plan, a county agency that runs the initiative programs.

For single mothers such as Celia Gonzalez of San Jose, the program is the only way she can get health coverage for her 13-year-old son, Erick Villasenor, and her 3-year-old daughter, Valerie DeLatorre.

"This is absolutely the best way to get health care,'' she said in Spanish, speaking through an interpreter at the Family Resource Center on South White Road in East San Jose, where people can enroll in the programs.

She heard about the initiative from friends and saw advertisements, then enrolled two years ago, she said. Before then, she had to take her children to emergency rooms, which she said was "very difficult.''

"I had to pay the doctor at the point of treatment. Just a simple consultation was $150, and then you have to buy the medicines,'' said Gonzalez, who works as a waitress.

"The emergency system is a terrible way to get health care,'' said Macrum, who explained that the Children's Health Initiative's Healthy Kids insurance program became a catalyst that boosted enrollment of uninsured children in Healthy Families and Medi-Cal.

Macrum credited those increases with the initiative's outreach programs at schools and health fairs.

Many people didn't know that their children were eligible for the state and federal insurance programs. And children whose families didn't meet the eligibility requirements for Medi-Cal and Healthy Families because of income levels or immigration issues can be covered by the locally funded Healthy Kids, he said.

Last week, the initiative got more help when it received a waiver from the federal government that could bolster the Healthy Kids program by $746,000 a year. But that new money can only be used to defray health insurance costs for legally documented children.

The survey showing the initiative's success was commissioned by the David and Lucile Packard Foundation, which financially supports the program, and conducted by Mathematica Policy Research.

The survey found that in 2001 and 2002, there were 62,082 formerly uninsured children enrolled in Medi-Cal and Healthy Families, an estimated 13,500 of which likely would not have been enrolled without the health incentive's outreach.

During the same period, 15,638 children were enrolled in the Healthy Kids program.

The Children's Health Initiative was developed by a coalition of community groups, county agencies and the local Medicaid health plan to improve the health and well-being of low-income children in Santa Clara County.

Santa Clara Family Health Plan, the county's Medi-Cal HMO, administers the plan, processing applications from families and paying claims. Parents pay small premiums and co-payments on a sliding scale, and fees are waived for those who can't afford them.

Funded by tobacco tax money and the city of San Jose and county's shares of the tobacco lawsuit settlement, as well as contributions from the private sector, the Children's Health Initiative works in two areas:

•  It finances and operates the Healthy Kids insurance program that covers children whose family incomes are less than 300 percent of the federal poverty level and thus ineligible for the two major state insurance programs. The program costs $13 million to $14 million a year.

•  It finds uninsured children through schools and community organizations, determines their eligibility and enrolls them in appropriate programs.

The initiative was proposed by Working Partnerships USA, a local labor-affiliated research group, and People Acting in Community Together (PACT), faith-based neighborhood organizers.

Santa Clara County supervisors approved the Children's Health Initiative in December 2000, aimed at bringing full insurance coverage -- medical, dental and vision care -- to 70,000 children in the county estimated to be uninsured.

Since then, similar programs have been started in San Francisco, San Mateo and Alameda counties.