June, 12, 2002
Mateo County launches initiative so every child can have health care
thousand. Repeat: 21,000. In San Mateo County, one of the richest counties
in the nation, that’s the number of children who are not covered
by health insurance. Their families can’t afford it. These are
children who get no preventive care and don’t even see dentists.
They may have undiagnosed vision or learning problems. They may have
a chronic disease like asthma, or have a contagious illness. When they
get really sick, their families head for the emergency room —
which is hard on the kid, and an expensive use of medical resources.
“Most of these children are from working families. Most are just
above the federal poverty level,” Health Services Director Margaret
Taylor told a Children’s Health Summit in April. “We want
to level the playing field so every child has a chance.” Now San
Mateo County is launching an initiative — called Healthy Kids
— that will patch the holes in the Byzantine health care system
so that every child can get medical help when it’s needed.
County Manager John Maltbie is proposing a supplemental insurance program
that will cover some 6,750 uninsured children from low-income families
who do not qualify for existing programs. The cost would be $7.7 million
per year, which will include about $90 per child per month. Eligibility
for the current state and federal insurance programs of Medi-Cal and
Healthy Families are so complex that in some families, individual kids
will move on and off insurance programs as they get older.
The amount of coverage is pegged to age, income level, and legal status.
Undocumented kids are not eligible for Healthy Families, and receive
emergency-room care only under Medi-Cal, according to Toby Douglas,
health access manager for the county. Healthy Kids would cover children
who fall between the cracks of other programs.
Families would pay a few dollars a month for each child, and have a
choice of health plans. The program would also cover all children up
to 400 percent of the federal poverty level — which is $15,020
per year for a family of three. While 400 percent of the poverty level
may sound high, it actually comes to $60,080 for a family of three.
In this area, a mother with two kids can barely pay for housing, food,
child care, transportation, and clothes on that income, much less health
insurance. At $200 per child per month or more, “health care is
often the first to go,” said Supervisor Rich Gordon. He noted
the county’s cost for the proposed program, $90 per child per
month, is the price of a dinner in San Francisco. The county has identified
onethird of the $7.7 million needed to launch Healthy Kids.
The Children and Families First Commission, which dispenses tobacco
tax money, has promised $2.3 million a year to cover all children under
6. However, in a horrendous budget year, sponsors still need another
$5.4 million per year from public and private sources, to launch the
initiative. In his proposed budget, Mr. Maltbie recommends that the
county match private contributions dollar for dollar up to $2.7 million.
Ms. Taylor is already on the road, seeking money for Healthy Kids from
hospital groups, foundations, businesses, labor, and charities. “It’s
the right thing to do,” she says. “Also, it’s much
cheaper to do preventive care for children than see them in an emergency
The county Board of Supervisors will decide on the Healthy Kids initiative
during budget hearings starting Monday, June 24. Who are they? "This
is a diverse population — two populations, really," says
Mr. Douglas in a notable understatement. Many are working families struggling
to make ends meet, who make too much money to qualify for existing programs,
but not enough to buy health insurance.
Some lost jobs after September 11 or in the dot.com collapse; others
are struggling off of welfare, and have lost benefits. Others work low-wage
jobs or are self-employed with no insurance. Many are minorities who
speak other languages — Latinos or Pacific Islanders.
They are often immigrants, often undocumented. Undocumented parents
often have children born in this country, which makes the children legal
citizens. Yet these are the gardeners and janitors, the caregivers and
nannies, the restaurant and hotel workers, who make life pleasant for
the affluent community, notes community health advocate Marmi Bermudez.
"Healthy Kids will pick up children without legal status and those
whose income is above the Healthy Families limit," Ms. Bermudez
"We also want to reach workers who don't sound poor, but have trouble
paying their bills. This is a group that needs help but may not realize
it." Ms. Bermudez, who trains the county's outreach workers, describes
one of many families she has worked with.
Mele Tonga, not her real name, of East Palo Alto, attends the Belle
Haven health clinic and is a volunteer minister at the Tongan church
in Menlo Park. She has three children: two were born in this country
and are legal citizens; her older daughter is stil undocumented. She
and her husband, a construction worker, were in the process of obtaining
legal status when a scaffolding at work fell and killed him. Her legal
status is now on hold. Ms. Bermudez met Ms. Tonga at a Pacific Islander
health fair and started connecting her and her family with available
Ms. Tonga lives on about $1,800 per month in Social Security plus $500
in death benefits. Her children with legal status now qualify for Healthy
Families, while the older girl can sign onto Healthy Kids, which doesn't
ask about residential status.
Outreach Rosalina Estrada is just the sort of person Ms. Bermudez likes
to meet. Ms. Estrada wasn't feeling well last Thursday, so she brought
her two grandchildren to the Belle Haven clinic while she waited to
see a doctor. As an outreach worker, Ms. Bermudez goes where she will
find people who may need health services.
She interviews them and tries to make them feel comfortable with a system
that is often — rightly or wrongly — perceived as unfriendly.
After a short interview, Ms. Bermudez found they were all uninsured,
and thinks it likely that the parents may be undocumented.
She has scheduled another appointment so she can determine what health
services the family may qualify for. This kind of systematic outreach
— in clinics, schools, fairs, and community groups — is
bringing more and more people into the health care system. Healthy kids
do better in school and lose fewer days sick at home; parents take less
time off from work to deal with sick kids. "It benefits everybody,"
says Ms. Bermudez.
"The keys to this program are outreach, outreach, outreach,"
says Mr. Douglas. "We work one-on-one to break down barriers and
build trust." The health services department is focusing on bringing
health services to under-served populations. In the South County, particularly,
Latino and Pacific Islanders face language and cultural barriers; many
are worried about their legal status. "That's why Marmi and her
staff are so important," Mr. Douglas says.
They can work with clients individually, ease their worries, assure
them that health programs will not affect their residential status,
and steer them through the bewildering system. Ms. Bermudez adds, "This
work takes a lot of time, patience, energy, and hand-holding —
and a passion for the work." Ms. Taylor hopes the Healthy Kids
program, together with existing programs, will give 21,000 more county
children good health care and a brighter future. "We have 21,000
kids who don't have access to a pediatrician," she says. "We
want kids to have a medical home — one place they can go for good
Anyone wanting information on county health programs for kids may call
the Community Health Hotline at 573 3595.