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The Almanac
June, 12, 2002

San Mateo County launches initiative so every child can have health care

Twenty-one 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 room."

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 says.

"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 services.

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 medical advice."

Anyone wanting information on county health programs for kids may call the Community Health Hotline at 573 3595.