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 CHI Home > FAQ
Fequently Asked Questions
FAQ (PDF) (PDF en español)
What is the Children's Health Initiative (CHI)?
What is CHI's goal?
How do children qualify for health insurance?
How much do families pay for their child's insurance?
How is CHI and Healthy Kids funded?
Who administers the Healthy Kids Program?
Who determines eligibility for Healthy Kids?
Why should all children, regardless of immigration
status, have access to comprehensive insurance?
Why does Healthy Kids cover children up to 400% of FPL?
How will CHI prevent parents from dropping employer
coverage for children and enrolling in HK?
Is CHI maximizing existing federal and state resources?
Are there other counties that have the Healthy Kids program?
What is the Children’s
Health Initiative (CHI)?
CHI is a broad-based coalition of public and private partners
formed to ensure that all children in San Mateo County have access
to health care. In San Mateo County, one of the most affluent areas
in the country, nearly 10 percent of its children, about 17,000
kids between the ages of 0-18, lack access to continuous health
insurance. Nine out of 10 of these uninsured children come from
hard-working families trying to provide for their children in jobs
without health benefits. CHI brings together and simplifies access
to Medi-Cal and the state's Healthy Families insurance program,
and adds Healthy Kids to fill the gap for those who don't qualify
for the other programs. CHI provides one-stop shopping and qualification
for any of the three programs available with the simple message
of health insurance for all children. Through broad-based-community
outreach, CHI works to make families aware of these programs and
enroll them in the appropriate insurance plan. <TOP>
What is CHI’s goal?
CHI expects to accomplish several important outcomes including:
100 percent health coverage for all children from low and middle
income families; improved health status of previously uninsured
children; decreased health care costs for previously uninsured children;
and enhanced delivery and stability of the San Mateo County health
care system. <TOP>
How do children qualify for health
insurance?
Application Specialists will help families complete
the application form. The family will provide proof of income and
county residency. Annual requalification will be required to maintain
coverage. All three health insurance programs—Medi-Cal, Healthy
Families, and Healthy Kids--require a family to fill out an application
asking various questions about the parent/guardian, the children
in need of coverage, household monthly income, and health benefit
options. The family will also provide proof of income, county of
residence, and the age of their children. <TOP>
How much do families pay for their child's insurance?
For Healthy Kids and Healthy Families, parents
pay a share of the child’s monthly premium (which is approximately
$93 for Healthy Kids). Depending on their family income, parents
pay $4 to $20 per child per month. Parents also will pay $5 co-pays
for their children’s visits and prescription drugs (preventive
care are free). Parents whose children are enrolled in full-scope
Medi-Cal do not have to pay a share of the premium or co-pays for
doctor’s visits. <TOP>
How is CHI and Healthy Kids funded?
The initiative is funded with a mix of public and
private contributions with close to $8 million raised to date. Over
90 percent of the Children's Health Initiative funding goes toward
premiums for the new Healthy Kids program, with the other 10 percent
paying for outreach and application assistance activities that increase
enrollment in Medi-Cal and Healthy Families for children. Contributors
are:
- First 5 San Mateo County has committed $2.3 million annually for 10 years to insure every child from 0 through 5;
- Sequoia and Peninsula Healthcare Districts have allocated $2.1 million to insure every child within their districts;
- Peninsula Community Foundation has committed $250,000
- David and Lucile Packard Foundation has committed $700,000;
- The County Board of Supervisors approved matching funds of up to $2.7 million per year for 5 years;
- Kaiser Permanente, Lucille Packard Foundation for Children’s
Health, the United Way of the Bay Area and the San Mateo County
Children’s Fund have all contributed funding;
These contributions are not sufficient to sustain the Children's
health Initiative over the long term. Consequently, CHI is looking
for private donations to help fill the budget gap. You can help
by donating to the Peninsula Community Foundation (PCF) which is
serving as the fund holder for all private donations
to the CHI. <TOP>
Who administers the Healthy Kids Program?
The Health Plan of San Mateo (HPSM), the
County’s state licensed, mixed model HMO for over 15 years,
administers the Healthy Kids program. It is a natural extension
of responsibility for HPSM because it focuses on the uninsured and
underserved, has demonstrated cultural competency and a relationship
with County agencies. HPSM is the only Health Plan that covers the
Medi-Cal population and is the low-cost, community provider for
the Healthy Families program. By using HPSM for Healthy Kids, the
County can continue to move toward a seamless benefit system where
low-income families can enroll all their children - whether
they are Medi-Cal, Healthy Families, or Healthy Kids eligible -
into a single health plan. <TOP>
Who determines eligibility for Healthy Kids?
The San Mateo County Human Services Agency
(HSA) determines final eligibility for Healthy Kids. HSA has the
best qualifications for taking on this role, as it already determines
final eligibility for Medi-Cal on behalf of the State and has developed
quality assurance and fraud investigation processes as part of this
role. Its staff can also ensure that children are screened first
for Medi-Cal and Healthy Families eligibility and are only enrolled
into Healthy Kids as the last alternative. <TOP>
Why should all children, regardless of immigration status, have access to comprehensive insurance?
Just as all children are guaranteed access to education, it is essential
to provide every child with comprehensive health insurance. Uninsured
children are likely to go without needed care, and as a result are
also likely to pass on communicable diseases to insured children,
in school and in the community. Uninsured children also most often
end up receiving care in an emergency room, usually within the public
health care system where care is more expensive to provide and typically
not reimbursed. Consequently, the community as a whole is burdened
with increasing costs as communicable diseases are spread and emergency
care becomes more expensive. <TOP>
Why does Healthy Kids cover children up to 400% of federal income guidelines?
According to the
most recent San Mateo County specific cost of living data, illustrated
in the table below, a family of three (single parent and two children)
must spend $4,480 monthly or $53,760 annually to make ends meet.
| Family of Three |
| Expense Items | Monthly Cost |
| 2 Bedroom Apartment | $1,600 |
| Child Care for Two Young Children | $1,660 |
| Food and Transportation | $730 |
| Other Expenses* | $485 |
| Total | $4,480 |
Adding these expenses and including monthly taxes of $1,120 (20
percent of gross Income), a family of three must earn a pre-tax
income of $5,600 per month or $67,200 annually in order to pay for
all expenses and remain self-sufficient. These expense numbers illustrate
that a family of three earning at or below 400 percent of the —
$61,000 annually — and working in a job without dependent
health coverage does not have the financial means to purchase out
of pocket health insurance. <TOP>
How will CHI prevent parents
from dropping employer coverage for children and enrolling in Healthy
Kids?
CHI has several safeguards to prevent this from occurring:
- Children are required to be without health insurance for
six months in order to qualify for Healthy
Kids;
- Households earning 250 percent to 400 percent of the federal
income guidelines are required to pay $12- $20 monthly;
- CHI uses a random audit system to investigate whether the
applicant’s employer offers health coverage for dependents,
if the applicant was purchasing dependent coverage in the recent
past, and whether the worker contribution necessary to cover children
is affordable. <TOP>
Is CHI maximizing existing federal
and state resources?
CHI’s mission is to enroll children into all available health
coverage programs without supplanting existing federal and state
dollars with local private and public resources.
CHI relies first on Medi-Cal and Healthy Families and turns to Healthy
Kids only for children who do not meet the Medi-Cal and Healthy
Families eligibility criteria. CHI also requires eligible Healthy
Kids members to use the existing California Children’s Services
(CCS) program for certain physical disabilities. <TOP>
Are there other counties that have the Healthy Kids program?
Yes, San Mateo County is the 2nd county in California to launch a Healthy Kids program. Other counties such as San Francisco, Santa Clara, Santa Cruz, San Joaquin, Fresno, San Luis Obispo and Los Angeles all have established programs. Furthermore, there is legislation at the state level pushing to make Healthy Kids statewide. For more information: www.100percentcampaign.org<TOP>
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