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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 ItemsMonthly Cost
2 Bedroom Apartment$1,600
Child Care for Two Young Children $1,660
Food and Transportation $730
Other Expenses* $485
Total $4,480

*Personal care/clothing, telephone, utilities and housekeeping supplies

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:<TOP>