Photograph by Jacqueline Ramseyer
Medically Covered: Angel Jamison, 15, and his sister Ainslee, 12, play with their new chihuahua puppy in their Willow Glen home. The Jamisons recently qualified for health, dental and vision insurance under the Healthy Kids Program.
After one year, S.C. County program is keeping 8,000 kids stay healthy
Healthy Kids still reaching out to families, donors
By Kate Carter
Willow Glen resident Dinorah Jamison realized she needed help when she had to take her daughter, Ainslee Miramontes, 12, to the emergency room last summer.
Ainslee had hurt herself at school and, although she was fine, her treatment cost $2,000. Ainslee didn't have health insurance and Jamison had to pay the entire bill.
So, last October, Jamison, a health provider herself at the Gardner Family Health Center but one who didn't receive insurance for her dependents, enrolled Ainslee and her son, Angel Miramontes, 15, in Santa Clara County's pioneer Healthy Kids program, which provides health coverage to children who wouldn't otherwise receive it. The program was "the missing piece" to fulfilling the county's goal of providing health insurance to all of its children, says Leona Butler, CEO of the Santa Clara Family Health Plan, which administrates Healthy Kids.
"It's just been an extraordinary year," Butler says. "Our entire staff has just been on sort of a permanent high. We probably couldn't have picked a harder time." But it's a time when it's most needed, she adds.
Healthy Kids was started at the beginning of last year to satisfy the goal of the Children's Health Initiative, which was to insure 100 percent of the county's children. Some children were already eligible for health coverage through the state and federal Medi-Cal and Healthy Families programs, Butler says. But undocumented families and families who earned between 250 and 300 percent of the federal poverty level weren't eligible for those programs. The numbers of those people in the county are significant, and with the recent economic downturn, are growing, she says.
"Obviously, there's a missing piece," Butler says. "In this county, that's still poverty level."
Healthy Kids is a managed health-care program, but it is different from the traditional HMO--health management organization--in that it is nonprofit and almost all doctors are willing to participate, Butler says.
"We really don't even use the words anymore because we don't want to be associated with all those prohibitions," she says.
Parents apply for their children who are 18 and younger by filling out a two-page application. Program staff work with applicants to make sure they understand the forms as well as to verify their income and eligibility. Coverage begins the first of the following month, and parents are encouraged to attend orientations that teach them-many of whom have never had health insurance-about their benefits and responsibilities, Butler says.
"The more educated a person is to use the plan, the better they use it," she says.
Program participants receive medical, vision and dental coverage and are able to change their doctors, see their medical records and be involved in medical decision-making.
The program helps people choose a doctor or clinic based on their location, their language and the kinds of treatment their children may need. All the county's clinics and hospitals and almost all the pediatricians in the county are participants, as well as many of the family practitioners, Butler says.
In addition, doctors whose patients join Healthy Kids are usually willing to accept the program, and program staff are willing to talk with doctors and encourage them to accept it on the patients' behalf, she says.
Photograph by Jacqueline Ramseyer
Qualified: Willow Glen resident Dinorah Jamison (right) sits in her living room with her children Angel, 15 (left) and Ainslee, 12. Jamison, a prenatal counselor at the Gardner Health Center, recently qualified for the Healthy Kids program so that her children would be covered with health, vision and dental insurance that they otherwise wouldn't have received.
Healthy Kids pays Preferred Care Providers a fixed amount every month per patient, which gives them an incentive to maintain children's preventative care, Butler says. In addition, the program pays for all regularly scheduled pediatric care.
"We're able to keep costs down because we're not for profit," Butler says. "Our doctors are working at less than they would charge you, but not a whole lot less."
Craig Walsh, executive director of the Santa Clara Family Health Foundation, which oversees the funding for Healthy Kids, says the program needs about a million dollars a year for every 1,000 children it insures. It receives $3 million from the county's tobacco settlement money, $2 million from the state's tobacco tax money, more than $1 million from the city of San Jose and money from other agencies, companies and individuals. Because much of the money is not from public sources, it can be used for children in undocumented families who would otherwise receive no assistance, he says.
"Those kids are in school, getting an education," he says. "It's important that they're in the classroom, ready to learn."
The program was anticipated to have 5,000 people signed up by the beginning of this year. So far, though, they have more than 8,000 signed up, Butler says. She says that although numbers are difficult to predict, especially as the economy has changed, they estimate about 18,000 children are eligible for Healthy Kids. That leaves about 10,000 left.
"We think that, in reality, 14,000 will enroll," Butler says. "There will always be some number that won't" due to fear, movement and children turning 19.
Walsh says the program is in a position to cover the youth it has signed up already but faces a continuing struggle of having sufficient funding from year to year.
"We're really in fairly good shape right now," he says. "Every year we need to go back to the well and get more funding."
One of the ways the organization is trying to do that is by reaching out to individual donors, "to get people to really be a part of this," Butler says. "That, to me, is probably better. Our own staff members are contributing to it."
Companies are establishing giving programs and matching the donations made by their employees, she says. Those are the kinds of relationships that will make Healthy Kids not only financially solvent but welcome in the community.
It has been such a success, Butler says, that San Francisco adopted a similar program and began covering children Feb. 1.
For Jamison, though, the success is knowing that her two children are able to get the care they need when they need it.
"It's a great program," she says. "I'm really glad they developed help for low-income people."
For more information and to donate online, visit healthykidsfund.org. To enroll, call 888.244.5222, and to donate or volunteer, call foundation coordinator Ann Wade, 408.260.4489.
Willow Glen, California Since 1992
