Next year Medi-Cal begins a huge undertaking: expanding full-scope coverage to hundreds of thousands of low-income undocumented children. One group that deserves extra attention from those implementing the expansion is the estimated 22,000 undocumented kids already enrolled in coverage through county-based programs, including those in the 10 Healthy Kids (HK) programs.
Transitioning children out of these programs and into full-scope Medi-Cal presents administrative hurdles that can cause these kids to experience disruptions in care or coverage, or to drop out of the system altogether. Another 73,000 children are enrolled in the Kaiser Permanente Child Health Program, and they potentially face similar hurdles.
Consider a typical Healthy Kids enrollee. Isabella (not her real name) is 10 years old and undocumented. Her parents speak little English. She's enrolled in HK in a county with only one Medi-Cal managed care plan. She receives regular primary care by a network provider. Because she has comprehensive coverage through HK, she is not enrolled in restricted-scope Medi-Cal.
If the process plays out the way many think it will next year, Isabella will need to enroll in fee-for-service (FFS) Medi-Cal first to get into the system. (If she enrolls before the expansion implementation date, her first point of entry will be restricted-scope Medi-Cal; after the implementation date, Isabella will enroll directly into full-scope.) Once in full-scope Medi-Cal, she will then be enrolled into a Medi-Cal managed care plan.
What are the challenges to her successful enrollment?
- Isabella's parents have to understand how and why to enroll her in Medi-Cal, even though she has comprehensive coverage through HK, which can be a confusing and intimidating process, especially for immigrant families.
- They also need to know that, to maintain her access to comprehensive coverage and connection with her current provider, she will need to stay enrolled in HK until the transition to full-scope Medi-Cal is complete.
- Then she will be, at least for a short time, in FFS Medi-Cal, with different available providers and no health plan.
The irony is that after jumping through all these hoops, she would end up enrolled in the same plan she had as a Healthy Kids enrollee, since there's only one plan in her county. For HK enrollees who live in a county with a choice of plans, the final step would include her family choosing a managed care plan (another potentially confusing step), then transitioning to the new plan with a new set of providers.
We can do better to streamline this process, but it will require the Department of Health Care Services (DHCS) and local entities working together with an increased focus on addressing the unique challenges of transitioning this population.
This week the California Health Care Foundation released Major Transition with Minor Disruption: Moving Undocumented Children from Healthy Kids to Full Scope Medi-Cal. The report recommends actions that can smooth the transition process, and suggests specific roles and responsibilities for DHCS, managed care plans, local Children's Health Initiatives (CHIs), social service agencies, and philanthropy. While focusing on HK programs, many of the issues and recommendations are relevant for transitioning children from other county programs and the much larger Kaiser Permanente Child Health Program.
Read the full report for further recommendations and analysis, and share your feedback in the comments below or via social media (@chcfnews). CHCF will stay engaged with our partners at the state, county, and local levels as this crucial implementation unfolds.