Los Angeles CalKids, a program designed to provide health insurance for low-income children who are not U.S. citizens, has drawn higher than expected participation and elicited high satisfaction ratings among low-income immigrant families in Los Angeles County. Nevertheless, nearly half of all enrollees allowed their coverage to lapse at the end of the first year, despite the fact there were no monthly premiums, according to a study released today.
"CalKids succeeded in demonstrating that formal health insurance could appeal to L.A.'s low-income immigrant families. But maintaining enrollment has been a challenge, just as it has been in Medi-Cal and Healthy Families," said Mark D. Smith, M.D., M.B.A., president and CEO of the California HealthCare Foundation, which provided a $1.5-million grant to subsidize the cost of insurance premiums through L.A. CalKids and funded the evaluation of the program's effectiveness.
The program, also known as the Riordan Initiative of CaliforniaKids, was highly successful in enrolling its target population of non-citizen, uninsured, primarily Latino children with household incomes less than 250% of the Federal Poverty Level. Within two years, the program enrolled 6,000 children, exceeding the initial target of 4,000. Nine out of ten kids had no previous private health coverage. A variety of outreach methods were used, with "word of mouth" proving the strongest.
The program, which covered outpatient care, dental, vision, behavioral health, emergency care, and pharmacy services, improved access to health care, nearly doubled dental use, and decreased use of emergency room services. Nearly 30 percent of surveyed families indicated that their child had not obtained needed medical care within six months prior to enrollment in the program, but only 7 percent of families reported forgoing care after enrollment in the program. Ninety percent of surveyed respondents rated the program very good to excellent and 97 percent said they would recommend it to others.
Children whose parents were employed were more likely to re-enroll, suggesting that family stability was an important factor in re-enrollment, according to the authors. Nearly 30% of the phone numbers had changed since completing the initial enrollment form. More frequent contact with enrollees might improve re-enrollment, the authors suggest, as well as better education about the program benefits and how to access services.
Conducted by the University of Southern California Center for Health Financing, Policy and Management, the Evaluation of the Los Angeles CalKids Program was commissioned by CHCF to assess the program's effectiveness in outreach, its impact on utilization and cost of health services, and enrollee satisfaction. The study was based on telephone interviews of families at enrollment and after an interval of six months to a year, analysis of health plan utilization data, and case study interviews with outreach and administrative staff. The study's authors are Glenn Melnick, Ph.D., Joyce Mann, Ph.D., LaVonna Blair-Lewis, Ph.D., Susan Maerki, M.H.S.A, M.A.E., Lois Green, M.H.S.A., and Nasreen Dhanani, Ph.D.
Both the executive summary and full report of the evaluation survey are available for download through the link below.