Modesto Bee Article

By Ken Carlson, Modesto Bee Staff Writer
last updated: November 20, 2008 01:21:07 AM

Efforts to close an $11.2 billion state budget deficit have shaken up the state's Healthy Families program, which provides health care to about 13,300 children and pregnant women in Stanislaus County.

Next month, the state is preparing to freeze enrollment in the program, which provides medical, dental and vision care to children whose families earn too much to receive Medi-Cal but can't afford private insurance. If the Managed Risk Medical Insurance Board approves the proposal Dec. 17, families trying to enroll children will be placed on a waiting list at least until June 30.

Officials stressed that Healthy Families recipients in Stanislaus County need to be aware of two other developments:

The state has moved the period for changing health plans, which is normally in April, to Nov. 15 through Dec. 31. The period allows families to change managed care plans that give them a choice of doctors and medical facilities. In Stanislaus County, some people will need to make changes.

The Health Net and Blue Cross Healthy Family plans have served notice that they are dropping Stanislaus County as of Feb. 1. Families that have those plans will have to change to one of two remaining plans: Blue Shield or Health Plan of San Joaquin.

Nilda Johnson, a program manager for the county Health Services Agency, said she's concerned that word isn't getting out to families.

"People are supposed to have received packets from the state," Johnson said. "We are advising families to get in touch with their certified application assistants."

Certified application assistants in Stanislaus County include the Parent Resource Center in Modesto, Casa Del Rio in Riverbank, Family Resource Center in Oakdale and the United Way of Stanislaus County.

State officials say Healthy Families, in some ways, became a victim of its success. More than 900,000 children statewide are covered by the program and new enrollments averaged 27,000 a month in the past year. Eligible parents have insured their children by paying premiums from $4 to $15 per child per month.

But the state has run out of money for covering more children and that's happened as growing unemployment will leave more children uninsured. If the state board approves the enrollment freeze, health care advocates estimate that 162,000 eligible children could be denied Healthy Families coverage from Dec. 18 through June 30.

"Because of the economic downturn, we are seeing a lot of families wanting to apply for Healthy Families," Johnson said.

Amy Sheyer, spokeswoman for Health Net, said Tuesday that state budget cuts led to the insurer's decision to drop its Healthy Families plan in Stanislaus County. "It's no longer financially viable for us to stay in the county," she said, adding that Health Net's Medi-Cal plan is still in place.

The statewide enrollment freeze could affect some families in the Healthy Families program. The state does an annual review of each family's eligibility -- on the anniversary of entering the program -- and slight changes in income disqualify some families.

Johnson said those families often become eligible again in a month or so, when their income changes again, but with the freeze, they will be placed on the waiting list. Families are advised to stay current on premium payments, because nonpayment can result in losing coverage.

If some families are no longer eligible for Healthy Families, the certified application assistants can try to get them into Medi-Cal or a Kaiser Permanente children's program for families that can't afford insurance, Johnson said.

The Managed Risk Medical Insurance Board said the Healthy Families enrollment freeze would be reviewed in June when the state takes a hard look at its 2009-10 budget.

Michael Sullivan, executive director of Golden Valley Health Centers, which has safety net clinics in Merced and Stanislaus counties, said he hopes President-elect Barack Obama and the Democrats will push through more federal health care funds for children.

"You have people who are eligible who are going to be uninsured," Sullivan said. "For the most part, these are kids. I think what the state is doing is a step in the wrong direction."

Bee staff writer Ken Carlson can be reached at kcarlson@modbee.com or 578-2321.