Could California Children Moving to Medi-Cal Lose Access to Care?

On January 1, California will begin transitioning children from the Healthy Families Program, a low-cost health insurance program for kids and teens, into Medi-Cal, the state’s version of Medicaid. Under the plan - crafted in an effort to balance the state budget - an estimated 875,000 children enrolled in Healthy Families will be transitioned into Medi-Cal in four phases over the next year.

As the transition looms, health advocates are expressing concern that low-income children from rural counties could lose access to medical care. Health journalists could play an important role in ensuring the transition goes smoothly and reporting on any cracks in the system.

“Healthy Families is not shuttered, but it will be,” said Kris Calvin, CEO of the California chapter of the American Academy of Pediatrics. “People need to recognize that it is not a question of whether, it’s a question of when.” The transition, she said, “will disproportionately impact those who have trouble accessing care to begin with.”

Advocates acknowledge the plan could provide some advantages to low-income families. For example, Medi-Cal is an entitlement program that can’t be capped due to budget constraints, as Healthy Families sometimes was. Also, Medi-Cal’s benefit package offers more guarantees for kids.

The worry, though, is that low-income families in rural areas could face even more barriers to accessing to medical care after transitioning out of Healthy Families, because fewer doctors accept Medi-Cal. Especially in rural regions with a shortage of doctors, it could also be challenging to find providers who understand the unique languages and cultural traditions of the state’s diverse population.

“It’s harder to find a doctor in rural areas that will accept Medi-Cal in the first place,” said Kelly Hardy, director of health policy for Children Now. “Medi-Cal is a great program, but reimbursement rates are much lower than Healthy Families, so there are [fewer] providers that can keep a practice afloat on Medi-Cal rates.”

Advocates and legislators have also questioned whether the state has established an adequate monitoring system to oversee the transition. This changeover could be tricky for journalists to follow.

Emily Bazar, a senior writer with the California HealthCare Foundation’s Center for Health Reporting, offered some tips on how reporters can keep a close eye on the transition. She has contributed to the organization’s excellent reporting on the ineffectiveness of a dental health care model that was piloted in Sacramento County beginning in 1994.

For reporters interested in tracking the successes and challenges of transitioning children from Healthy Families to Medi-Cal, Bazar recommended reaching out to people on the ground. County medical societies, she said, will know if medical providers are being overwhelmed by a surge in new Medi-Cal cases. Family resource centers can provide great sources, and school nurses will know if students are able to see specialists, and how far they need to travel to receive care, she said. She also recommended reaching out directly to doctors who do and don’t accept Medi-Cal.

“The big question about the transition is access, and whether kids who are transitioning from Healthy Families to Medi-Cal are going to have adequate access in the system,” Bazar said. To determine whether children and their families are receiving adequate medical care once they are transitioned into Medi-Cal, “you have to get in close with people who are somehow monitoring access."

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