In the absence of change at the federal
level, several states and localities have embarked on innovative
health coverage expansions in recent years. New models are more
likely to be pioneered and replicated at the local level, with the
results having an immediate and visible impact on local communities.
Importantly, local coverage programs serve as laboratories for innovative
models of financing and delivery of health services.
Since early 2000, many California counties have adopted innovative
solutions to expand health insurance coverage to uninsured children
and families through the Children’s Health Initiative (CHI).
To some degree the structure, financing, and political dynamics
have varied in each county with a CHI, but the vision, target population,
and expansion products have been fairly similar in scope. The programs
seek to reach all children living in families with incomes up to
300% of the federal poverty level (with the exceptions of San Mateo
and Riverside Counties), who do not qualify for existing public
coverage. While their circumstances and approaches differ, most
CHIs share a bold vision of health coverage
for all children and three key supporting strategies. These
(1) Cultivating Public-Private Partnerships to provide affordable
health coverage to all chldren;
(2) Creating a Single “One Open Door” Outreach and Enrollment
(3) Creating a New and Comprehensive Healthy Kids Insurance Program.
Currently, the counties of Alameda, Santa Clara, San Francisco,
Riverside, San Mateo, Los Angeles, San Bernardino, San Joaquin,
Santa Cruz, Kern, San Luis Obispo, Santa Barbara, Napa, Solano, Sonoma, Yolo, Fresno, Tulare, Colusa, Sacramento, Yuba and El Dorado are operating children’s coverage
expansion programs. To date, these programs have cumulatively enrolled
approximately 87,000 children in their Healthy Kids programs and covered
tens of thousands more under Medi-Cal and Healthy Families.
Other counties, including Merced, Kings and Placer are well on their way to implementing
similar types of coverage expansions. A number of other counties
are realigning and/or integrating their systems of care to help
improve access for uninsured children.
More information on each county’s program can be found on
the Local Children’s
Coverage Expansion Table and Map.
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