By Sarah Arnquist

After years of seeing decreasing numbers of uninsured children, California is poised to go the other direction.

For years, child enrollment in private health insurance plans decreased as companies scaled back on health care costs by increasing employees’ share of the premiums or by stopping dependent coverage altogether.

But those declines were offset by increased enrollment in public programs. Recognizing that half the uninsured children already qualified for Medi-Cal (California’s version of Medicaid), and Healthy families (the
state’s SCHIP program), school districts and advocates focused efforts on finding and enrolling those children.

But now, things aren’t looking so rosy. State and county budgets constraints threaten to erode the children’s enrollment gains in
Medi-Cal, Healthy Families  and Healthy
Kids programs, county-organized health plans.

"Come next spring, you could have a double or triple whammy of kids
losing health coverage," said Joel Diringer, a consultant who helped
many California counties create the local programs.

California saw more than a 20 percent drop in the number of
uninsured children between 2001 and 2006. Yet, an estimated 800,000
California children still lack insurance, according data from the California Health Interview Survey.

About half of those uninsured California children are
ineligible for Medi-Cal and Healthy Families due to their immigration
status or family income.

California made great gains in covering those children because
children’s advocates quit waiting for state lawmakers to fulfill their
promise of universal children’s coverage and took matters to the local
level.

The advocates raised tobacco tax money, foundation money, private
donations and convinced county governments to set aside millions for
kids health insurance.These programs became known as Children’s Health
Initiatives and they operated Healthy Kids insurance plans.

Today, Diringer said, Healthy Kids plans cover about 80,000 California children otherwise ineligible for public insurance.

But these local efforts were meant only to be a stop-gap measure,
and so they lack sustainable funding. Already, 20,000 children
statewide — mostly 6 to 18 year olds — are on lists waiting for
insurance. And earlier this month, Alameda County, home to Oakland,
announced its program will shut down altogether, dropping 1,000
children.

"Alameda isn’t the only county where this will happen," Anthony Wright wrote
on the Health Access blog. "It’s a shocking thing, for California
counties to drop kids from coverage, but that’s exactly what is
happening."

Diringer said Alameda is, for now, an isolated case, but Los Angeles
County’s Children’s Health Initiative is running on month-to-month
funding, which will run out completely in September.

What’s more frightening, he said, are the Medi-Cal cuts coming down
the pipeline. The state budget (which is late as ever) proposes to save
by forcing paperwork every six months onto families. That should result
in 250,000 children losing coverage by 2011, according to budget
analysts.

"We’re going backwards when everybody promised we’d be moving forward," Diringer said.

Then next spring, California’s Healthy Families program won’t have
sufficient funds to cover all children currently enrolled. That’s
because Congress barely managed to reauthorize SCHIP during a long and
bitter battle last year, and failed to increase funding despite cries
from many states who said flat funding would result in disenrollment.

Trying to find something positive to grasp onto, Diringer said the
November presidential election could bolster the state reform efforts
that Schwarzenegger still hasn’t entirely abandoned. His plan includes
universal coverage for children.