Sonoma County expands health coverage for undocumented children

Sonoma County is now closer than ever to achieving a 15-year-old goal of enrolling every single child in the county into comprehensive health care coverage - regardless of the child’s immigration status.

Today, county staff will begin upgrading health care coverage for about 1,000 undocumented children currently enrolled in a restricted form of Medi-Cal, California’s version of the federal Medicaid program. These children are currently limited to emergency medical services.

As many as 3,300 local undocumented children not currently enrolled in the restricted Medi-Cal program could ultimately be enrolled in comprehensive coverage under a new state law.

Overall, there are between 3,600 and 4,300 children in the county who are eligible for comprehensive care under the new state law, said Mary Maddux-Gonzalez, chief medical officer of the Redwood Community Health Coalition, a consortium of health centers across four Northern California counties.

“This is an historic opportunity to have real access to full-scope health coverage for all low-income children in our community,” Maddux-Gonzalez said. “This will improve their health outcomes, which we know even impacts school performance.”

Maddux-Gonzalez said the comprehensive Medi-Cal program covers preventive services, primary care visits, emergency services, hospitalization, prescription drugs, specialty care, eye exams, eyeglasses and dental services.

For Araceli Uribe of Rohnert Park, the new law means her 15-year-old son Jafet now has health coverage. Uribe and her husband brought Jafet, who is undocumented, to the United States from Mexico when he was 5 years old.

Uribe said Jafet lost insurance through Kaiser Permanente two years ago and has been without ever since. The couple’s 6-year-old daughter, Nisi, already has full-scope Medi-Cal because she was born in the U.S.

“My son hasn’t had insurance for two years,” Uribe said, speaking in Spanish. “It’s a relief now. With the new program he now qualifies for health insurance. I worried about him becoming ill or having to go to the doctor and pay the full cost of his care.”

The swap is made possible through a new state law, SB 75, that seeks to close the insurance gap left by President Barack Obama’s Affordable Care Act. Undocumented immigrants who are in the country illegally are not eligible for the Affordable Care Act’s two major components - the expansion of Medicaid and state and federal health insurance exchange programs.

The state Department of Health Care Services or DHCS estimates that a total of 170,000 undocumented children in California qualify for complete coverage.

More than 115,000 undocumented children are already enrolled in restricted Medi-Cal and will be transitioned to full-scope coverage.

An additional 55,000 undocumented children are not enrolled in Medi-Cal but qualify for coverage under SB 75, according to DHCS estimates.

Half of those 55,000 kids are expected to apply for the program over the next 12 months.

Children already enrolled in the emergency Medi-Cal program will not need to sign up for the full-scope version ,and their comprehensive coverage will automatically become effective after today’s implementation date.

The state estimates it will cost $26.2 million in the fiscal year that ends June 30 and $177.3 million the following year to implement SB 75, DHCS spokesman Anthony Cava said.

“We’re delighted at this chance to expand comprehensive health coverage to reach thousands more California children,” DHCS Director Jennifer Kent said in a statement.

To implement the new law, county staff must first modify a county computer system used to determine eligibility for Medi-Cal benefits and ensure it communicates seamlessly with the state’s computer ?system.

“Info has to align for those two systems to communicate with each other,” said Kim Seamans, director of economic assistance for the county Human Services Department. “We have specific staff working on our end to make sure transition occurs smoothly next week.”

Likewise, the state will be monitoring its computer systems to ensure a smooth transition.

“We’ve been working hard with our county partners to make sure the transition is as smooth as possible, and we’ll be monitoring next week to quickly address any unexpected issues that might come up,” Kent said.

Seamans said county eligibility workers have not seen any new applicants come forward for full-scope Medi-Cal coverage.

Outreach, education and enrollment efforts are being spearheaded by groups like the Redwood Community Health Coalition, or RCHC, and Covered Sonoma, formerly the county’s Healthy Kids initiative, which more than a decade ago sought to extend health insurance coverage to all kids in the county.

Aside from those who are currently enrolled in limited Medi-Cal, there are about 1,000 undocumented children enrolled in a subsidized Kaiser Permanente insurance program.

“We’ve been working in a group with RCHC and Catholic Charities, the county health department and Kaiser to identify the population and to try to make the transition as smooth as possible,” Seamans said.

Kaiser patients will be given the option to stay within the Kaiser system, though their coverage will be reimbursed by Medi-Cal, or they can switch to Partnership HealthPlan, the managed care system that operates the state Medi-Cal program.