Growing Pains for the Los Angeles Healthy Kids Program: Findings from the Second Evaluation Case Study

Growing Pains for the Los Angeles Healthy Kids Program Findings from the Second Evaluation Case Study Prepared for: Prepared by: Ian Hill Patricia Barreto Brigette Courtot Eriko Wada The Urban Institute April 2008 The University of Southern California The University of California at Los Angeles THE URBANINSTITUTETHE URBANINSTITUTETHE URBANINSTITUTE Acknowledgments We would like to acknowledge the support and cooperation of the numerous individuals who met with our research team to provide the information summarized in this report. These individuals were extraordinarily generous in giving their time and sharing their insights about Healthy Kids and the Children’s Health initiative. (A complete list of key informants appears in Appendix A.) In addition, we would like to acknowledge the program staff at First 5 LA, the Los Angeles County Department of Public Health, and the LA Care Health Plan for their invaluable assistance with the planning and coordination of our site visit. Finally, we are grateful for the careful direction and support provided by our project officers at First 5 LA—Will Nicholas and Christine Ong—and at The California Endowment—Astrid Hendricks. For more information about First 5 LA and its initiatives, go to www.first5la.org. Contents Executive Summary ......................................................................................................................... i I. Introduction ................................................................................................................................. 1 II. Outreach, Enrollment, and Retention .........................................................................................4 III. Benefits, Service Delivery, and Access .................................................................................. 17 IV. Financing and Sustainability................................................................................................... 35 V. Options for Policy and Program Change ................................................................................. 42 VI. Conclusions............................................................................................................................. 48 References..................................................................................................................................... 50 Appendix A: List of Site Visit Informants iExecutive Summary The Los Angeles Healthy Kids program has achieved a great deal during its first four years of existence. Designed to cover all children, regardless of immigration status, living in families with incomes below 300 percent of the federal poverty level and ineligible for Medi-Cal or Healthy Families, the program has provided hands-on outreach, assistance, and support to families throughout the County, and succeeded in extending comprehensive and affordable health coverage to over 40,000 very poor, very vulnerable children. Furthermore, according to newly released survey results, Healthy Kids has had a demonstrable positive impact on children’s access to and use of care, reduced parents’ concerns about obtaining care for their children, reduced unmet need for virtually all types of services, and actually improved the health of enrolled children. Yet, over the past two years, Health Kids has faced serious challenges as well, primarily related to financing. Specifically, while funding for younger enrollees ages 0 to 5 remains stable, resources for older children began to run short as early as the spring of 2005, and Healthy Kids was forced to impose an “enrollment hold” for 6 to 18 year-olds. Aggressive fundraising efforts continued with the goal of maintaining coverage for existing enrollees rather than to enable new enrollment. Indeed, enrollment for children ages 6 to 18 has never reopened and, over time after the hold’s implementation, enrollment levels for all children have slipped. Beyond financing, Healthy Kids has also faced challenges related to some of the chronic problems in the systems of care into which the program was introduced. At this critical juncture, the Healthy Kids Program Evaluation continues to monitor the implementation of Healthy Kids and assess its impacts on the target population and systems of care for children. This second case study report was developed under a four-year contract iibetween First 5 LA and the Urban Institute and its partners. Based on information gathered in interviews with over 40 key informants during a week-long site visit to Los Angeles, this report analyzes the status of the maturing program and delves into some of the complex challenges it has faced. Outreach, Enrollment, and Retention Healthy Kids outreach and application assistance are provided through a broad and diverse network of community-based agencies. Relying on a cadre of trusted, multi-lingual staff, these agencies find families with uninsured children, inform them of