A Profile of Young Children in the Los Angeles Healthy Kids Program

A Profile of Young Children in the Los Angeles Healthy Kids Program: Who Are They and What Are Their Experiences on the Program? Prepared for: Prepared By Embry Howell Lisa Dubay Genevieve Kenney Louise Palmer Ian Hill The Urban Institute Moira Inkelas The University of California at Los Angeles Martha Kovac Mathematica Policy Research October 2006 The University of California at Los Angeles Mathematica Policy Research, Inc. The Urban Institute ACKNOWLEDGMENTS The staff of the survey division of Mathematica Policy Research, under the leadership of Martha Kovac and Betsy Santos, led the sampling and fielded the survey, achieving very high response rates. We appreciate the help of Elaine Batchlor and Eleanor Young of L.A. Care Health Plan, who facilitated our access to data for sampling and to HEDIS data on immunizations. Our project officer, William Nicholas, provided critical support and comments throughout survey development and analysis. Stephen Zuckerman of the Urban Institute provided helpful comments on the draft report. EXECUTIVE SUMMARY The Healthy Kids program of Los Angeles County provides insurance coverage to low income children who do not have access to other health insurance. This report is one of a series of reports being produced under the Healthy Kids program evaluation, which is designed to provide feedback to stakeholders on the progress of the initiative. First 5 L.A. contracts with The Urban Institute and its partners to conduct the evaluation. The report provides an analysis of data from a survey—conducted by Mathematica Policy Research for the evaluation—of the parents of Healthy Kids children ages 1 to 5. The key findings from the analysis of the survey are as follows: Most Healthy Kids enrollees are age 3 to 5 and are in two-parent, Latino working families. • Most of Healthy Kids parents have been in the U.S. for some time. • The majority of Healthy Kids families are very poor, with relatively low parental educational attainment. • Most parents are Spanish speaking, suggesting a high need for culturally- and linguistically-appropriate services. Despite this general pattern, there is diversity among Healthy Kids, which should be taken into account when planning for the best way to target services. For example, it is possible that different Healthy Kids outreach approaches could succeed at enrolling increased numbers of certain types of children, such as more younger children or higher income children. • While most Healthy Kids are in good health, a substantial proportion are not, according to several different measures. Special attention should be paid to health access for these vulnerable children, because of their fragile health status. • Consistent with findings from the evaluation case study and focus groups, parents reported very positive experiences about the outreach, enrollment, and renewal processes for Healthy Kids. • Healthy Kids is not substituting for employer-sponsored health insurance to any great degree, since few Healthy Kids enrollees have access to private insurance coverage. • Emergency Medi-Cal plays an important role in providing financial access to health services for uninsured young children in Los Angeles County, and a large number of Healthy Kids enrollees retain Emergency Medi-Cal coverage after enrolling. • Access to care for Healthy Kids enrollees is very good for many services, particularly preventive and primary care services, and the use of preventive care is high compared to national benchmarks. Almost all Healthy Kids enrollees have a usual source of care, and the location of the usual source of care was usually close to the child’s home. • Unmet need was very low for care for urgent health problems. • Healthy Kids provides critical access to immunizations, and four and five year olds are still being caught up on their immunizations under the program. This shows that Healthy Kids has a public health effect broader than its own program’s beneficiaries. • In contrast to preventive care, the use of specialty services is lower than national benchmarks for SCHIP enrollees, and unmet need for specialty services is relatively high. Consistent with this finding, unmet need in general was higher for children with health problems. • In spite of this generally positive picture of access to care, some parents had difficulty getting after-hours advice for health problems, when Healthy Kids parents needed to reach a doctor after the clinic was closed. In addition, a large share of parents who reported unmet need said that the main reason that they did not obtain care was that the clinic or doctors office was not open during times that were convenient. • In spite of the generous coverage and low cost sharing under Healthy Kids, almost 30 percent of Healthy Kids enrollees reported that obtaining needed health care for their child was creating a financial burden for the families. Understanding the origin of these f