Toldeo Health Insurance

Health care program for kids saved

Kaiser Permanente and a coalition of community health clinics are stepping forward to salvage the Healthy Kids program, which serves more than 8,000 uninsured children in Sonoma County's low-income families       The program had been threatened with near-extinction since last summer due to state budget cuts that sought to save money by gradually eliminating health coverage to more and more children.

However, the county Department of Health Services has arranged to shift administrative responsibility for the program to the Redwood Community Health Coalition, an agency that links 15 health centers and clinics in Sonoma, Napa, Marin and Yolo counties. Under the plan, uninsured children qualifying for health services will get them delivered either at the clinics or at Kaiser Permanente medical offices.

A dramatic change in program administration and in medical delivery is necessary because state funds will end in 2010, as will funding from the California Endowment and the Blue Shield Foundation, which had been paying health insurance premiums amounting to $250,000 annually, said Cliff Coates, Healthy Kids manager since 2005.

Coates said funding from First 5 Sonoma County, funded by tobacco taxes, will continue, but some grants from hospital groups, such as St. Joseph Health System Foundation, are nearing an end.

'This action is necessary to move from cash insurance coverage to in-kind services' provided by Kaiser and the clinics, Coates said.

County supervisors approved the transfer of program management to the clinic coalition on Nov. 10 and the transition is scheduled to begin early next year. County public health director Dr. Mary Maddux-Gonzalez said the move would save the county about $150,000 in administrative costs.

'We are facing challenges in funding and that is part of the reason for the shift in administration,' Maddux-Gonzalez said.

Under the new program structure, children 5 years old and younger will receive most of their care at community clinics while those 6 to 18 would be seen at Kaiser facilities.

Coates credited Kaiser with helping save the program by enrolling more children and delivering far more in-kind medical services than the program's original business plan had estimated.

Originally, Kaiser was projected to serve 789 children under the program, but ended up reaching 3,245 by June 2009, Coates said. In addition, the value of Kaiser's in-kind medical services over the last four years has amounted to $9.5 million, twice the original projections.

As a result, the four-year effort of Healthy Kids to expand coverage to uninsured children added nearly 4,000 children, instead of original projections of 2,035.

'Kaiser has surpassed the expectations that we had for enrollment,' said Supervisor Efren Carrillo. 'To enroll 9,000 low-income kids is a phenomenal feat. But there are still 10,000 kids uninsured so we still have our work cut out for us.'

The California Healthcare Foundation has estimated that, because of declines in employer-based medical insurance, there are still as many as 10,000 uninsured children in Sonoma County.

Pedro Toledo, enrollment coordinator for the Redwood Community Health Coalition, said clinics like Southwest Community Health Center, Alliance Medical Center and Petaluma Health Center were gearing up to accept more children as patients. Toledo said all clinics have a goal of establishing a consistent 'medical home' where uninsured families can access health services.