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California's Children's Health Initiatives: County-Based Programs to Guarantee Coverage

California counties are taking creative approaches to guarantee that all low- to mid-income children have access to health coverage. As of April 2005, 10 counties have implemented and another 18 are planning Children's Health Initiatives (CHIs). With funding from private philanthropies, local and state contributions, and tobacco tax revenues, these counties have extensive outreach campaigns to enroll eligible children in Medi-Cal and Healthy Families (California's Medicaid and CHIP programs) or the new "Healthy Kids" programs (implemented and funded in each county) for children who are not eligible for public programs.[1] Together, these counties have enrolled more than 70,000 children in their Healthy Kids plans and tens of thousands more under Medi-Cal and Healthy Families.

Results from the first CHI, begun in Santa Clara County in 2001, are promising. A new evaluation of the impact of the program found a 50 percent reduction in unmet need for medical and dental care.[2] An earlier assessment found that for every child enrolled in Santa Clara's Healthy Kids plan, CHI added nearly one additional child to Medi-Cal or Healthy Families. This represented an increase in the latter programs of about 28%, bringing into the county an additional $24.4 million in state and federal dollars during the initiative's first two years.[3]

The foundation support for Healthy Kids is intended only as bridge funding until a permanent source of public funding is established. A coalition of advocates called the 100% Campaign and Pacific Institute for Community Organization California are working to expand the program statewide and guarantee stable public financing, possibly with a private trust fund as a supplement.[4]

The coalition has sponsored legislation to expand health coverage to all children in the state, called Californians for Healthy Kids.

[1] California Endowment, the David and Lucile Packard Foundation, Blue Shield of California Foundation, The California HealthCare Foundation, First 5 California and local First 5 Commissions. The California Endowment has funded a technical assistance consortium to work with counties to help them implement their CHIs.

[2] Trenholm, C.A., Howell E., Hughes D., and Orzol S.. Santa Clara Healthy Kids Program Reduces Gaps in Children's Access to Medical and Dental Care, Mathematica Policy Research, Inc., April 2005

[3]Trenholm, C.A. Expanding Coverage for Children: The Santa Clara County Children's Health Initiative, Mathematica Policy Research, Inc., June 2004

[4] The 100% Campaign is a collaborative effort of Children Now, Children's Defense Fund, and The Children's Partnership, with primary funding from The California Endowment. The campaign's goal is to ensure universal access to health coverage for all children in California.

For More Information: Institute for Health Policy Solutions Web site,
Santa Clara program:
Statewide campaign:
Contact: Institute for Health Policy Solutions California 650 287-4210, Liane Wong, California Director, [email protected], or Hilary Frazer, Senior Program Researcher [email protected].

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