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Healthy and Happy

Author: Cerrissa MacNichols
June, 2010 Issue

NorthBay biz takes a look at Healthy Kids Sonoma County, a program that provides immediate access to health care and comprehensive health insurance for children of low income families.

When I told a good friend of mine (let’s call her Liz) that I was working on an article about the Healthy Kids Sonoma County program, she was embarrassed to tell me her two children were enrolled in an insurance plan through the program. Liz worked when her children were young, but as her mortgage broker husband’s salary increased, she was able to take some time off and be a stay-at-home mom.

Like so many other families, their income decreased dramatically in 2009, and when her husband’s company dropped dependent health care insurance, Liz began looking for a job. She and her husband are self-conscious about using the program, yet extremely thankful their children continue to have access to quality health care. They know how important it is for their kids to be insured. According to the Children’s Defense Fund, children without health coverage have death rates that are about 50 percent higher than insured children.
Healthy Kids Sonoma County is a locally developed and funded program that provides comprehensive health coverage for children of low-income families in Sonoma County (Marin and Napa Counties each have their own version of the program). Healthy Kids builds on state-sponsored programs, such as MediCal and Healthy Families, to provide health insurance coverage to qualifying families who can’t afford private health coverage.

All children under age 19 who are county residents and living in families with incomes that are at or below 300 percent of the federal poverty level are eligible. That means, for example, children living in a family of four with an annual income of $66,204 would qualify. A family’s cost to insure a child ranges from $0 to a maximum of $24 per month. Depending on income level, families also share the costs with a co-pay between $5 and $10 for some medical, dental and vision services, with no family paying more than $250 annually per child.

During the past six years, Healthy Kids has helped more than 25,000 children access comprehensive health insurance coverage, which includes medical, vision, dental and mental health services. Dr. Mary Maddux-Gonzalez, MD, MPH, and Sonoma County public health officer and division director, says, “Healthy Kids is a remarkable collaboration of local hospitals, clinics, the United Way, Community Action Partnership, the county, public education, Sonoma County Medical Association and community members. It’s been highly effective in expanding access to health insurance and medical care to more than 9,000 children in Sonoma County.”

Twenty-plus community organizations formed the Healthy Kids collaborative in 2004 after it was conceived and developed by members of the local Children’s Health Initiative to expand health care access to uninsured children in the community, beyond the scope of existing state programs. In 2010, administrative responsibilities for the program were moved from the county to the Redwood Community Health Coalition (RCHC), an agency that links 15 health centers and clinics in Sonoma, Napa, Marin and Yolo counties. The change was necessary because funds from the state, the California Endowment and the Blue Shield Foundation were nearing an end. At a time when the county was facing its own funding challenges, the move saved about $80,000 a year. United Way of the Wine Country leads Healthy Kids Sonoma County’s fundraising efforts, and Sutter Medical Foundation, St. Joseph Health System and Kaiser Permanente all provide financial support.

Based on California Health Interview Service (CHIS) data available when Healthy Kids was started, the steering committee estimated fewer than 2,000 of the 8,000 uninsured children in the county would not qualify for public health programs such as MediCal and Healthy Families. Of those 2,000 children, committee members thought about 800 kids would be assigned to Kaiser and another 1,200 would receive private coverage and be seen at county health clinics. The reality was, thousands more children than expected didn’t qualify for public coverage, and still thousands more were eligible for public health coverage programs. (The vast majority—about 75 percent—of the children enrolled into health insurance actually qualify for MediCal or Healthy Families.)

As foundation funding has decreased, Healthy Kids has been unable to enroll more children in its private Healthy Kids program. In response, Kaiser has so far provided insurance to more than 4,000 children who don’t qualify for public programs, and it’s committed to accepting eligible children as long as capacity permits. The value of Kaiser’s in-kind services over the last four years has amounted to $9.5 million—twice the amount initially projected. However, if the local clinics weren’t paying for the enrollment workers, then there would be very few kids enrolling in Kaiser. RCHC’s Sonoma County-based Community Health Centers have invested more than $5 million in hiring and training the network of workers that enroll children into MediCal, Healthy Families, Healthy Kids and Kaiser.

Military service and health coverage end

Lance Gates separated from the U.S. Marine Corps two months before his son Brody was born; medical coverage for his family ended the same day as his active service. According to Laura, his wife of five years, there was no way they could afford Tricare, the continuation insurance offered through the military for six months after her husband’s service ceased. The Gates would have had to pay for three months’ worth of premiums—at a cost of more than $2,000—60 days before he left the military.

When they began researching new plans, they were shocked at the cost and decided to only focus on purchasing insurance for their infant son. Sandy Sakwa, an outreach and enrollment coordinator for Healthy Kids, determined which children’s insurance program would work best for Brody and it was Healthy Kids.

Sakwa points out most health plans operate for full calendar months, meaning clients can’t begin or end coverage mid-month. Since it’s not possible to enroll into a children’s insurance program while you have some other comprehensive insurance, this can create a gap in coverage. Qualified enrollment coordinators navigate the complicated maze to assist parents in getting the best and most immediate coverage possible. The Gates now pay $8 per month for Brody’s health plan co-premium, and Lance has since started attending college (with help from the G.I. Bill), working toward an engineering degree.

Healthy Kids’ business impact

Dr. James Heckman, a Nobel laureate economist from the University of Chicago, has said, “Investing in early childhood development builds the human capital we need for economic success.” Economists have shown that public investments in high-quality early childhood care and education generate a higher rate of return than almost any other public investment.

The North Bay Leadership Council (NBLC), a group of Marin and Sonoma County employers committed to regional prosperity and quality of life, hosted a presentation in January 2010 at Infineon Raceway. The title says it all: Key to Economic Success in the 21st Century: Investment in Early Childhood Care and Development, Why Early Childhood Care and Development Is So Important to Business and How We Can Partner to Improve It. The event was co-sponsored by NBLC, First 5 Marin Children and Families Commission, and First 5 Sonoma County.

First 5 Sonoma County invests in the health and healthy development of Sonoma County’s youngest children. It funds critical health and social services for young children from the prenatal stage through age five to prevent more expensive downstream problems such as child abuse, school dropout, special education and criminal justice involvement.

“How do you feel if you don’t sleep well for a few nights? Imagine what it’s like for a child who can’t get enough sleep because of tooth decay, illness or injury,” says Carol Caldwell-Ewart, communication coordinator for First 5 Sonoma County. “They can’t succeed at school because they aren’t well-rested and are in pain.”

Such children can get misdiagnosed with attention deficit disorder (ADD) or other syndromes when what they really need are medical and dental issues addressed, adds Sara Randall of the Pediatric Dental Initiative in Windsor. Joel Gordon, chair of the First 5 Sonoma County Commission and dean of early childhood education at Santa Rosa Junior College, says, “First 5 Sonoma County has made a multi-year funding commitment to Healthy Kids, because we believe getting young children off to a healthy start is critical to their success in school and throughout their lives.”

Publicly and privately funded

At full implementation, the Healthy Kids program costs $1.1 million annually for premiums, outreach, enrollment and management. Funding comes from a combination of public and private sources. “Community investments in Healthy Kids pay dividends by ensuring children and families in Sonoma County thrive,” says Pedro Toledo, JD, director of government and community relations for RCHC and Healthy Kids.

United Way of the Wine Country President/CEO Walter Collins says, “Nationally, United Way has outlined specific health-related goals, one of which is health insurance coverage for all children. Here in California, our United Way has taken a leadership role in advocating for children’s health insurance coverage, and we credit our efforts with the safeguarding of the Healthy Families program during the last round of state budget negotiations.

“Clearly, the health interests of our community are the interests of United Way, so a partnership with Healthy Kids Sonoma County was a natural fit and consistent with our increased focus on prevention strategies that have long-term, positive outcomes. Health insurance coverage has been shown to keep kids out of the emergency room, in school and free of long-term illnesses. Coverage is also linked to educational achievement and future economic success.”

United Way raises funds for Healthy Kids by hosting a popular annual event. The Third Annual United Way Golf Tournament will take place this year in August at Fountaingrove Golf and Athletic Club in Santa Rosa. “This event has been a resounding success, particularly because our corporate partners recognize how important children’s health coverage is to our community. We live in an incredibly caring community, an   ts health is a top priority to our businesses. They recognize that our business and personal lives are intertwined. When we reach out and help one child, we help the whole community,” says Collins.

The tournament always sells out in advance, and Collins expects a similar response this year. With the recession impacting many families in the community, United Way is expecting additional demands on community health resources and is responding accordingly. “We’re increasing our statewide advocacy efforts to preserve and expand existing health insurance coverage programs,” says Collins. “We’re working harder to raise more funds for Healthy Kids Sonoma County. Additionally, United Way is evaluating efforts to dramatically prevent health care issues from arising in the first place. Our collaboration with Health Action Sonoma County places an emphasis on healthy eating and healthy living, with a primary focus on our schools. This is a developing effort, and is sure to yield some positive, long-term community outcomes.”

“Healthy Kids represents a broad community collaboration that seeks to protect children by ensuring each one has access to a guaranteed level of health coverage,” adds Toledo. Contributors range from large and small corporations, community and private foundations, hospitals, clinics, large and small nonprofit institutions and individual donors.

Dental health matters

In 2000, the U.S. Surgeon General declared early childhood caries (ECC), also known as tooth decay, a “silent epidemic “ of childhood. More prevalent than childhood obesity and diabetes, ECC is the most chronic childhood disease in the nation, above asthma and hay fever.

The Pediatric Dental Initiative of the North Coast (PDI) was formed in 2001 when a group of health providers, child advocates, social service and public health programs from Sonoma, Mendocino and Lake counties joined forces to address unmet oral health needs for low income children. Initial funding to support PDI in these early planning efforts was received from The American Academy of Pediatrics/HRSA-Healthy Tomorrows; Community Foundation Sonoma County; California Endowment; the First 5 Commissions of Sonoma, Mendocino and Lake counties; California Department of Developmental Disabilities; and Bank of the West.

One of the initial goals of PDI was to build an oral surgery center for children from low-income families, and children and adults with developmental disabilities, throughout Northern California. A capital campaign began in October 2006. A clever donor tier—with labels such as Roll with Laughter ($250,000+), Chortle ($25,000+) and Beam ($100)—is loaded with the names of foundations and corporations (including many nearby wineries), as well as local residents who made construction of the facility (and its continuing operation) possible. The new $1.2 million state-of-the-art surgery center in Windsor opened its doors in January 2008 and a second surgery room was added in August of the same year. PDI has already treated more than 3,000 patients.

“By the time they get to us, a lot of these kids are in tremendous pain,” says CEO Viveka Rydell, Esq. The most common procedures performed at the center  are extractions, fillings, crowns and caps for children under the age of 6. Dentists at the center have seen young children with cavities in all 20 of their baby teeth. “When a child’s first set of teeth are rotted, it can affect the condition of their adult teeth,” says Rydell.

What’s more, she notes, bad-looking teeth can be detrimental to a child’s self-esteem and can also be a stigma for an adult looking for a job. Poor oral health can lead to heart disease, diabetes and other life threatening illness. When a severely decayed tooth becomes abscessed, a painful infection occurs at the root of tooth (or between the gum and the tooth) and can spread into the jawbone. “When the gums are inflamed and there’s an infection, it can spread throughout the blood system, even to the brain, and then there’s a huge risk for death,” says Rydell.

PDI serves a low-income population, and the reimbursement for MediCal and DentiCal patients is quite low (and has decreased with California’s budget woes). Rydell says this forces the dental surgery center to be extremely efficient to be sustainable. In addition to surgery, PDI also strives for long-term change by providing bilingual education and prevention information for parents, children and the community, on how to keep teeth and gums in good shape to prevent serious dental problems.

The potential of health care

Efren Carrillo, Sonoma County Fifth District Supervisor, says, “The goal of Healthy Kids is to see that all children in our community have health insurance and affordable access to care. Investing in the overall health of our youth fosters a stronger community and economy, and a more productive workforce. Despite the overall success of Healthy Kids, a continued strong, local outreach and enrollment effort will be necessary to reduce the thousands of uninsured children in Sonoma County. When we invest in children, we invest in our future.”

The California Healthcare Foundation has estimated that, with the declines in employer-based medical insurance, there are still as many as 10,000 uninsured children in Sonoma County. Toledo notes that Kaiser and clinics such as Southwest Community Health Center, Alliance Medical Center and Petaluma Health Center, along with other providers, are already gearing up to accept more children as patients. “The goal of Healthy Kids is to make sure children have access to a patient-centered medical home,” he says. “Our efforts save countless dollars by preventing spiraling medical issues, unnecessary suffering and needless emergency room visits.” Toledo works with insurance brokers who refer families to the Healthy Kids program after an employer reduces dependant coverage.

For people like my friend Liz and her husband, their income will rise when she secures a job, and her husband’s salary will increase as the economy recovers. Lance Gates will graduate from college and find a job that offers benefits for him and his family. It’s inevitable, though, that over time, companies will fold and new ones will start up—and, in the midst of all this, some employees will be without insurance. There are also the working poor, who spend 40-plus hours per week at a job that will never pay well or offer affordable benefits. These individuals also want a better life for their children and know good health and education are key to making that happen.

Children without regular health care suffer disproportionately from acute illness and developmental delays. Preventable ailments such as dental disease become chronic problems and cumulatively result in thousands of missed school days (and work days for parents). Hospital emergency rooms stand in for pediatricians and family doctors, who could more efficiently provide basic health care and preventive screening. Providing every child with basic health care is essential so they can thrive and achieve their full potential. And it’s cost effective. After all, the children of today are the citizenry and workforce of tomorrow.



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