California Parents Lack Knowledge of Healthy Families and Medi-Cal, Study Reveals

Many low-income California parents are either unaware of the existence of the state's CHIP program or fail to understand how it differs from Medicaid, and many are not sure in which program their children are enrolled, according to a recent study from the Henry J. Kaiser Family Foundation. To understand how parents of eligible California children view Medi-Cal, the state's Medicaid program, and Healthy Families, the state's CHIP program, researchers held eight focus groups throughout the state with parents of children who were either uninsured or enrolled in one of the programs. Each focus group consisted of two sessions: the first session in which interviewers asked participants about Medi-Cal and Healthy Families without giving them any information; and a second session in which the participants were given information and then asked to evaluate each program. Below are some of the study's findings:

• Medi-Cal: In the first discussion period, all participating parents said they were aware of Medi-Cal and most had a "positive impression" of the program. However, they also listed several concerns, including a "difficult enrollment process," anxiety over their children being "treated badly by health providers and their staff because they are 'Medi-Cal recipients,'" problems finding physicians who accept Medi-Cal and "inadequate dental coverage." In the second discussion session, after receiving information about the program, many parents said they had been unaware of the recent program changes, including the availability of mail-in applications, that the application is only four pages long, that "Medi-Cal will cover past medical expenses and that certain immigrant children may not be eligible."
• Healthy Families: In the first session, fewer parents had heard of the CHIP program, and many were unaware of the differences between Healthy Families and Medi-Cal. In addition, those whose children had coverage were not sure in which program their children were enrolled -- a fact the report attributed to the prevalence of managed care in both programs and the tendency for parents to associate their health care more with their health plan than with a particular government program. Many parents had favorable impressions of Healthy Families, but several said that it was too new and that they did not have enough information to evaluate it. In the second session, many parents were surprised to learn that adults are not eligible for Healthy Families, given its name (Medi-Cal allows enrollment of some low-income adults). They were also unaware, but viewed favorably, the fact that children remain eligible for 12 months once approved for Healthy Families. The participating parents were aware that Healthy Families requires premiums and a co-payment for services, but said these were "manageable" compared to private insurance charges. Many were "frustrated" that the program doesn't cover parents, but a "few" said Healthy Families should "retain its focus on children."
• Which is Better?: Citing the opportunity for some parental enrollment and the lack of fees, a majority of parents said that Medi-Cal was the "better program" for their family. A minority concluded that Healthy Families was preferable, as they took pride in "paying their own way" and believed that the program offered better care because it requires payments.

Policy Implications
Based on these findings, the report offers three recommendations for improving parental access to and information about Medi-Cal and Healthy Families:

• The state should provide "more detailed information about Healthy Families," and outreach efforts should include clearer eligibility information.
• A state-provided "Medi-Cal Update" would be a useful way to inform both those who have participated in the program and those without prior Medi-Cal experience about program changes.
• The state should expand Healthy Families to cover parents of low-income children. Recent California legislation "directs the state to seek" a federal waiver to perform such an expansion (Perry, "Medi-Cal and Healthy Families: Focus Groups with California Parents to Evaluate the Medi-Cal and Healthy Families Programs," Jan. 2000).