The Health Coverage Unit and the Children’s Health Initiative

In July 2009, the County of San Mateo established the Health Coverage Unit after reaching key milestones in the Children’s Health Initiative (CHI) and the pilot phase of the Adult Health Care Coverage Initiative, led by the Blue Ribbon Task Force on Adult Coverage Expansion (BRTF).

The CHI Oversight Coalition had achieved success in its campaign to maximize children’s enrollment in federal/state insurance programs, and create and sustain a locally-funded Healthy Kids program for children ineligible for state programs. In 2008, the BRTF reached its goal of launching a local coverage program for uninsured adults called Access and Care for Everyone (ACE). More than 24,000 adults enrolled in its first two years.

Outreach and Enrollment Team

Both initiatives shared a component critical to their efforts in reaching uninsured community members—a team of community-based advocates who reach out to eligible low-income and uninsured residents, assist them in the enrollment process and in navigating the complex healthcare system. Community Health Advocates (CHAs) became well-versed over time in assessing eligibility and enrollment in state and local programs for uninsured adults, children, and pregnant women. The team of CHAs is now called the Health Coverage Unit (HCU).

Sustaining universal coverage for San Mateo County’s children continues to be governed by the CHI Oversight Coalition.

Evolution & Milestones

2001

A Coalition Begins to Form Around Children’s Health Coverage

Robert Wood Johnson Foundation grant brings together early stakeholders. In response to the Community Access Program grant to expand access to health care, the San Mateo County Health System, Central Labor Council, El Concilio, the Health Plan of San Mateo, Ravenswood Family Health Center, and the County Human Services Agency work together to increase enrollment in Medi-Cal and Healthy Families. Questions are raised regarding how to address the coverage gap for children ineligible to enroll, due to family documentation status or income requirements. Local hospitals and doctors voice concern about uninsured children. The Hospital Consortium identifies universal coverage for children in San Mateo County as a top priority. Hospitals express growing concern about the impact of lack of insurance coverage for many low-income, and immigrant children who are not eligible for Medi-Cal and Healthy Families. Enrollment projects highlight the coverage gap among ineligible children. Although the San Mateo County Health Department in partnership with community-based groups continues to succeed in projects to improve enrollment among eligible children, project stakeholders reinforce their concern for the significant proportion of children not eligible for coverage.
2002

First 5 Commission Presents Funding Opportunity for Universal Coverage

Health Summit convenes local stakeholders to plan the Initiative In response to the San Mateo County First 5 Commission’s commitment to help fund universal coverage for children from birth to age 5, the Hospital Consortium, the County Health Department, and the Peninsula Community Foundation convene a summit to initiate discussions on how to strategically use, and match, the First 5 Commission’s long-term investment of 2.3 million per year, for ten years. The Peninsula and Sequoia Health Care Districts join the group of local funders that continue to support and sustain universal health coverage for children in San Mateo County. Other philanthropic partners supported the launch of a locally created health insurance program for children ineligible for federal and state programs.
2003

CHI and Healthy Kids are Launched

The Children’s Health Initiative (CHI) and its Coalition

Shortly after the Health Summit, the following key stakeholders move forward with formalizing their collaborative leadership as the CHI Coalition, to launch and govern the San Mateo County’s Children Health Initiative: San Mateo County First 5 Commission, Central Labor Council, Peninsula Community Foundation, Health Plan of San Mateo, and the San Mateo County Health Department and Human Services Agency. Their goals were to enroll 100% of eligible children in the existing, state-funded Medi-Cal and Healthy Families insurance programs, and create a local Healthy Kids program that provides coverage to children not eligible for the state-funded programs, the majority of whom are from undocumented immigrant families.
2005

CHI’s Impact on Children’s Coverage is Measured and Recognized

In just 2 years after its launch, an evaluation of the CHI and its impact on children’s coverage in the county shows that the number of uninsured kids in San Mateo County decreased from 17,000 in 2003, to just 3,000 in 2005! CHI receives the San Mateo County Board of Supervisors’ STARS Award for its efforts in reaching this historic milestone.
2006 – 2008

Blue Ribbon Task Force on Adult Health Care Expansion and ACE

In 2006, the San Mateo County Board of Supervisors (BOS) convenes a task force to propose recommendations on how to address the growing community concern about the uninsured, low-income adult population. An analysis of the shared cost burdens to local government and employers, shows how long term lack of coverage and coordinated care, contributes to medical debt incurred through inappropriate use of services at the San Mateo Medical Center. In 2008, the BOS approves BRTF recommendations on how to finance sustainable coverage expansion for adults, and implement a coordinated delivery system of care. The County is also one of ten counties awarded federal funds through California’s 1115 Medi-Cal waiver, to launch its coverage program for adults in 2008, called Access and Care for Everyone (ACE). The ACE program received $21 million over three years, allowing for more than 24,000 adults to be enrolled by 2010.
2009

CHI Outreach and Enrollment becomes the Health Coverage Unit

The County Health System recognizes the significant increase in the role of Community Health Advocates in providing information and assistance with enrollment, and retention, in the Medi-Cal and ACE adult coverage programs. This role is expected to continue with the 2011 implementation of the federal Medicaid Coverage Expansion program for adults, created to accommodate the increase of eligible adults generated by the national health reform law. In view of these changes and opportunities to apply best practices in customer service, and advocacy, the Health System creates the Health Coverage Unit (HCU). The HCU works closely with the Human Services Agency and the Health Plan of San Mateo, as well as a broad range of community partners, to serves all residents of San Mateo County.