HANFORD -- How Kings County can achieve universal health care for children remains an open question until more is known about what works best.
But those behind the endeavor at least got the first clues in a public forum held by First 5 Kings County Wednesday.
People learned how other communities have approached their Child Health Initiative, and they took a hard look at what it might take Kings County to enroll all uninsured kids in health plans.
"It achieved its purpose," said Lisa Watson, executive director of First 5 Kings County, which is leading the planning. "We wanted to educate the community about what's going on in the state and the Valley. This public forum was crucial for our planning process."
Bay Area counties have been insuring children at a dramatic rate through universal health care. Now the idea is gaining momentum among Valley counties. Kern recently launched its own program, and Fresno and Tulare are ready to get started.
Kings County, however, is still in the discussion stage.
The forum provided the public with the chance to hear directly from representatives of Fresno, Tulare, Kern and San Luis Obispo counties about what must be considered when structuring a program.
Local government leaders don't necessarily see it as a disadvantage, although they acknowledged Kings County faces its unique challenges.
"We are in a unique position to evaluate the surrounding counties and pick out the best option for us," said Joe Neves, Kings County supervisor who chairs the First 5 commission. "We didn't want to stutter and stop. We are a small county. We weren't willing to lose money because we don't have the funds to reinvent the wheel."
Collaboration with other counties becomes almost imperative because Kings County will have a hard time drawing more specialty care providers for children, Neves said.
A question of access
Providing affordable insurance to children of need is "essential" in improving access of care, said Steve Naylon, a local pediatric nurse who joined the panel at the forum.
Oftentimes, uninsured children are not getting proper follow-up care for their conditions because parents would rather make multiple visits to an emergency room than see a primary care physician, Naylon said.
The Adventist Health employee said the rural health clinics in the communities have improved access, but more should be done.
Lack of specialty care in the area is just as pressing an issue as the uninsured.
"I think we need to work on how we can attract more providers to the community, especially pediatric-oriented mental health," Naylon said. Increased access is also needed in orthopedic and traumatology, he said.
The concern was echoed among a few participants.
"From a business point of view, if you don't have the providers who accept the program, you have nothing," one participant said.
Uninsured at a cost
Children without health coverage have a higher death rate than insured children. Most uninsured children with asthma never see a doctor, and many are hospitalized for acute asthma attacks. Children often cannot keep up in school because an easily preventable illness tends to keep them at home.
The initiative is an attempt to insure those who fall through the cracks, but in the process, officials are hoping to step up the recruitment for two existing health care programs, Medi-Cal and Healthy Families.
Of the estimated 4,000 uninsured children 0-17 in Kings County, nearly 75 percent are thought to be eligible for either of the two programs.
An enrollment effort is already undertaken by family resource centers throughout the county. FRCs help apply for those programs. The new child health initiative, which creates a new plan, is expected to streamline the process of subsidized health care options.
The priority for the county should be an outreach and education for families not only to enroll more children into programs they qualify for, but also to keep them insured, a group of forum participants said.
Children get disenrolled often because parents who are unfamiliar with the system failed to make payments, said Catherine Quinn of Fresno County's Child Health Initiative program. Having information available is not enough, Quinn said. Families need people who can be trusted to navigate them through the system, she said.
Neves said the outreach can be effectively done through collaboration with schools.
"Schools are already overburdened, but they are supposed to be the logical starting point because all the kids are at school age," Neves said.
A new volunteer task force is rolling up its sleeves to deal with that issue. The steering committee leading the child health program planning has recently created two subcommittees to boost outreach, enrollment and retention as well as fund-raising efforts.
Shifting the course for kids
When First 5 Kings County first planned its child health project a few years ago, it had a quite different idea than universal health care.
The commission was originally pursuing a home visitation program for at-risk new mothers, said Watson, First 5 Kings County executive director.
But everything changed when the health department found new money to fund the program, Watson said.
All of a sudden left with unused money, First 5 went back to the drawing board. That's when First 5 Kings County began eyeing a way to extend health care coverage to all children, Watson said.
The agency decided to let the money lay dormant while pursuing a new child health program.
A total of $800,000 has been set aside so far, Watson said. The First 5 commission will identify specific use of the money when it redefines the goal of its child health initiative during strategic planning in September, Watson said.
Funding will certainly become an issue because tobacco-tax commissions can only fund programs that directly serve children age 0-5. But it can be done.
For example, the Tulare County First 5 agency solved its issue by segregating the funding streams for different age groups.
Complex and uncertain
In the coming months, Kings County must hammer out many issues such as funding, outreach, and partnership development to figure out a model that works best for the community.
There are different options for local children's coverage.
In counties such as Los Angeles and San Joaquin, children are enrolled into a county-run HMO called Healthy Kids program, which offers benefits that are similar to Healthy Families. Others use California Kids program, which offers a limited scope of benefits at lower cost, or a fee-for-service program to cover children who are ineligible for Healthy Families or Medi-Cal.
Leadership structures could differ from county to county as well.
In San Luis Obispo, the program is run by a nonprofit corporation, while it's run by the First 5 agency in Tulare County. In Kern, the work is subcontracted to the county health department and community organizations.
Kings County may be at a disadvantage if it wanted to follow the model being used by the surrounding counties.
Fresno, Kern and Tulare counties are under a managed care delivery model of Medi-Cal, so they already have the network of providers in place, said Perry Richard, director of the Kings County Health Department.
Managed-care can cut the cost by eliminating the overuse of unnecessary services, but here is a dilemma: Kings County still uses the old fee-for-service model.
To model the new plan after an indemnity health insurance would be costly. It would also be costly and time-consuming to create the providers network from scratch, Richard said.
But the county has a few hopes to get around the challenges.
A proposal is in Sacramento to convert many counties into managed-care environments within the next two years. Kings is one of them, Richard said. The model used by its neighbors could then become feasible.
Officials also heard something they did not know during the forum.
The state Managed Risk Medical Insurance Board, an agency that administers Healthy Families, could potentially allow counties to piggyback a new plan onto the existing Healthy Families providers.
If such an arrangement is possible, it opens up a whole other opportunity. The county could then negotiate with one of the providers for a new local children's coverage program.