Insurers are failing to provide coverage for people under 26 in key areas such as immunizations, mental health, and well-child visits.
Written by Mark Kreidler, capital and main
This article is produced by an award-winning journalism nonprofit. capital and main Co-published here with permission.
This seems contradictory. Children's advocates give California an “A-minus” rating for providing children with the health care they need, but a “D-plus” for access to health care and overall accountability. How can a rating be given?
Dear Children Now reviewers, these ratings are not contradictory. They reflect the current state of play. The fact that children have health insurance does not mean that they will actually receive the care they need.
“This is not a new story, but it is happening right now,” said the group, which promotes legislative and state executive solutions to challenges facing Californians ages 0 to 26. said Kelly Hardy, senior managing director of health and research. .
“We should applaud California for its great efforts to cover children, because 20% of California children did not have health insurance. [compared with 3% now]” Hardy said. “But that's just the first step. Many more steps are needed.”
The scores are included in the advocacy group's 2024 California Children's Report Card, the latest edition that assesses children's conditions in areas such as health, education, family support and child welfare. Children Now has been publishing grades every two years for more than 30 years, using established metrics and in consultation with coalition partners and experts. The group said this is primarily to give lawmakers and California's governor's administration what advocates believe is a roadmap to help young people grow and prosper in the state.
The latest edition of Children Now shows that this condition is barely passing. California received a C-minus or lower on nearly half of the 33 questions that matter to youth that were graded. And of his nine issues under the general heading of health, he only rated one above a C.
This is more than just a thought exercise for Children Now. The organization is working with lawmakers to draft legislation that would change the course of many California youth, with an emphasis on children from low-income families and children of color. Approximately 47% of California's population under the age of 26 is Latino, by far the largest group of its kind.
In recent years, the state has made significant progress in getting young people insured. Medi-Cal, the state's version of Medicaid, grew to cover 5.7 million children in California before the redetermination, and Gov. Gavin Newsom expanded the program to admit more young people regardless of immigration status. expanded. The state also made coverage through Covered California affordable to thousands of families starting this year.
But when Children Now researchers looked at whether young people were getting the care they needed when they actually needed it, they found that states were falling short. In 2021, more than half of the state's managed care plans fell below minimum performance levels for immunization rates, well-child visits, and well-child visits, among other things. This is a red flag, given that states pay these plans to coordinate and deliver Medi-Cal services.
“The responsibility ultimately lies with the state of California,” said Richaun Francis, the advocacy group's senior director of behavioral health. “We have a contractual obligation to young people to make sure they get the care they're promised under their health insurance coverage, and they're not getting it. That's not happening with Medi-Cal. , it’s not even happening in commercial insurance.”
The state's health care providers also lag in providing mental health services, a reality that applies to all age groups but is keenly felt among young Californians. Between 2016 and 2020, the percentage of California children ages 3 to 17 diagnosed with anxiety or depression jumped 70%, according to data analyzed by the Annie E. Casey Foundation. Only South Dakota experienced a more dramatic increase during this period.
Children Now gave the state a D+ for mental health support. “It is through perseverance, privilege and luck, not a comprehensive system, that families are able to find child mental health services and support from schools, doctors and community-based organizations,” the report's authors said. are writing.
Children Now is sponsoring a bill that would automatically trigger an appeal to the state level if a person under the age of 26 is denied mental health services by a mental health provider, and Francis said he would It was part of an effort to turn the situation around. The bill was fiercely opposed by the health care industry, and the state's Department of Managed Care concluded it would cost tens of millions of dollars to implement. The bill was shelved by the Assembly Appropriations Committee.
In 2024, the bill's author, state Sen. Scott Wiener (D-San Francisco), plans to introduce a similar measure. Under the bill, only denials of emergency or life-threatening services would be automatically filed with the state, and all other denials would be automatically filed with the provider itself, Francis said. This would shift much of the financial burden from the state to the health plan.
Children Now organizers also want to put a stop to education funding. California spends 3% of its economic output on K-12 education, which is below the national average, and the organization says the state ranks among the 50th in racial and ethnic achievement gaps. He is said to be ranked 43rd in the league. But the state's projected $68 billion budget deficit casts doubt on the spending increase.
“There's nothing we're talking about that someone can't solve,” Francis said. Based on the latest set of results, the state has a lot to discuss, but the budget is another matter entirely.
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