County officials seek help in closing health care coverage gap

By: ANDREA MOSS - Staff Writer | Wednesday, August 22, 2007 5:17 AM PDT ∞

ESCONDIDO -- Stumped as to why hundreds of children who are eligible for state and federal health care programs are not enrolled in them, San Diego County health officials sought the community's help Tuesday in finding some answers.

About 30 doctors, hospital and medical clinic administrators, and others who provide health care to low-income residents helped brainstorm reasons for and possible solutions to the low enrollment rate problem, during a four-hour forum at the county Health and Human Services Agency's Valley Parkway office.

The forum was the fifth of six scheduled throughout the region, with each forum zeroing in on the area in which it is held.

Tuesday's session focused on three census tracts: one each in Escondido and San Marcos, and a third that straddles the two cities' shared border. A separate breakout session focused on each of the areas.

Nick Macchione, deputy director for the county agency's northern regions, and county epidemiologists Leslie Ray and Holly Shipp laid the groundwork by saying the county recently analyzed gaps in children's health care coverage.

The effort merged household income, age breakdowns and other information from the 2000 Census with lists of children who were enrolled in either the state Medi-Cal or the federal Healthy Families health care programs in December 2006, they said.

The programs offer free or low-cost health insurance coverage for children and other vulnerable segments of the population whose annual household incomes are 250 percent of the federal poverty level or less.

County officials said that translates to about $41,000 per year, or roughly the starting salary for a teacher.

When Health and Human Services used special software to map the analysis' results, they said, it revealed that a surprising number of San Diego County children ---- 81,000 ---- qualify for one of the health care programs but are not enrolled.

Another pattern showed the unenrolled children tend to be clustered in specific census tracts, suggesting Medi-Cal and Healthy Families outreach, enrollment and retention efforts aimed at those areas may not be working, county officials said.

They identified tracts with at least 500 unenrolled children as being of the most concern. However, the officials said they needed people who are familiar with those areas to help determine whether the agency should target those areas and, if so, the best ways to do so.

Environmental factors such as a lack of nearby health clinics, large immigrant populations, and potentially high percentages of military families who get a different type of federal health insurance were some factors cited as possibly being worth considering.

"What we need you to tell us (is) what might be going on in this community that might explain the low enrollment rate," said Shipp.

Broken into small groups that tackled their assignment areas separately, audience members offered plenty of insights and suggestions. The group tackling two census tracts that straddle Escondido and San Marcos, for instance, quickly shifted focus to an adjoining area after noting the original one included rural Elfin Forest, industrial pockets and a senior mobile-home park.

Working with local schools, making the application process easier, and using new technology to reach families with hectic schedules, privacy issues or concerns about the stigma of enrolling in a government health-care program were some of the ideas offered.

Gregory Knoll, executive director and chief counsel for the Legal Aid Society of San Diego and a forum participant, said the county's desire to get more eligible children enrolled in the state and federal health care programs is important for public health and community clinic funding reasons. He had high praise for the decision to get local providers involved in addressing the low-enrollment problem.

"You need local people helping to come up with solutions for their community," he said. "It's the people in the community looking at the results of the information and saying, 'I know that big red square, and that's an industrial area.' "

-- Contact staff writer Andrea Moss at (760) 739-6654 or amoss@nctimes.com.

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