Healthy Families offers generous benefits |

Healthy Families offers generous benefits

Healthy Families, the low-cost health coverage program for the children of working parents, has been up and running for almost four years. Yet more than 400,000 California children are eligible for the program whose parents have not applied for coverage. Why might that be?

Based on my work as a Healthy Families advocate, I would surmise that part of the problem lies with misinformation or misperceptions about the program. Let me share with you some facts about Healthy Families that you may not know.

Healthy Families income guidelines are generous. Income eligibility is based on family size and age of the child. For example, a family with two parents and two school-age children can gross up to $3,771 per month and be eligible for Healthy Families coverage. This program truly is designed for the children of working parents. In addition to meeting income guidelines, children must be California residents, U.S. citizens or eligible immigrants. Children are eligible up to 19 – and eligibility begins for an unborn three months prior to birth.

Private health plans provide medical, dental and vision coverage for the Healthy Families program. Families in Nevada County have a choice of HealthNet, Blue Cross EPO or Blue Shield HMO for medical, and Premier Access or Delta Dental for dentistry. Vision Service Plan (VSP) provides vision coverage. The premium is low – $4 to $9 per child per month. And contrary to what some seem to believe, there is a good selection of providers from whom families can choose.

Medical coverage is comprehensive – and co-pay, required for some services, is only $5. Prescriptions, prevention services and well-baby care coverage are included. Other benefits include mental health services, physical and speech therapy, and diagnostic X-ray and laboratory services. Some health plans include acupuncture and chiropractic services.

Health plans generally pay the same amount to doctors and dentists for Healthy Families patients as they do for other patients. A common misperception is that doctors and dentists are reimbursed at a lower rate for their Healthy Families patients than for their other HMO-contracted patients. However, Blue Cross, Blue Shield, HealthNet and Premier Access have assured me they maintain the same fee schedule for Healthy Families and other children. The VSP fee schedule for Healthy Families is the some one used for California State employees. Delta Dental’s contract with dentists reimburses at a reduced rate.

The process of applying is easy. Several local Certified Application Assistants are available to help families fill out the application form (and duplicate the documentation that needs to be included) free of charge. The application is not that hard to complete (it has been modified so it is not as long as it once was). In addition, the application enables families to apply for no-cost MediCal if their income is below the minimum set for Healthy Families. And everything about the application and enrollment process is confidential.

Five area agencies have joined forces to get the word out about the Healthy Families program and assist applicants. They constitute the Sierra Nevada Healthy Families Collaborative. Certified application assistants are available at each of the agencies involved in the collaboration. Call HelpLine, 273-2273, Sierra Nevada Children’s Services, 272-8866, Nevada County Adult and Family Services, 265-1340, or Sierra County Children and Families First Commission, 993-4884, if you have questions or wish to set up an appointment. Assistance also is available to help families re-enroll in the program.

If you know of families who might qualify for the Healthy Families program, we hope you’ll let them know there are local Healthy Families representatives eager to serve them. We will be at the school open houses being held this spring, and will be taking applications at the Day of the Young Child on May 4 (call to find out what documentation to bring). Help us reduce the number of uninsured children in our county.

Cynthia Schuetz is a Healthy Families advocate with HelpLine Information and Assistance.

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