(film reel clattering) Welcome to Ethnic Media Services' weekly news briefing.

I'm Sandy Close, EMS Director.

Today, our focus is on the end of the federal COVID-19 Public Health Emergency program, a program which kept millions of people insured during the pandemic.

PHE is set to end on July 15th.

This means that 40 million children nationwide, many currently enrolled in Medicaid or CHIP are at risk for losing health insurance coverage.

Our speakers today will explain what exactly is at stake for children, what resources are there for families to keep children insured, and what legislative efforts are underway at the state and federal level to address this impending health care crisis?

Our speakers include Mayra Alvarez president of The Children's Partnership; Georgina Maldonado, executive director of the Community Health Initiative of Orange County; and Joan Alker, research professor and executive director, Georgetown University Center for Children and Families.

Now, I turn the conference over to veteran journalist Sunita Sohrabji, associate editor of Ethnic Media Services.

Sunita?

- Thank you, Sandy, and thank you to all our speakers and reporters who join us today for this very important discussion.

We start out with Mayra Alvarez of the Children's Partnership to let us know what's at stake here.

Mayra, welcome.

- Thank you, Sunita, very much for the opportunity to join you today.

Good morning, everyone.

Again, my name is Mayra Alvarez, and I am proud to be the president of the Children's Partnership.

We're a statewide advocacy organization focused on advancing child health equity here in California.

Before I start my official remarks, I want to begin by thanking you for the work you do to inform our communities.

The last two years have been incredibly challenging for communities of color as they've been hardest hit by COVID-19 and have also had to remain on the front lines of keeping our economy open.

And it all impacts their health, their physical health, their emotional health, their mental health.

And, of course, that of their children.

So today, as we're going to work together to call for solutions that provide for families hardest hit by this pandemic, we cannot overlook the essential role that health insurance coverage and access to health care plays in the lives of our children, especially during this current public health crisis.

As Sandy opened, we are currently operating under a public health emergency.

It is set to expire in July, but we expect it to be renewed, which you'll hear more about from my colleague Joan Alker.

During the pandemic, under this Public Health Emergency authority, a number of flexibilities were put in place to allow communities to be supported and protected.

For example, you may have heard that there were telehealth flexibilities; there were flexibilities with COVID testing and treatments and payment and certain public programs were provided flexibilities.

One of those was to allow families to stay enrolled in health care coverage through Medicaid without additional administrative renewals, without having to redetermine or prove their eligibility during this public health crisis.

As we look to the ending of the public health emergency, the covered protections offered will end and families will face these administrative hurdles again, putting millions of families across the country at risk of losing their coverage.

14 million people across the country are estimated to lose Medicaid coverage within a year after the emergency ends.

That's about 7 million children nationwide who are at risk of losing this coverage, being uninsured and potentially missing out on critical health care needs.

For the state of California, according to our own Department of Health Care Services, which we are honored to have with us today, an estimated 2.3 million Medi-Cal beneficiaries will lose their Medi-Cal coverage after the emergency ends.

That would translate to roughly 800,000 and up to 1.2 million children losing their Medi-Cal coverage in California.

And, why is this so important to this group of reporters?

This will disproportionately impact children of color who are more likely to rely on Medi-Cal for coverage.

Medi-Cal is the primary source of coverage for Latinx and Native American children.

75% of the more than 5 million kids in Medi-Cal, are kids of color.

Gaps in coverage mean disruption in a child's health care.

So much so that they'll miss out on critical, preventive and primary care services that are especially important for our youngest children.

We're here today because we need to help families keep their children's and their own medical coverage, as we look to come out of this public health emergency.

Keeping families enrolled in health care is essential to ensuring that their children are healthy and that their care is not disrupted.

Consistent access to health care is necessary for all of us to be healthy and to thrive, particularly during this pandemic that we have seen has exacerbated mental health issues for our young people.

Also, children still need to catch up on certain health needs like their vaccinations, their well-child visits that we know were not only missed during this pandemic, but that our state has not done a good enough job in ensuring that they're accessing those preventive services.

But this is particularly important during the first few years of a child's life.

Those first few years is when 90% of a child's brain development occurs.

So, those healthy-- that path for healthy childhood development depends on those frequent, timely, well-child visits and screenings that any disruption in coverage will disrupt.

So, during a time when health services are helping keep our family members alive, when we all want to keep our children on the right track developmentally, keeping kids covered is the right thing to do.

At The Children's Partnership, we have worked with Assemblymember Blanca Rubio to introduce AB 2402.

This piece of legislation will allow children enrolled in Medi-Cal to stay enrolled without making their families jump through administrative hurdles, and will keep them enrolled up to age five.

Through the bill's multi-year continuous coverage, children will have the opportunity to not miss the 14 well-child visits recommended for their healthy development.

We are fortunate that the Senate has included this policy in their budget priorities that are currently under negotiations with the Assembly.

And just yesterday, the legislation passed unanimously in the California Assembly Appropriations Committee, and it will next be heard by the full Assembly and hopefully move on to the Senate.

When three out of four Medi-Cal children are children of color, we have an opportunity for our state to advance an anti-racist approach to Medi-Cal enrollment one that removes barriers for families and gives every child a healthy start, beginning with ensuring that, that coverage is stable and continuous.

And, we're grateful to see that our leaders are prioritizing the health and well-being of our children and families through this bill.

It's The Children's Partnership and our advocacy partners that will continue to push for passage.

But as you have heard many times, even before the pandemic, longstanding, structurally racist policy and practices have created an environment where families of color experience a significantly greater degree of instability in everything from employment to income to housing.

These economic and housing conditions are what heighten the risk of disruptions in health coverage, and that eliminate the security that comes with having that coverage.

Again, it's why during this public health emergency our policymakers didn't require families to jump through those hoops.

We know that when we combine disruptions with burdensome administrative requests to fill out forms and prove eligibility, we risk disrupting the very coverage that keeps our kids able to get those critical screenings, those supports, that care that's necessary for them to grow up healthy and thrive.

And, it's those first few years that provide this paramount opportunity to set them up for healthy outcomes throughout their life.

And I can say, regardless of whether that legislation moves forward or not, this public health emergency is going to eventually end.

And we all have a role to play in keeping our children enrolled.

In addition to what I discussed at the legislative level, there are so many efforts happening on the ground in communities to help make sure parents and families are aware of the possibility that their health insurance may be disrupted and they'll have to re-enroll.

You'll hear from that at the local level.

With the-- with Orange County Community Initiative, but also with our partners from DHCS, who will speak specifically about some programs to reach out to families.

Thank you so much for being with us today, and I'm happy to answer any questions.

Thank you.

- Mayra, thank you.

We have a number of questions in the chat box.

I wanted to ask a clarification, and to what extent to-- does, did PHE protect undocumented families?

I think that's a very important question for our reporters today.

- So, in California, depending on the age group that you are part of, you are eligible to keep and stay enrolled in Medi-Cal and that public health emergency authority, the flexibility allowed everyone in Medi-Cal to stay enrolled.

So, it wasn't whether you were a citizen or whether you were undocumented or a legal permanent resident, if you are enrolled in the Medi-Cal program.

- Okay.

Thank you.

And, Julia Dudley has a very good question.

Julia?

- My question is relative to-- I'm sure you're aware of the recent hepatitis cases amongst children that is actually rising in California.

Could that be one perspective that we as journalists can look at as a reason why this emergency coverage needs to continue?

Thank you.

- I think it's important.

Yes!

Regardless, of the health situation that's at hand.

These are emergencies.

These are crises for our families.

And having the security of health insurance coverage helps that family feel better about their situation.

That they can get the treatment necessary, that they can go to the doctor without having to worry of that coverage is even there.

So, absolutely.

I see a direct connection to the security of coverage and whatever outbreaks may be happening at the local level.

- Thank you.

Kahlil Abdullah has a question for you.

Khalil?

- Yes.

Unmute.

Can you hear me?

- [Sunita] Yes, we can.

- Okay.

So, I was wondering whether one, the data-- what percentage of eligible folks actually use the services?

I mean, we get a-- a broad sense that, yes, they're eligible but I was wondering, are the services actually being used?

And then also, if you could compare California to other states in terms of how the programs are working on the ground elsewhere.

- Joan, I don't know if you want to answer any questions about other states, and what's happening.

- So, I'm not going to speak to California.

I'll leave that to the California experts.

But in general, there's really two ways to think about your question.

The first question is how many of children and parents who are eligible for Medicaid are actually enrolled?

That's question number one, because a lot of uninsured children in this country are eligible for Medicaid, but they're not enrolled; more than half.

And that's actually been one of the virtues of this provision we're talking about today is that I think we've gotten a greater percentage of children because we've kept them in coverage.

And normally, we lose kids due to red tape, renewal, and things like that.

But that was actually one of the things I'm going to talk about is the silver lining of ensuring that kids who are eligible are remaining enrolled.

But the second part of your question is 'are they using their insurance card?'

Right?

They have one, but are they using it and are they getting services?

So, I want to say two things about that.

First, having the insurance card is very valuable.

Even if you are a healthy kid who doesn't need a lot of care normally, because we all know that children fall on the playground, break a wrist on the soccer field, and a family is going to face huge medical bills in that situation.

Right?

So, that's very important.

The question of whether children are getting the preventive services they need, the well-child care, the asthma medication, those kinds of questions I can tell you from national data, looking at children on Medicaid versus children who have private insurance, that it's quite similar for many measures.

For example, well-child visits?

Quite similar.

Medicaid might be a little lower, but it's quite similar.

There are areas where it's definitely lower and one is dental care.

Children on Medicaid definitely getting less access to dental care.

And then, we have some areas like behavioral health, which is a huge need where frankly, children across the board are not able to access services, whether they have Medicaid or a private insurance, there is a huge shortage.

So, you have to kind of think about it that way.

Is it a Medicaid problem?

Is it a health care system problem like the behavioral health and, of course, there are differences state to state.

But, it's a great question.

- Thank you.

Mayra, we have one more question from Jorge Macias and then a question from Henrietta Burroughs.

Jorge, could you please ask your question?

- Jorge Macias, La Opinión newspaper, @Excelsior.

The question I have is do you really believe that Governor Gavin Newsom has the political will to do the right thing, then to protect these millions of children of California?

- Mayra, I believe that question is directed to you.

- Thank you for that question, Jorge.

You know, the governor has portrayed incredible leadership in his commitment to children over and over the time that he's been in office, just recently, you know, launching a multi-billion dollar initiative to prioritize child and youth mental health and making investments in communities and in our systems to better respond.

He's also created, you know, multiple efforts to support our youngest children through early childhood, early care and learning investments and ensuring our systems are better responsive.

So, from his past actions and in his may-- in his budgets, yes, he has prioritized children, and we're looking for him to build on that.

This next step really is a discussion between the governor and the state assembly and the state senate.

So, it's really as they work to refine the budget for the next year, which we hope to finalize in June, we're hoping that it could be part of that budget.

And if not, that it can move forward through the legislative process.

So, that's why this time is particularly important.

And we're hopeful that given the track record and the commitment to children, that we can see this... this continued coverage be a priority for the governor and the legislature.

- Thank you.

One final question for you, Mayra, from Henrietta Burroughs.

Henrietta?

- Thanks so much, Sunita.

Mayra, is there any opposition to continuing this type of health coverage?

And also, is there specific opposition to the bill?

- It's a great question, Henrietta.

And I will say, you know, primarily there is a cost to keeping children enrolled in Medi-Cal.

It does cost our system to not have to lose people from the rolls.

Of course, it does.

So, folks that are interested in the cost of our public programs may oppose the bill for that reason and thinking through the system cost.

Additionally, there are people who believe poverty is a personal responsibility and that there should be steps that people have to prove their eligibility for their programs.

Well, we believe keeping families enrolled in coverage, keeping our children enrolled in coverage is an anti-racist approach to Medi-Cal.

It really enables us to offer that security to families.

So, we want to ensure that these public programs, which we have a right to, are actually available to families.

So, there is some opposition if you are looking to make people prove their eligibility for these programs, or are concerned, obviously, with the cost of programs more broadly.

Those could be reasons.

- Thank you.

And, we move on to Georgina Maldonado.

Georgina, welcome.

- Good afternoon, everyone.

Georgina Maldonado, executive director at Community Health Initiative of Orange County.

It is a great pleasure to be here.

And a privilege, actually, because this is a topic of discussion that for us as a local organization who does the direct contact and direct work and advocacy with our clients in the county of Orange in California, we, on the-- we are at the forefront of all of these barriers that Mayra has mentioned, that Joan has mentioned.

We see this day in and day out, whether it's coverage for an adult, whether it's coverage for children.

And, just to go back.

Our mission of our organization is access to health care, access to quality and affordable health care in the county of Orange.

We are one of one of the state agencies in the state of California that is at the forefront of these enrollment, not necessarily barriers, because there's also has been a lot of open doors for more and more expansion for children and families.

Just to go back a little bit into history.

As all of you may be aware, The Health for All Children Initiative was-- the expansion happened a few years ago.

And so, that was one of our biggest wins as a state, but also as a local community where the undocumented children were now eligible for full scope Medi-Cal.

And as an organization, we were at the forefront of enrolling the children and families into health care coverage.

And, what we have seen is exactly what Mayra and Joan have mentioned.

It is the resources, the lack of communication between the addresses that are lost, the lack of understanding of the letters that are sent to our clients because they're working one or two jobs, maybe three jobs, because they also work during the weekend.

The children; what we're facing is that most parents that have never navigated the managed health care system in our county and our state have never had benefits in the past.

So, how do you teach them how to navigate these benefits as we talk about the insurance card?

It's wonderful to have a lot more children eligible.

But how do we teach them to navigate the services that now they, rightfully so, qualify for.

The majority of them don't even know who their primary care provider is.

So, yes, enrollment and disenrollment is vital, but accompanying that is the navigation of services.

"How do I re-enroll?

"How do we target our, you know, "identify our primary care provider?

"How will I identify transportation?

"How will we get there if the doctor opens Monday through Friday, and I only have Saturday off?"

And so, as we talk about all of the barriers that Joan and Mayra have mentioned, these are systemic barriers that historically have impacted communities of color.

And, those are the communities and folks that we serve at the local level as a lead entity in the county of Orange, where we attempt to build capacity, and other organizations that serve diverse communities outside of the purview of Community Health Initiative of Orange County.

And, who I have invited also to tell a direct story about the barriers that our clients have faced is Marisela Carlos who not only has been an enroller on the front lines, but also now conducts our Know Your Benefits trainings in the community.

What happens after you do receive your health care coverage based on this expansion?

And so, what we are seeing with the lapse of the public health emergency is that a lot of our clients will not-- will lose coverage the moment it happens.

Because if we're not there at the forefront with the similar messaging, with marketing, with text messaging, we will lose our community and we will lose the health in our community that we so rightfully have expanded these policies to.

What-- you know, what Mayra is doing in Sacramento with the bill is vital to the continuity of care.

And the continuity of care really impacts the efforts as we try and build a more equitable health care system for all.

And, I want to turn it over to Marisela to share two anecdotal stories regarding two of our clients that we just faced most recently The floor is yours, Marisela.

- Marisela, could you limit your remarks to two minutes?

Thank you.

- Yes.

Really quick.

We see families every single day with these kinds of barriers.

One that stands out is a mom who had a child in the care of somebody else, and she received a call that the child had gotten injured.

So, they needed to take them to the emergency room.

She had already received the renewal letter.

However, because she had-- she didn't have the flexibility to request time off of work.

She didn't feel comfortable filling out the information herself.

She couldn't seek services like ours that we serve.

She didn't know that we existed at that time.

So, unfortunately, when she took the child to the emergency room, they discovered that they didn't have coverage.

So, unfortunately, she received the bill; you know, had to go through all of that.

Her friend, when she was sharing this with her neighbor, then told her about our services.

And then when she came in, we helped her with you know, trying to cover the bill, trying to give her information on how to cover it.

So, luckily, she had that resource but not a lot of these families do.

The other story that stands out is of those families who have literacy problems where they receive a verifying-- a letter from social services requesting verifying documents.

You know, on that letter, they specify that they needed pay stubs, tax information.

But, this family earned cash income.

So their first thought was, "I'm not able to provide a pay stub.

"I'm not able to provide my taxes.

"So, I guess I'm not able to qualify for the service again."

So, not having that knowledge, you know, where we could help them with the affidavit.

But again, because of that letter and how it's stated, it confuses the clients into what they can and cannot send.

So, if they don't have an agency like ours that can help them navigate this, you know, they're disencouraged to try and re-enroll.

So, those are some of the barriers that we've encountered.

- Georgina and Marisela, thank you so much for joining us today.

We very much appreciate it.

Thank you.

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