This section profiles two private-sector approaches to providing health care coverage for children. Blue Cross and Blue Shield Caring Programs operate in several states and together provide subsidized coverage for more children than any other private program. "Kaiser Permanente Cares for Kids," which was started in California in 1997, is part of a national subsidy program for uninsured people that will be expanded by Kaiser Permanente in the next few years.

Caring Programs

Blue Cross and Blue Shield Caring Programs offer subsidized coverage for primary and preventive services for low-income children in 25 states. Although the particular designs of each program vary slightly, most Caring Programs cover outpatient care, well-child visits, immunizations, primary care for illnesses and accidents, emergency services, laboratory and X-ray services, and outpatient surgery. Caring Programs serve uninsured children who are under age 19, live in low-income families, and do not qualify for Medicaid.

Caring Programs receive the majority of their funding from the private sector, although Pennsylvania and Massachusetts have provided additional support for children's health benefits by increasing the state cigarette tax. In Iowa, Kansas, Missouri, Montana, and North Carolina, the state also provides some subsidies. Local businesses, foundations, religious organizations, civic groups, schools, unions, and individuals sponsor children in the Caring Programs. Many community contributions are matched by the participating Blue Cross and Blue Shield plans. All administrative services are donated by Blue Cross and Blue Shield, so every dollar contributed is used towards providing health care coverage for children. The annual premium across all of the programs averages about $270 (Hill et al., 1993).

Determining eligibility is straightforward and simple. The applications are never more than one page, no restrictions are imposed on assets, no income verification is required, and families pay no enrollment fee. Also, because Caring Programs were created to supplement Medicaid, their plans require that potentially eligible children first apply for Medicaid. When outreach, public education, and enrollment efforts identify children who are eligible but not enrolled in Medicaid, children are referred to the Medicaid program (Hill et al., 1993; LaVallee, 1997).

Despite their continued growth, most Caring Programs still remain relatively small. The Western Pennsylvania Caring Program has the largest enrollment of all the plans, and, in cooperation with the state, provides health insurance for 60,000 children. Yet together these two programs reach only 21 percent of the children currently eligible in that service area (Gauthier and Schrodel, 1997).

The dependence on charitable donations limits the expansion possibilities of the Caring Programs. Presently, most of the programs have waiting lists for coverage. However, Caring Programs have assisted thousands of families who otherwise would have been unable to access health care for their children (Lief, 1997).

Kaiser Permanente Cares for Kids

A total of 1.8 million children in California are uninsured. About 84 percent of the uninsured children in California come from working families, including 60 percent with parents who work full time (Brown et al., 1997). Medi-Cal, the state's Medicaid program, covers 25 percent of the children in California, but 835,000 children who live in low-income, working families are ineligible for Medi-Cal. California's health insurance rates are among the highest in the country, making them unaffordable for low-income families.

In June 1997, Kaiser Permanente announced that it would donate $100 million over five years ($20 million annually) to subsidize health care coverage for up to 50,000 children a year in California. Children in California who are eligible for "Kaiser Permanente Cares for Kids" (between 200 and 275



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