Children's Health Initiatives in California: the experiences of local coalitions pursuing universal coverage for children.
OBJECTIVE
Many county coalitions throughout California have created local health insurance programs known as Healthy Kids to cover uninsured children ineligible for public programs as a result of family income level or undocumented immigrant status. We sought to gain an understanding of the experiences of these coalitions as they pursue the goal of universal coverage for children.


METHODS
We conducted semistructured telephone-based or in-person interviews with coalition leaders from 28 counties or regions engaged in expansion activities.


RESULTS
Children's Health Initiative coalitions have emerged in 31 counties (17 are operational and 14 are planned) and have enrolled more than 85000 children in their health insurance program, Healthy Kids. Respondents attributed the success of these programs to strong leadership, diverse coalitions of stakeholders, and the generosity of local and statewide contributors. Because Healthy Kids programs face major sustainability challenges and difficulties with provider capacity, most are cautiously looking toward statewide legislative solutions.


CONCLUSIONS
The expansion of Healthy Kids programs demonstrates the ability of local coalitions to reduce the number of uninsured children through local health reform. Such local programs may become important models as other states struggle with declines in employer-based coverage and increasing immigration and poverty rates.
Stevens
Gregory D
GD
Center for Community Health Studies, Department of Family Medicine, Keck School of Medicine, University of Southern California, Alhambra, CA 91803, USA. gstevens@usc.edu
Rice
Kyoko
K
Cousineau
Michael R
MR
D000293:Adolescent; D002140:California; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D003625:Data Collection; D004641:Emigration and Immigration; D006265:Health Care Coalitions; D006801:Humans; D017057:Medically Uninsured; D011203:Poverty; D019472:Universal Health Insurance