Journal Issue: Health Insurance for Children Volume 13 Number 1 Spring 2003
Over the past decade, expansions under Medicaid and the State Children's Health Insurance Program (SCHIP) have brought a significant infusion of federal dollars into state and county health systems and have produced a variety of state-level programs. Yet, the expansion of public health insurance programs at the state level has had mixed success in providing coverage and improving access to care for children.1 In some cases, states have fallen short of their enrollment projections because of barriers such as some children remaining ineligible for coverage2 or families finding programs difficult to access.
In response to these barriers, counties and local communities have increasingly emerged as "hubs of innovation" by using creative strategies to make insurance coverage and access to care available to children who do not meet the state eligibility criteria. This article describes the programs of two counties that have attempted to expand access to care for children: the Children's Health Initiative in Santa Clara County, California; and the Kids Get Care program in King County, Washington. The Santa Clara County Children's Health Initiative (CHI) adopted an insurance expansion model through its local initiative health plan, while the King County Kids Get Care (KGC) program is a service coordination model that directly links families to community-based "medical homes."3 The article begins by describing these two county-level programs and comparing the approach each has taken, then draws on these experiences to outline important elements for counties that want to create universal health care for children and families: committed leadership, health systems infrastructure, multiple financing sources, and community support.