Presented at Enroll America's 2016 State of Enrollment conference.

1. © 2016 Enroll America | StateOfEnrollment.org
Kristelle Jose, Fatima Morales and Betzy Estudillo | Lori Miller Nascimento, Moderator
05.12.16
Engaging Youth Populations:
Strategies for Engaging Schools, Former Foster Youth & Youth
Immigration Groups

2. California Highlights
Population: >39 million
>9 million children
Covered California
~ 1.6 million enrollees
Medi-Cal (Medicaid) expansion
~ 13 million enrolled
~ 5 million children
Medi-Cal coverage for all
children, regardless of
immigration status starting
May 16, 2016!

3. Coveredtil26:
Medi-Cal Coverage for
Former Foster Youth

4. School-Based Health Services
Home Visiting
Developmental Screening
& Early Intervention
Childhood Trauma
Family Preservation
& Reunification
Stability & Permanency
Juvenile Justice
CHILDREN’S HEALTH EDUCATION
Coverage & Access
(ACA Implementation,
Health Homes)
Former Foster Youth
Health Coverage
Oral Health
Early Mental Health
Nutrition
Media & Health
(Advertising & Obesity,
Nutrition, Portrayal of Race)
Early Learning Access & Quality
(Child Care, Preschool and TK)
Kindergarten
Readiness Assessment
Common Core Implementation
STEM
Finance Reform
Accountability
Chronic Absence
School Discipline
Foster Youth Education Reform
Teaching Effectiveness
Expanded Learning
Education Technology
CROSS SECTOR ISSUES
CHILD WELFARE
Current Issue Coverage
Children Now – Who We Are
Non-partisan
national, state, and
local research,
policy
development, and
advocacy
organization
dedicated to
improving
children's overall
well-being

5. The Affordable Care Act & Former Foster Youth
Allows young adults to remain on their parent’s
insurance up to age 26
Provides equity for Former Foster Youth through
Medicaid up to age 26
Fills a critical need for a very vulnerable population
• FFY tend to have higher health care needs due to
childhood abuse, neglect, and trauma
• Youth who age out of foster care often lack adequate
supports to navigate the transition to adulthood

6. Former Foster Youth Eligibility
• In foster care at age 18 or older
- In California, OR
- In another state
• Living in California now
• Under the age of 26
No income or assets test. Former
foster youth qualify regardless of income.
Former foster youth qualify regardless of
placement type. Includes youth placed with
relatives and youth in probation-supervised
placements.

7. Peer-to-
peer &
youth
friendly
outreach
Outreach &
technical
assistance to
direct service
providers &
county
agencies
Policymaker
education &
advocacy
Media work
Coveredtil26 Outreach and Education
Campaign

8. Key Successes
Policy Advocacy Wins
“No wrong door”
enrollment in Medi-Cal
• FFY fixes to Covered California enrollment system
reprioritized
• Developed and issued guidance to counties on
simplified enrollment and retention policies for FFY
• Revised the MC 250A and issued guidance to counties
with instructions to accept it for any FFY up to age 26
• Issued instructions to counties to fix incorrect Covered
California eligibility determinations received prior to
programming fixes
• Streamlined FFY enrollment into Medi-Cal through the
Hospital Presumptive Eligibility program
Automatic transition
into the Medi-Cal
program for FFY for
youth exiting care at
age 18 or older
• CDSS issued guidance to social workers and probation
officers with best practices for ensuring coverage for
youth transitioning out of care
• CDSS and DHCS executed a global data sharing
agreement that includes FFY as a covered population.
This allows CDSS and DHCS to track and reconcile data
for all youth 18-26

9. Key Successes
Policy Advocacy Wins
Immediate enrollment
based on self attestation
• Clear instructions to counties on their responsibility to
verify FFY status ex parte; FFY not required to
provide documentation
• AB 592 (Stone): Developed a statewide process for
youth to obtain information about their FFY status for
various state education, health, and other services.
Former foster youth
should receive timely and
accurate information about
eligibility for Medi-Cal
coverage
• Created and instructed counties to use new notices
of action specifically tailored to FFY
Youth-friendly retention
policies
• FFY not required to fill out or return anything on a
yearly basis to stay covered until age 26 and no loss
of coverage due to a loss of contact.

10. Key Successes
DHCS significantly increased its
outreach & education efforts
related to Medi-Cal coverage
for FFY
DHCS created a monthly FFY
workgroup in response to our
advocacy efforts

11. Lessons Learned
Local and state approaches are
key
Partner with trusted messengers
and local experts
“Ground” and “air” strategies are
essential

12. • www.coveredtil26.org: youth-friendly
website with FAQs and enrollment tips,
free outreach materials, policy guidance,
and more.
• The Children’s Movement: receive
updates and information about key kids'
issues and campaigns in CA
http://www.childrennow.org/take-action/
@ChildrenNow
@Health_CN
Children Now is spearheading Coveredtil26. Funded by a grant from The California
Wellness Foundation.
Resources

13. Kristelle Jose
Senior Outreach Associate
kjose@childrenspartnership.org

14. ALL IN For Health
Campaign
ALL IN For Health brings new tools and information about health coverage and
care opportunities directly into communities. Through high-impact
partnerships with local organizations in communities, we reach families and
children where they live, learn, and play.

15. How to Connects With Schools What do Schools Need?
• Identify key school staff to lead
• Develop materials specific for the school
community
• Make it easy for schools to participate
with sample and tailored messages
• Understand the way schools/school
districts communicate with their staff,
students, and parents
• Follow the academic calendar and school
themes i.e., Back-To-School
• Tailored materials
• Health outreach and enrollment
education
• Connections to enrollment
assisters
• Assistance with outreach and
enrollment activities

16. Roles of Partners
• Provide strong connection to
leaders with deep education and
community networks
• Provide strategic advice
• Disseminate materials
• Spread information through
networks
• Amplify messages through social
media
• Create a culture of coverage

17. Best Practices
1. Understand schools’ priorities and capacities
» Provide different points of entry for schools to engage with tailored materials
and messaging
» Simplify the process and provide simple instructions
2. Materials increase engagement
» Have pre-printed material readily available
» Provided translated & customizable versions
3. Strategic communications- repeat messaging at every level
» Schools, administrators, organizations, parents, etc. and on social media
4. Provide assistance with enrollment events
» Connect schools with enrollment counselors
» Help plan and coordinate events
5. Enlist trusted partners
» Highly credible statewide organizations

18. Materials
• ALL IN Toolkit
 Fact sheets
 Flyers
 Bookmarks
 Robocall scripts
 Pre-made social media messages
 Regular newsletter blurbs for
newsletters and eblasts
 All materials are available in Spanish
• ALL IN can provide technical assistance and
support at hosting trainings, presentations,
health fairs & enrollment events

19. Immigrant Health in California:
Opportunities for DACA Recipients
and the Fight for Health4All
BETZABEL ESTUDILLO
CALIFORNIA IMMIGRANT POLICY

20. Founded in 1996, CIPC is a non-partisan, non-profit
statewide organization that seeks to inform public
debate and policy decisions on issues affecting the
state’s immigrants and their families in order to
improve the quality of life for all Californians. CIPC
engages in policy advocacy, and also
provides technical assistance, training and education
on immigrant issues.

21. Undocumented Californians and Health
Access
The Affordable Care Act (ACA) has expanded health coverage to
millions of Californians
Remaining Uninsured
• UC Berkeley Labor Center study- After the full implementation
of the ACA, there will be 2.7-3.4 million Californians who will
remain uninsured
• About 1.2 million will be undocumented Californians
Access “Band Aid” Care - Patchwork of coverage for the
undocumented.
• Some counties offer coverage, other counties don’t offer any
coverage, and some offer limited scope/duration coverage.
• Emergency and charity care

22. What is DACA?
• Deferred Action for Childhood Arrivals
• Program was announced by the Secretary of DHS in June 2012
• Deferred Action is limited relief from immigration enforcement
• not just limited to DACA recipients
• DACA Eligibility
• DACA recipients receive deferred action and employment
authorization and is renewable for 2 year periods
• In some states DACA recipients also have access to a state-issued
ID and Driver’s License and Medicaid

23. How did DACA come about?
Organizing and direct action by immigrant youth
• “Right to Dream” campaign established after the
DREAM Act failed in 2011
• Legal analysis by policy experts, including NILC
Immigrant youth continue to lead in policy
conversations/campaigns
• Health4All
• stopping deportation/detention
• immigrant inclusive policies

24. DACA Demographics
UC Berkeley Labor Center/UCLA Center for Health Policy Research
Report Study (February 2014)
• 154,000 Californians granted deferred action under DACA
(December 2013)
• Estimated that up to 125,000 would be eligible for Medi-Cal
Many DACA recipients in CA will likely remain uninsured because
they do not qualify for or will enroll in Medi-Cal or will lack access
to affordable private coverage
Current Data:
• DACA recipients nationwide: 1,198,605 approved cases(March 21, 2016)
• DACA Recipients in CA: 347, 878 approved cases (March 21, 2016)

25. Taking the ACA out of DACA
• President Obama’s announcement to exclude DACA individuals from the
Affordable Care Act (ACA)
• U.S. Department of Health and Human Services (HHS) specifically
excluded DACA recipients from eligibility for health insurance through
federal Medicaid and the Marketplaces (with or without subsidies)
• Not subject to the individual mandate
Photo Credit: Pocho-One Photography

26. DACA & Medi-Cal
• Medicaid (Medi-Cal in CA) Expansion— Starting January 1, 2014, all
low-income childless adults including qualified immigrants and PRUCOL
are eligible for full-scope Medi-Cal, if they meet the income requirement.
• DACA individuals are eligible for full-scope Medi-Cal, if they meet the
income requirement.
How is this true?
• In California DACA status is considered Permanently Residing in the U.S.
under the Color of Law (PRUCOL) and are eligible for state-funded full-
scope Medi-Cal benefits
•

27. Challenges & Opportunities
• DACA recipients unaware they may be eligible for full-scope Medi-Cal
• County eligibility workers unaware of DACA status and eligibility for
Medi-Cal, or provided incorrect information
• DACA recipients concerns with applying due to fear of deportation
(for extended undoc family members), public charge, and that it may
hurt their chances of adjusting their status in the future
• Opportunity to work with immigrant youth, advocates, immigrant
rights organizations, and the Department of Health Care Services
(DHCS)
• Key step towards ensuring that all Californians have access to
healthcare

28. Medi-Cal
Eligibility
Division
Information
Letter No.: I
14-45

29. DACA+ & DAPA
• President Obama announcement on November 2014
to expand DACA to 3 years, eliminate the age cap, and
change the date of entry to 2010
• Extend deferred action to parents of US Citizens and
lawful permanent resident children
• DAPA: Deferred Action for Parents of Americans and
lawful permanent residents

30. Texas v. U.S
Texas and 25 other states sued the Obama
Administration to block the President’s November 2014
administrative action.
They claimed that:
• they had ‘standing’ to bring the case because they would incur
costs such as issuing drivers’ licenses to more people with
deferred action
• the President was not authorized to take the actions without
following administrative rulemaking procedures
Important: the original (2012) DACA program is not
affected

31. HEALTH4ALL

33. Legislative History
• Proposal by Senator Ricardo Lara to ensure that all
Californians have access to quality and affordable
healthcare, regardless of immigration status
• Health4All bill first introduced in 2014
• Re-introduced in December 2014
• SB 4 was signed by Governor Brown on October 9,
2015!
• SB 10 & SB 1418– 2016 proposal authored by
Senator Lara

34. Health4All Kids- SB 4 & SB 75
• The 2015-2016 California budget included an initial $40 million and an
ongoing commitment to expand access to full-scope Medi-Cal for all
children, regardless of immigration status.
• Beginning May 16, 2016 undocumented children under the age of 19
will have access to full-scope Medi-Cal
• This expansion will guarantee comprehensive coverage to 170,000 –
250,000 undocumented children
• Implementation and outreach efforts underway asking families to enroll
undocumented children in restricted-scope “emergency” Medi-Cal
• More information: www.health4allkids.org

35. SB 10 (Lara): Providing All Californians
Access to Covered California
• On April 7, 2016 Covered California Board supported a 1332
waiver proposal to allow undocumented Californians and DACA
recipients to purchase a health plan
• SB 10 allows undocumented people and DACA recipients to
purchase coverage through Covered California with their own
money by requiring the state to apply for a federal Section
1332 waiver (a formal request to the federal government).
• We are also in conversations with the federal administration
on the process of the waiver

36. SB 1418 (Lara):Expanding Full-Scope
Medi-Cal to Undocumented Adults
• SB 1418 expands access to health care coverage to
Californians unjustly excluded from care because of their
immigration status.
• The bill seeks to allow undocumented adults to receive full-
scope comprehensive Medi-Cal upon availability of funding
through the state budget.
• Undocumented adults at or below 138% of the FPL will be
able to enroll in full-scope Medi-Cal and receive an array of
services including doctor visits, tests, medications, emergency
care.

37. Group Activity
• Write down three partners you wish
to connect with in your community
• Write down three strategies to
connect to them and what that
partnership looks like

38. Questions

39. Contact Information
Fatima Morales - fmorales@childrennow.org
Kristelle Jose - kjose@childrenspartnership.org
Betzabel Estudillo - bestudillo@caimmigrant.org