Billboards along Highway 99 tout inexpensive health insurance for children from working families.

Schools hold parent nights to sign up children. Hospital workers sit down beside families in emergency rooms to help parents decipher the applications.

Yet, two years after the state launched Healthy Families, a massive program intended to provide health insurance to more children, half of those who qualify are not enrolled.

While officials say it's impossible to calculate the number of eligible children with no coverage here, they're sure of one thing: Thousands of parents in the Northern San Joaquin Valley have not signed up their children for the health insurance, as cheap as $4 a child a month.

"People just don't know about it," said Patti Kishi, who helps sign up children in Atwater schools. "There's a huge lack of awareness out there."

Some blame the way the government has structured the program. Some find fault in the statewide billboards and television commercials. Others say many parents assume they make too much money to qualify.

Without health insurance, boys and girls aren't likely to see doctors when the children come down with earaches or high fevers.

"Instead, a cold turns into pneumonia and they wind up in the emergency room," said Kimberly Scott, outreach coordinator for Golden Valley health clinics in Merced and San Joaquin counties. "All that could have been prevented if they had health insurance."

The mediocre participation rate means California isn't spending all the federal money it received for the program. Federal officials want to take back $590 million because all the money wasn't used by Sept. 30.

The money was part of a three-year grant given to the state by the federal government in 1997.

Gov. Davis has asked for one more year to allow the state to spend the money.

"The idea is to extend the deadline to get more children enrolled," said Nilda Johnson, a program manager with the Stanislaus County Health Services Agency.

$4 per child

California's Healthy Families program, launched in July 1998, is the state's version of the Children's Health Insurance Program, approved by Congress the year before.

The state program offers private medical, dental and vision benefits to uninsured children whose families earn too much to qualify for Medi-Cal.

Depending on their income and the number of children in each family, parents pay rates ranging from $4 per child to a maximum of $27 per family a month.

It's a good deal, said JoAnn Harris, who enrolled her 10-year-old daughter two years ago.

The Modesto mother, who is an aide at Petersen Alternative Center for Education, said she remembers the days when her daughter wasn't covered by insurance.

Harris once paid more than $300 for a leg X-ray. "Now, when I'm talking with a parent, I always mention Healthy Families," she said. "I pay $7 a month. That's nothing."

When Harris signed up for Healthy Families, she struggled through a 28-page application. Since then, the state has shortened the form to four pages. Also, it's available in 11 languages.

Applications and ads

But parents still don't flock to apply, perhaps because the application is combined with an application for Medi-Cal, the state insurance program for low-income people.

"A lot of families don't really understand the difference," said Kathy Amos, a manager with the Tuolumne County Health Department. "It looks and feels and smells like a Medi-Cal program."

Statewide advertisements haven't helped much, said Betty Elliott, Healthy Families coordinator for Modesto's Parent Resource Center.

Billboards and TV commercials don't tell parents how much they can earn and still qualify for the program, Elliott said. A family of four with a yearly income of $42,636 may be eligible.

Elliott said state advertising money could be put to better use if it went to community agencies like hers, which works with schools to get the word out about Healthy Families. Elliott and two part-time employees visit three campuses each week to help parents with applications.

New immigrants present another challenge. Immigrant parents sometimes fear that signing up their children and accepting aid from the state will jeopardize their efforts to become U.S. citizens, said Scott, who works for Golden Valley health clinics.

Workers try to convince parents that this won't happen -- it's against the law. They also explain that children who are U.S. citizens are eligible, even if their parents aren't in the country legally.

Meanwhile, workers do their best to get the word out.

Golden Valley employees attend health fairs, job fairs and church events in the hope of letting parents know they may qualify. Atwater schools hold special evening events to introduce parents to the insurance program.

And members of a Stanislaus County task force last week sent 60,000 Healthy Families fliers home with schoolchildren. The task force workers say their next step is to target employers, who in turn would tell their part-time and seasonal employees about the low-cost insurance.

"We're looking at new ways to reach children, their guardians and their families," said Johnson of the Stanislaus County Health Services Agency.

"Our big goal," she said, "is to get as many children insured as possible."

Bee staff writer Kerry McCray can be reached at 578-2358 or kmccray@modbee.com.

Reprinted by permission of Modesto Bee.