By Jane Meredith Adams, EdSource Today

Students learn how to care for their teeth and receive preventive care at a dental clinic at James Madison Middle School in Oakland. (Photo/Alameda County Public Health Department)

As California educators grapple with boosting student achievement across economic lines, the teeth of poor children are holding them back.

Hundreds of thousands of children suffering from dental disease, some with teeth rotted to the gum line, are presenting California school districts with a widespread public health problem.

Increasingly, dental health advocates are looking to school districts to help solve the crisis. Innovative oral health care projects have been launched in school districts around the state that provide students with no-cost dental screening or treatment. Insurance companies are billed whenever possible.

Dental disease is at “epidemic” levels among California children, according to the U.S. Surgeon General, and low-income children are disproportionately affected. They are 12 times more likely to miss school because of dental problems than children from higher-income families.

But many districts lack the resources, or balk at being asked to provide dental care on top of a rigorous curriculum.

“It’s a great idea to bring universal prevention programs of all types, including dental, to schools,” said Kimberly Uyeda, director of student medical services for the Los Angeles Unified School District. “Whether there’s enough time in the day is another question.”

Lost revenue

Still, schools have a vested interest in helping solve the problem.

Dental problems keep California students out of school an estimated 874,000 days a year, costing schools about $29.7 million in lost attendance based-funding, according to the 2007 California Health Interview Survey, conducted by researchers at UCLA.

Advocates say the dental health crisis is exacerbated by the failure of Medi-Cal’s dental program, called Denti-Cal, to adequately serve low-income children, lack of funding for a state school-based dental disease prevention program for low-income children, and the lack of money to enforce existing state laws requiring oral screenings and preventive care for school children.

School-based dental clinics can play a large part in the solution, given the holes in the state’s safety net. One model is to house dental care inside a school-based medical clinic. Some 61 school-based health clinics, out of about 200 in California, offer dental screening or treatment.

Outside of a school setting, finding a dentist who accepts Denti-Cal is a significant obstacle for low-income children. California’s reimbursement rates to Denti-Cal dentists are among the lowest in the nation, according to a recent report by The Children’s Partnership.

The numbers of low-income children who need care are expected to increase when the Affordable Care Act — including its Medi-Cal expansion — is fully implemented. Come January 1, nearly half of California’s children will be Denti-Cal patients, according to The Children’s Partnership report.

The implications are clear, advocates say. “You’ve got to bring the services to the children,” said Roseann Mulligan, with the USC School of Dentistry and one of the authors of the study regarding oral health and student achievement.

Reaching students

A number of districts are doing just that. Some of the dental services are financially self-sustaining through billing to insurers, while others rely on grants and partnerships. The goal is for all clinics to become self-sustaining.

Two days a week, inside the sleek new student health center housed at James Madison Middle School in Oakland, students spend about 50 minutes during physical education class period or the “sixth period” extra time in a baby-blue dental chair. A hygienist screens students for tooth decay, cleans teeth, and applies fluoride varnish and sealants. The clinic, which doesn’t provide fillings or other restorative dentistry, accepts dental insurance and Denti-Cal, and provides free service to the uninsured. Services are funded by the Alameda County Public Health Department and The Atlantic Philanthropies.

Another model is a mobile dental clinic. In the San Diego Unified School District, the La Maestra Mobile Health Clinic, which includes dental services, began operating in fall 2012 to provide fillings and restorative dentistry to students at the Hoover Cluster of schools: 10 elementary schools, two middle schools, and one high school in the City Heights neighborhood, an area of high need.

“What we are trying to do is make it a positive experience,” said Dorothy Zirkle, a consultant for Price Charities, a nonprofit dedicated to improving the quality of life for children in City Heights. “Our kids have a high need for multiple fillings. We need to build trust.”

All services are no-cost, with providers seeking reimbursement from insurers when possible. Among the organizations funding the facilities and services at the mobile dental clinic are La Maestra Community Health Centers, private foundations including the City Heights Partnership for Children, and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

A third model is a partnership with a nearby dental college to offer expanded services for students. In the El Monte City School District, students receive comprehensive dental care at two dental clinics housed in elementary schools, as well as from a mobile dental unit.

Advocates say these programs and others like them are key to helping solve the dental health crisis facing California students.

Data that show the connection between oral health and student achievement will help persuade districts to support school-based dental care, said Maryjane Puffer, executive director of the Los Angeles Trust for Children’s Health, a nonprofit founded to serve students in LA Unified.

“School districts are eager to find a way to help kids stay in school and achieve,” she said.

Learn more:

California’s Most Common Childhood Health Problem? Dental Disease (KQED Public Radio)

KQED’s Stephanie Martin interviewed one of the study’s authors, Dr. Robert Lustig from UCSF. Lustig is an expert on childhood obesity and has been vocal about the health hazards of sugar for years. His video “Sugar: The Bitter Truth” has more than three million views on YouTube.

Lustig told Martin that the study was very carefully done — researchers looked at sugar consumption in 175 countries over a decade and controlled for just about everything including obesity, poverty, and physical activity. They found that the more sugar in the food supply, the higher the rates of diabetes in that country, no matter what the obesity rates were.

In the study, sugar was 11 times stronger than total calories in explaining diabetes rates around the world. “Those countries where sugar went up showed increases in [diabetes] rates. Those countries where sugar availability went down, showed decreases in rate.”

Lustig said their findings point to proof of causation that should be accepted by doctors. “This is the same level of proof that was available to us when we implicated cigarettes as the cause of lung cancer back in the 1960′s,” he told Martin. He believes the findings are sufficiently strong to lead to policy interventions around sugar.

Lustig has long suspected sugar as a major driver of diabetes. He pointed out that diabetes afflicts people across the weight spectrum.

“Twenty percent of obese people have completely normal metabolic signatures,” Lustig told Martin. “Conversely, up to 40 percent of normal weight people have the exact same metabolic problems that the obese do; they are just not obese. The obesity is a marker for the metabolic problems which we call metabolic syndrome, rather than  a cause.” He cautioned that people who are normal weight, but eat a lot of sugar, could be sick and not know it.

The study was not designed to address whether the type of sugar mattered — for example, table sugar versus high fructose corn syrup. Lustig said that in the study researchers looked at all sugars collectively, not individually.

At present, sugar is classified by the Food and Drug Administration as “Generally Regarded As Safe.” Lustig believes the FDA should re-evaluate whether sugar should stay on that list. He has previously called for sugar to be regulated in the same way alcohol is.

Marion Nestle, professor of nutrition, food studies and public health at New York University was not affiliated with the study, but in a release she praised the research saying it was the first paper she knew of to link sugar consumption to diabetes. She said the study adds to a body of research that is sufficient to “advise people to keep their sugar a lot lower than it normally is.”

In his medical practice, Lustig says he sees adolescents with Type 2 diabetes. He asserts that one-fourth of U.S. adolescents consume at least 840 calories a day in sugar, more than 40 percent of a daily diet of 2,000 calories. “The question is,” he asked rhetorically, “what does that do to you? What does that do to your liver? What does that do to your pancreas?”

Learn More:

Sugar’s Role in Rise of Diabetes Gets Clearer (NPR)

During the physical activity component of CATCH Healthy Habits, kids play active games for 30 minutes. (Photo: Marnette Federis)

A novel after-school program in the San Diego area is bringing together older and younger generations and helping encourage healthy lifestyles.

The program, called Coordinated Approach To Child Health, or CATCH Healthy Habits, trains and places senior volunteers in after-school programs and youth clubs where they teach kids about health.

CATCH is run by San Diego OASIS, an older adult educational center that encourages productive living for adults 50 years of age or older.

Many volunteers are retired teachers and nurses who said they were looking to give back to the community and be active even though they are no longer in the workforce.

Lala Bence, 69, worked as a pre-school teacher for 25 years. “I love children, I retired [from teaching] for a year and I couldn’t do without it,” said Bence, who now works with CATCH in San Diego’s Logan Heights neighborhood.

Each class of CATCH Healthy Habits, usually held for one hour each week for up to eight weeks, is made up of three elements — a healthy snack, a nutrition lesson and physical activity.

The classes always start with adults encouraging kids to eat something healthy such as grains, yogurt, fruit or vegetables. The volunteers then go on to teach nutritional facts. For example, volunteers talk to third and fifth graders about the importance of fiber and to be careful about daily sodium intake. Younger-aged kids, from kindergarten through second grade, learn about food that is healthy versus ones that are unhealthy. Then kids play tag and other games that get them moving.

Erica Macht, coordinator for CATCH, says the curriculum gives children simple tools on how they can make healthy decisions in their lives.

“I always say it’s implanting that little seed in their head,” says Macht, “They might not get a whole bunch of stuff out of the program, but if they can go away with just a little bit, that would be great.”

Proponents say what makes CATCH unique is its intergenerational approach to health and nutrition education. They said the program not only benefits the young, but also the retirees who feel that they are doing something productive.

Bence said the dynamic between the older and younger generations works because the volunteers are seen as the “grandmother and grandfather” figures, unlike other adults, such as a parent or a teacher, who have to play more authoritative roles.

Many of the children said they enjoyed interacting with the seniors.

“They’re really nice and caring,” said 8-year-old Bubba, a CATCH participant.

Diane Lieberman, 63, said she has plenty of other physical activities, such as cycling and soccer. But she said volunteering is different.

“This is the one thing that I really get the most satisfaction out of,” said Lieberman, who volunteers with CATCH at an elementary school in east San Diego.

“Since I started volunteering,” said Malcolm Carmichael, 73, “my general health is so much better than it would be if I didn’t participate in these things.”

The program is funded by Anthem Blue Cross Foundation and administered around the country through regional branches of OASIS. CATCH is also in Los Angeles County, and program coordinators are looking to bring CATCH to the Sacramento area. 

Before and after the 8-week sessions both the children and volunteers take surveys to track whether they changed their eating and exercise habits. Nationally, surveys show a significant increase in physical activity, fruit and vegetable consumption, and nutrition label reading within the adult and children groups.

Volunteers said one important component of the program is that the kids are encouraged to bring what they learn to their families.

“Parents always pay attention to their children no matter what, so if a child says ‘Mom, salt isn’t good for you, let’s read the label,’ … that’s a big deal,” said Bence.

CATCH Healthy Habits is even more important to communities such as Logan Heights, a working-class neighborhood in southeast San Diego.

Ricardo Sandoval the director of Boys & Girls Club, whose membership is 80 percent Latino families, said the kids in CATCH  learn about the importance of a balanced lifestyle.

“Especially with Hispanic cooking that might have lard, grease, a lot of carbs … it’s a lot of things that add up,” said Sandoval.

School sites and youth clubs decide who is eligible to participate in the free program. Sandoval said that while CATCH is still new at the Boys & Girls Club, enthusiasm for the program is high.

“I think it’s really good and healthy, they always give us healthy foods, and they always make us feel better and they give us healthy stuff,” said 8-year-old Heaven.

CATCH Healthy Habits is at 20 locations throughout the San Diego region. This includes elementary schools, youth clubs and some city-run facilities such as local libraries.

Marnette Federis is a freelance writer living in San Diego.

By Elaine Korry

Pediatrician Porshia Mack examines 3-year-old Sania Bettancourt at Richmond LifeLong community health clinic. (Photo:Elaine Korry)

More than a million California children who currently lack health insurance will qualify for coverage under the Affordable Care Act. When the health care overhaul goes into effect in 2014, more children from poor families will qualify for Medi-Cal, and other children will get subsidies for private low-cost insurance through the new state Exchange, Covered California. But children’s advocates are concerned that some kids won’t get the best coverage.

The nation’s pediatricians devised a gold standard of care. The name is a mouthful — the Early and Periodic Screening, Diagnostic and Treatment Services, or EPSDT for short. It’s a standard to meet kids’ medical needs — and it’s the standard of care at the Richmond LifeLong Medical Care, a community clinic in San Francisco’s East Bay that serves low-income families.

On a recent visit, Dr. Porshia Mack, head of pediatrics at the clinic, treated 3-year-old Sania Bettancourt. Dr. Mack listened to Sania’s lungs, checked her heartbeat, and peered into her throat and ears. Mack told Sania’s mother that all seemed well except for one recurring problem. Sania’s mild anemia was back, so Mack prescribed a multi-vitamin.

Dr. Mack has treated Sania since she was a baby and knew her well enough to realize that this bout of anemia was not serious. But she said that wouldn’t necessarily be the case for kids who aren’t covered for early pediatric care. “It could be a sign of something more ominous than it is, and we wouldn’t know that unless I saw her on a regular interval,” says Mack. “The AAP, the American Academy of Pediatrics, recommends certain lab tests drawn at certain intervals so we can catch these things.”

Under the Affordable Care Act, children who are on Medi-Cal, like Sania, will continue to have the full range of coverage recommended by the AAP. Children whose families have slightly more income and qualify for coverage under the new insurance Exchange will likely get significantly better benefits than they have now, but those benefits may not be equal to those under Medi-Cal.

The federal law outlines the so-called essential health benefits that insurers in the state Exchanges must cover. Each state must pick an existing insurance plan as a model — a plan that has equivalent benefits to a “typical” employer plan. California was among the first states to pick its model benchmark.

“It’s a huge step forward for children’s health,” says Kelly Hardy, director of health policy at Children Now, a statewide advocacy group. California chose as its benchmark a Kaiser Small Group plan. That is the baseline plan, and there will be more expensive plans to trade up to, if people want to pay for more benefits. Although Kelly rejects the idea of one-size-fits-all insurance, she says state lawmakers did expand on the Kaiser plan to meet some of children’s needs.

“We’re really pleased that the legislature chose to add strong vision and comprehensive dental benefits for children,” says Kelly. “Those are two additions that are really important.” (By comparison, people with employer-based health insurance often have separate insurance plans for dental and vision coverage.)

Yet children’s advocates like Hardy did not get everything they hoped for. Most importantly, she says, they did not convince state lawmakers to adopt the EPSDT for children insured through the state’s Exchange. Hardy says that wasn’t practical to include for all kids because it’s simply too expensive. She also noted that many private plans, employer-based health insurance plans included, may not meet that standard.

Many pediatricians say that in reality, even the AAP standard is minimal coverage, especially for children with special needs such as asthma, Down syndrome or heart disease. As east bay physician Dr. Thomas Long puts it, “Is it the floor or is it the ceiling? We think it’s the floor, and the least we can do for all children.”

Dr. Long is an expert on child health financing with the American Academy of Pediatrics. He says the new Exchange’s standard of care falls short on things like mental health benefits, access to pediatric specialists and other needed coverage.

Insurers respond that the Exchange benefits package is broad enough — and is certainly an improvement for children who have no or very limited insurance now. Charles Bacci, with the California Association of Health Plans, says there’s always a tradeoff between coverage and cost. “The more broad the benefit package, the more expensive your healthcare premiums are,” says Bacci. “The more narrow the benefit, the more affordable your premiums are.”

So the irony is that children on Medi-Cal, including half a million new enrollees under the Affordable Care Act, may have the broadest coverage, while children from slightly higher income families in the Exchange, may have at least somewhat narrower benefits. But, says Bacci, if the half-million new kids in the Exchange were also guaranteed the best coverage, healthcare costs would explode.

Support for this report came from the Lucile Packard Foundation for Children’s Health Journalism Fund, a program of the USC Annenberg School of Journalism’s California Endowment Health Journalism Fellowships.

Maria Garibay worries her daughters won't be able to stay with their current doctors when they switch from Healthy Families to Medi-Cal next year.(Mina Kim: KQED)

Next January, the state will begin transferring hundreds of thousands of low-income kids from its popular Healthy Families insurance plan to Medi-Cal — which offers medical coverage to the state’s poorest residents.

Ending Healthy Families was one of Governor Jerry Brown’s budget-balancing priorities and now families are feeling the weight of that decision.

At Children’s Health Initiative in Napa, a nonprofit that helps get kids into affordable health plans, Maria Garibay has just gotten the news. Next year, her three girls will be moved from Healthy Families to Medi-Cal.

Speaking through an interpreter, Garibay says she’s worried her monthly premium will go up. That’s because last year Medi-Cal told her she’d need to start paying $1300 each month, per child, because of her income from a part-time restaurant job.

But then Garibay learned that she qualified for Healthy Families. The federally subsidized program is for families whose incomes are just above the federal poverty level. Under Healthy Families, Garibay pays a total premium of $14 a month. It’s a godsend for Garibay whose oldest daughter has a heart condition.

Garibay, through the interpreter, says “My daughter’s been seeing the same cardiologist since she was three years old. Will she be able to see her same cardiologist when she switches to Medi-Cal?”

Children’s Health Initiative manager Elba Gonzalez-Mares says she just doesn’t know. Medi-Cal reimburses doctors at a lower rate than Healthy Families, so some doctors limit the number of Medi-Cal patients they take, or refuse to see them altogether.

Gonzales-Mares says she’s been reassuring parents that their payments will be similar when the plan changes. But she hasn’t been able to guarantee that their kids will be able to see the same doctors.

“The reaction is very upsetting,” Gonzales-Mares says of the families. “They’re concerned.”

The state is ending Healthy Families as part of a budget deal between Governor Brown and Democratic lawmakers. It’s designed to cut costs and save other health programs. Moving the nearly 900,000 kids in the Healthy Families program to Medi-Cal is expected to save $72 million a year by 2015.

Latino children make up nearly half the Healthy Families enrollees, and Gonzales-Mares worries they’ll suffer the greatest disruptions in care. She says a survey of families the agency sees raises concerns about whether they’ll understand that Healthy Families is ending.

“The Latino family, yes, they speak Spanish. But their literacy levels are very low, a third grade level,” she says, “even in Spanish.”

But Medi-Cal officials say the program is equipped to deal with the needs of Spanish speakers. Toby Douglas leads the state’s Department of Health Care Services, which oversees Medi-Cal.

“Our proportion of individuals on the Medi-Cal program that are Spanish speaking or Latino descent are the same as those on Healthy Families,” Douglas explains. “So it’s an essential component of our Medi-Cal program today.”

Douglas says his office is working hard to make sure there will be enough doctors and specialists to treat these kids. ”Close to 90 percent of the providers who participate in Healthy Families participate in the Medi-Cal program, and we believe that these providers will continue to see these children when they transition.”

Douglas says under the federal health care overhaul, Medi-Cal reimbursement rates will rise significantly for two years, beginning this January.

But some pediatricians, like Napa pediatrician Victoria Morgese, are skeptical the state will maintain the higher rates when those federal funds go away. “The way I was raised, you can’t get blood out of a turnip,” she says. “If the money’s not there, the money’s not there.”

Morgese is one of thousands of California doctors now forced to decide whether to keep her Healthy Families patients once they switch over to Medi-Cal. “My mentality is to take care of these people, to be a care provider,” she says.  ”And yet, I have to take everything into consideration because I have to run a business!”

Morgese has more than 500 Healthy Families patients. She limits the number of Medi-Cal recipients to 10 percent of her patient load. Morgese says at current Medi-Cal reimbursement rates, she’d need to see three times the number of patients to keep the lights on.

“That means that the model of practice that we have set up here,” she explains, “which is to spend a long time with our patients, to have a lower than average volume of patients per day in our office … I wouldn’t be able to do that.”

Some children’s health advocates are pushing for a delay to the transition. The four phase, year-long transfer is scheduled to begin in January.

Organic produce. (Siel Ju: Flickr)

As Amy Standen reported this morning for KQED, researchers at Stanford University have combed through hundreds of scientific papers, comparing organically-grown produce to conventional. In one important respect, they found very little difference.

The study, published Monday in the Annals of Internal Medicine, didn’t ask whether organic fruits and vegetables are better for the environment, or create a safer workplace for farm workers.

It didn’t ask whether organic foods taste better, or whether trace amounts of pesticides can affect human health over time.

Rather, said physician Dena Bravata, the study’s co-author, the question was:

“What is the evidence that organic and conventional foods differ in either their nutritional benefit or their safety?”

The answer? There isn’t much evidence of that at all. Bravata says when it comes to healthfulness, “there is, in general, not a robust evidence base for the difference between organic and conventional foods.”

Over at NPR, the Salt blog added this context:

When it comes to their nutritional quality, vegetables vary enormously, and that’s true whether they are organic or conventional. One carrot in the grocery store, for instance, may have two or three times more beta carotene (which gives us vitamin A) than its neighbor. That’s due to all kinds of things: differences in the genetic makeup of different varieties, the ripeness of the produce when it was picked, even the weather.

So there really are vegetables that are more nutritious than others, but the dividing line between them isn’t whether or not they are organic. “You can’t use organic as your sole criteria for judging nutritional quality,” says Smith-Spangler.

Of course, people may have other reasons for buying organic food. It’s a different style of agriculture. Organic farmers often control pests by growing a greater variety of crops. They increase the fertility of their fields through nitrogen-fixing plants, or by adding compost instead of applying synthetic fertilizer.

That can bring environmental benefits, such as more diverse insect life in the field or less fertilizer runoff into neighboring streams. But such methods also cost money. That’s part of what you are buying when you buy organic.

So if you really want to find the most nutritious vegetables, and the organic label won’t take you there, what will?

At the moment, unfortunately, there isn’t a good guide. But a lot of scientists are working on it.

In the meantime, Standen reports, children who ate organic produce had less pesticide in their urine than kids who ate conventional produce. But in both groups, pesticide levels were below federal limits.

A girl wears kohl around her eyes. Similar products are known in other languages as tiro and surma. (Photo: New York City Health Department)

After a Massachusetts doctor found high levels of lead in an infant’s blood last year, hospital staff found no hazards in common sources of the toxic metal – paint at the family’s home, residue from workplace exposure, kitchenware and diet. Instead, they identified an unusual culprit: makeup.

For months, three to four times a week, the family had applied a Nigerian cosmetic and folk remedy called “tiro” to the boy’s eyelids. The amount of lead in the boy’s blood — 13 micrograms per deciliter — was more than double the level of concern set by the Centers for Disease Control and Prevention. A test revealed the cosmetic was 82.6 percent lead.

The findings, published earlier this month by the CDC, raise concerns about a product that certain immigrant populations often use but that health care providers rarely question as a source of lead exposure. The case is the first to the CDC’s knowledge of an infant being poisoned by a cosmetic like tiro, said Jay Dempsey, the agency’s health communications specialist.

Lead can build up in the body and damage the nervous system and brain, kidneys and other major organs. There is no known safe level of lead, which can cause learning and behavior problems, seizures and death. Children are especially vulnerable because they absorb the toxin more easily, are still developing and often put their hands or objects that can be contaminated with lead in their mouths.

Born in the United States to Nigerian parents, the Massachusetts boy received tiro from a grandparent who had purchased the black powder from a street vendor in Kwara State, Nigeria. Similar products are used in other parts of Africa, Asia and the Middle East, and are known in different languages as “kohl,” “surma,” “kajal,” “tozali” and “kwalli.”

In Nigeria, tiro is generally used on infants and by women for both cosmetic and medicinal purposes, Dr. Abdulsalami Nasidi, project director of the Nigeria Centre for Disease Control, said in an email. The product is used to cleanse eyes, beautify eyelids and improve eyesight.

In the United States, the Food and Drug Administration and various state and local health departments have published warnings about such products, most often identified as kohl or surma. Still, cosmetics are a little-known source of possible lead exposure, said Lisa Archer, campaign director of the Campaign for Safe Cosmetics, which has conducted tests that found lead in lipsticks.

“People just don’t know — they don’t know that cosmetics could be dangerous,” she said. “They think that somebody’s watching the aisle in the store, and in reality, that’s just not the case.”

It’s unknown how widespread the use of tiro and similar products is in California. The California Department of Public Health estimates that cosmetics are involved in less than 5 percent of childhood lead poisoning cases in the state, according to a statement provided to California Watch by Dr. Rick Kreutzer, chief of the California Department of Public Health’s environmental and occupational disease control division.

Some eyeliners and shadows use the word “kohl” to describe their black coloring but do not actually contain kohl; the FDA advises consumers to avoid products that do not list approved color additives in their ingredients.

Real kohl is illegal in the United States. But unlike the Consumer Product Safety Commission, which can issue mandatory recalls of lead-tainted toys and jewelry, the FDA does not have recall authority over cosmetics.

California’s Safe Cosmetics Program requires commercial vendors of cosmetics to report products that contain any amount of certain chemicals, including lead, that are known to cause cancer, or reproductive or developmental harm. But even if a vendor reports that a cosmetic contains harmful ingredients, the state cannot ban the product’s sale, Kreutzer said.

The program has not received any reports of eye cosmetics containing lead, Kreutzer said. And among cases of childhood lead poisoning in California involving surma, which date back to 1993, none stemmed from commercial cosmetics. Surma and products like it are often brought into the country by individuals.

The Massachusetts case is “an example of the bigger problem where cosmetics are virtually unregulated in this country,” Archer said. Still, she said, “even if we had the best laws in the world, it might be challenging to keep this stuff out of people’s homes.”

(JasonHickey: Flickr)

Together with the Annie E. Casey Foundation, the Oakland-based nonprofit Children Now released their 2012 report on children’s well-being. The report looks across four broad categories: economic well-being; education; health; and family and community. California children had one bright spot — health — where the state ranked in the middle, at 23rd. But in the other three categories, the state ranked near the bottom in each, earning a combined score of 41st in the country.

In an interview with KQED’s Joshua Johnson, Ted Lempert, president of Children Now, expressed deep concern. “Our kids are not faring well and it’s a real tragedy that we’re in the bottom 10 among the 50 states in just about every indicator other than health. Kids are really bearing the brunt of the economic downturn we’ve been in.”

No kidding. According to the report, more than one-third (36 percent) of California children live in families where no parent has a full-time, year-round job. More than one in five children in the state (22 percent) are living in poverty.

At the other end from these low numbers was the one seeming bright spot for California children: health. Overall, California ranked 23rd, but that comparatively higher ranking is in part due to the state’s lower percentage of low-birthweight babies — less than 7 percent, making California #11 among the 50 states. California’s First Five program targets both prenatal care, infant health and child development up to 5 years of age. “The health stats show that if you have a long-time sustained focus that you can do better,” Lempert said. “We’ve had a real focus on pre-natal care and infant care in this state and that’s showing in terms of relatively better stats. But as a lifetime Californian, I’m not jumping around saying, ‘Yay, we’re #11.’ I’d like to be high in all the rankings.”

And if money spent on infant health nets better outcomes, money not spent in other areas takes a toll.  For example, education. A whopping 75 percent of 4th graders are not proficient in reading, according to the report. California’s children rank near the bottom — 43rd in the country in the education category. “These national comparisons are important,” Lempert told Joshua Johnson. “California is in the bottom half when it comes to educational funding. We are higher up in lots of other areas, corrections and law enforcement and others. So these budget cuts do take a toll, and we need to get serious about not just giving lip service to education but making sure it truly is the top priority in terms of funding,” he said. “The fact that we rank 42nd in high school graduation, that’s a bigger hit to our economy than the downturn in recent years. For us to have that many kids not getting a high school degree puts us in severe jeopardy going forward.”

So which states scored high? Coming in 1st, 2nd and 3rd overall were New Hampshire, Massachusetts and Vermont. While these states are significantly smaller and less diverse than California, Lempert insists California could learn much from them. “When you look at how our state prioritizes kids, there’s a lot that our leaders in Sacramento could be doing, and that we could be doing locally, to really make kids the priority. Yes, we have challenges that other states don’t, but that’s no excuse for some of these measures where we really have not been prioritizing our children.”

You can dive into the full report here [PDF] or below is a recap of the overall rankings, plus the state rankings in each of the four categories.

(Kids Count Data Book: Annie E. Casey Foundation)

By Emily Bazar, CHCF Center for Health Reporting

(David Mason: Flickr)

As the Legislature debated — and ultimately approved –- a budget-cutting plan to transfer nearly 900,000 California children on the Healthy Families program into Medi-Cal next year, dozens of groups joined in opposition.

They ranged from the California Medical Association, a professional organization that represents the state’s doctors, to the California Primary Care Association, which represents community clinics.

Mostly, they were groups that focus on children and families, such as Children Now and United Ways of California.

They warned that the transition could disrupt care for thousands of children and ultimately lead to a lack of access to care, particularly in parts of California where doctors – especially those who accept Medi-Cal – are scarce.

But it turns out that opposition to the proposal was not unanimous, even among nonprofits that advocate for children and families.

“We were supportive of what happened,” said Vanessa Cajina, a Western Center on Law & Poverty lobbyist who focuses on health-related budget items.

First, a little background. Medi-Cal is a public health insurance program for the lowest-income Californians. Healthy Families covers children in families with incomes too high to qualify for Medi-Cal, up to 250 percent of the poverty level.

Under the transition plan that the Legislature agreed to, 415,000 Healthy Families children will move to Medi-Cal on Jan. 1, 2013, with the remainder making the move later in the year. (Check out this fact sheet from the Legislature for more details on the transition.)

Cajina said her group supports the transition, in part, because Medi-Cal covers a broader array of medical services for children than Healthy Families, a point echoed by Lynn Kersey, executive director of Maternal and Child Health Access.

Kersey pointed to a benefit under Medi-Cal called Early and Periodic Screening, Diagnosis and Treatment, which she said mandates that “any service a child needs that is medically necessary must be provided. If a plan doesn’t have that in its package, there are outside services that have to be included.”

As a result, she said, treatment options for certain medical issues, such as mental health and orthodontia, are better under Medi-Cal than Healthy Families.

Norman Williams, spokesman for the state Department of Health Care Services, which administers Medi-Cal, provided another example.

“Chiropractic treatments are limited under Healthy Families to a certain number,” he said. “Under Medi-Cal, children can go beyond the limit if there is a medical necessity identified.”

Cajina and Kersey also said that families will save money with the transition to Medi-Cal. Healthy Families children pay premiums on a sliding scale and children with Medi-Cal do not.

“For children in Medi-Cal under 150 percent of the federal poverty level, there won’t be any cost sharing or monthly premiums, which they had in Healthy Families,” Cajina said.

Cajina and Kersey noted other issues that bolster their support for the transition, such as increased efficiencies and more due process rights for participants. Both also agreed that access to care under Medi-Cal will be a continuing concern.

But “if everybody is in the same program, we’re all fighting for the same improvements,” Kersey said.

Mike Odeh, senior health policy associate for Children Now, said he agrees with the points that Cajina and Kersey make, but worries more about access to care.

“If kids don’t have access to care, then who cares if they’re paying a premium or not? … We’re concerned not just about the kids in Healthy Families who will move to Medi-Cal and their access to care. We’re also concerned about the kids who are already in Medi-Cal,” he said.

Odeh pointed out that under the transition, the rates that plans received to provide coverage under Healthy Families will drop to Medi-Cal levels, which may result in providers dropping out of the program.

“What happens when you add almost 900,000 more kids to a system that is in some ways fractured?” he asked. “We want to make sure we don’t do that and can strengthen the Medi-Cal program before we do this transition.”