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Children and the Health Care Overhaul: Where is Coverage Best?

Editor’s note: this post was updated to clarify benefits available to children who receive Medi-Cal and benefits available in the new Health Insurance Exchange.

By Elaine Korry

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