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"content": "\u003cp>More than half of the 410 hospitals in California have at least one building that likely wouldn’t be able to operate after a major earthquake hit their region, and with many institutions claiming they don’t have the money to meet a 2030 legal deadline for earthquake retrofits, the state is now granting relief to some while ramping up pressure on others to get the work done.\u003c/p>\n\u003cp>Gov. Gavin Newsom in September vetoed legislation championed by the California Hospital Association that would have allowed all hospitals to apply for an extension of the deadline for up to five years. Instead, the Democratic governor signed a more narrowly tailored bill that allows small, rural, or “distressed” hospitals to get an extension of up to three years.\u003c/p>\n\u003cp>“It’s an expensive thing and a complicated thing for hospitals — independent hospitals in particular,” said Elizabeth Mahler, an associate chief medical officer for Alameda Health System, which is undertaking a $25 million retrofit of its hospital in Alameda.\u003c/p>\n\u003cp>The debate over how seismically safe California hospitals should be dates to the 1971 Sylmar quake near Los Angeles, which prompted a law requiring new hospitals to be built to withstand an earthquake and continue operating. In 1994, after the magnitude 6.7 Northridge quake killed at least 57 people, lawmakers required existing facilities to be upgraded.\u003c/p>\n\u003cp>The two laws have left California hospitals with two sets of standards to meet. The first — which originally had a deadline of 2008 but was pushed to 2020 — required hospital buildings to stay standing after an earthquake. About 20 facilities have yet to meet that requirement for at least one of their buildings, although some have received extensions from the state.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Many more — 674 buildings spread across 251 licensed hospitals — do not meet the second set of standards, which require hospital facilities to remain functional in the event of a major earthquake. That work is supposed to be done by 2030.\u003c/p>\n\u003cp>“The importance of it is hard to argue with,” said Jonathan Stewart, a professor at UCLA’s Samueli School of Engineering, citing a 2023 earthquake in Turkey that damaged or destroyed multiple hospitals. “There were a number of hospitals that were intact but not usable. That’s better than a collapsed structure. But still not what you need at a time of emergency like that.”\u003c/p>\n\u003cp>The influential hospital industry has unsuccessfully lobbied lawmakers for years to extend the 2030 deadline, though the state has granted various extensions to specific facilities. Newsom’s signature on one of the three bills addressing the issue this year represents a partial victory for the industry.\u003c/p>\n\u003cp>Hospital administrators have long complained about the steep cost of seismic retrofits.\u003c/p>\n\u003cp>“While hospitals are working to meet these requirements, many will simply not make the 2030 deadline and be forced by state law to close,” wrote Carmela Coyle, president and CEO of the California Hospital Association, in a letter to Newsom before he vetoed the CHA bill. A \u003ca href=\"https://www.rand.org/news/press/2019/03/28.html\">2019 Rand Corp. study\u003c/a> paid for by the CHA pinned the price of meeting the 2030 standards at between $34 billion and $143 billion statewide.\u003c/p>\n\u003cp>[aside label='Related Coverage' tag='health']\u003c/p>\n\u003cp>Labor unions representing nurses and other medical workers, however, say the hospitals have had plenty of time to get their buildings into compliance and that most have the money to do so.\u003c/p>\n\u003cp>“They’ve had 30 years to do this,” Cathy Kennedy, a nurse in Roseville and one of the presidents of the California Nurses Association, said in an interview prior to the governor’s action. “We are kicking the can down the road year after year, and unfortunately, lives are going to be lost.”\u003c/p>\n\u003cp>In his veto message on the CHA bill, Newsom wrote that a blanket five-year extension wasn’t justified and that any extension “should be limited in scope, granted only on a case-by-case basis to hospitals with demonstrated need and a clear path to compliance, and in combination with strong accountability and enforcement mechanisms.”\u003c/p>\n\u003cp>He also vetoed a bill directed specifically at helping several hospitals operated by Providence, a Catholic hospital chain.\u003c/p>\n\u003cp>But he signed a third bill, which allows small, rural, and “critical access” hospitals, and some others, to apply for a three-year extension and directs the Department of Health Care Access and Information to offer them “technical assistance” in meeting the deadline.\u003c/p>\n\u003cp>The state designates 37 hospitals as providing “critical access,” while 56 are considered “small,” meaning they have fewer than 50 beds, 59 are considered “rural,” and 32 are “district” hospitals, meaning special government entities fund them called “health care districts.” They can seek a three-year extension as long as they submit a seismic compliance plan and identify milestones for implementing it.\u003c/p>\n\u003cp>Debi Stebbins, executive director of the Alameda Health Care District, which owns the Alameda Hospital buildings, said small hospitals face a big challenge. Even though Alameda is very close to San Francisco and Oakland, the tunnels, bridges, and ferries that connect it to the mainland could easily be shut in an emergency, making the island’s hospital a lifeline.\u003c/p>\n\u003cp>“It’s an unfunded mandate,” Stebbins said of the state’s 2030 deadline.\u003c/p>\n\u003cp>The Rand study estimated the average cost of a retrofit at \u003ca href=\"https://www.rand.org/pubs/research_reports/RR3059.html\">more than $92 million\u003c/a> per building, but the amount could vary greatly depending on whether it’s a building that houses hospital beds.\u003c/p>\n\u003cp>Small and rural hospitals can get some aid from the state via grants financed by the California Electronic Cigarette Excise Tax, but HCAI spokesperson Andrew DiLuccia said it would yield just $2-3 million total annually. He added that the Small and Rural Hospital Relief Program has also received a one-time infusion of $50 million from a tax on health insurers to help with the seismic work.\u003c/p>\n\u003cp>Labor unions and critics of the extensions often point to the large profits that some hospitals reap: A California Health Care Foundation report published in August found that California’s hospitals made $3.2 billion in profit during the first quarter of 2024. The study notes that there “continues to be wide variation in financial performance among hospitals, with the bottom quartile showing a net income margin of -5%, compared to +13% for the top quartile.”\u003c/p>\n\u003cp>Stebbins has had to help her district figure out a plan.\u003c/p>\n\u003cfigure id=\"attachment_11937937\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11937937\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/01/010323-ALAMEDA-HOSPITAL-MHN-05-CM-2-copy-800x533.jpg\" alt='A beige building with \"Alameda Hospital\" written on it in blue lettering and a carpark in the foreground.' width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/01/010323-ALAMEDA-HOSPITAL-MHN-05-CM-2-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/01/010323-ALAMEDA-HOSPITAL-MHN-05-CM-2-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/01/010323-ALAMEDA-HOSPITAL-MHN-05-CM-2-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/01/010323-ALAMEDA-HOSPITAL-MHN-05-CM-2-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/01/010323-ALAMEDA-HOSPITAL-MHN-05-CM-2-copy.jpg 1568w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">A view of Alameda Hospital, which serves the city of Alameda, on Jan. 3, 2023. Alameda Hospital sought a 2-year extension for seismic retrofits in 2022, but Gov. Gavin Newsom vetoed it. \u003ccite>(Martin do Nascimento for CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>After Newsom vetoed a bill in 2022 that would have granted an extension on the seismic retrofit deadline specifically for Alameda Hospital, the hospital system and its partner health care district used parcel tax money to help back \u003ca href=\"https://www.alamedahealthsystem.org/alameda-hospital-seismic-updates-and-faqs/\">a loan\u003c/a>.\u003c/p>\n\u003cp>The cost to retrofit will be about $25 million, and the system is also investing millions more into other projects, such as a new skilled nursing facility. The construction work is set to be completed in 2027.\u003c/p>\n\u003cp>“No one wants things crashing in an earthquake or anything else, but at the same time, it’s a burden,” Mahler, the Alameda Health System associate chief medical officer, said. “How do we make sure that they get what they need to stay open?”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This article was produced by \u003c/em>\u003ca href=\"https://kffhealthnews.org/about-us\">\u003cem>KFF Health News\u003c/em>\u003c/a>\u003cem>, which publishes \u003c/em>\u003ca href=\"http://www.californiahealthline.org/\">\u003cem>California Healthline\u003c/em>\u003c/a>\u003cem>, an editorially independent service of the \u003c/em>\u003ca href=\"http://www.chcf.org/\">\u003cem>California Health Care Foundation\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>More than half of the 410 hospitals in California have at least one building that likely wouldn’t be able to operate after a major earthquake hit their region, and with many institutions claiming they don’t have the money to meet a 2030 legal deadline for earthquake retrofits, the state is now granting relief to some while ramping up pressure on others to get the work done.\u003c/p>\n\u003cp>Gov. Gavin Newsom in September vetoed legislation championed by the California Hospital Association that would have allowed all hospitals to apply for an extension of the deadline for up to five years. Instead, the Democratic governor signed a more narrowly tailored bill that allows small, rural, or “distressed” hospitals to get an extension of up to three years.\u003c/p>\n\u003cp>“It’s an expensive thing and a complicated thing for hospitals — independent hospitals in particular,” said Elizabeth Mahler, an associate chief medical officer for Alameda Health System, which is undertaking a $25 million retrofit of its hospital in Alameda.\u003c/p>\n\u003cp>The debate over how seismically safe California hospitals should be dates to the 1971 Sylmar quake near Los Angeles, which prompted a law requiring new hospitals to be built to withstand an earthquake and continue operating. In 1994, after the magnitude 6.7 Northridge quake killed at least 57 people, lawmakers required existing facilities to be upgraded.\u003c/p>\n\u003cp>The two laws have left California hospitals with two sets of standards to meet. The first — which originally had a deadline of 2008 but was pushed to 2020 — required hospital buildings to stay standing after an earthquake. About 20 facilities have yet to meet that requirement for at least one of their buildings, although some have received extensions from the state.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Labor unions representing nurses and other medical workers, however, say the hospitals have had plenty of time to get their buildings into compliance and that most have the money to do so.\u003c/p>\n\u003cp>“They’ve had 30 years to do this,” Cathy Kennedy, a nurse in Roseville and one of the presidents of the California Nurses Association, said in an interview prior to the governor’s action. “We are kicking the can down the road year after year, and unfortunately, lives are going to be lost.”\u003c/p>\n\u003cp>In his veto message on the CHA bill, Newsom wrote that a blanket five-year extension wasn’t justified and that any extension “should be limited in scope, granted only on a case-by-case basis to hospitals with demonstrated need and a clear path to compliance, and in combination with strong accountability and enforcement mechanisms.”\u003c/p>\n\u003cp>He also vetoed a bill directed specifically at helping several hospitals operated by Providence, a Catholic hospital chain.\u003c/p>\n\u003cp>But he signed a third bill, which allows small, rural, and “critical access” hospitals, and some others, to apply for a three-year extension and directs the Department of Health Care Access and Information to offer them “technical assistance” in meeting the deadline.\u003c/p>\n\u003cp>The state designates 37 hospitals as providing “critical access,” while 56 are considered “small,” meaning they have fewer than 50 beds, 59 are considered “rural,” and 32 are “district” hospitals, meaning special government entities fund them called “health care districts.” They can seek a three-year extension as long as they submit a seismic compliance plan and identify milestones for implementing it.\u003c/p>\n\u003cp>Debi Stebbins, executive director of the Alameda Health Care District, which owns the Alameda Hospital buildings, said small hospitals face a big challenge. Even though Alameda is very close to San Francisco and Oakland, the tunnels, bridges, and ferries that connect it to the mainland could easily be shut in an emergency, making the island’s hospital a lifeline.\u003c/p>\n\u003cp>“It’s an unfunded mandate,” Stebbins said of the state’s 2030 deadline.\u003c/p>\n\u003cp>The Rand study estimated the average cost of a retrofit at \u003ca href=\"https://www.rand.org/pubs/research_reports/RR3059.html\">more than $92 million\u003c/a> per building, but the amount could vary greatly depending on whether it’s a building that houses hospital beds.\u003c/p>\n\u003cp>Small and rural hospitals can get some aid from the state via grants financed by the California Electronic Cigarette Excise Tax, but HCAI spokesperson Andrew DiLuccia said it would yield just $2-3 million total annually. He added that the Small and Rural Hospital Relief Program has also received a one-time infusion of $50 million from a tax on health insurers to help with the seismic work.\u003c/p>\n\u003cp>Labor unions and critics of the extensions often point to the large profits that some hospitals reap: A California Health Care Foundation report published in August found that California’s hospitals made $3.2 billion in profit during the first quarter of 2024. The study notes that there “continues to be wide variation in financial performance among hospitals, with the bottom quartile showing a net income margin of -5%, compared to +13% for the top quartile.”\u003c/p>\n\u003cp>Stebbins has had to help her district figure out a plan.\u003c/p>\n\u003cfigure id=\"attachment_11937937\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11937937\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/01/010323-ALAMEDA-HOSPITAL-MHN-05-CM-2-copy-800x533.jpg\" alt='A beige building with \"Alameda Hospital\" written on it in blue lettering and a carpark in the foreground.' width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/01/010323-ALAMEDA-HOSPITAL-MHN-05-CM-2-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/01/010323-ALAMEDA-HOSPITAL-MHN-05-CM-2-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/01/010323-ALAMEDA-HOSPITAL-MHN-05-CM-2-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/01/010323-ALAMEDA-HOSPITAL-MHN-05-CM-2-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/01/010323-ALAMEDA-HOSPITAL-MHN-05-CM-2-copy.jpg 1568w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">A view of Alameda Hospital, which serves the city of Alameda, on Jan. 3, 2023. Alameda Hospital sought a 2-year extension for seismic retrofits in 2022, but Gov. Gavin Newsom vetoed it. \u003ccite>(Martin do Nascimento for CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>After Newsom vetoed a bill in 2022 that would have granted an extension on the seismic retrofit deadline specifically for Alameda Hospital, the hospital system and its partner health care district used parcel tax money to help back \u003ca href=\"https://www.alamedahealthsystem.org/alameda-hospital-seismic-updates-and-faqs/\">a loan\u003c/a>.\u003c/p>\n\u003cp>The cost to retrofit will be about $25 million, and the system is also investing millions more into other projects, such as a new skilled nursing facility. The construction work is set to be completed in 2027.\u003c/p>\n\u003cp>“No one wants things crashing in an earthquake or anything else, but at the same time, it’s a burden,” Mahler, the Alameda Health System associate chief medical officer, said. “How do we make sure that they get what they need to stay open?”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>California has allocated \u003ca href=\"https://www.gov.ca.gov/wp-content/uploads/2023/03/Fentanyl-Opioids-Glossy-Plan_3.20.23.pdf?emrc=86c07e\">more than $1 billion (PDF)\u003c/a> in recent years to combating its opioid crisis. Much of the money has been used to distribute fentanyl test strips and the overdose-reversal drug naloxone, as well as to deliver medical care to unhoused people. The state has an \u003ca href=\"https://californiamat.org/matproject/youth-opioid-education-and-awareness-and-fentanyl-education-and-awareness-campaign/\">opioid awareness campaign\u003c/a> tailored to youth and recently \u003ca href=\"https://www.gov.ca.gov/2023/04/28/sf-fentanyl-operation/\">called on the National Guard\u003c/a> to help detect drug traffickers.\u003c/p>\n\u003cp>Yet the problem keeps getting worse.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Keith Humphreys, professor of psychiatry and behavioral sciences, Stanford University\"]‘Even if we do a lot of things right in policy, we’re going to have a fair amount of deaths in the coming years.’[/pullquote]Driven largely by the prevalence of fentanyl, a synthetic opioid up to 100 times stronger than morphine, \u003ca href=\"https://calhps.com/wp-content/uploads/2023/04/2023-04_CalHPS_CA_Overdose_Report_Final.pdf\">drug overdoses in California now kill more than twice as many people as car accidents (PDF)\u003c/a>, more than four times as many as homicides, and more than either diabetes or lung cancer, according to California Health Policy Strategies, a Sacramento consulting group. And the state’s overdose surveillance dashboard indicates \u003ca href=\"https://skylab.cdph.ca.gov/ODdash/?tab=Home\">most opioid overdose deaths involve fentanyl\u003c/a>.\u003c/p>\n\u003cp>Provisional data for last year from the Centers for Disease Control and Prevention shows \u003ca href=\"https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm\">a small annual increase in overdose deaths in California, to nearly 12,000\u003c/a>. Across the U.S., overdose deaths again topped 100,000.\u003c/p>\n\u003cp>“As a parent, it scares the hell out of me. As a governor, I see it, I recognize the nature of what’s occurred on the streets,” Gov. Gavin Newsom said May 12 in announcing more funding for \u003ca href=\"https://ebudget.ca.gov/2023-24/pdf/Revised/BudgetSummary/HealthandHumanServices.pdf\">California to produce its own naloxone (PDF)\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[aside tag=\"fentanyl\" label=\"Related Posts\"]Despite all the state is doing to reduce drug overdose deaths, public health policy experts say there are no easy or clear answers. Drug policy experts applaud California’s effort to make naloxone as commonly available as fire extinguishers \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202320240SB10\">in schools\u003c/a>, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202320240AB24\">bars, libraries and gas stations\u003c/a>, but they also recommend diverting more offenders from prisons and jails into treatment and encourage ramping up the use of anti-addiction medication.\u003c/p>\n\u003cp>“Even if we do a lot of things right in policy, we’re going to have a fair amount of deaths in the coming years,” said Keith Humphreys, professor of psychiatry and behavioral sciences at Stanford University and a drug policy expert.\u003c/p>\n\u003cp>He said lawmakers should examine the underlying, complex causes of addiction if they want to make lasting change. Lawmakers have created a \u003ca href=\"https://www.assembly.ca.gov/committees/select-select-committee-on-fentanyl%2C-opioid-addiction%2C-and-overdose-prevention-regular-session\">Select Committee on Fentanyl, Opioid Addiction and Overdose Prevention\u003c/a> and are advancing a bill to create a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB33\">Fentanyl Addiction and Overdose Prevention Task Force\u003c/a>. The bill would require the task force to start meeting next year and submit an interim report by January 2025 and recommendations by July 2025.\u003c/p>\n\u003cp>“It really is something, like COVID, that we have to focus on and make some permanent structural changes, like to health care, mental health care and funding to deal with addiction,” Humphreys said.\u003c/p>\n\u003cp>Newsom acknowledged as much, saying, “We have a lot more work to do.”\u003c/p>\n\u003cp>The Democratic governor was joined last month by Attorney General Rob Bonta in calling on the California National Guard, California Highway Patrol and state Department of Justice to crack down on fentanyl dealing in San Francisco, where fatal overdoses jumped more than 40% in the first three months of this year over 2022.\u003c/p>\n\u003cp>The move was criticized as “a law enforcement-first approach to matters of public health” in a joint statement from 28 organizations including the American Civil Liberties Union of Northern California and the San Francisco Public Defender’s Office.\u003c/p>\n\u003cp>While the governor has focused on fentanyl trafficking and making naloxone more readily available, state lawmakers have recently been debating whether and how to stiffen punishments for dealers, many of whom also use fentanyl.\u003c/p>\n\u003cp>Several proposals have already stalled, such as one to send \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202320240AB955\">dealers to jail for up to nine years\u003c/a> if they sell fentanyl on a social media platform and another warning \u003ca href=\"https://sd34.senate.ca.gov/sb-44\">dealers they could be charged with murder\u003c/a> if someone dies taking their drugs. Lawmakers kept alive two bills to boost punishments for \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB701\">dealers of large volumes of fentanyl\u003c/a> and those who \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202320240AB675\">carry a gun\u003c/a>.\u003c/p>\n\u003cp>Democrats who control the Legislature’s public safety committees are reluctant to support tougher penalties for fear of sparking a new war on drugs or reprising the steep penalties around crack cocaine that criminalized Black people disproportionately.\u003c/p>\n\u003cp>Black and Latino Californians experienced an increase in overdose deaths of more than 200% between 2017 and 2021, according to Konrad Franco, who conducted the research for California Health Policy Strategies. Black people make up 6% of California’s population but accounted for 13% of its overdose deaths in 2021.\u003c/p>\n\u003cp>“We cannot go backwards and fill our prisons with kids of color,” said Assemblymember Liz Ortega, a Democrat from San Leandro, during a special hearing last month on fentanyl-related bills.\u003c/p>\n\u003cp>Georges Benjamin, executive director of the American Public Health Association, questioned the effectiveness of increased penalties for people who are largely controlled by their addictions.\u003c/p>\n\u003cp>Benjamin said lawmakers should instead support drug courts that promote treatment programs over incarceration, though he said incarceration may be needed to protect the public mostly from violent offenders who refuse treatment and harm others.\u003c/p>\n\u003cp>Humphreys pointed to the \u003ca href=\"https://nij.ojp.gov/topics/articles/hopeful-approach-understanding-implications-hope-program\">Honest Opportunity Probation With Enforcement\u003c/a> and \u003ca href=\"https://wesavelives.org/solve-the-problem/247-sobriety-program/\">24/7 Sobriety\u003c/a> programs as models. They combine regularly testing offenders for drugs and alcohol, with short penalties for violations.\u003c/p>\n\u003cp>“You use the criminal justice system in a way that in the long run actually reduces incarceration rather than increasing it,” Humphreys said of the approach.\u003c/p>\n\u003cp>Yet, Tanya Tilghman, a Black woman from San Francisco, supports tougher penalties for fentanyl dealers and said the issue crosses racial lines. She became an activist with \u003ca href=\"https://madaad.org/who-we-are\">Mothers Against Drug Addiction and Deaths\u003c/a> after her son became addicted to methamphetamine and more recently to fentanyl.\u003c/p>\n\u003cp>“When people are doing drugs, it doesn’t see color or racial boundaries,” she said. “It’s killing a lot more people and it’s killing a lot of Black people.”\u003c/p>\n\u003cp>Daniel Ciccarone, a drug policy expert at UCSF, said enforcement efforts may be popular with the public but “simply don’t work as well as we want them to.” At minimum, he said, any crackdown should be coupled with an equal public health approach.\u003c/p>\n\u003cp>“We’ve thrown tens of billions of dollars at the war on drugs over two generations, almost three generations now, and believe it or not, drugs across category — from marijuana to cocaine to heroin/fentanyl — drugs are ever more pure and ever cheaper despite impressive levels of effort,” Ciccarone said. “The most honest answer is there’s no clear answer as to what to do about the fentanyl crisis.”\u003c/p>\n\u003cp>He recommended California allow supervised consumption sites where opioid users could legally use drugs, \u003ca href=\"https://apnews.com/article/covid-health-los-angeles-san-francisco-gavin-newsom-51414d98c6d41caed29373e147ca146f\">an idea Newsom vetoed last fall\u003c/a> but that Ciccarone said can ease people into treatment. Other harm-reduction strategies, including expanding the use of test strips and other chemical analyses to check drugs for contamination with fentanyl, can also save lives, he said.\u003c/p>\n\u003cp>Humphreys led \u003ca href=\"https://opioids.stanford.edu/commission-recommendations\">a 17-member commission that examined the opioid crisis and made recommendations\u003c/a> including expanding the availability of prescription drugs such as buprenorphine, naltrexone and methadone to ease drug cravings and withdrawal symptoms.\u003c/p>\n\u003cp>Still, some parents of children who have experienced opioid addiction say tougher penalties must be part of the response.\u003c/p>\n\u003cp>“What they don’t understand is that fentanyl has changed the drug landscape like no other drug has in the history of the United States of America,” said Jaime Puerta, whose only son, Daniel, died from fentanyl in 2020 at age 16.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/span>\u003c/i>\u003c/p>\n\n",
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"excerpt": "According to consulting firm California Health Policy Strategies, drug overdoses in California now kill more than twice as many people as car accidents, more than four times as many as homicides, and more than either diabetes or lung cancer.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California has allocated \u003ca href=\"https://www.gov.ca.gov/wp-content/uploads/2023/03/Fentanyl-Opioids-Glossy-Plan_3.20.23.pdf?emrc=86c07e\">more than $1 billion (PDF)\u003c/a> in recent years to combating its opioid crisis. Much of the money has been used to distribute fentanyl test strips and the overdose-reversal drug naloxone, as well as to deliver medical care to unhoused people. The state has an \u003ca href=\"https://californiamat.org/matproject/youth-opioid-education-and-awareness-and-fentanyl-education-and-awareness-campaign/\">opioid awareness campaign\u003c/a> tailored to youth and recently \u003ca href=\"https://www.gov.ca.gov/2023/04/28/sf-fentanyl-operation/\">called on the National Guard\u003c/a> to help detect drug traffickers.\u003c/p>\n\u003cp>Yet the problem keeps getting worse.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Driven largely by the prevalence of fentanyl, a synthetic opioid up to 100 times stronger than morphine, \u003ca href=\"https://calhps.com/wp-content/uploads/2023/04/2023-04_CalHPS_CA_Overdose_Report_Final.pdf\">drug overdoses in California now kill more than twice as many people as car accidents (PDF)\u003c/a>, more than four times as many as homicides, and more than either diabetes or lung cancer, according to California Health Policy Strategies, a Sacramento consulting group. And the state’s overdose surveillance dashboard indicates \u003ca href=\"https://skylab.cdph.ca.gov/ODdash/?tab=Home\">most opioid overdose deaths involve fentanyl\u003c/a>.\u003c/p>\n\u003cp>Provisional data for last year from the Centers for Disease Control and Prevention shows \u003ca href=\"https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm\">a small annual increase in overdose deaths in California, to nearly 12,000\u003c/a>. Across the U.S., overdose deaths again topped 100,000.\u003c/p>\n\u003cp>“As a parent, it scares the hell out of me. As a governor, I see it, I recognize the nature of what’s occurred on the streets,” Gov. Gavin Newsom said May 12 in announcing more funding for \u003ca href=\"https://ebudget.ca.gov/2023-24/pdf/Revised/BudgetSummary/HealthandHumanServices.pdf\">California to produce its own naloxone (PDF)\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Despite all the state is doing to reduce drug overdose deaths, public health policy experts say there are no easy or clear answers. Drug policy experts applaud California’s effort to make naloxone as commonly available as fire extinguishers \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202320240SB10\">in schools\u003c/a>, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202320240AB24\">bars, libraries and gas stations\u003c/a>, but they also recommend diverting more offenders from prisons and jails into treatment and encourage ramping up the use of anti-addiction medication.\u003c/p>\n\u003cp>“Even if we do a lot of things right in policy, we’re going to have a fair amount of deaths in the coming years,” said Keith Humphreys, professor of psychiatry and behavioral sciences at Stanford University and a drug policy expert.\u003c/p>\n\u003cp>He said lawmakers should examine the underlying, complex causes of addiction if they want to make lasting change. Lawmakers have created a \u003ca href=\"https://www.assembly.ca.gov/committees/select-select-committee-on-fentanyl%2C-opioid-addiction%2C-and-overdose-prevention-regular-session\">Select Committee on Fentanyl, Opioid Addiction and Overdose Prevention\u003c/a> and are advancing a bill to create a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB33\">Fentanyl Addiction and Overdose Prevention Task Force\u003c/a>. The bill would require the task force to start meeting next year and submit an interim report by January 2025 and recommendations by July 2025.\u003c/p>\n\u003cp>“It really is something, like COVID, that we have to focus on and make some permanent structural changes, like to health care, mental health care and funding to deal with addiction,” Humphreys said.\u003c/p>\n\u003cp>Newsom acknowledged as much, saying, “We have a lot more work to do.”\u003c/p>\n\u003cp>The Democratic governor was joined last month by Attorney General Rob Bonta in calling on the California National Guard, California Highway Patrol and state Department of Justice to crack down on fentanyl dealing in San Francisco, where fatal overdoses jumped more than 40% in the first three months of this year over 2022.\u003c/p>\n\u003cp>The move was criticized as “a law enforcement-first approach to matters of public health” in a joint statement from 28 organizations including the American Civil Liberties Union of Northern California and the San Francisco Public Defender’s Office.\u003c/p>\n\u003cp>While the governor has focused on fentanyl trafficking and making naloxone more readily available, state lawmakers have recently been debating whether and how to stiffen punishments for dealers, many of whom also use fentanyl.\u003c/p>\n\u003cp>Several proposals have already stalled, such as one to send \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202320240AB955\">dealers to jail for up to nine years\u003c/a> if they sell fentanyl on a social media platform and another warning \u003ca href=\"https://sd34.senate.ca.gov/sb-44\">dealers they could be charged with murder\u003c/a> if someone dies taking their drugs. Lawmakers kept alive two bills to boost punishments for \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB701\">dealers of large volumes of fentanyl\u003c/a> and those who \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202320240AB675\">carry a gun\u003c/a>.\u003c/p>\n\u003cp>Democrats who control the Legislature’s public safety committees are reluctant to support tougher penalties for fear of sparking a new war on drugs or reprising the steep penalties around crack cocaine that criminalized Black people disproportionately.\u003c/p>\n\u003cp>Black and Latino Californians experienced an increase in overdose deaths of more than 200% between 2017 and 2021, according to Konrad Franco, who conducted the research for California Health Policy Strategies. Black people make up 6% of California’s population but accounted for 13% of its overdose deaths in 2021.\u003c/p>\n\u003cp>“We cannot go backwards and fill our prisons with kids of color,” said Assemblymember Liz Ortega, a Democrat from San Leandro, during a special hearing last month on fentanyl-related bills.\u003c/p>\n\u003cp>Georges Benjamin, executive director of the American Public Health Association, questioned the effectiveness of increased penalties for people who are largely controlled by their addictions.\u003c/p>\n\u003cp>Benjamin said lawmakers should instead support drug courts that promote treatment programs over incarceration, though he said incarceration may be needed to protect the public mostly from violent offenders who refuse treatment and harm others.\u003c/p>\n\u003cp>Humphreys pointed to the \u003ca href=\"https://nij.ojp.gov/topics/articles/hopeful-approach-understanding-implications-hope-program\">Honest Opportunity Probation With Enforcement\u003c/a> and \u003ca href=\"https://wesavelives.org/solve-the-problem/247-sobriety-program/\">24/7 Sobriety\u003c/a> programs as models. They combine regularly testing offenders for drugs and alcohol, with short penalties for violations.\u003c/p>\n\u003cp>“You use the criminal justice system in a way that in the long run actually reduces incarceration rather than increasing it,” Humphreys said of the approach.\u003c/p>\n\u003cp>Yet, Tanya Tilghman, a Black woman from San Francisco, supports tougher penalties for fentanyl dealers and said the issue crosses racial lines. She became an activist with \u003ca href=\"https://madaad.org/who-we-are\">Mothers Against Drug Addiction and Deaths\u003c/a> after her son became addicted to methamphetamine and more recently to fentanyl.\u003c/p>\n\u003cp>“When people are doing drugs, it doesn’t see color or racial boundaries,” she said. “It’s killing a lot more people and it’s killing a lot of Black people.”\u003c/p>\n\u003cp>Daniel Ciccarone, a drug policy expert at UCSF, said enforcement efforts may be popular with the public but “simply don’t work as well as we want them to.” At minimum, he said, any crackdown should be coupled with an equal public health approach.\u003c/p>\n\u003cp>“We’ve thrown tens of billions of dollars at the war on drugs over two generations, almost three generations now, and believe it or not, drugs across category — from marijuana to cocaine to heroin/fentanyl — drugs are ever more pure and ever cheaper despite impressive levels of effort,” Ciccarone said. “The most honest answer is there’s no clear answer as to what to do about the fentanyl crisis.”\u003c/p>\n\u003cp>He recommended California allow supervised consumption sites where opioid users could legally use drugs, \u003ca href=\"https://apnews.com/article/covid-health-los-angeles-san-francisco-gavin-newsom-51414d98c6d41caed29373e147ca146f\">an idea Newsom vetoed last fall\u003c/a> but that Ciccarone said can ease people into treatment. Other harm-reduction strategies, including expanding the use of test strips and other chemical analyses to check drugs for contamination with fentanyl, can also save lives, he said.\u003c/p>\n\u003cp>Humphreys led \u003ca href=\"https://opioids.stanford.edu/commission-recommendations\">a 17-member commission that examined the opioid crisis and made recommendations\u003c/a> including expanding the availability of prescription drugs such as buprenorphine, naltrexone and methadone to ease drug cravings and withdrawal symptoms.\u003c/p>\n\u003cp>Still, some parents of children who have experienced opioid addiction say tougher penalties must be part of the response.\u003c/p>\n\u003cp>“What they don’t understand is that fentanyl has changed the drug landscape like no other drug has in the history of the United States of America,” said Jaime Puerta, whose only son, Daniel, died from fentanyl in 2020 at age 16.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "'It's a Very Stressful Job': California First Responders Say More PTSD Injuries Should Be Covered by Workers' Compensation",
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"headTitle": "‘It’s a Very Stressful Job’: California First Responders Say More PTSD Injuries Should Be Covered by Workers’ Compensation | KQED",
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"content": "\u003cp>A paramedic for about 30 years, Susan Farren knew all was not well with first responders: Eight of her colleagues had died by suicide. Others had experienced substance abuse or gone through painful divorces.\u003c/p>\n\u003cp>So, in 2018, Farren founded a nonprofit in Santa Rosa to train and support emergency personnel struggling with trauma and stress. Hundreds of firefighters, police officers and other first responders have since availed themselves of the organization’s timely help.\u003c/p>\n\u003cp>“Nobody prepares you to walk into a house where four people have been murdered,” said Farren, executive director of \u003ca href=\"https://www.resiliency1st.org/\">First Responders Resiliency\u003c/a>.[pullquote size=\"medium\" align=\"right\" citation=\"Karen Larsen, CEO, Steinberg Institute\"]‘We wouldn’t think twice about taking care of a first responder who broke their leg, and we shouldn’t think twice about taking care of their mental health needs.’[/pullquote]\u003c/p>\n\u003cp>Firefighters, paramedics and police often respond to the worst days of people’s lives — accidents, deaths, fires and other distressing events. After the deadly mass shootings earlier this year in Monterey Park and Half Moon Bay, and countless others across the country, \u003ca href=\"https://www.latimes.com/california/story/2023-01-31/monterey-park-officials-apologize-to-firefighters-first-responders\">awareness of how such trauma affects first responders\u003c/a> has grown.\u003c/p>\n\u003cp>But there is no national consensus on when and which emergency personnel should be provided workers’ compensation benefits.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We wouldn’t think twice about taking care of a first responder who broke their leg, and we shouldn’t think twice about taking care of their mental health needs,” Karen Larsen, CEO of the Steinberg Institute, a nonprofit public policy institute, said in an email.\u003c/p>\n\u003cp>This year, there has been a push in California by first responders for laws that expand access to workers’ compensation for post-traumatic stress injuries among their ranks. But some business groups and local governments want to pump the brakes, citing worries about potential fraud or abuse of the workers’ compensation system.\u003c/p>\n\u003cp>The allegation that some people could take advantage of a more open workers’ compensation system should not deter California from providing immediate access to mental health treatment to those who need it, said Farren, who noted that many of the first responders she works with are denied workers’ compensation coverage or have to go through many steps to get it approved.\u003c/p>\n\u003cp>“That shouldn’t keep us from getting help to those who really need it. That help should be available often, and affordably, and it should be available immediately,” Farren said.\u003c/p>\n\u003cp>Perceptions about employers’ responsibility for alleviating work-related mental stress have changed over time, and that’s showing up in workers’ compensation. Each state has its own workers’ compensation laws, which provide benefits like disability pay and medical care to workers injured or sickened on the job.\u003c/p>\n\u003cp>More than half \u003ca href=\"https://workcompauto.optum.com/content/owca/owca/en/insights/blog/policy-matters-blog/2021/PTSD-Coverage.html\">have enacted PTSD policies or policy changes since 2018\u003c/a>, according to a 2021 report by Optum, a company that creates workers’ compensation programs. Coverage varies widely for post-traumatic stress injuries, which can be triggered by a single traumatic event or continued exposure to high stress and traumatic events.\u003c/p>\n\u003cp>In 2019, Gov. Gavin Newsom signed legislation to give California firefighters and police officers a stronger chance at earning workers’ compensation. The bill, \u003ca href=\"https://www.firerescue1.com/legislation-funding/articles/new-calif-law-lets-first-responders-seek-workers-comp-for-ptsd-N6kxZ0pCyRnz8AOQ/\">SB 542\u003c/a>, authored by state Sen. Henry Stern (D-Calabasas), changed state law so that post-traumatic stress “injury,” such as PTSD, is legally presumed to be work-related for those first responders.\u003c/p>\n\u003cp>It was a small step by lawmakers in a state where recognition of work-related injuries for workers’ compensation has typically been limited to physical illnesses such as heart disease and cancer. Previously, psychiatric conditions were handled differently, with employers and insurance companies long contending that psychological injuries can have many sources and might be too easy to blame on work.\u003c/p>\n\u003cp>Researchers at the Rand Corp. suggested in a 2021 report that \u003ca href=\"https://www.rand.org/pubs/research_briefs/RBA1391-1.html\">further study is needed to evaluate the financial toll the 2019 law has had on employers\u003c/a> — particularly counties and other municipalities that pay for police, firefighters and other first responders. Rand researchers estimated the added costs for local governments and the state to cover post-traumatic stress injuries could rise from $20 million to $116 million annually.\u003c/p>\n\u003cp>Firefighters and police in most cases now no longer have to prove that work was mostly responsible for their PTSD. But the law sunsets in 2025 and excludes many other first responders, including dispatchers, paramedics and first responders at state hospitals.\u003c/p>\n\u003cp>This year, legislation by state Sen. John Laird (D-Santa Cruz), \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202320240SB623\">SB 623\u003c/a>, co-sponsored by an advocacy group representing firefighters in the state — California Professional Firefighters — would extend PTSD workers’ compensation coverage until 2032 and open it up to state firefighters, additional law enforcement officers, public safety dispatchers and other emergency response communication employees who work for public agencies. The Senate Labor, Public Employment and Retirement Committee unanimously approved the bill in April, and it is awaiting a vote by the Senate Appropriations Committee.\u003c/p>\n\u003cp>Business groups and local governments — many of which opposed the 2019 law — are lobbying against more expansion. In letters to lawmakers, groups including the California Chamber of Commerce, California Coalition on Workers’ Compensation, California Hospital Association, and California State Association of Counties warned that pending legislation could “open the door to abuse and fraud.”\u003c/p>\n\u003cp>“There is no evidence that workers are being inappropriately denied the care or benefits that they need,” Virginia Drake, spokesperson for the California Coalition on Workers’ Compensation, told KFF Health News. The group represents employers, cities and counties, insurance brokers and government agencies on issues of workers’ compensation.\u003c/p>\n\u003cp>Legislation that would extend benefits to more first responders would “put taxpayer funds at risk by tying the hands of public employers and forcing them to pay even the most questionable claims,” she added in a statement.\u003c/p>\n\u003cp>In addition, there does not seem to be consensus on which emergency personnel should get covered.\u003c/p>\n\u003cp>A measure by Assemblymember Freddie Rodriguez, a Democrat from Chino who worked as an emergency medical technician for three decades, has stalled. AB 597 would expand workers’ compensation coverage to paramedics and emergency medical technicians, but it didn’t get a hearing in the Assembly. Unions representing paramedics and EMTs in California did not return messages seeking comment.\u003c/p>\n\u003cp>“It’s a very stressful job,” said Rodriguez, who told KFF Health News that two of his paramedic friends had died by suicide. “It affects people differently.”\u003c/p>\n\u003cp>Clearing a path to speedy mental health recovery, particularly after traumatic incidents, “should be automatic,” he added.\u003c/p>\n\u003cp>It’s unclear whether Newsom will back Laird’s bill extending coverage for groups of emergency responders, amid a \u003ca href=\"https://calbudgetcenter.org/resources/qa-what-does-the-projected-budget-shortfall-mean-for-california/\">projected $22.5 billion deficit\u003c/a>. A spokesperson for his office, Omar Rodriguez, said the governor typically does not comment on pending legislation and “will evaluate the bills on their own merits if they reach his desk.”\u003c/p>\n\u003cp>Last year, the Democratic governor \u003ca href=\"https://www.gov.ca.gov/wp-content/uploads/2022/09/SB-284-VETO.pdf?emrc=765aa9\">vetoed similar legislation (PDF)\u003c/a>, saying in a statement that it would be premature to shift coverage of PTSD before any studies had been conducted on how the current law has worked for those who are covered.\u003c/p>\n\u003cp>Broadening coverage, Newsom wrote, “could set a dangerous precedent that has the potential to destabilize the workers’ compensation system going forward.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/span>\u003c/i>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A paramedic for about 30 years, Susan Farren knew all was not well with first responders: Eight of her colleagues had died by suicide. Others had experienced substance abuse or gone through painful divorces.\u003c/p>\n\u003cp>So, in 2018, Farren founded a nonprofit in Santa Rosa to train and support emergency personnel struggling with trauma and stress. Hundreds of firefighters, police officers and other first responders have since availed themselves of the organization’s timely help.\u003c/p>\n\u003cp>“Nobody prepares you to walk into a house where four people have been murdered,” said Farren, executive director of \u003ca href=\"https://www.resiliency1st.org/\">First Responders Resiliency\u003c/a>.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Firefighters, paramedics and police often respond to the worst days of people’s lives — accidents, deaths, fires and other distressing events. After the deadly mass shootings earlier this year in Monterey Park and Half Moon Bay, and countless others across the country, \u003ca href=\"https://www.latimes.com/california/story/2023-01-31/monterey-park-officials-apologize-to-firefighters-first-responders\">awareness of how such trauma affects first responders\u003c/a> has grown.\u003c/p>\n\u003cp>But there is no national consensus on when and which emergency personnel should be provided workers’ compensation benefits.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We wouldn’t think twice about taking care of a first responder who broke their leg, and we shouldn’t think twice about taking care of their mental health needs,” Karen Larsen, CEO of the Steinberg Institute, a nonprofit public policy institute, said in an email.\u003c/p>\n\u003cp>This year, there has been a push in California by first responders for laws that expand access to workers’ compensation for post-traumatic stress injuries among their ranks. But some business groups and local governments want to pump the brakes, citing worries about potential fraud or abuse of the workers’ compensation system.\u003c/p>\n\u003cp>The allegation that some people could take advantage of a more open workers’ compensation system should not deter California from providing immediate access to mental health treatment to those who need it, said Farren, who noted that many of the first responders she works with are denied workers’ compensation coverage or have to go through many steps to get it approved.\u003c/p>\n\u003cp>“That shouldn’t keep us from getting help to those who really need it. That help should be available often, and affordably, and it should be available immediately,” Farren said.\u003c/p>\n\u003cp>Perceptions about employers’ responsibility for alleviating work-related mental stress have changed over time, and that’s showing up in workers’ compensation. Each state has its own workers’ compensation laws, which provide benefits like disability pay and medical care to workers injured or sickened on the job.\u003c/p>\n\u003cp>More than half \u003ca href=\"https://workcompauto.optum.com/content/owca/owca/en/insights/blog/policy-matters-blog/2021/PTSD-Coverage.html\">have enacted PTSD policies or policy changes since 2018\u003c/a>, according to a 2021 report by Optum, a company that creates workers’ compensation programs. Coverage varies widely for post-traumatic stress injuries, which can be triggered by a single traumatic event or continued exposure to high stress and traumatic events.\u003c/p>\n\u003cp>In 2019, Gov. Gavin Newsom signed legislation to give California firefighters and police officers a stronger chance at earning workers’ compensation. The bill, \u003ca href=\"https://www.firerescue1.com/legislation-funding/articles/new-calif-law-lets-first-responders-seek-workers-comp-for-ptsd-N6kxZ0pCyRnz8AOQ/\">SB 542\u003c/a>, authored by state Sen. Henry Stern (D-Calabasas), changed state law so that post-traumatic stress “injury,” such as PTSD, is legally presumed to be work-related for those first responders.\u003c/p>\n\u003cp>It was a small step by lawmakers in a state where recognition of work-related injuries for workers’ compensation has typically been limited to physical illnesses such as heart disease and cancer. Previously, psychiatric conditions were handled differently, with employers and insurance companies long contending that psychological injuries can have many sources and might be too easy to blame on work.\u003c/p>\n\u003cp>Researchers at the Rand Corp. suggested in a 2021 report that \u003ca href=\"https://www.rand.org/pubs/research_briefs/RBA1391-1.html\">further study is needed to evaluate the financial toll the 2019 law has had on employers\u003c/a> — particularly counties and other municipalities that pay for police, firefighters and other first responders. Rand researchers estimated the added costs for local governments and the state to cover post-traumatic stress injuries could rise from $20 million to $116 million annually.\u003c/p>\n\u003cp>Firefighters and police in most cases now no longer have to prove that work was mostly responsible for their PTSD. But the law sunsets in 2025 and excludes many other first responders, including dispatchers, paramedics and first responders at state hospitals.\u003c/p>\n\u003cp>This year, legislation by state Sen. John Laird (D-Santa Cruz), \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202320240SB623\">SB 623\u003c/a>, co-sponsored by an advocacy group representing firefighters in the state — California Professional Firefighters — would extend PTSD workers’ compensation coverage until 2032 and open it up to state firefighters, additional law enforcement officers, public safety dispatchers and other emergency response communication employees who work for public agencies. The Senate Labor, Public Employment and Retirement Committee unanimously approved the bill in April, and it is awaiting a vote by the Senate Appropriations Committee.\u003c/p>\n\u003cp>Business groups and local governments — many of which opposed the 2019 law — are lobbying against more expansion. In letters to lawmakers, groups including the California Chamber of Commerce, California Coalition on Workers’ Compensation, California Hospital Association, and California State Association of Counties warned that pending legislation could “open the door to abuse and fraud.”\u003c/p>\n\u003cp>“There is no evidence that workers are being inappropriately denied the care or benefits that they need,” Virginia Drake, spokesperson for the California Coalition on Workers’ Compensation, told KFF Health News. The group represents employers, cities and counties, insurance brokers and government agencies on issues of workers’ compensation.\u003c/p>\n\u003cp>Legislation that would extend benefits to more first responders would “put taxpayer funds at risk by tying the hands of public employers and forcing them to pay even the most questionable claims,” she added in a statement.\u003c/p>\n\u003cp>In addition, there does not seem to be consensus on which emergency personnel should get covered.\u003c/p>\n\u003cp>A measure by Assemblymember Freddie Rodriguez, a Democrat from Chino who worked as an emergency medical technician for three decades, has stalled. AB 597 would expand workers’ compensation coverage to paramedics and emergency medical technicians, but it didn’t get a hearing in the Assembly. Unions representing paramedics and EMTs in California did not return messages seeking comment.\u003c/p>\n\u003cp>“It’s a very stressful job,” said Rodriguez, who told KFF Health News that two of his paramedic friends had died by suicide. “It affects people differently.”\u003c/p>\n\u003cp>Clearing a path to speedy mental health recovery, particularly after traumatic incidents, “should be automatic,” he added.\u003c/p>\n\u003cp>It’s unclear whether Newsom will back Laird’s bill extending coverage for groups of emergency responders, amid a \u003ca href=\"https://calbudgetcenter.org/resources/qa-what-does-the-projected-budget-shortfall-mean-for-california/\">projected $22.5 billion deficit\u003c/a>. A spokesperson for his office, Omar Rodriguez, said the governor typically does not comment on pending legislation and “will evaluate the bills on their own merits if they reach his desk.”\u003c/p>\n\u003cp>Last year, the Democratic governor \u003ca href=\"https://www.gov.ca.gov/wp-content/uploads/2022/09/SB-284-VETO.pdf?emrc=765aa9\">vetoed similar legislation (PDF)\u003c/a>, saying in a statement that it would be premature to shift coverage of PTSD before any studies had been conducted on how the current law has worked for those who are covered.\u003c/p>\n\u003cp>Broadening coverage, Newsom wrote, “could set a dangerous precedent that has the potential to destabilize the workers’ compensation system going forward.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"slug": "long-covid-patients-feel-swept-under-the-rug-by-end-to-pandemic-emergencies",
"title": "Long COVID Patients Feel ‘Swept Under the Rug’ by End to Pandemic Emergencies",
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"headTitle": "Long COVID Patients Feel ‘Swept Under the Rug’ by End to Pandemic Emergencies | KQED",
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"content": "\u003cp>Lost careers. Broken marriages. Family and friends who dismiss and don’t believe.\u003c/p>\n\u003cp>These are some of the emotional and financial struggles long COVID patients face years after their infections. Physically, they are debilitated and in pain: unable to walk up stairs, focus on a project or hold down a job. Facing the end of the federal public health emergency in May, many people experiencing lingering effects of the virus say they feel angry and abandoned by policymakers eager to move on.\u003c/p>\n\u003cp>“Patients are losing hope,” said Shelby Hedgecock, a self-described long COVID survivor from Knoxville, Tennessee, who now advocates for patients like herself. “We feel swept under the rug.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention estimated in March that \u003ca href=\"https://www.cdc.gov/nchs/covid19/pulse/long-covid.htm\">6% of U.S. adults\u003c/a>, or about 16 million people, were experiencing long COVID, or ongoing health problems that continue or emerge after a bout of COVID-19. Researchers estimate that 1.6% of U.S. adults, or about 4 million people, have symptoms that have significantly reduced their ability to carry out day-to-day activities.\u003c/p>\n\u003cp>While patients are no longer contagious, their health issues can stretch on and affect almost every system in the body. More than 200 symptoms and conditions, including fatigue and depression, are linked to long COVID, said Linda Geng, a physician who treats patients at Stanford Medicine’s \u003ca href=\"https://stanfordhealthcare.org/medical-clinics/post-covid-clinic.html\">Post-Acute COVID-19 Syndrome Clinic\u003c/a>.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Shelby Hedgecock, long COVID survivor\"]‘Patients are losing hope. We feel swept under the rug.’[/pullquote]\u003c/p>\n\u003cp>The severity and duration of long COVID vary. Some people recover in a few weeks, while a smaller number have debilitating and lingering health issues. There is currently no test, treatment or cure. There’s not even an accepted medical definition.\u003c/p>\n\u003cp>“When you don’t have any tests that show that anything’s abnormal, it can be quite invalidating and anxiety-provoking,” Geng said.\u003c/p>\n\u003cp>The physical and emotional toll have left some feeling hopeless. A 2022 study of adults in Japan and Sweden found that those with post-COVID conditions were \u003ca href=\"https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-022-03874-7\">more than twice as likely to develop mental health issues\u003c/a>, including depression, anxiety and post-traumatic stress, as people without them.\u003c/p>\n\u003cfigure id=\"attachment_11946940\" class=\"wp-caption aligncenter\" style=\"max-width: 744px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11946940\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/04/Long_covid_Shelby_Hedgecock_4.jpg\" alt='A woman stands in front of a billboard pictured in the distance. It reads, \"I was a healthy person before this. Shelby, age 29, covid-19 survivor.\"' width=\"744\" height=\"726\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/Long_covid_Shelby_Hedgecock_4.jpg 744w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/Long_covid_Shelby_Hedgecock_4-160x156.jpg 160w\" sizes=\"auto, (max-width: 744px) 100vw, 744px\">\u003cfigcaption class=\"wp-caption-text\">Shelby Hedgecock stands in front of a billboard from a Los Angeles County public health campaign that features her as a long COVID patient. \u003ccite>(Courtesy Gustavo Sosa)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“One of my friends committed suicide in May of 2021,” Hedgecock said. “She had a mild COVID infection, and she progressively had medical complications continuously pop up, and it just got so bad that she decided to end her life.”\u003c/p>\n\u003cp>In Los Angeles County, 46% of adults who contracted COVID had fully recovered a month later, but the rest — a majority — reported one or more continuing symptoms, according to a \u003ca href=\"https://californiahealthline.org/wp-content/uploads/sites/3/2023/03/Long-Covid-Study-Graphic.jpg\">675-patient study\u003c/a> by the University of Southern California’s COVID-19 Pandemic Research Center. The researchers found that chronic fatigue topped the list of health issues, followed by brain fog and a persistent cough, all of which affect people’s daily lives.\u003c/p>\n\u003cp>Among the respondents who identified as living with long COVID, 77% said their condition limited daily activities such as going to school or work or socializing. One-quarter reported experiencing severe limitations.\u003c/p>\n\u003cp>Taking antivirals cuts the risk of developing long COVID in people who are newly infected. But for people already suffering, medical science is trying to catch up.\u003c/p>\n\u003cp>Here’s a look at Hedgecock and two other patients who have had long COVID for years.\u003c/p>\n\u003ch2>A debilitating brain injury\u003c/h2>\n\u003cp>Before contracting COVID during spring 2020, Hedgecock’s life revolved around fitness. She worked as a personal trainer in Los Angeles and competed in endurance competitions on the weekends. At 29, she was about to launch an online wellness business. Then she started having trouble breathing.\u003c/p>\n\u003cp>“One of the scariest things that happened to me was I couldn’t breathe at night,” Hedgecock said. “I did go to the emergency room on three different occasions, and each time I was told, ‘You’re up and you’re moving. You’re young, you’re healthy. It’s going to be fine.’”\u003c/p>\n\u003cfigure id=\"attachment_11946939\" class=\"wp-caption aligncenter\" style=\"max-width: 744px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11946939 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/04/Long_covid_Shelby_Hedgecock_3.jpg\" alt=\"A white woman in a blue mask lies in a hospital bed with monitors stuck to her chest alongside a floral shoulder tattoo and a small gold chain with a white gemstone pendant.\" width=\"744\" height=\"906\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/Long_covid_Shelby_Hedgecock_3.jpg 744w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/Long_covid_Shelby_Hedgecock_3-160x195.jpg 160w\" sizes=\"auto, (max-width: 744px) 100vw, 744px\">\u003cfigcaption class=\"wp-caption-text\">Shelby Hedgecock, a personal trainer, was about to launch an online wellness business before contracting COVID in spring 2020. \u003ccite>(Courtesy Shelby Hedgecock)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Her primary care physician at the time told her she didn’t need supplemental oxygen even though her oxygen saturation dipped below normal at night, leaving her gasping for breath and crying in frustration.\u003c/p>\n\u003cp>Her condition kept her from one of her favorite hobbies, reading, for 19 months.\u003c/p>\n\u003cp>“I couldn’t look at a page and tell you what it said. It was like there was a disconnect between the words and my brain,” she said. “It was the strangest, most discouraging thing ever.”[pullquote size=\"medium\" align=\"right\" citation=\"Shelby Hedgecock, long COVID survivor\"]‘I couldn’t look at a page and tell you what it said. It was like there was a disconnect between the words and my brain. It was the strangest, most discouraging thing ever.’[/pullquote]Months later, under the direction of a specialist, Hedgecock underwent a test measuring electrical activity in the brain. It revealed that her brain had been starved of oxygen for months, damaging the section controlling memory and language.\u003c/p>\n\u003cp>Since then, she has moved back to Tennessee to be close to family. She doesn’t leave her apartment without a medical alert button that can instantly call an ambulance. She works with a team of specialists, and she feels lucky — she knows people in online long COVID groups who are losing health coverage as \u003ca href=\"https://californiahealthline.org/news/article/medicaid-unwinding-coverage-loss-california-post-pandemic/\">Medicaid pandemic protections expire\u003c/a>, while others remain unable to work.\u003c/p>\n\u003cp>“A lot of them have lost their life savings. Some are experiencing homelessness,” she said.\u003c/p>\n\u003ch2>In bed for a year\u003c/h2>\n\u003cp>Julia Landis led a fulfilling life as a therapist before contracting COVID in spring 2020.\u003c/p>\n\u003cp>“I was really able to help people, and it was great work and I loved my life, and I’ve lost it,” said the 56-year-old, who lives with her husband and dog in Ukiah.\u003c/p>\n\u003cp>In 2020, Landis was living in an apartment in Phoenix and received treatment via telehealth for her COVID-related bronchitis. What started out as a mild case of COVID spiraled into severe depression.\u003c/p>\n\u003cp>“I just stayed in bed for about a year,” she said.\u003c/p>\n\u003cp>Her depression has continued, along with debilitating pain and anxiety. To make up for her lost income, Landis’ husband works longer hours, which in turn exacerbates her loneliness.\u003c/p>\n\u003cfigure id=\"attachment_11946941\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11946941 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/04/LongCovid.jpg\" alt=\"A photo spread of three images of women's faces: one smiles with long, gray hair and a pink and purple floral top; one has short, brown hair and cat eye glasses and a blue blouse; the last woman has a shoulder of floral tattoos exposed as she wears a black workout tank top as she smiles at the camera with earbuds in and her hair pulled back.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/LongCovid.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/LongCovid-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/LongCovid-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/LongCovid-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/LongCovid-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Linda Rosenthal, Julia Landis and Shelby Hedgecock share their stories of long COVID. \u003ccite>(California Healthline)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“It would be nice to be living somewhere where there were people around seven days a week so I wouldn’t have to go through days of being just terrified to be alone all day,” Landis said. “If this were cancer, I’d be living with family. I’m sure of it.”[pullquote size=\"medium\" align=\"right\" citation=\"Julia Landis, long COVID survivor\"]‘It’s terrifying because there’s just no way of knowing if this is going to be for the rest of my existence.’[/pullquote]Landis refers to herself as a professional patient, filling her days with physical therapy and medical appointments. She’s gradually improving and can socialize on occasion, though it leaves her exhausted, and it can take days to recover.\u003c/p>\n\u003cp>“It’s terrifying because there’s just no way of knowing if this is going to be for the rest of my existence,” she said.\u003c/p>\n\u003ch2>‘I felt betrayed’\u003c/h2>\n\u003cp>Linda Rosenthal, a 65-year-old retired high school paraprofessional, has long COVID symptoms, including inflammation in her chest that makes breathing difficult. She has found it hard to get medical care.[aside label='More on Health' tag='health']She called and set up a treatment plan with a local cardiologist near her home in Laguna Woods, Orange County, but received a letter five days later telling her he would no longer be able to provide her medical services. The letter gave no reason for the cancellation.\u003c/p>\n\u003cp>“I was so surprised,” she said. “And then I felt betrayed because it is terrible to get a letter where a doctor, although within their rights, says that they don’t want you for a patient anymore, because it causes self-doubt.”\u003c/p>\n\u003cp>Rosenthal found another cardiologist willing to do telehealth visits and who has staff wear masks in the office even though the state rule has expired. The practice, however, is more than an hour’s drive from where she lives.\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Lost careers. Broken marriages. Family and friends who dismiss and don’t believe.\u003c/p>\n\u003cp>These are some of the emotional and financial struggles long COVID patients face years after their infections. Physically, they are debilitated and in pain: unable to walk up stairs, focus on a project or hold down a job. Facing the end of the federal public health emergency in May, many people experiencing lingering effects of the virus say they feel angry and abandoned by policymakers eager to move on.\u003c/p>\n\u003cp>“Patients are losing hope,” said Shelby Hedgecock, a self-described long COVID survivor from Knoxville, Tennessee, who now advocates for patients like herself. “We feel swept under the rug.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention estimated in March that \u003ca href=\"https://www.cdc.gov/nchs/covid19/pulse/long-covid.htm\">6% of U.S. adults\u003c/a>, or about 16 million people, were experiencing long COVID, or ongoing health problems that continue or emerge after a bout of COVID-19. Researchers estimate that 1.6% of U.S. adults, or about 4 million people, have symptoms that have significantly reduced their ability to carry out day-to-day activities.\u003c/p>\n\u003cp>While patients are no longer contagious, their health issues can stretch on and affect almost every system in the body. More than 200 symptoms and conditions, including fatigue and depression, are linked to long COVID, said Linda Geng, a physician who treats patients at Stanford Medicine’s \u003ca href=\"https://stanfordhealthcare.org/medical-clinics/post-covid-clinic.html\">Post-Acute COVID-19 Syndrome Clinic\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The severity and duration of long COVID vary. Some people recover in a few weeks, while a smaller number have debilitating and lingering health issues. There is currently no test, treatment or cure. There’s not even an accepted medical definition.\u003c/p>\n\u003cp>“When you don’t have any tests that show that anything’s abnormal, it can be quite invalidating and anxiety-provoking,” Geng said.\u003c/p>\n\u003cp>The physical and emotional toll have left some feeling hopeless. A 2022 study of adults in Japan and Sweden found that those with post-COVID conditions were \u003ca href=\"https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-022-03874-7\">more than twice as likely to develop mental health issues\u003c/a>, including depression, anxiety and post-traumatic stress, as people without them.\u003c/p>\n\u003cfigure id=\"attachment_11946940\" class=\"wp-caption aligncenter\" style=\"max-width: 744px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11946940\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/04/Long_covid_Shelby_Hedgecock_4.jpg\" alt='A woman stands in front of a billboard pictured in the distance. It reads, \"I was a healthy person before this. Shelby, age 29, covid-19 survivor.\"' width=\"744\" height=\"726\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/Long_covid_Shelby_Hedgecock_4.jpg 744w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/Long_covid_Shelby_Hedgecock_4-160x156.jpg 160w\" sizes=\"auto, (max-width: 744px) 100vw, 744px\">\u003cfigcaption class=\"wp-caption-text\">Shelby Hedgecock stands in front of a billboard from a Los Angeles County public health campaign that features her as a long COVID patient. \u003ccite>(Courtesy Gustavo Sosa)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“One of my friends committed suicide in May of 2021,” Hedgecock said. “She had a mild COVID infection, and she progressively had medical complications continuously pop up, and it just got so bad that she decided to end her life.”\u003c/p>\n\u003cp>In Los Angeles County, 46% of adults who contracted COVID had fully recovered a month later, but the rest — a majority — reported one or more continuing symptoms, according to a \u003ca href=\"https://californiahealthline.org/wp-content/uploads/sites/3/2023/03/Long-Covid-Study-Graphic.jpg\">675-patient study\u003c/a> by the University of Southern California’s COVID-19 Pandemic Research Center. The researchers found that chronic fatigue topped the list of health issues, followed by brain fog and a persistent cough, all of which affect people’s daily lives.\u003c/p>\n\u003cp>Among the respondents who identified as living with long COVID, 77% said their condition limited daily activities such as going to school or work or socializing. One-quarter reported experiencing severe limitations.\u003c/p>\n\u003cp>Taking antivirals cuts the risk of developing long COVID in people who are newly infected. But for people already suffering, medical science is trying to catch up.\u003c/p>\n\u003cp>Here’s a look at Hedgecock and two other patients who have had long COVID for years.\u003c/p>\n\u003ch2>A debilitating brain injury\u003c/h2>\n\u003cp>Before contracting COVID during spring 2020, Hedgecock’s life revolved around fitness. She worked as a personal trainer in Los Angeles and competed in endurance competitions on the weekends. At 29, she was about to launch an online wellness business. Then she started having trouble breathing.\u003c/p>\n\u003cp>“One of the scariest things that happened to me was I couldn’t breathe at night,” Hedgecock said. “I did go to the emergency room on three different occasions, and each time I was told, ‘You’re up and you’re moving. You’re young, you’re healthy. It’s going to be fine.’”\u003c/p>\n\u003cfigure id=\"attachment_11946939\" class=\"wp-caption aligncenter\" style=\"max-width: 744px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11946939 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/04/Long_covid_Shelby_Hedgecock_3.jpg\" alt=\"A white woman in a blue mask lies in a hospital bed with monitors stuck to her chest alongside a floral shoulder tattoo and a small gold chain with a white gemstone pendant.\" width=\"744\" height=\"906\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/Long_covid_Shelby_Hedgecock_3.jpg 744w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/Long_covid_Shelby_Hedgecock_3-160x195.jpg 160w\" sizes=\"auto, (max-width: 744px) 100vw, 744px\">\u003cfigcaption class=\"wp-caption-text\">Shelby Hedgecock, a personal trainer, was about to launch an online wellness business before contracting COVID in spring 2020. \u003ccite>(Courtesy Shelby Hedgecock)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Her primary care physician at the time told her she didn’t need supplemental oxygen even though her oxygen saturation dipped below normal at night, leaving her gasping for breath and crying in frustration.\u003c/p>\n\u003cp>Her condition kept her from one of her favorite hobbies, reading, for 19 months.\u003c/p>\n\u003cp>“I couldn’t look at a page and tell you what it said. It was like there was a disconnect between the words and my brain,” she said. “It was the strangest, most discouraging thing ever.”\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Months later, under the direction of a specialist, Hedgecock underwent a test measuring electrical activity in the brain. It revealed that her brain had been starved of oxygen for months, damaging the section controlling memory and language.\u003c/p>\n\u003cp>Since then, she has moved back to Tennessee to be close to family. She doesn’t leave her apartment without a medical alert button that can instantly call an ambulance. She works with a team of specialists, and she feels lucky — she knows people in online long COVID groups who are losing health coverage as \u003ca href=\"https://californiahealthline.org/news/article/medicaid-unwinding-coverage-loss-california-post-pandemic/\">Medicaid pandemic protections expire\u003c/a>, while others remain unable to work.\u003c/p>\n\u003cp>“A lot of them have lost their life savings. Some are experiencing homelessness,” she said.\u003c/p>\n\u003ch2>In bed for a year\u003c/h2>\n\u003cp>Julia Landis led a fulfilling life as a therapist before contracting COVID in spring 2020.\u003c/p>\n\u003cp>“I was really able to help people, and it was great work and I loved my life, and I’ve lost it,” said the 56-year-old, who lives with her husband and dog in Ukiah.\u003c/p>\n\u003cp>In 2020, Landis was living in an apartment in Phoenix and received treatment via telehealth for her COVID-related bronchitis. What started out as a mild case of COVID spiraled into severe depression.\u003c/p>\n\u003cp>“I just stayed in bed for about a year,” she said.\u003c/p>\n\u003cp>Her depression has continued, along with debilitating pain and anxiety. To make up for her lost income, Landis’ husband works longer hours, which in turn exacerbates her loneliness.\u003c/p>\n\u003cfigure id=\"attachment_11946941\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11946941 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/04/LongCovid.jpg\" alt=\"A photo spread of three images of women's faces: one smiles with long, gray hair and a pink and purple floral top; one has short, brown hair and cat eye glasses and a blue blouse; the last woman has a shoulder of floral tattoos exposed as she wears a black workout tank top as she smiles at the camera with earbuds in and her hair pulled back.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/LongCovid.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/LongCovid-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/LongCovid-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/LongCovid-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/LongCovid-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Linda Rosenthal, Julia Landis and Shelby Hedgecock share their stories of long COVID. \u003ccite>(California Healthline)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“It would be nice to be living somewhere where there were people around seven days a week so I wouldn’t have to go through days of being just terrified to be alone all day,” Landis said. “If this were cancer, I’d be living with family. I’m sure of it.”\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Landis refers to herself as a professional patient, filling her days with physical therapy and medical appointments. She’s gradually improving and can socialize on occasion, though it leaves her exhausted, and it can take days to recover.\u003c/p>\n\u003cp>“It’s terrifying because there’s just no way of knowing if this is going to be for the rest of my existence,” she said.\u003c/p>\n\u003ch2>‘I felt betrayed’\u003c/h2>\n\u003cp>Linda Rosenthal, a 65-year-old retired high school paraprofessional, has long COVID symptoms, including inflammation in her chest that makes breathing difficult. She has found it hard to get medical care.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>She called and set up a treatment plan with a local cardiologist near her home in Laguna Woods, Orange County, but received a letter five days later telling her he would no longer be able to provide her medical services. The letter gave no reason for the cancellation.\u003c/p>\n\u003cp>“I was so surprised,” she said. “And then I felt betrayed because it is terrible to get a letter where a doctor, although within their rights, says that they don’t want you for a patient anymore, because it causes self-doubt.”\u003c/p>\n\u003cp>Rosenthal found another cardiologist willing to do telehealth visits and who has staff wear masks in the office even though the state rule has expired. The practice, however, is more than an hour’s drive from where she lives.\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Gov. Gavin Newsom declared last month that \u003ca href=\"https://twitter.com/GavinNewsom/status/1632811406344192000?s=20\">California was “done” doing business with Walgreens\u003c/a> after the pharmacy chain said it would not distribute an abortion pill in 21 states where Republicans have threatened legal action. Since then, KHN has learned that the Democratic governor must compromise on his hard-line tweet.\u003c/p>\n\u003cp>California is legally bound to continue doing business with Walgreens through the state’s massive Medicaid program, health law experts said. And according to a public records request, the state paid Walgreens $1.5 billion last year.[pullquote size=\"medium\" align=\"right\" citation=\"Tony Cava, spokesperson, California Department of Health Care Services\"]‘California has no intention of taking any action that would violate federal Medicaid requirements, or that could undermine access for low-income individuals.’[/pullquote]\u003c/p>\n\u003cp>Newsom’s administration confirmed it will “continue to comply” with federal law by paying Walgreens through Medi-Cal, which provides health coverage to roughly 15 million residents with low incomes and disabilities. Were California to stop covering Medi-Cal prescriptions filled at Walgreens stores, legal scholars warned, the state would run afoul of federal law, which allows patients to get their medications at any approved pharmacy.\u003c/p>\n\u003cp>“California has no intention of taking any action that would violate federal Medicaid requirements, or that could undermine access for low-income individuals,” said Tony Cava, spokesperson for the California Department of Health Care Services, in a statement.\u003c/p>\n\u003cp>Newsom spokesperson Anthony York said, “Tweeting is not policy.” He added the governor will not “take any action that hurts people who need access to care.” Walgreens has even been reinvited to apply for \u003ca href=\"https://www.gov.ca.gov/2023/03/08/governor-newsom-california-pulls-back-renewal-of-walgreens-contract/\">a specialty drug contract that Newsom pulled back on renewing last month\u003c/a>, York said. Walgreens has received about $54 million from the state under the contract.\u003c/p>\n\u003cp>The dustup with the Illinois-based pharmacy chain illustrates Newsom’s panache for sweeping announcements on social media, where he garners national headlines but offers few specifics and little follow-through, political strategists said. Newsom has raised his national profile — and speculation of a presidential bid — by traveling to red states and launching \u003ca href=\"https://apnews.com/article/california-governor-newsom-president-democrats-2024-843877ca6aca701a5a68b8cb022203a2\">a new political action committee\u003c/a>.\u003c/p>\n\u003cp>“It’s much more about appearances and style and approach than it is about substance,” said David McCuan, political science department chair at Sonoma State University. Newsom and his administration “oversell their pronouncements and don’t actually deliver.”\u003c/p>\n\u003cp>On March 6, the governor tweeted, “California won’t be doing business with @walgreens — or any company that cowers to the extremists and puts women’s lives at risk,” after the second-largest U.S. pharmacy chain said it would not dispense mifepristone in states where it is illegal to dispense the pill or where the company would face potential lawsuits if it did so.\u003c/p>\n\u003cp>Democratic strategist Steve Maviglio said continuing to pay Walgreens through Medi-Cal doesn’t take away from Newsom’s support of abortion rights.\u003c/p>\n\u003cp>“He’s going to get the headline for protecting abortion rights, and this he can chalk up to a technical difficulty,” Maviglio said. “He will be rewarded for standing up to a corporation.”\u003c/p>\n\u003cp>Federal law is designed to ensure Medicaid patients have choices in where they get health care, including prescriptions. Approved providers like Walgreens are protected by \u003ca href=\"https://www.govinfo.gov/content/pkg/COMPS-8765/pdf/COMPS-8765.pdf#=page26\">Medicaid statute (PDF)\u003c/a>, which states that no health plan or entity can “restrict the choice of the qualified person from whom the individual may receive services.” Legal and Medicaid experts said that makes it extremely difficult for the Newsom administration to disqualify Walgreens.[aside postID=\"news_11942999,news_11922237\" label=\"Related Posts\"]“As long as Walgreens is performing for Medicaid beneficiaries as it should, dispensing all legal drugs in a manner that is consistent with permissible pharmacy practice, then I don’t see the basis for excluding them,” said Sara Rosenbaum, professor of health law and policy at George Washington University.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-431/subpart-B/section-431.51\">federal regulations\u003c/a> that protect Walgreens are the same that have allowed Planned Parenthood to offer health care services to Medicaid enrollees in conservative states, where leaders have sought unsuccessfully to exclude the network of clinics from receiving taxpayer funding.\u003c/p>\n\u003cp>An approved pharmacy company can be excluded from state networks only if it has committed fraud or other contract violations, added Edwin Park, a research professor with expertise in Medicaid law at Georgetown University.\u003c/p>\n\u003cp>“Certainly, that wouldn’t be the case for Walgreens,” Park said.\u003c/p>\n\u003cp>It’s unclear whether Newsom was aware of how difficult it would be for California to unwind its Medi-Cal provider agreement with Walgreens, said Daniel Schnur, a Republican-turned-independent strategist who also teaches political science at the University of Southern California.\u003c/p>\n\u003cp>“The original announcement sounded like a seminal step for the state of California to take on principle, even at great financial expense,” Schnur said. “They’ve quietly backed away.”\u003c/p>\n\u003cp>Through a records request, KHN learned the state paid Walgreens $1.5 billion last year to buy and dispense prescriptions to Medi-Cal enrollees. The bulk of the payment, $1.4 billion, reimbursed Walgreens for the prescriptions it distributed. And the remaining $123 million went to dispensing fees, a payment to pharmacists for each prescription they fill. The federal government covers at least half the state’s payments, which are also offset by rebates from drug manufacturers.\u003c/p>\n\u003cp>A Walgreens spokesperson declined to comment on its business with California, referring to the same statement it issued in March: “Providing legally approved medications to patients is what pharmacies do, and is rooted in our commitment to the communities in which we operate.”\u003c/p>\n\u003cp>Walgreens said it plans to dispense mifepristone “in any jurisdiction where it is legally permissible to do so.” The company was responding to an \u003ca href=\"https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/information-about-mifepristone-medical-termination-pregnancy-through-ten-weeks-gestation\">FDA rule finalized in January that allows certified pharmacies to dispense the abortion pill\u003c/a>, which is the most common way people terminate pregnancies. Walgreens isn’t proposing to limit abortion pill sales in California or other states where abortion is legal and pharmacies are allowed to dispense it.\u003c/p>\n\u003cp>Democrats have \u003ca href=\"https://www.governor.state.nm.us/wp-content/uploads/2023/03/Governor-Letter-to-Pharmacy-Retail-Companies__3.14.23.docx.pdf\">urged pharmacy chains to sell the abortion pill (PDF)\u003c/a> even as GOP attorneys general threaten legal action. But many, including Walmart, Costco, Albertsons and Health Mart, have not waded into the fight. Only Rite Aid and CVS have said they plan to begin certification to dispense the pills.\u003c/p>\n\u003cp>Had Newsom been able to sever Medi-Cal’s relationship with Walgreens, he would have contradicted one of his signature health initiatives: When he took office in 2019, Newsom proposed the state take over prescription drug coverage for Medi-Cal patients, many of whom had been covered through managed-care plans.\u003c/p>\n\u003cp>Part of Newsom’s pitch: Patients could go to \u003ca href=\"https://www.medi-calrx.dhcs.ca.gov/home/education\">nearly any pharmacy\u003c/a> in California.\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"title": "Feds to Block Gov. Newsom From Cutting Ties With Walgreens | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Gov. Gavin Newsom declared last month that \u003ca href=\"https://twitter.com/GavinNewsom/status/1632811406344192000?s=20\">California was “done” doing business with Walgreens\u003c/a> after the pharmacy chain said it would not distribute an abortion pill in 21 states where Republicans have threatened legal action. Since then, KHN has learned that the Democratic governor must compromise on his hard-line tweet.\u003c/p>\n\u003cp>California is legally bound to continue doing business with Walgreens through the state’s massive Medicaid program, health law experts said. And according to a public records request, the state paid Walgreens $1.5 billion last year.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Newsom’s administration confirmed it will “continue to comply” with federal law by paying Walgreens through Medi-Cal, which provides health coverage to roughly 15 million residents with low incomes and disabilities. Were California to stop covering Medi-Cal prescriptions filled at Walgreens stores, legal scholars warned, the state would run afoul of federal law, which allows patients to get their medications at any approved pharmacy.\u003c/p>\n\u003cp>“California has no intention of taking any action that would violate federal Medicaid requirements, or that could undermine access for low-income individuals,” said Tony Cava, spokesperson for the California Department of Health Care Services, in a statement.\u003c/p>\n\u003cp>Newsom spokesperson Anthony York said, “Tweeting is not policy.” He added the governor will not “take any action that hurts people who need access to care.” Walgreens has even been reinvited to apply for \u003ca href=\"https://www.gov.ca.gov/2023/03/08/governor-newsom-california-pulls-back-renewal-of-walgreens-contract/\">a specialty drug contract that Newsom pulled back on renewing last month\u003c/a>, York said. Walgreens has received about $54 million from the state under the contract.\u003c/p>\n\u003cp>The dustup with the Illinois-based pharmacy chain illustrates Newsom’s panache for sweeping announcements on social media, where he garners national headlines but offers few specifics and little follow-through, political strategists said. Newsom has raised his national profile — and speculation of a presidential bid — by traveling to red states and launching \u003ca href=\"https://apnews.com/article/california-governor-newsom-president-democrats-2024-843877ca6aca701a5a68b8cb022203a2\">a new political action committee\u003c/a>.\u003c/p>\n\u003cp>“It’s much more about appearances and style and approach than it is about substance,” said David McCuan, political science department chair at Sonoma State University. Newsom and his administration “oversell their pronouncements and don’t actually deliver.”\u003c/p>\n\u003cp>On March 6, the governor tweeted, “California won’t be doing business with @walgreens — or any company that cowers to the extremists and puts women’s lives at risk,” after the second-largest U.S. pharmacy chain said it would not dispense mifepristone in states where it is illegal to dispense the pill or where the company would face potential lawsuits if it did so.\u003c/p>\n\u003cp>Democratic strategist Steve Maviglio said continuing to pay Walgreens through Medi-Cal doesn’t take away from Newsom’s support of abortion rights.\u003c/p>\n\u003cp>“He’s going to get the headline for protecting abortion rights, and this he can chalk up to a technical difficulty,” Maviglio said. “He will be rewarded for standing up to a corporation.”\u003c/p>\n\u003cp>Federal law is designed to ensure Medicaid patients have choices in where they get health care, including prescriptions. Approved providers like Walgreens are protected by \u003ca href=\"https://www.govinfo.gov/content/pkg/COMPS-8765/pdf/COMPS-8765.pdf#=page26\">Medicaid statute (PDF)\u003c/a>, which states that no health plan or entity can “restrict the choice of the qualified person from whom the individual may receive services.” Legal and Medicaid experts said that makes it extremely difficult for the Newsom administration to disqualify Walgreens.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“As long as Walgreens is performing for Medicaid beneficiaries as it should, dispensing all legal drugs in a manner that is consistent with permissible pharmacy practice, then I don’t see the basis for excluding them,” said Sara Rosenbaum, professor of health law and policy at George Washington University.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-431/subpart-B/section-431.51\">federal regulations\u003c/a> that protect Walgreens are the same that have allowed Planned Parenthood to offer health care services to Medicaid enrollees in conservative states, where leaders have sought unsuccessfully to exclude the network of clinics from receiving taxpayer funding.\u003c/p>\n\u003cp>An approved pharmacy company can be excluded from state networks only if it has committed fraud or other contract violations, added Edwin Park, a research professor with expertise in Medicaid law at Georgetown University.\u003c/p>\n\u003cp>“Certainly, that wouldn’t be the case for Walgreens,” Park said.\u003c/p>\n\u003cp>It’s unclear whether Newsom was aware of how difficult it would be for California to unwind its Medi-Cal provider agreement with Walgreens, said Daniel Schnur, a Republican-turned-independent strategist who also teaches political science at the University of Southern California.\u003c/p>\n\u003cp>“The original announcement sounded like a seminal step for the state of California to take on principle, even at great financial expense,” Schnur said. “They’ve quietly backed away.”\u003c/p>\n\u003cp>Through a records request, KHN learned the state paid Walgreens $1.5 billion last year to buy and dispense prescriptions to Medi-Cal enrollees. The bulk of the payment, $1.4 billion, reimbursed Walgreens for the prescriptions it distributed. And the remaining $123 million went to dispensing fees, a payment to pharmacists for each prescription they fill. The federal government covers at least half the state’s payments, which are also offset by rebates from drug manufacturers.\u003c/p>\n\u003cp>A Walgreens spokesperson declined to comment on its business with California, referring to the same statement it issued in March: “Providing legally approved medications to patients is what pharmacies do, and is rooted in our commitment to the communities in which we operate.”\u003c/p>\n\u003cp>Walgreens said it plans to dispense mifepristone “in any jurisdiction where it is legally permissible to do so.” The company was responding to an \u003ca href=\"https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/information-about-mifepristone-medical-termination-pregnancy-through-ten-weeks-gestation\">FDA rule finalized in January that allows certified pharmacies to dispense the abortion pill\u003c/a>, which is the most common way people terminate pregnancies. Walgreens isn’t proposing to limit abortion pill sales in California or other states where abortion is legal and pharmacies are allowed to dispense it.\u003c/p>\n\u003cp>Democrats have \u003ca href=\"https://www.governor.state.nm.us/wp-content/uploads/2023/03/Governor-Letter-to-Pharmacy-Retail-Companies__3.14.23.docx.pdf\">urged pharmacy chains to sell the abortion pill (PDF)\u003c/a> even as GOP attorneys general threaten legal action. But many, including Walmart, Costco, Albertsons and Health Mart, have not waded into the fight. Only Rite Aid and CVS have said they plan to begin certification to dispense the pills.\u003c/p>\n\u003cp>Had Newsom been able to sever Medi-Cal’s relationship with Walgreens, he would have contradicted one of his signature health initiatives: When he took office in 2019, Newsom proposed the state take over prescription drug coverage for Medi-Cal patients, many of whom had been covered through managed-care plans.\u003c/p>\n\u003cp>Part of Newsom’s pitch: Patients could go to \u003ca href=\"https://www.medi-calrx.dhcs.ca.gov/home/education\">nearly any pharmacy\u003c/a> in California.\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"slug": "gov-newsoms-prescription-housing-plan-would-cover-6-months-rent-through-medi-cal",
"title": "Gov. Newsom's Prescription Housing Plan Would Cover 6 Months' Rent Through Medi-Cal",
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"content": "\u003cp>Gov. Gavin Newsom, whose administration is struggling to contain a worsening homelessness crisis despite \u003ca href=\"https://khn.org/news/article/california-homeless-crisis-governor-gavin-newsom-political-future/\">record spending\u003c/a>, is trying something bold: tapping federal health care funding to cover rent for unhoused people and those at risk of losing their housing.\u003c/p>\n\u003cp>States are barred from using federal Medicaid dollars to pay directly for rent, but California’s governor is asking the administration of President Joe Biden, a fellow Democrat, to authorize a new program called “\u003ca href=\"https://ebudget.ca.gov/2023-24/pdf/BudgetSummary/HealthandHumanServices.pdf\">transitional rent (PDF)\u003c/a>,” which would provide up to six months of rent or temporary housing for\u003ca href=\"https://khn.org/news/article/californias-massive-medicaid-program-works-for-some-but-fails-many-others/\"> enrollees with \u003c/a>\u003ca href=\"https://khn.org/news/article/californias-massive-medicaid-program-works-for-some-but-fails-many-others/\">lower incomes\u003c/a> who rely on the state’s health care safety net — a new initiative to fight and prevent homelessness.\u003c/p>\n\u003cp>“I’ve been talking to the president. We cannot do this alone,” Newsom told California Healthline.\u003c/p>\n\u003cp>The governor is pushing California’s version of Medicaid, called Medi-Cal, to fund experimental housing subsidies for people experiencing homelessness, betting that it’s cheaper for taxpayers to cover rent than to allow people to fall into crisis or costly institutional care in hospitals, nursing homes and jails. Early in his tenure, \u003ca href=\"https://www.gov.ca.gov/2020/02/19/governor-newsom-delivers-state-of-the-state-address-on-homelessness/\">Newsom proclaimed\u003c/a> that “doctors should be able to write prescriptions for housing the same way they do for insulin or antibiotics.”\u003c/p>\n\u003cp>But it’s a risky endeavor in a high-cost state where \u003ca href=\"https://www.zillow.com/rental-manager/market-trends/ca/\">median rent is nearly $3,000 a month\u003c/a>, and even higher in coastal regions, where most of California’s unhoused people reside. Experts expect the Biden administration to scrutinize the plan to use health care money to pay rent, and also question its potential effectiveness in light of the state’s \u003ca href=\"https://calmatters.org/housing/2022/10/newsom-california-housing-crisis/\">housing crisis\u003c/a>.\u003c/p>\n\u003cp>“Part of the question is whether this is really Medicaid’s job,” said \u003ca href=\"https://counciloncj.org/vikki-wachino/\">Vikki Wachino\u003c/a>, who served as national Medicaid director in the Obama administration. “But there is a recognition that social factors like inadequate housing are driving health outcomes, and I think the federal government is open to developing approaches to try and address that.”\u003c/p>\n\u003cp>Bruce Alexander, spokesperson for the Centers for Medicare and Medicaid Services, declined to say whether the federal government would approve California’s request. Yet, Biden’s Medicaid officials have approved similar experimental programs in \u003ca href=\"https://www.oregon.gov/oha/HSD/Medicaid-Policy/Pages/Changes.aspx\">Oregon\u003c/a> and \u003ca href=\"https://www.hhs.gov/about/news/2022/10/14/hhs-approves-arizonas-medicaid-interventions-target-health-related-social-needs.html\">Arizona\u003c/a>, and California is modeling its program after them.[aside label=\"Related Stories\" postID=\"news_11934623,news_11932895,news_11927968\"]\u003ca href=\"https://www.ppic.org/blog/homeless-populations-are-rising-around-california/#:~:text=As%20of%202022%2C%2030%25%20of,of%20the%20nation's%20homeless%20population\">California is home to an estimated 30% of unhoused people in the U.S.\u003c/a>, despite representing just 12% of the country’s overall population. And Newsom has acknowledged that the numbers are likely far greater than official homelessness tallies show. Top health officials say that, to contain soaring safety-net spending and to help unhoused people get healthy, Medi-Cal has no choice but to combine social services with housing.\u003c/p>\n\u003cp>Statewide, 5% of Medi-Cal patients account for a staggering 44% of the program’s spending, according to state data. And many of the costliest patients lack stable housing: Nearly half of patients experiencing homelessness visited the emergency room four times or more in 2019 and were more likely than other adults with lower incomes to be admitted to the hospital, and a large majority of visits were covered by Medi-Cal, \u003ca href=\"https://www.ppic.org/publication/how-hospital-discharge-data-can-inform-state-homelessness-policy/\">according to the Public Policy Institute of California\u003c/a>.\u003c/p>\n\u003cp>“What we have today doesn’t work,” said \u003ca href=\"https://www.chhs.ca.gov/about/#secretary\">Dr. Mark Ghaly\u003c/a>, secretary of the California Health and Human Services Agency, explaining his argument that housing is a critical component of health care. “Why do we have to wait so long for people to be so sick?”\u003c/p>\n\u003cp>The federal government has already approved \u003ca href=\"https://khn.org/news/article/california-medicaid-makeover-newsom-california-medi-cal-homeless-public-funds/\">a massive social experiment in California\u003c/a>, known as \u003ca href=\"https://www.dhcs.ca.gov/calaim\">CalAIM\u003c/a>, which is transforming Medi-Cal. Over five years, the initiative is expected to pour $12 billion into new Medi-Cal services delivered outside of traditional health care. In communities across the state, it is already funding services for some patients with lower income, including paying rental security deposits for unhoused people and those facing eviction; \u003ca href=\"https://khn.org/news/article/california-medicaid-medically-tailored-meal-delivery-experiment/\">delivering prepared healthy meals\u003c/a> for people with diabetes; and helping formerly incarcerated people find jobs.\u003c/p>\n\u003cp>The transitional rent program would add another service to \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCQMD/Community-Supports-Elections-by-MCP-and-County.pdf\">those already available (PDF)\u003c/a>, though \u003ca href=\"https://khn.org/news/article/california-governor-newsom-pricey-medicaid-reforms-leave-most-patients-behind/\">only a sliver of the 15.4 million Medi-Cal enrollees\u003c/a> actually receive those new and expensive social services.\u003c/p>\n\u003cp>Rent payments could begin as soon as 2025 and cost roughly $117 million per year once fully implemented. And while state officials say anyone who is homeless or at risk of becoming homeless would be eligible, not everyone who qualifies will receive new services due to capacity limits. Among those who stand to benefit are nearly 11,000 people already enrolled in \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/CalAIM-HHI-a11y.pdf\">Medi-Cal housing services (PDF)\u003c/a>.\u003c/p>\n\u003cp>“The ongoing conversation is how do we convince the federal government that housing is a health care issue,” said \u003ca href=\"https://www.sellersdorsey.com/team-member/cantwell-mari/\">Mari Cantwell\u003c/a>, who served as Medi-Cal director from 2015 to 2020. “You have to convince them that you’re going to save money because you’re not going to have as many people showing up at the emergency room and in long-term hospitalizations.”\u003c/p>\n\u003cp>Health care experiments in California and around the country that funded housing supports have demonstrated early success in reducing costs and making people healthier. But while some programs paid for housing security deposits or participants’ first month of rent, none directly covered rent for an extended period.[pullquote align=\"right\" size=\"medium\" citation=\"Vikki Wachino, former national director, Medicaid\"]‘Part of the question is whether this is really Medicaid’s job. But there is a recognition that social factors like inadequate housing are driving health outcomes, and I think the federal government is open to developing approaches to try and address that.’[/pullquote]“Without that foundational support, we are playing in the margins,” Newsom said.\u003c/p>\n\u003cp>State health officials argue that paying for six months of rent will be even more successful at reducing health care costs and improving enrollees’ health, but experts say that, to work, the initiative must have strict accountability and be bundled with an array of social services.\u003c/p>\n\u003cp>In a precursor to the state’s current initiative, California experimented with a mix of housing assistance programs and social services through its “\u003ca href=\"https://apnews.com/article/california-health-8e353e5539ce36c9068a78f6ee7baeb7\">Whole Person Care\u003c/a>” pilot program. \u003ca href=\"https://healthpolicy.ucla.edu/about/staff/pages/detail.aspx?StaffID=94\">Nadereh Pourat\u003c/a>, of the UCLA Center for Health Policy Research, \u003ca href=\"https://healthpolicy.ucla.edu/publications/search/pages/detail.aspx?PubID=2385\">evaluated the program\u003c/a> for the state concluding that local trials reduced emergency visits and hospitalizations, saving an average of $383 per Medi-Cal beneficiary per year — a meager amount compared with the program’s cost.\u003c/p>\n\u003cp>Over five years, the state spent \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2023/Final-Evaluation-of-CA-Whole-Person-Care-Report.pdf#page=31\">$3.6 billion (PDF)\u003c/a> serving about 250,000 patients enrolled in \u003ca href=\"https://www.dhcs.ca.gov/services/Pages/WholePersonCarePilots.aspx\">local experiments\u003c/a>, Pourat said.\u003c/p>\n\u003cp>And \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/32976633/\">a randomized control trial\u003c/a> in Santa Clara County that provided supportive housing for unhoused people showed reductions in psychiatric emergency room visits and improvements in care. “Lives stabilized and we saw a huge uptick in substance-use care and mental health care, the things that everybody wants people to use to get healthier,” said \u003ca href=\"https://profiles.ucsf.edu/margot.kushel\">Dr. Margot Kushel\u003c/a>, director of the University of California-San Francisco’s Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, who worked on the study.\u003c/p>\n\u003cp>But insurers implementing the broader Medi-Cal initiative say they are skeptical that spending health care money on housing will save the system money. And health care experts say that, while six months of rent can be a bridge while people wait for permanent housing, there’s a bigger obstacle: California’s affordable-housing shortage.\u003c/p>\n\u003cp>“We can design incredible Medicaid policies to alleviate homelessness and pay for all the necessary supportive services, but without the adequate housing, frankly, it’s not going to work,” Kushel said.\u003c/p>\n\u003cp>Newsom acknowledges that criticism. “The crisis of homelessness will never be solved without first solving the crisis of housing,” he said last week, arguing California should plow more money into housing for homeless people with severe mental health conditions or addiction disorders.[pullquote align=\"right\" size=\"medium\" citation=\"Dr. Margot Kushel, UCSF Center for Vulnerable Populations director, ZSFGH\"]‘We can design incredible Medicaid policies to alleviate homelessness and pay for all the necessary supportive services, but without the adequate housing, frankly, it’s not going to work.’[/pullquote]He will ask the legislature to put before voters a \u003ca href=\"https://www.latimes.com/california/story/2023-03-19/newsom-mental-health-housing-bond-measure-services-counties-substance-use-treatment\">2024 ballot initiative\u003c/a> that would infuse California’s mental health system with at least 6,000 new treatment beds and supportive housing units for people struggling with mental health and addiction disorders, \u003ca href=\"https://capitolweekly.net/newsom-takes-another-swing-at-getting-mentally-ill-homeless-off-the-streets/\">many of whom are experiencing homelessness\u003c/a>. The proposed bond measure would generate from $3 billion to $5 billion for psychiatric housing and treatment villages aimed at serving more than 10,000 additional people a year. The initiative also would ask voters to set aside at least $1 billion a year for supportive housing from an \u003ca href=\"https://www.dhcs.ca.gov/services/MH/Pages/MH_Prop63.aspx\">existing tax on California millionaires\u003c/a> that funds local mental health programs.\u003c/p>\n\u003cp>“People who are struggling with these issues, especially those who are on the streets or in other vulnerable conditions, will have more resources to get the help they need,” Newsom said.\u003c/p>\n\u003cp>For transitional rent, six months of payments would be available for select high-need residents enrolled in Medi-Cal, particularly those who are unhoused or at risk of becoming unhoused — and those transitioning from more costly institutions such as mental health crisis centers, jails and prisons, and foster care. Medi-Cal patients at risk of inpatient hospitalization or who frequent the emergency room would also be eligible.\u003c/p>\n\u003cp>“It’s a pretty big challenge; I’m not going to lie,” said \u003ca href=\"https://conference.healthmanagement.com/jacey-cooper/\">Jacey Cooper\u003c/a>, the Medi-Cal director. “But we know that people experiencing homelessness cycle in and out of emergency rooms, so we have a real role to play in both preventing and ending homelessness.”\u003c/p>\n\u003cp>Public health experts say the \u003ca href=\"https://khn.org/news/article/california-homeless-crisis-governor-gavin-newsom-political-future/\">problem will continue to explode\u003c/a> without creative thinking about how to fund housing in health care, but they warn the state must be wary of potential abuses of the program.\u003c/p>\n\u003cp>“It has to be designed carefully because, unfortunately, there are always people looking to game the system,” said \u003ca href=\"https://www.calendow.org/leadership/\">Dr. Tony Iton\u003c/a>, a public health expert who is now a senior vice president at the California Endowment. “Decisions must be made by clinicians — not housing organizations just looking for another source of revenue.”\u003c/p>\n\u003cp>For Stephen Morton, who lives in the Orange County community of Laguna Woods, the journey from homelessness into permanent housing illustrates the amount of public spending it can take for the effort to pay off.\u003c/p>\n\u003cfigure id=\"attachment_11944656\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11944656\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-800x533.jpg\" alt=\"A white middle aged man combs his hair in front of a mirror in a bedroom with a lamp, a speaker, a bottle of eau de toilette anfd a box with a card on a dresser in front of the mirror.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-1920x1280.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy.jpg 2048w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Stephen Morton, who lived in shelters and sometimes in his car for almost 2 years before finding permanent housing, receives weekly deliveries of medically tailored meals as part of a Medi-Cal initiative. Since getting his apartment, Morton says he’s been able to stop taking one diabetes medication and lose weight. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Morton, 60, bounced between shelters and his car for nearly two years and racked up extraordinary Medi-Cal costs due to prolonged hospitalizations and repeated emergency room trips to treat chronic heart disease, asthma and diabetes.\u003c/p>\n\u003cp>Medi-Cal covered Morton’s open-heart surgery and hospital stays, which lasted weeks. He landed temporary housing through a state-sponsored program called \u003ca href=\"https://www.cdss.ca.gov/inforesources/cdss-programs/housing-programs/project-roomkey\">Project Roomkey\u003c/a> before getting permanent housing through a federal low-income housing voucher — an ongoing benefit that covers all but $50 of his rent.\u003c/p>\n\u003cp>Since getting his apartment, Morton said, he’s been able to stop taking one diabetes medication and lose weight. He attributes improvements in his blood sugar levels to his housing and the healthy, home-delivered meals he receives via Medi-Cal.\u003c/p>\n\u003cp>“It’s usually scrambled eggs for breakfast and the fish menu for dinner. I’m shocked it’s so good,” Morton said. “Now I have a microwave and I’m indoors. I’m so grateful and so much healthier.”\u003c/p>\n\u003cp>\u003cem>California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "California's bold new 'transitional rent' plan would save costs from frequent ER visits and lengthy hospital stays for Medi-Cal patients, but Newsom needs to convince Biden, saying, 'We cannot do this alone,' and lack of affordable housing across the state remains a concern.",
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"title": "Gov. Newsom's Prescription Housing Plan Would Cover 6 Months' Rent Through Medi-Cal | KQED",
"description": "California's bold new 'transitional rent' plan would save costs from frequent ER visits and lengthy hospital stays for Medi-Cal patients, but Newsom needs to convince Biden, saying, 'We cannot do this alone,' and lack of affordable housing across the state remains a concern.",
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"headline": "Gov. Newsom's Prescription Housing Plan Would Cover 6 Months' Rent Through Medi-Cal",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Gov. Gavin Newsom, whose administration is struggling to contain a worsening homelessness crisis despite \u003ca href=\"https://khn.org/news/article/california-homeless-crisis-governor-gavin-newsom-political-future/\">record spending\u003c/a>, is trying something bold: tapping federal health care funding to cover rent for unhoused people and those at risk of losing their housing.\u003c/p>\n\u003cp>States are barred from using federal Medicaid dollars to pay directly for rent, but California’s governor is asking the administration of President Joe Biden, a fellow Democrat, to authorize a new program called “\u003ca href=\"https://ebudget.ca.gov/2023-24/pdf/BudgetSummary/HealthandHumanServices.pdf\">transitional rent (PDF)\u003c/a>,” which would provide up to six months of rent or temporary housing for\u003ca href=\"https://khn.org/news/article/californias-massive-medicaid-program-works-for-some-but-fails-many-others/\"> enrollees with \u003c/a>\u003ca href=\"https://khn.org/news/article/californias-massive-medicaid-program-works-for-some-but-fails-many-others/\">lower incomes\u003c/a> who rely on the state’s health care safety net — a new initiative to fight and prevent homelessness.\u003c/p>\n\u003cp>“I’ve been talking to the president. We cannot do this alone,” Newsom told California Healthline.\u003c/p>\n\u003cp>The governor is pushing California’s version of Medicaid, called Medi-Cal, to fund experimental housing subsidies for people experiencing homelessness, betting that it’s cheaper for taxpayers to cover rent than to allow people to fall into crisis or costly institutional care in hospitals, nursing homes and jails. Early in his tenure, \u003ca href=\"https://www.gov.ca.gov/2020/02/19/governor-newsom-delivers-state-of-the-state-address-on-homelessness/\">Newsom proclaimed\u003c/a> that “doctors should be able to write prescriptions for housing the same way they do for insulin or antibiotics.”\u003c/p>\n\u003cp>But it’s a risky endeavor in a high-cost state where \u003ca href=\"https://www.zillow.com/rental-manager/market-trends/ca/\">median rent is nearly $3,000 a month\u003c/a>, and even higher in coastal regions, where most of California’s unhoused people reside. Experts expect the Biden administration to scrutinize the plan to use health care money to pay rent, and also question its potential effectiveness in light of the state’s \u003ca href=\"https://calmatters.org/housing/2022/10/newsom-california-housing-crisis/\">housing crisis\u003c/a>.\u003c/p>\n\u003cp>“Part of the question is whether this is really Medicaid’s job,” said \u003ca href=\"https://counciloncj.org/vikki-wachino/\">Vikki Wachino\u003c/a>, who served as national Medicaid director in the Obama administration. “But there is a recognition that social factors like inadequate housing are driving health outcomes, and I think the federal government is open to developing approaches to try and address that.”\u003c/p>\n\u003cp>Bruce Alexander, spokesperson for the Centers for Medicare and Medicaid Services, declined to say whether the federal government would approve California’s request. Yet, Biden’s Medicaid officials have approved similar experimental programs in \u003ca href=\"https://www.oregon.gov/oha/HSD/Medicaid-Policy/Pages/Changes.aspx\">Oregon\u003c/a> and \u003ca href=\"https://www.hhs.gov/about/news/2022/10/14/hhs-approves-arizonas-medicaid-interventions-target-health-related-social-needs.html\">Arizona\u003c/a>, and California is modeling its program after them.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003ca href=\"https://www.ppic.org/blog/homeless-populations-are-rising-around-california/#:~:text=As%20of%202022%2C%2030%25%20of,of%20the%20nation's%20homeless%20population\">California is home to an estimated 30% of unhoused people in the U.S.\u003c/a>, despite representing just 12% of the country’s overall population. And Newsom has acknowledged that the numbers are likely far greater than official homelessness tallies show. Top health officials say that, to contain soaring safety-net spending and to help unhoused people get healthy, Medi-Cal has no choice but to combine social services with housing.\u003c/p>\n\u003cp>Statewide, 5% of Medi-Cal patients account for a staggering 44% of the program’s spending, according to state data. And many of the costliest patients lack stable housing: Nearly half of patients experiencing homelessness visited the emergency room four times or more in 2019 and were more likely than other adults with lower incomes to be admitted to the hospital, and a large majority of visits were covered by Medi-Cal, \u003ca href=\"https://www.ppic.org/publication/how-hospital-discharge-data-can-inform-state-homelessness-policy/\">according to the Public Policy Institute of California\u003c/a>.\u003c/p>\n\u003cp>“What we have today doesn’t work,” said \u003ca href=\"https://www.chhs.ca.gov/about/#secretary\">Dr. Mark Ghaly\u003c/a>, secretary of the California Health and Human Services Agency, explaining his argument that housing is a critical component of health care. “Why do we have to wait so long for people to be so sick?”\u003c/p>\n\u003cp>The federal government has already approved \u003ca href=\"https://khn.org/news/article/california-medicaid-makeover-newsom-california-medi-cal-homeless-public-funds/\">a massive social experiment in California\u003c/a>, known as \u003ca href=\"https://www.dhcs.ca.gov/calaim\">CalAIM\u003c/a>, which is transforming Medi-Cal. Over five years, the initiative is expected to pour $12 billion into new Medi-Cal services delivered outside of traditional health care. In communities across the state, it is already funding services for some patients with lower income, including paying rental security deposits for unhoused people and those facing eviction; \u003ca href=\"https://khn.org/news/article/california-medicaid-medically-tailored-meal-delivery-experiment/\">delivering prepared healthy meals\u003c/a> for people with diabetes; and helping formerly incarcerated people find jobs.\u003c/p>\n\u003cp>The transitional rent program would add another service to \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCQMD/Community-Supports-Elections-by-MCP-and-County.pdf\">those already available (PDF)\u003c/a>, though \u003ca href=\"https://khn.org/news/article/california-governor-newsom-pricey-medicaid-reforms-leave-most-patients-behind/\">only a sliver of the 15.4 million Medi-Cal enrollees\u003c/a> actually receive those new and expensive social services.\u003c/p>\n\u003cp>Rent payments could begin as soon as 2025 and cost roughly $117 million per year once fully implemented. And while state officials say anyone who is homeless or at risk of becoming homeless would be eligible, not everyone who qualifies will receive new services due to capacity limits. Among those who stand to benefit are nearly 11,000 people already enrolled in \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/CalAIM-HHI-a11y.pdf\">Medi-Cal housing services (PDF)\u003c/a>.\u003c/p>\n\u003cp>“The ongoing conversation is how do we convince the federal government that housing is a health care issue,” said \u003ca href=\"https://www.sellersdorsey.com/team-member/cantwell-mari/\">Mari Cantwell\u003c/a>, who served as Medi-Cal director from 2015 to 2020. “You have to convince them that you’re going to save money because you’re not going to have as many people showing up at the emergency room and in long-term hospitalizations.”\u003c/p>\n\u003cp>Health care experiments in California and around the country that funded housing supports have demonstrated early success in reducing costs and making people healthier. But while some programs paid for housing security deposits or participants’ first month of rent, none directly covered rent for an extended period.\u003c/p>\u003c/div>",
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"content": "‘Part of the question is whether this is really Medicaid’s job. But there is a recognition that social factors like inadequate housing are driving health outcomes, and I think the federal government is open to developing approaches to try and address that.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“Without that foundational support, we are playing in the margins,” Newsom said.\u003c/p>\n\u003cp>State health officials argue that paying for six months of rent will be even more successful at reducing health care costs and improving enrollees’ health, but experts say that, to work, the initiative must have strict accountability and be bundled with an array of social services.\u003c/p>\n\u003cp>In a precursor to the state’s current initiative, California experimented with a mix of housing assistance programs and social services through its “\u003ca href=\"https://apnews.com/article/california-health-8e353e5539ce36c9068a78f6ee7baeb7\">Whole Person Care\u003c/a>” pilot program. \u003ca href=\"https://healthpolicy.ucla.edu/about/staff/pages/detail.aspx?StaffID=94\">Nadereh Pourat\u003c/a>, of the UCLA Center for Health Policy Research, \u003ca href=\"https://healthpolicy.ucla.edu/publications/search/pages/detail.aspx?PubID=2385\">evaluated the program\u003c/a> for the state concluding that local trials reduced emergency visits and hospitalizations, saving an average of $383 per Medi-Cal beneficiary per year — a meager amount compared with the program’s cost.\u003c/p>\n\u003cp>Over five years, the state spent \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2023/Final-Evaluation-of-CA-Whole-Person-Care-Report.pdf#page=31\">$3.6 billion (PDF)\u003c/a> serving about 250,000 patients enrolled in \u003ca href=\"https://www.dhcs.ca.gov/services/Pages/WholePersonCarePilots.aspx\">local experiments\u003c/a>, Pourat said.\u003c/p>\n\u003cp>And \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/32976633/\">a randomized control trial\u003c/a> in Santa Clara County that provided supportive housing for unhoused people showed reductions in psychiatric emergency room visits and improvements in care. “Lives stabilized and we saw a huge uptick in substance-use care and mental health care, the things that everybody wants people to use to get healthier,” said \u003ca href=\"https://profiles.ucsf.edu/margot.kushel\">Dr. Margot Kushel\u003c/a>, director of the University of California-San Francisco’s Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, who worked on the study.\u003c/p>\n\u003cp>But insurers implementing the broader Medi-Cal initiative say they are skeptical that spending health care money on housing will save the system money. And health care experts say that, while six months of rent can be a bridge while people wait for permanent housing, there’s a bigger obstacle: California’s affordable-housing shortage.\u003c/p>\n\u003cp>“We can design incredible Medicaid policies to alleviate homelessness and pay for all the necessary supportive services, but without the adequate housing, frankly, it’s not going to work,” Kushel said.\u003c/p>\n\u003cp>Newsom acknowledges that criticism. “The crisis of homelessness will never be solved without first solving the crisis of housing,” he said last week, arguing California should plow more money into housing for homeless people with severe mental health conditions or addiction disorders.\u003c/p>\u003c/div>",
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"content": "‘We can design incredible Medicaid policies to alleviate homelessness and pay for all the necessary supportive services, but without the adequate housing, frankly, it’s not going to work.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>He will ask the legislature to put before voters a \u003ca href=\"https://www.latimes.com/california/story/2023-03-19/newsom-mental-health-housing-bond-measure-services-counties-substance-use-treatment\">2024 ballot initiative\u003c/a> that would infuse California’s mental health system with at least 6,000 new treatment beds and supportive housing units for people struggling with mental health and addiction disorders, \u003ca href=\"https://capitolweekly.net/newsom-takes-another-swing-at-getting-mentally-ill-homeless-off-the-streets/\">many of whom are experiencing homelessness\u003c/a>. The proposed bond measure would generate from $3 billion to $5 billion for psychiatric housing and treatment villages aimed at serving more than 10,000 additional people a year. The initiative also would ask voters to set aside at least $1 billion a year for supportive housing from an \u003ca href=\"https://www.dhcs.ca.gov/services/MH/Pages/MH_Prop63.aspx\">existing tax on California millionaires\u003c/a> that funds local mental health programs.\u003c/p>\n\u003cp>“People who are struggling with these issues, especially those who are on the streets or in other vulnerable conditions, will have more resources to get the help they need,” Newsom said.\u003c/p>\n\u003cp>For transitional rent, six months of payments would be available for select high-need residents enrolled in Medi-Cal, particularly those who are unhoused or at risk of becoming unhoused — and those transitioning from more costly institutions such as mental health crisis centers, jails and prisons, and foster care. Medi-Cal patients at risk of inpatient hospitalization or who frequent the emergency room would also be eligible.\u003c/p>\n\u003cp>“It’s a pretty big challenge; I’m not going to lie,” said \u003ca href=\"https://conference.healthmanagement.com/jacey-cooper/\">Jacey Cooper\u003c/a>, the Medi-Cal director. “But we know that people experiencing homelessness cycle in and out of emergency rooms, so we have a real role to play in both preventing and ending homelessness.”\u003c/p>\n\u003cp>Public health experts say the \u003ca href=\"https://khn.org/news/article/california-homeless-crisis-governor-gavin-newsom-political-future/\">problem will continue to explode\u003c/a> without creative thinking about how to fund housing in health care, but they warn the state must be wary of potential abuses of the program.\u003c/p>\n\u003cp>“It has to be designed carefully because, unfortunately, there are always people looking to game the system,” said \u003ca href=\"https://www.calendow.org/leadership/\">Dr. Tony Iton\u003c/a>, a public health expert who is now a senior vice president at the California Endowment. “Decisions must be made by clinicians — not housing organizations just looking for another source of revenue.”\u003c/p>\n\u003cp>For Stephen Morton, who lives in the Orange County community of Laguna Woods, the journey from homelessness into permanent housing illustrates the amount of public spending it can take for the effort to pay off.\u003c/p>\n\u003cfigure id=\"attachment_11944656\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11944656\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-800x533.jpg\" alt=\"A white middle aged man combs his hair in front of a mirror in a bedroom with a lamp, a speaker, a bottle of eau de toilette anfd a box with a card on a dresser in front of the mirror.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-1920x1280.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy.jpg 2048w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Stephen Morton, who lived in shelters and sometimes in his car for almost 2 years before finding permanent housing, receives weekly deliveries of medically tailored meals as part of a Medi-Cal initiative. Since getting his apartment, Morton says he’s been able to stop taking one diabetes medication and lose weight. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Morton, 60, bounced between shelters and his car for nearly two years and racked up extraordinary Medi-Cal costs due to prolonged hospitalizations and repeated emergency room trips to treat chronic heart disease, asthma and diabetes.\u003c/p>\n\u003cp>Medi-Cal covered Morton’s open-heart surgery and hospital stays, which lasted weeks. He landed temporary housing through a state-sponsored program called \u003ca href=\"https://www.cdss.ca.gov/inforesources/cdss-programs/housing-programs/project-roomkey\">Project Roomkey\u003c/a> before getting permanent housing through a federal low-income housing voucher — an ongoing benefit that covers all but $50 of his rent.\u003c/p>\n\u003cp>Since getting his apartment, Morton said, he’s been able to stop taking one diabetes medication and lose weight. He attributes improvements in his blood sugar levels to his housing and the healthy, home-delivered meals he receives via Medi-Cal.\u003c/p>\n\u003cp>“It’s usually scrambled eggs for breakfast and the fish menu for dinner. I’m shocked it’s so good,” Morton said. “Now I have a microwave and I’m indoors. I’m so grateful and so much healthier.”\u003c/p>\n\u003cp>\u003cem>California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "California's Massive Medicaid Program Works for Some, but Fails Many Others",
"headTitle": "California Healthline | KQED News",
"content": "\u003cp>Newborns. Formerly incarcerated people. College students. Pregnant people. People with disabilities. Foster kids. Unhoused people. Single dads.\u003c/p>\n\u003cp>Your neighbor. Your co-worker.\u003c/p>\n\u003cp>You.\u003c/p>\n\u003cp>California’s Medicaid program, called Medi-Cal, serves a whopping 15.4 million people, offering care from cradle to grave: \u003ca href=\"https://www.chcf.org/publication/2021-edition-medi-cal-facts-figures/\">Half of all births are covered by Medi-Cal\u003c/a>, as are more than half of all stays in nursing homes.\u003c/p>\n\u003cp>Everything about Medi-Cal is massive, from its \u003ca href=\"https://ebudget.ca.gov/2023-24/pdf/BudgetSummary/HealthandHumanServices.pdf\">upcoming fiscal year budget of $139 billion (PDF)\u003c/a> to the expansive list of benefits and services it offers. The way the program works — or doesn’t — could spell life or death for many enrollees.\u003c/p>\n\u003cp>“It’s critical, from the single pregnant mom, to the extremely frail elderly population that needs a nursing home,” said Jennifer Kent, former director of the state Department of Health Care Services, which administers Medi-Cal. “If it weren’t for Medi-Cal, so many people would either be dead or would be severely compromised.”\u003c/p>\n\u003cp>In a new series, California Healthline will shed light on Medi-Cal’s successes and failures through the experiences of its enrollees. They include Stephanie Lammers, who can’t get her troubling abdominal symptoms checked at a clinic 50 miles from her small Calaveras County town because the transportation Medi-Cal is supposed to provide isn’t trustworthy; Carolina Morga Tapia, a Fresno woman who credits Medi-Cal with helping her have five healthy children; and Lucas Moreno Ramirez, a Los Angeles County man with stage 4 lung cancer who had to fight to keep his treatment going.\u003c/p>\n\u003cp>Medi-Cal is at a critical juncture as it attempts to serve the needs of a diverse patient population with a dizzying array of medical needs — from childhood vaccinations and cancer screenings to state-of-the-art care for rare genetic disorders. \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/statistics/Documents/FastFacts-March2022.pdf\">Roughly half of enrollees are Hispanic (PDF)\u003c/a>, and, next year, \u003ca href=\"https://californiahealthline.org/news/article/covered-california-bill-undocumented-immigrant-health-insurance/\">California will become the first state to expand eligibility to all immigrants who qualify, regardless of their legal status\u003c/a>.[aside postID=news_11926757 hero='https://ww2.kqed.org/app/uploads/sites/10/2022/09/GettyImages-1340030341.jpg']Medi-Cal is also undertaking several new initiatives that aim to save taxpayer money and improve quality. State \u003ca href=\"https://khn.org/news/article/californias-reboot-of-troubled-medi-cal-puts-pressure-on-health-plans/\">officials are demanding that the 23 health insurers that serve most Medi-Cal patients provide better care\u003c/a> — or face significant penalties, including potential expulsion from the program.\u003c/p>\n\u003cp>The state is also \u003ca href=\"https://khn.org/news/article/california-medicaid-makeover-newsom-california-medi-cal-homeless-public-funds/\">adding innovative social services\u003c/a> that fall outside the traditional realm of medicine, including helping some enrollees pay for rent and buy groceries.\u003c/p>\n\u003cp>“People are watching California,” said Cindy Mann, who served as federal Medicaid director under former President Barack Obama. “What the state is doing is ambitious and very aggressive. It makes a significant mark on health care and health policy, not just because of the size and breadth of its program, but by being very comprehensive.”\u003c/p>\n\u003cp>But only a sliver of enrollees will get the new social services, even as \u003ca href=\"https://khn.org/news/article/california-governor-newsom-pricey-medicaid-reforms-leave-most-patients-behind/\">many patients struggle to obtain basic care\u003c/a> or get in to see their doctors. In reality, the type of care you get in Medi-Cal depends on where you live and which insurer provides your benefits.\u003c/p>\n\u003cp>That means the program is working for some, but failing for many others.\u003c/p>\n\u003cp>If you are in Medi-Cal, \u003ca href=\"https://californiahealthline.org/faces-of-medi-cal-submissions/\">we would like to hear from you\u003c/a>, whether you live in a big city or a rural region, regardless of your age, race or ethnicity, and whatever your medical, dental or mental health condition. Have you had difficulty seeing the right doctor for what ails you, even to the point of putting your life at risk? Or did Medi-Cal provide good care, perhaps sparing you serious harm or disability? Either way, \u003ca href=\"https://californiahealthline.org/faces-of-medi-cal-submissions/\">please consider sharing your experience with us\u003c/a>.\u003c/p>\n\u003cp>Here are snapshots of patients who have used the program at a critical time in their lives.\u003c/p>\n\u003ch2>'I just don't go to the doctor anymore'\u003c/h2>\n\u003cp>When Stephanie Lammers leans over to put on her shoes, it feels as if she’s squishing something inside her abdomen, she said.\u003c/p>\n\u003cp>Lammers, 53, has been suffering from frequent bouts of nausea, pain and bloating for six months.\u003c/p>\n\u003cp>Her gastroenterologist wants to perform diagnostic procedures, including a colonoscopy and, if anything shows up, a biopsy. But Lammers, who lives in a motel with her boyfriend and teenage daughter in the Gold Rush town of San Andreas, doesn’t have a working car and can’t readily get to the clinic — which is 50 miles away.\u003c/p>\n\u003cfigure id=\"attachment_11942519\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942519 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-800x548.jpg\" alt=\"A middle-aged white woman with a long-sleeved shirt with horizontal blue-and-white stripes, with one shoulder pulled down to reveal a tattoo of an eye, looks at the camera as she leans against a door jamb. To her left, a white husky dog looks out from a window.\" width=\"800\" height=\"548\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-800x548.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-1020x699.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-160x110.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-1536x1052.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-2048x1402.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-1920x1315.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Stephanie Lammers says the ride service provided by her Medi-Cal health plan is so bad that she stopped trying to use it about a year ago, after it left her in the lurch multiple times. 'I just don't go to the doctor anymore,' she says. \u003ccite>(Rich Pedroncelli/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For Lammers, like many Medi-Cal enrollees who live in rural areas, lack of transportation is a major impediment to obtaining care. The problem is particularly acute for patients who need to see specialists.\u003c/p>\n\u003cp>Lammers’ dermatologist and eye doctor are over an hour away from San Andreas, the county seat of Calaveras County, about 125 miles northeast of San Francisco. She isn’t seeing a neurologist, despite a series of mini-strokes and stress-related seizures. And she hasn’t been to a podiatrist in two years, even though her toes are twisted over one another and hang down, causing her to trip. She’s often in excruciating pain when she walks.\u003c/p>\n\u003cp>Medi-Cal is supposed to provide \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/Pages/Transportation.aspx\">free transportation to enrollees\u003c/a> who can’t otherwise get to their appointments.\u003c/p>\n\u003cp>But Lammers — whose health plan is California Health and Wellness, owned by Centene, \u003ca href=\"https://khn.org/news/article/centene-political-donations-medicaid-contracts-overbilling-allegations/\">the nation’s largest commercial Medicaid insurer\u003c/a> — stopped using its ride service nearly a year ago, after she missed dozens of appointments because drivers just didn’t show up, she said. She was getting threatening letters from doctors’ offices over the no-shows.\u003c/p>\n\u003cp>Once, she had to hitchhike more than 30 miles home from a counseling appointment. On other occasions, Lammers said, she did not receive the reimbursement she was owed for arranging her own rides.\u003c/p>\n\u003cp>“I just don’t go to the doctor anymore,” Lammers said. “If I go to the doctor, my boyfriend has to take the day off work, and if he takes the day off work, we have no money.”\u003c/p>\n\u003cp>During the last three months of 2022, Lammers canceled five appointments she had scheduled for the diagnostic abdominal procedures because her boyfriend had to work each time and couldn’t take her. She finally stopped rescheduling.\u003c/p>\n\u003cp>California Health and Wellness contracts with ModivCare, a Denver-based medical transportation company that is no stranger to \u003ca href=\"https://khn.org/news/article/medicaid-transportation-nonemergency-benefit-patients-stranded/\">patient complaints and lawsuits\u003c/a>.\u003c/p>\n\u003cp>Before she gave up on the ride service, Lammers said, she would call California Health and Wellness to try to resolve the issue, only to be told that ModivCare was a separate company. “I’m like, ‘If you guys hired them and put them in charge of transportation, who oversees their screwups?,’” she said.\u003c/p>\n\u003cfigure id=\"attachment_11942520\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942520 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-800x614.jpg\" alt=\"A white woman, standing in a crowded room of unmade beds, dishes potatoes onto a plate of biscuits and gravy from a hot plate on a cabinet next to a fridge. \" width=\"800\" height=\"614\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-800x614.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-1020x783.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-160x123.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-1536x1180.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-2048x1573.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-1920x1475.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Stephanie Lammers has serious abdominal symptoms, and her gastroenterologist wants to run diagnostic tests, but she had to cancel five appointments in the last three months of 2022 because she didn't have transportation. \u003ccite>(Rich Pedroncelli/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Courtney Schwyzer, a member of a legal aid team representing Lammers on various Medi-Cal matters, said the failure of medical ride services is a systemic problem. In late February, Schwyzer and her fellow attorneys filed a petition in court that she hopes will force the state Department of Health Care Services to address the problem.\u003c/p>\n\u003cp>California Health and Wellness spokesperson Darrel Ng said the company monitors the quality of its contractors, but a shortage of transportation providers in rural areas “has created unique challenges.”\u003c/p>\n\u003cp>ModivCare provides more than 4 million rides for Medi-Cal recipients annually, and more than 99% are without complaint, said Melody Lai, a company spokesperson.\u003c/p>\n\u003cp>Lammers, who is unemployed and trying to start a custom craft business called Stuff by Steph, said doctors have warned her that if she doesn’t reduce her stress level, it could shorten her life. But arranging medical care is the most stressful thing in her life right now, so she doesn’t try anymore.\u003c/p>\n\u003cp>“In order to keep from dying, I have to not go to the doctor,” she said.\u003c/p>\n\u003ch2>'It's a blessing'\u003c/h2>\n\u003cp>Medi-Cal helped save the life of Carolina Morga Tapia, a 30-year-old full-time mother of five who lives with her family amid almond groves in an agricultural enclave of Fresno.\u003c/p>\n\u003cp>Nine years ago, a bacterial infection triggered premature labor during the 25th week of her second pregnancy, and Morga Tapia almost died. She spiked a fever, bled profusely and needed immediate transfusions and emergency surgery. After several days in critical care, she fully recovered.\u003c/p>\n\u003cfigure id=\"attachment_11942521\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942521 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-800x534.jpg\" alt=\"A Latina woman with a blue cardigan and a black shirt looks at the camera, arms akimbo, standing in a leafless orchard.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-1536x1025.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-2048x1367.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-1920x1281.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Carolina Morga Tapia stands amid almond trees outside her home in Fresno. She, her husband and their five children are enrolled in Medi-Cal, and she says she is very happy with the care it has provided, including emergency surgery that saved her life after she fell gravely ill during her second pregnancy. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But the doctors could not stop the premature birth, and her baby came out weighing just 1 pound. She and her husband, David Nuñez, named her Milagros Guadalupe, and she died four days later, on Sept. 13, 2013.\u003c/p>\n\u003cp>In each of her subsequent pregnancies, Medi-Cal paid for Morga Tapia to get shots of synthetic progesterone, intended to prevent another preterm birth. Those shots — one a week for about 20 weeks — can cost an average of \u003ca href=\"https://www.npr.org/sections/health-shots/2020/01/24/798731110/drug-to-prevent-premature-birth-divides-doctors-insurers-and-fda-experts\">more than $10,000 per pregnancy\u003c/a>.\u003c/p>\n\u003cp>Morga Tapia and Nuñez, a construction worker, signed up for Medi-Cal when she was pregnant with her first child more than a decade ago. They’ve been on the same Anthem Blue Cross Medi-Cal plan ever since.\u003c/p>\n\u003cp>The plan paid for prenatal care through all six of Morga Tapia’s pregnancies, and it has provided all the medical and dental care the family needs, she said.\u003c/p>\n\u003cp>“Without Medi-Cal, we would have to be paying for all of our children,” said Morga Tapia. “It saves a lot of money, and it’s a blessing to have that extra help.”\u003c/p>\n\u003cp>Her children, four girls and a boy, range in age from 1 to 10. They all go to the same children’s clinic and see the same pediatrician.[pullquote align=\"right\" size=\"medium\" citation=\"Carolina Morga Tapia\"]'Without Medi-Cal, we would have to be paying for all of our children. It saves a lot of money, and it's a blessing to have that extra help.'[/pullquote]The kids, all in good health, get routine checkups, vaccinations and other preventive care, Morga Tapia said. She gets appointment reminders via text and cards in the mail notifying her when it’s time for the kids’ vaccinations and wellness checks, as well as her Pap smears, she said.\u003c/p>\n\u003cp>Her family’s experience contrasts sharply with the state’s assessment of their health plan, according to a \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/reports/Documents/Enhancing-Quality-for-Medi-Cal-Members.pdf\">report on quality of care in Medi-Cal issued late last year (PDF)\u003c/a>. The report, which evaluated Medi-Cal health plans on pediatric care, women’s health and chronic disease management, put Anthem Blue Cross in the lowest tier, and below par on multiple measures in numerous counties, including Fresno.\u003c/p>\n\u003cp>Another state report, released in late January, detailed how quickly insurers provide appointments for their patients, and put \u003ca href=\"https://www.dmhc.ca.gov/Portals/0/Docs/OPM/MY2021TAR.pdf\">Anthem Blue Cross’ Medi-Cal plan near the bottom of the heap (PDF)\u003c/a>.\u003c/p>\n\u003cp>Anthem Blue Cross spokesperson Michael Bowman said in a statement that the period covered in the reports coincide with the COVID-19 pandemic, “when our safety net providers dealt with significant challenges with workforce and appointment availability.”\u003c/p>\n\u003cp>Morga Tapia doesn’t give the insurer low marks. “It’s different for everybody. I have a good, healthy family, and what Medi-Cal covers is really fortunate for us,” she said.\u003c/p>\n\u003ch2>'I don't want to die yet'\u003c/h2>\n\u003cp>In late 2021, doctors gave Lucas Moreno Ramirez a few months to live.\u003c/p>\n\u003cp>Struggling with diabetes and late-stage lung cancer, Moreno Ramirez suffered debilitating pain as he hacked and labored for breath. His doctors recommended that he stop treatment and start hospice care.\u003c/p>\n\u003cp>He felt as if they were giving up on him.\u003c/p>\n\u003cp>“They said they’re going to give me opioids for my pain and help me have a comfortable death,” said Moreno Ramirez, 68, who lives in Norwalk, in Los Angeles County. “I told them I don’t believe in that. I don’t want to die yet.”\u003c/p>\n\u003cfigure id=\"attachment_11942525\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942525 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-800x534.jpg\" alt=\"A middle-aged Latino man, with a bushy gray mustache and thick gray hair combed back from his forehead, sits at a long table along a wall, on the other side of which a gauzy white curtain blows inward. He rests his right arm on the table, holding a blue-and-white mug. He looks at the camera, and is surrounded by cabinets with CDs, a massive water bottle, salt-and-pepper shakers, a clock on the wall and a nearby wind chime, and other homey detritus.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-1536x1025.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-2048x1367.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-1920x1281.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Lucas Moreno Ramirez, a former landscaper and factory worker, has been diagnosed with both diabetes and lung cancer. Working alongside a care manager through his Medi-Cal managed-care plan, he has fought for better care and treatment for both conditions. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A former landscaper and factory worker, Moreno Ramirez learned he had to be his own advocate, fighting for the care he believed he deserved from Medi-Cal.\u003c/p>\n\u003cp>He said his Christian faith gave him strength, and over the next few months, he pushed the program and his doctors to keep battling his cancer, using a different treatment with fewer side effects than chemotherapy.\u003c/p>\n\u003cp>“I believe in prayer,” he said. “But I believe in science and medication, too.”\u003c/p>\n\u003cp>Moreno Ramirez is one of the \u003ca href=\"https://www.chcf.org/publication/in-alignment-calaims-plan-coordinate-care-dual-enrollees-medicare-medi-cal/\">roughly 1.6 million Californians enrolled in both Medicare, which covers people who are 65 and older or have disabilities, and Medi-Cal\u003c/a>, which \u003ca href=\"https://www.kff.org/medicare/issue-brief/a-profile-of-medicare-medicaid-enrollees-dual-eligibles/?utm_campaign=KFF-2023-Medicaid&utm_medium=email&_hsmi=243959452&_hsenc=p2ANqtz--_YdJIpoiPQ6BsTqKV7XWKRpOoR_sJTFFsZI7MrJWw-BvXTcEh0PRgAq42XpbIvOpISMXOG8GW_lDUH-w2IgL2Syf6YA&utm_content=243959452&utm_source=hs_email\">kicks in to cover the costs and benefits that Medicare doesn’t\u003c/a>.\u003c/p>\n\u003cp>He also relies on his Medi-Cal insurer to help him navigate the Byzantine system. L.A. Care, the largest Medi-Cal plan with nearly 2.6 million members, connected him with a care manager who worked with him to identify \u003ca href=\"https://www.cancer.gov/publications/dictionaries/cancer-terms/def/tagrisso\">a different treatment called Tagrisso\u003c/a> and advocated for him to get it.[aside label=\"Related Stories\" postID=\"news_11940023,news_11941075,news_1981588\"]Even with the new medication, Moreno Ramirez’s coughing fits returned last year, and his symptoms grew so painful he suspected the cancer was growing. He asked to see his pulmonologist but was told the first appointment would be in June 2023. So he switched doctors and scored an appointment nearly six months sooner.\u003c/p>\n\u003cp>“My old doctor didn’t help me. I didn’t trust him,” Moreno Ramirez said. “He was always too busy for me. I told my doctors, ‘Give me a chance.’”\u003c/p>\n\u003cp>Having taken his care into his own hands, he says he’s not in pain, his cough has subsided and he feels hopeful for the future. “Now I feel good,” he said.\u003c/p>\n\u003cp>He has also sought more attention for his diabetes and received a continuous glucose monitor to measure his blood sugar. It’s better controlled now than it has been in decades, he said.\u003c/p>\n\u003cp>“You have to stand up for yourself and advocate,” said Joann Pacelo, the care manager who helped Moreno Ramirez change doctors, get quicker referrals to specialists and get approved for in-home nursing visits.\u003c/p>\n\u003cp>“A lot of times, it’s difficult with Medi-Cal because the doctors are busy and the reimbursements are so low, but no one should be denied the care they deserve.”\u003c/p>\n\u003cp>\u003cem>California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Serving over 15 million people and with an annual budget of $139 billion, California's massive Medicaid program — Medi-Cal — is at a critical juncture as it attempts to serve the needs of a diverse patient population with a dizzying array of medical needs.",
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"nprByline": "\u003ca href=\"https://californiahealthline.org/news/author/angela-hart/\">Angela Hart\u003c/a> and \u003ca href=\"https://californiahealthline.org/news/author/bernard-j-wolfson/\">Bernard J. Wolfson\u003c/a>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Newborns. Formerly incarcerated people. College students. Pregnant people. People with disabilities. Foster kids. Unhoused people. Single dads.\u003c/p>\n\u003cp>Your neighbor. Your co-worker.\u003c/p>\n\u003cp>You.\u003c/p>\n\u003cp>California’s Medicaid program, called Medi-Cal, serves a whopping 15.4 million people, offering care from cradle to grave: \u003ca href=\"https://www.chcf.org/publication/2021-edition-medi-cal-facts-figures/\">Half of all births are covered by Medi-Cal\u003c/a>, as are more than half of all stays in nursing homes.\u003c/p>\n\u003cp>Everything about Medi-Cal is massive, from its \u003ca href=\"https://ebudget.ca.gov/2023-24/pdf/BudgetSummary/HealthandHumanServices.pdf\">upcoming fiscal year budget of $139 billion (PDF)\u003c/a> to the expansive list of benefits and services it offers. The way the program works — or doesn’t — could spell life or death for many enrollees.\u003c/p>\n\u003cp>“It’s critical, from the single pregnant mom, to the extremely frail elderly population that needs a nursing home,” said Jennifer Kent, former director of the state Department of Health Care Services, which administers Medi-Cal. “If it weren’t for Medi-Cal, so many people would either be dead or would be severely compromised.”\u003c/p>\n\u003cp>In a new series, California Healthline will shed light on Medi-Cal’s successes and failures through the experiences of its enrollees. They include Stephanie Lammers, who can’t get her troubling abdominal symptoms checked at a clinic 50 miles from her small Calaveras County town because the transportation Medi-Cal is supposed to provide isn’t trustworthy; Carolina Morga Tapia, a Fresno woman who credits Medi-Cal with helping her have five healthy children; and Lucas Moreno Ramirez, a Los Angeles County man with stage 4 lung cancer who had to fight to keep his treatment going.\u003c/p>\n\u003cp>Medi-Cal is at a critical juncture as it attempts to serve the needs of a diverse patient population with a dizzying array of medical needs — from childhood vaccinations and cancer screenings to state-of-the-art care for rare genetic disorders. \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/statistics/Documents/FastFacts-March2022.pdf\">Roughly half of enrollees are Hispanic (PDF)\u003c/a>, and, next year, \u003ca href=\"https://californiahealthline.org/news/article/covered-california-bill-undocumented-immigrant-health-insurance/\">California will become the first state to expand eligibility to all immigrants who qualify, regardless of their legal status\u003c/a>.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Medi-Cal is also undertaking several new initiatives that aim to save taxpayer money and improve quality. State \u003ca href=\"https://khn.org/news/article/californias-reboot-of-troubled-medi-cal-puts-pressure-on-health-plans/\">officials are demanding that the 23 health insurers that serve most Medi-Cal patients provide better care\u003c/a> — or face significant penalties, including potential expulsion from the program.\u003c/p>\n\u003cp>The state is also \u003ca href=\"https://khn.org/news/article/california-medicaid-makeover-newsom-california-medi-cal-homeless-public-funds/\">adding innovative social services\u003c/a> that fall outside the traditional realm of medicine, including helping some enrollees pay for rent and buy groceries.\u003c/p>\n\u003cp>“People are watching California,” said Cindy Mann, who served as federal Medicaid director under former President Barack Obama. “What the state is doing is ambitious and very aggressive. It makes a significant mark on health care and health policy, not just because of the size and breadth of its program, but by being very comprehensive.”\u003c/p>\n\u003cp>But only a sliver of enrollees will get the new social services, even as \u003ca href=\"https://khn.org/news/article/california-governor-newsom-pricey-medicaid-reforms-leave-most-patients-behind/\">many patients struggle to obtain basic care\u003c/a> or get in to see their doctors. In reality, the type of care you get in Medi-Cal depends on where you live and which insurer provides your benefits.\u003c/p>\n\u003cp>That means the program is working for some, but failing for many others.\u003c/p>\n\u003cp>If you are in Medi-Cal, \u003ca href=\"https://californiahealthline.org/faces-of-medi-cal-submissions/\">we would like to hear from you\u003c/a>, whether you live in a big city or a rural region, regardless of your age, race or ethnicity, and whatever your medical, dental or mental health condition. Have you had difficulty seeing the right doctor for what ails you, even to the point of putting your life at risk? Or did Medi-Cal provide good care, perhaps sparing you serious harm or disability? Either way, \u003ca href=\"https://californiahealthline.org/faces-of-medi-cal-submissions/\">please consider sharing your experience with us\u003c/a>.\u003c/p>\n\u003cp>Here are snapshots of patients who have used the program at a critical time in their lives.\u003c/p>\n\u003ch2>'I just don't go to the doctor anymore'\u003c/h2>\n\u003cp>When Stephanie Lammers leans over to put on her shoes, it feels as if she’s squishing something inside her abdomen, she said.\u003c/p>\n\u003cp>Lammers, 53, has been suffering from frequent bouts of nausea, pain and bloating for six months.\u003c/p>\n\u003cp>Her gastroenterologist wants to perform diagnostic procedures, including a colonoscopy and, if anything shows up, a biopsy. But Lammers, who lives in a motel with her boyfriend and teenage daughter in the Gold Rush town of San Andreas, doesn’t have a working car and can’t readily get to the clinic — which is 50 miles away.\u003c/p>\n\u003cfigure id=\"attachment_11942519\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942519 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-800x548.jpg\" alt=\"A middle-aged white woman with a long-sleeved shirt with horizontal blue-and-white stripes, with one shoulder pulled down to reveal a tattoo of an eye, looks at the camera as she leans against a door jamb. To her left, a white husky dog looks out from a window.\" width=\"800\" height=\"548\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-800x548.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-1020x699.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-160x110.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-1536x1052.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-2048x1402.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-1920x1315.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Stephanie Lammers says the ride service provided by her Medi-Cal health plan is so bad that she stopped trying to use it about a year ago, after it left her in the lurch multiple times. 'I just don't go to the doctor anymore,' she says. \u003ccite>(Rich Pedroncelli/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For Lammers, like many Medi-Cal enrollees who live in rural areas, lack of transportation is a major impediment to obtaining care. The problem is particularly acute for patients who need to see specialists.\u003c/p>\n\u003cp>Lammers’ dermatologist and eye doctor are over an hour away from San Andreas, the county seat of Calaveras County, about 125 miles northeast of San Francisco. She isn’t seeing a neurologist, despite a series of mini-strokes and stress-related seizures. And she hasn’t been to a podiatrist in two years, even though her toes are twisted over one another and hang down, causing her to trip. She’s often in excruciating pain when she walks.\u003c/p>\n\u003cp>Medi-Cal is supposed to provide \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/Pages/Transportation.aspx\">free transportation to enrollees\u003c/a> who can’t otherwise get to their appointments.\u003c/p>\n\u003cp>But Lammers — whose health plan is California Health and Wellness, owned by Centene, \u003ca href=\"https://khn.org/news/article/centene-political-donations-medicaid-contracts-overbilling-allegations/\">the nation’s largest commercial Medicaid insurer\u003c/a> — stopped using its ride service nearly a year ago, after she missed dozens of appointments because drivers just didn’t show up, she said. She was getting threatening letters from doctors’ offices over the no-shows.\u003c/p>\n\u003cp>Once, she had to hitchhike more than 30 miles home from a counseling appointment. On other occasions, Lammers said, she did not receive the reimbursement she was owed for arranging her own rides.\u003c/p>\n\u003cp>“I just don’t go to the doctor anymore,” Lammers said. “If I go to the doctor, my boyfriend has to take the day off work, and if he takes the day off work, we have no money.”\u003c/p>\n\u003cp>During the last three months of 2022, Lammers canceled five appointments she had scheduled for the diagnostic abdominal procedures because her boyfriend had to work each time and couldn’t take her. She finally stopped rescheduling.\u003c/p>\n\u003cp>California Health and Wellness contracts with ModivCare, a Denver-based medical transportation company that is no stranger to \u003ca href=\"https://khn.org/news/article/medicaid-transportation-nonemergency-benefit-patients-stranded/\">patient complaints and lawsuits\u003c/a>.\u003c/p>\n\u003cp>Before she gave up on the ride service, Lammers said, she would call California Health and Wellness to try to resolve the issue, only to be told that ModivCare was a separate company. “I’m like, ‘If you guys hired them and put them in charge of transportation, who oversees their screwups?,’” she said.\u003c/p>\n\u003cfigure id=\"attachment_11942520\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942520 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-800x614.jpg\" alt=\"A white woman, standing in a crowded room of unmade beds, dishes potatoes onto a plate of biscuits and gravy from a hot plate on a cabinet next to a fridge. \" width=\"800\" height=\"614\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-800x614.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-1020x783.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-160x123.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-1536x1180.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-2048x1573.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-1920x1475.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Stephanie Lammers has serious abdominal symptoms, and her gastroenterologist wants to run diagnostic tests, but she had to cancel five appointments in the last three months of 2022 because she didn't have transportation. \u003ccite>(Rich Pedroncelli/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Courtney Schwyzer, a member of a legal aid team representing Lammers on various Medi-Cal matters, said the failure of medical ride services is a systemic problem. In late February, Schwyzer and her fellow attorneys filed a petition in court that she hopes will force the state Department of Health Care Services to address the problem.\u003c/p>\n\u003cp>California Health and Wellness spokesperson Darrel Ng said the company monitors the quality of its contractors, but a shortage of transportation providers in rural areas “has created unique challenges.”\u003c/p>\n\u003cp>ModivCare provides more than 4 million rides for Medi-Cal recipients annually, and more than 99% are without complaint, said Melody Lai, a company spokesperson.\u003c/p>\n\u003cp>Lammers, who is unemployed and trying to start a custom craft business called Stuff by Steph, said doctors have warned her that if she doesn’t reduce her stress level, it could shorten her life. But arranging medical care is the most stressful thing in her life right now, so she doesn’t try anymore.\u003c/p>\n\u003cp>“In order to keep from dying, I have to not go to the doctor,” she said.\u003c/p>\n\u003ch2>'It's a blessing'\u003c/h2>\n\u003cp>Medi-Cal helped save the life of Carolina Morga Tapia, a 30-year-old full-time mother of five who lives with her family amid almond groves in an agricultural enclave of Fresno.\u003c/p>\n\u003cp>Nine years ago, a bacterial infection triggered premature labor during the 25th week of her second pregnancy, and Morga Tapia almost died. She spiked a fever, bled profusely and needed immediate transfusions and emergency surgery. After several days in critical care, she fully recovered.\u003c/p>\n\u003cfigure id=\"attachment_11942521\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942521 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-800x534.jpg\" alt=\"A Latina woman with a blue cardigan and a black shirt looks at the camera, arms akimbo, standing in a leafless orchard.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-1536x1025.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-2048x1367.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-1920x1281.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Carolina Morga Tapia stands amid almond trees outside her home in Fresno. She, her husband and their five children are enrolled in Medi-Cal, and she says she is very happy with the care it has provided, including emergency surgery that saved her life after she fell gravely ill during her second pregnancy. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But the doctors could not stop the premature birth, and her baby came out weighing just 1 pound. She and her husband, David Nuñez, named her Milagros Guadalupe, and she died four days later, on Sept. 13, 2013.\u003c/p>\n\u003cp>In each of her subsequent pregnancies, Medi-Cal paid for Morga Tapia to get shots of synthetic progesterone, intended to prevent another preterm birth. Those shots — one a week for about 20 weeks — can cost an average of \u003ca href=\"https://www.npr.org/sections/health-shots/2020/01/24/798731110/drug-to-prevent-premature-birth-divides-doctors-insurers-and-fda-experts\">more than $10,000 per pregnancy\u003c/a>.\u003c/p>\n\u003cp>Morga Tapia and Nuñez, a construction worker, signed up for Medi-Cal when she was pregnant with her first child more than a decade ago. They’ve been on the same Anthem Blue Cross Medi-Cal plan ever since.\u003c/p>\n\u003cp>The plan paid for prenatal care through all six of Morga Tapia’s pregnancies, and it has provided all the medical and dental care the family needs, she said.\u003c/p>\n\u003cp>“Without Medi-Cal, we would have to be paying for all of our children,” said Morga Tapia. “It saves a lot of money, and it’s a blessing to have that extra help.”\u003c/p>\n\u003cp>Her children, four girls and a boy, range in age from 1 to 10. They all go to the same children’s clinic and see the same pediatrician.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The kids, all in good health, get routine checkups, vaccinations and other preventive care, Morga Tapia said. She gets appointment reminders via text and cards in the mail notifying her when it’s time for the kids’ vaccinations and wellness checks, as well as her Pap smears, she said.\u003c/p>\n\u003cp>Her family’s experience contrasts sharply with the state’s assessment of their health plan, according to a \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/reports/Documents/Enhancing-Quality-for-Medi-Cal-Members.pdf\">report on quality of care in Medi-Cal issued late last year (PDF)\u003c/a>. The report, which evaluated Medi-Cal health plans on pediatric care, women’s health and chronic disease management, put Anthem Blue Cross in the lowest tier, and below par on multiple measures in numerous counties, including Fresno.\u003c/p>\n\u003cp>Another state report, released in late January, detailed how quickly insurers provide appointments for their patients, and put \u003ca href=\"https://www.dmhc.ca.gov/Portals/0/Docs/OPM/MY2021TAR.pdf\">Anthem Blue Cross’ Medi-Cal plan near the bottom of the heap (PDF)\u003c/a>.\u003c/p>\n\u003cp>Anthem Blue Cross spokesperson Michael Bowman said in a statement that the period covered in the reports coincide with the COVID-19 pandemic, “when our safety net providers dealt with significant challenges with workforce and appointment availability.”\u003c/p>\n\u003cp>Morga Tapia doesn’t give the insurer low marks. “It’s different for everybody. I have a good, healthy family, and what Medi-Cal covers is really fortunate for us,” she said.\u003c/p>\n\u003ch2>'I don't want to die yet'\u003c/h2>\n\u003cp>In late 2021, doctors gave Lucas Moreno Ramirez a few months to live.\u003c/p>\n\u003cp>Struggling with diabetes and late-stage lung cancer, Moreno Ramirez suffered debilitating pain as he hacked and labored for breath. His doctors recommended that he stop treatment and start hospice care.\u003c/p>\n\u003cp>He felt as if they were giving up on him.\u003c/p>\n\u003cp>“They said they’re going to give me opioids for my pain and help me have a comfortable death,” said Moreno Ramirez, 68, who lives in Norwalk, in Los Angeles County. “I told them I don’t believe in that. I don’t want to die yet.”\u003c/p>\n\u003cfigure id=\"attachment_11942525\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942525 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-800x534.jpg\" alt=\"A middle-aged Latino man, with a bushy gray mustache and thick gray hair combed back from his forehead, sits at a long table along a wall, on the other side of which a gauzy white curtain blows inward. He rests his right arm on the table, holding a blue-and-white mug. He looks at the camera, and is surrounded by cabinets with CDs, a massive water bottle, salt-and-pepper shakers, a clock on the wall and a nearby wind chime, and other homey detritus.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-1536x1025.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-2048x1367.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-1920x1281.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Lucas Moreno Ramirez, a former landscaper and factory worker, has been diagnosed with both diabetes and lung cancer. Working alongside a care manager through his Medi-Cal managed-care plan, he has fought for better care and treatment for both conditions. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A former landscaper and factory worker, Moreno Ramirez learned he had to be his own advocate, fighting for the care he believed he deserved from Medi-Cal.\u003c/p>\n\u003cp>He said his Christian faith gave him strength, and over the next few months, he pushed the program and his doctors to keep battling his cancer, using a different treatment with fewer side effects than chemotherapy.\u003c/p>\n\u003cp>“I believe in prayer,” he said. “But I believe in science and medication, too.”\u003c/p>\n\u003cp>Moreno Ramirez is one of the \u003ca href=\"https://www.chcf.org/publication/in-alignment-calaims-plan-coordinate-care-dual-enrollees-medicare-medi-cal/\">roughly 1.6 million Californians enrolled in both Medicare, which covers people who are 65 and older or have disabilities, and Medi-Cal\u003c/a>, which \u003ca href=\"https://www.kff.org/medicare/issue-brief/a-profile-of-medicare-medicaid-enrollees-dual-eligibles/?utm_campaign=KFF-2023-Medicaid&utm_medium=email&_hsmi=243959452&_hsenc=p2ANqtz--_YdJIpoiPQ6BsTqKV7XWKRpOoR_sJTFFsZI7MrJWw-BvXTcEh0PRgAq42XpbIvOpISMXOG8GW_lDUH-w2IgL2Syf6YA&utm_content=243959452&utm_source=hs_email\">kicks in to cover the costs and benefits that Medicare doesn’t\u003c/a>.\u003c/p>\n\u003cp>He also relies on his Medi-Cal insurer to help him navigate the Byzantine system. L.A. Care, the largest Medi-Cal plan with nearly 2.6 million members, connected him with a care manager who worked with him to identify \u003ca href=\"https://www.cancer.gov/publications/dictionaries/cancer-terms/def/tagrisso\">a different treatment called Tagrisso\u003c/a> and advocated for him to get it.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Even with the new medication, Moreno Ramirez’s coughing fits returned last year, and his symptoms grew so painful he suspected the cancer was growing. He asked to see his pulmonologist but was told the first appointment would be in June 2023. So he switched doctors and scored an appointment nearly six months sooner.\u003c/p>\n\u003cp>“My old doctor didn’t help me. I didn’t trust him,” Moreno Ramirez said. “He was always too busy for me. I told my doctors, ‘Give me a chance.’”\u003c/p>\n\u003cp>Having taken his care into his own hands, he says he’s not in pain, his cough has subsided and he feels hopeful for the future. “Now I feel good,” he said.\u003c/p>\n\u003cp>He has also sought more attention for his diabetes and received a continuous glucose monitor to measure his blood sugar. It’s better controlled now than it has been in decades, he said.\u003c/p>\n\u003cp>“You have to stand up for yourself and advocate,” said Joann Pacelo, the care manager who helped Moreno Ramirez change doctors, get quicker referrals to specialists and get approved for in-home nursing visits.\u003c/p>\n\u003cp>“A lot of times, it’s difficult with Medi-Cal because the doctors are busy and the reimbursements are so low, but no one should be denied the care they deserve.”\u003c/p>\n\u003cp>\u003cem>California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Almost 2 million of California’s lowest-income and most medically fragile residents may have to switch health insurers as a result of a new strategy by the state to improve care in its Medicaid program, called Medi-Cal.\u003c/p>\n\u003cp>A first-ever statewide contracting competition to participate in Medi-Cal required commercial managed-care plans to rebid for their contracts and compete against others hoping to take those contracts away. The contracts will be revamped to require insurers to offer new benefits and meet stiffer benchmarks for care.\u003c/p>\n\u003cp>The long-planned reshuffle of insurers is likely to come with short-term pain. Four of the managed-care insurers, including Health Net and Blue Shield of California, stand to \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/MCP-County-Enrollment-Table.pdf\">lose Medi-Cal contracts\u003c/a> in a little over a year, according to the \u003ca href=\"https://www.dhcs.ca.gov/formsandpubs/publications/oc/Documents/2022/22-10-MCP-Selections-8-25-22.pdf\">preliminary results of the bidding\u003c/a>, announced in late August. If the results stand, some enrollees in rural Alpine and El Dorado counties, as well as in populous Los Angeles, San Diego, Sacramento and Kern counties, will have to change health plans — and possibly doctors.[aside label='Related Coverage' tag='medicaid']“I’m still shocked and I’m still reeling from it,” said John Sturm, \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/MCP-County-Enrollment-Table.pdf\">one of about 325,000 members of Community Health Group\u003c/a>, the largest Medi-Cal plan in San Diego County, which could lose its contract. “Which doctors can I keep? How long is it going to take me to switch plans? Are there contingency plans when, inevitably, folks slip through the cracks?”\u003c/p>\n\u003cp>Sturm, 54, who has three mental health conditions, largely because of childhood sexual abuse, said finding a psychologist and psychiatrist he could trust took a lot of time and effort. He pointed to \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-patients-struggle-to-fill-prescriptions-medi-cal-rx/\">the disruption caused by the rollout of Medi-Cal’s new prescription drug program\u003c/a> this year, despite assurances it would go smoothly.\u003c/p>\n\u003cp>“I have concerns, and I know other people in the community have concerns about what we’re being told versus what the reality is going to be,” Sturm said.\u003c/p>\n\u003cp>Arguably, the biggest loser in the bidding is Health Net, the largest commercial insurer in Medi-Cal, which stands to lose half its enrollees — including more than 1 million in Los Angeles County alone. St. Louis-based Centene Corp., which \u003ca href=\"https://www.latimes.com/california/story/2022-04-07/california-investigating-corporation-took-over-medicaid-drug-program\">California is investigating\u003c/a> over allegations it overcharged the state for prescription drugs, \u003ca href=\"https://www.prnewswire.com/news-releases/centene-completes-acquisition-of-health-net-300241037.html\">bought Health Net\u003c/a> in 2016, in part for its Medicaid business, of which LA is the crown jewel.\u003c/p>\n\u003cp>But the state’s health plan selections are not set in stone. The losing insurers are fiercely contesting the results in formal appeals that read like declarations of war on their competitors and on the state. Some of the losers essentially call their winning rivals liars.\u003c/p>\n\u003cp>The stakes are high, with contracts in play worth billions of dollars annually. Insurers that lose their appeals with the state Department of Health Care Services, which runs Medi-Cal, are likely to take their complaints to court. That could delay final decisions by months or years, causing a headache for the department, which wants coverage under the new contracts to start Jan. 1, 2024.\u003c/p>\n\u003cp>State officials hope to spend the rest of this year and all of 2023 ensuring that the chosen health plans are up to the task, which includes having enough participating providers to minimize disruptions in care.\u003c/p>\n\u003cp>“Member access and continuity are really our top priorities as part of this transition, and we have dedicated teams that will be working with the health plans on the transition planning and the continuity planning,” Michelle Baass, director of the department, told KHN.[pullquote size=\"medium\" align=\"right\" citation=\"John Sturm, Medi-Cal recipient\"]‘I have concerns, and I know other people in the community have concerns about what we’re being told versus what the reality is going to be.’[/pullquote]Baass also noted that enrollees have continuity-of-care rights. “For example, if a member is currently under the care of a doctor during the prior 12 months, the member has the right to continue seeing that doctor for up to 12 months, if certain conditions are met,” she said.\u003c/p>\n\u003cp>The competitive bidding process is an effort by the department to address persistent complaints that \u003ca href=\"https://californiahealthline.org/news/article/californias-reboot-of-troubled-medi-cal-puts-pressure-on-health-plans/\">it has not effectively monitored subpar health plans\u003c/a>.\u003c/p>\n\u003cp>Eight commercial insurers bid for Medi-Cal business in 21 counties. They were required to submit voluminous documents detailing every aspect of their operations, including past performance; the scope of their provider networks; and their capacity to meet the terms of the new, stricter contracts.\u003c/p>\n\u003cp>The new contracts contain numerous provisions intended to bolster quality, health care equity and transparency — and to boost accountability of the subcontractors to whom \u003ca href=\"https://californiahealthline.org/news/article/layers-of-subcontracted-services-confuse-and-frustrate-medi-cal-patients/\">health plans often outsource patient care\u003c/a>. For example, the plans and their subcontractors will be required to reach or exceed \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCP-RFP-Issue-Brief.pdf\">the 50th percentile\u003c/a> among Medicaid plans nationally on a host of pediatric and maternal care measures — or face financial penalties.\u003c/p>\n\u003cp>They will also be on the hook for providing nonmedical social services that address socioeconomic factors, such as homelessness and food insecurity, in an ambitious $8.7 billion, \u003ca href=\"https://khn.org/news/article/california-medicaid-makeover-newsom-california-medi-cal-homeless-public-funds/\">five-year Medi-Cal initiative known as CalAIM\u003c/a>, that is already underway.\u003c/p>\n\u003cp>Local, publicly governed Medi-Cal plans, which cover about 70% of the \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/statistics/Documents/FastFacts-March2022.pdf\">12.4 million Medi-Cal members who are in managed care\u003c/a>, did not participate in the bidding, though their performance has not always been top-notch. Kaiser Permanente, which this year negotiated a controversial deal with the state for an \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-contract-kaiser-permanente-key-details-missing/\">exclusive Medi-Cal contract\u003c/a> in 32 counties, was also exempt from the bidding. (KHN is not affiliated with Kaiser Permanente.)\u003c/p>\n\u003cp>But all Medi-Cal health insurers, including KP and the local plans, will have to commit to the same goals and requirements.\u003c/p>\n\u003cp>In addition to Health Net, both Blue Shield of California and Community Health Group — which have contracts with Medi-Cal only in San Diego County — are also big losers, as is Aetna, which lost bids in 10 counties.\u003c/p>\n\u003cp>Blue Shield, which lost in all 13 counties where it submitted bids, filed a fiercely worded appeal that accuses its rivals Anthem Blue Cross, Molina and Health Net of failing to disclose hundreds of millions of dollars in penalties against them. It accused those three plans of poor performance “and even mendacity” and said they filled their bids with “puffery,” which the state “bought, hook, line and sinker,” without “an iota of independent analysis.”\u003c/p>\n\u003cfigure id=\"attachment_11926773\" class=\"wp-caption alignnone\" style=\"max-width: 724px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11926773\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/09/GettyImages-1279766844.jpg\" alt=\"A hand in the foreground holds a card as someone reaches out to hold it from across a table.\" width=\"724\" height=\"483\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/09/GettyImages-1279766844.jpg 724w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/09/GettyImages-1279766844-160x107.jpg 160w\" sizes=\"(max-width: 724px) 100vw, 724px\">\u003cfigcaption class=\"wp-caption-text\">The competitive bidding process is an effort by the state Department of Health Care Services to address persistent complaints that it has not effectively monitored subpar health plans. \u003ccite>(Willie B. Thomas/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Health Net’s appeal slammed Molina, which beat it out in LA, Sacramento, Riverside and San Bernardino counties. Molina’s bid, Health Net said, “contains false, inaccurate and misleading information.” The whole bidding process, it said, was “highly flawed,” resulting in “erroneous contract awards that jeopardize the stability of Medi-Cal.”\u003c/p>\n\u003cp>In particular, Health Net said, the Department of Health Care Services “improperly reopened the procurement” after the deadline, which allowed Molina to make “comprehensive changes” that raised its score.\u003c/p>\n\u003cp>The protesting health plans are requesting that they be awarded contracts or that the bidding process start over from scratch.\u003c/p>\n\u003cp>Joseph Garcia, chief operating officer for Community Health Group, said, “It would be easiest for all concerned if they just added us. They don’t have to remove anybody.”\u003c/p>\n\u003cp>Community Health Group has garnered an outpouring of support from hospital executives, physician groups, community clinics and the heads of multiple publicly governed Medi-Cal plans, \u003ca href=\"https://californiahealthline.org/wp-content/uploads/sites/3/2022/09/Medi-Cal-Reprocurement-Letter-of-Support-for-CHG-1.pdf\">who sent a letter to Baass\u003c/a> saying they were “shocked, concerned, and very disappointed” by the state’s decision. They called Community Health Group “our strongest partner of 40 years,” for whom “equity is not a buzzword or a new priority,” noting that more than 85% of its staff is bilingual and multicultural.\u003c/p>\n\u003cp>Community Health Group noted in its appeal that it had lost by less than a point to Health Net, which won a San Diego contract — “a minuscule difference that in itself resulted from deeply flawed scoring.”\u003c/p>\n\u003cp>Garcia said that if Community Health Group loses its appeal, it will “absolutely” sue in state court. A hearing officer appointed by Baass to consider the appeals has set deadlines to receive written responses and rebuttals by October 7.\u003c/p>\n\u003cp>There is ample precedent for protracted legal battles in bidding for Medicaid contracts. In Louisiana, Centene and Aetna \u003ca href=\"https://www.thecentersquare.com/louisiana/rejected-bidders-for-louisiana-medicaid-contracts-file-protests-alleging-bias/article_2fe6ecec-c44c-11e9-833d-331f84e9c8f0.html\">protested the results of a 2019 rebidding process\u003c/a>, which led the state to nullify its awards and restart the bidding. The \u003ca href=\"https://ldh.la.gov/news/ldh-mco-contracts\">new results\u003c/a> were announced this year, with Centene and Aetna among the winners. In Kentucky, the state court of appeals \u003ca href=\"https://www.courier-journal.com/story/news/local/2022/09/15/kentucky-medicaid-contracts-upheld-by-court-anthem-is-out-as-mco/69494863007/\">issued a ruling\u003c/a> this month in a contested Medicaid procurement that had been held two years earlier.\u003c/p>\n\u003cp>Another factor could delay the new contract: California is juggling several massive Medi-Cal changes at the same time. Among them are the implementation of CalAIM and the \u003ca href=\"https://lao.ca.gov/Publications/Report/4423\">anticipated enrollment of nearly 700,000 unauthorized immigrants age 26-49\u003c/a> by January 2024, on top of nearly a quarter-million unauthorized immigrants age 50 and older who \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-older-unauthorized-immigrants/\">became eligible this year\u003c/a>. And then there’s the recalculation of enrollees’ eligibility, which will take place whenever the federal COVID-19-related public health emergency ends. That could push \u003ca href=\"https://www.dhcs.ca.gov/Documents/PHE-UOP/Medi-Cal-COVID-19-PHE-Unwinding-Plan.pdf\">2 million to 3 million\u003c/a> Californians out of Medi-Cal.\u003c/p>\n\u003cp>“Just hearing you list all those things gave me a minor panic attack,” said Abigail Coursolle, a senior attorney at the National Health Law Program. “They are making a lot of work for themselves in a short amount of time.”\u003c/p>\n\u003cp>But, Coursolle added, the state has “a very positive vision for improving access and improving the quality of services that people in Medi-Cal receive, and that’s very important.”\u003c/p>\n\u003cp>\u003cem>California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Almost 2 million of California’s lowest-income and most medically fragile residents may have to switch health insurers as a result of a new strategy by the state to improve care in its Medicaid program, called Medi-Cal.\u003c/p>\n\u003cp>A first-ever statewide contracting competition to participate in Medi-Cal required commercial managed-care plans to rebid for their contracts and compete against others hoping to take those contracts away. The contracts will be revamped to require insurers to offer new benefits and meet stiffer benchmarks for care.\u003c/p>\n\u003cp>The long-planned reshuffle of insurers is likely to come with short-term pain. Four of the managed-care insurers, including Health Net and Blue Shield of California, stand to \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/MCP-County-Enrollment-Table.pdf\">lose Medi-Cal contracts\u003c/a> in a little over a year, according to the \u003ca href=\"https://www.dhcs.ca.gov/formsandpubs/publications/oc/Documents/2022/22-10-MCP-Selections-8-25-22.pdf\">preliminary results of the bidding\u003c/a>, announced in late August. If the results stand, some enrollees in rural Alpine and El Dorado counties, as well as in populous Los Angeles, San Diego, Sacramento and Kern counties, will have to change health plans — and possibly doctors.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“I’m still shocked and I’m still reeling from it,” said John Sturm, \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/MCP-County-Enrollment-Table.pdf\">one of about 325,000 members of Community Health Group\u003c/a>, the largest Medi-Cal plan in San Diego County, which could lose its contract. “Which doctors can I keep? How long is it going to take me to switch plans? Are there contingency plans when, inevitably, folks slip through the cracks?”\u003c/p>\n\u003cp>Sturm, 54, who has three mental health conditions, largely because of childhood sexual abuse, said finding a psychologist and psychiatrist he could trust took a lot of time and effort. He pointed to \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-patients-struggle-to-fill-prescriptions-medi-cal-rx/\">the disruption caused by the rollout of Medi-Cal’s new prescription drug program\u003c/a> this year, despite assurances it would go smoothly.\u003c/p>\n\u003cp>“I have concerns, and I know other people in the community have concerns about what we’re being told versus what the reality is going to be,” Sturm said.\u003c/p>\n\u003cp>Arguably, the biggest loser in the bidding is Health Net, the largest commercial insurer in Medi-Cal, which stands to lose half its enrollees — including more than 1 million in Los Angeles County alone. St. Louis-based Centene Corp., which \u003ca href=\"https://www.latimes.com/california/story/2022-04-07/california-investigating-corporation-took-over-medicaid-drug-program\">California is investigating\u003c/a> over allegations it overcharged the state for prescription drugs, \u003ca href=\"https://www.prnewswire.com/news-releases/centene-completes-acquisition-of-health-net-300241037.html\">bought Health Net\u003c/a> in 2016, in part for its Medicaid business, of which LA is the crown jewel.\u003c/p>\n\u003cp>But the state’s health plan selections are not set in stone. The losing insurers are fiercely contesting the results in formal appeals that read like declarations of war on their competitors and on the state. Some of the losers essentially call their winning rivals liars.\u003c/p>\n\u003cp>The stakes are high, with contracts in play worth billions of dollars annually. Insurers that lose their appeals with the state Department of Health Care Services, which runs Medi-Cal, are likely to take their complaints to court. That could delay final decisions by months or years, causing a headache for the department, which wants coverage under the new contracts to start Jan. 1, 2024.\u003c/p>\n\u003cp>State officials hope to spend the rest of this year and all of 2023 ensuring that the chosen health plans are up to the task, which includes having enough participating providers to minimize disruptions in care.\u003c/p>\n\u003cp>“Member access and continuity are really our top priorities as part of this transition, and we have dedicated teams that will be working with the health plans on the transition planning and the continuity planning,” Michelle Baass, director of the department, told KHN.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Baass also noted that enrollees have continuity-of-care rights. “For example, if a member is currently under the care of a doctor during the prior 12 months, the member has the right to continue seeing that doctor for up to 12 months, if certain conditions are met,” she said.\u003c/p>\n\u003cp>The competitive bidding process is an effort by the department to address persistent complaints that \u003ca href=\"https://californiahealthline.org/news/article/californias-reboot-of-troubled-medi-cal-puts-pressure-on-health-plans/\">it has not effectively monitored subpar health plans\u003c/a>.\u003c/p>\n\u003cp>Eight commercial insurers bid for Medi-Cal business in 21 counties. They were required to submit voluminous documents detailing every aspect of their operations, including past performance; the scope of their provider networks; and their capacity to meet the terms of the new, stricter contracts.\u003c/p>\n\u003cp>The new contracts contain numerous provisions intended to bolster quality, health care equity and transparency — and to boost accountability of the subcontractors to whom \u003ca href=\"https://californiahealthline.org/news/article/layers-of-subcontracted-services-confuse-and-frustrate-medi-cal-patients/\">health plans often outsource patient care\u003c/a>. For example, the plans and their subcontractors will be required to reach or exceed \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCP-RFP-Issue-Brief.pdf\">the 50th percentile\u003c/a> among Medicaid plans nationally on a host of pediatric and maternal care measures — or face financial penalties.\u003c/p>\n\u003cp>They will also be on the hook for providing nonmedical social services that address socioeconomic factors, such as homelessness and food insecurity, in an ambitious $8.7 billion, \u003ca href=\"https://khn.org/news/article/california-medicaid-makeover-newsom-california-medi-cal-homeless-public-funds/\">five-year Medi-Cal initiative known as CalAIM\u003c/a>, that is already underway.\u003c/p>\n\u003cp>Local, publicly governed Medi-Cal plans, which cover about 70% of the \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/statistics/Documents/FastFacts-March2022.pdf\">12.4 million Medi-Cal members who are in managed care\u003c/a>, did not participate in the bidding, though their performance has not always been top-notch. Kaiser Permanente, which this year negotiated a controversial deal with the state for an \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-contract-kaiser-permanente-key-details-missing/\">exclusive Medi-Cal contract\u003c/a> in 32 counties, was also exempt from the bidding. (KHN is not affiliated with Kaiser Permanente.)\u003c/p>\n\u003cp>But all Medi-Cal health insurers, including KP and the local plans, will have to commit to the same goals and requirements.\u003c/p>\n\u003cp>In addition to Health Net, both Blue Shield of California and Community Health Group — which have contracts with Medi-Cal only in San Diego County — are also big losers, as is Aetna, which lost bids in 10 counties.\u003c/p>\n\u003cp>Blue Shield, which lost in all 13 counties where it submitted bids, filed a fiercely worded appeal that accuses its rivals Anthem Blue Cross, Molina and Health Net of failing to disclose hundreds of millions of dollars in penalties against them. It accused those three plans of poor performance “and even mendacity” and said they filled their bids with “puffery,” which the state “bought, hook, line and sinker,” without “an iota of independent analysis.”\u003c/p>\n\u003cfigure id=\"attachment_11926773\" class=\"wp-caption alignnone\" style=\"max-width: 724px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11926773\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/09/GettyImages-1279766844.jpg\" alt=\"A hand in the foreground holds a card as someone reaches out to hold it from across a table.\" width=\"724\" height=\"483\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/09/GettyImages-1279766844.jpg 724w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/09/GettyImages-1279766844-160x107.jpg 160w\" sizes=\"(max-width: 724px) 100vw, 724px\">\u003cfigcaption class=\"wp-caption-text\">The competitive bidding process is an effort by the state Department of Health Care Services to address persistent complaints that it has not effectively monitored subpar health plans. \u003ccite>(Willie B. Thomas/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Health Net’s appeal slammed Molina, which beat it out in LA, Sacramento, Riverside and San Bernardino counties. Molina’s bid, Health Net said, “contains false, inaccurate and misleading information.” The whole bidding process, it said, was “highly flawed,” resulting in “erroneous contract awards that jeopardize the stability of Medi-Cal.”\u003c/p>\n\u003cp>In particular, Health Net said, the Department of Health Care Services “improperly reopened the procurement” after the deadline, which allowed Molina to make “comprehensive changes” that raised its score.\u003c/p>\n\u003cp>The protesting health plans are requesting that they be awarded contracts or that the bidding process start over from scratch.\u003c/p>\n\u003cp>Joseph Garcia, chief operating officer for Community Health Group, said, “It would be easiest for all concerned if they just added us. They don’t have to remove anybody.”\u003c/p>\n\u003cp>Community Health Group has garnered an outpouring of support from hospital executives, physician groups, community clinics and the heads of multiple publicly governed Medi-Cal plans, \u003ca href=\"https://californiahealthline.org/wp-content/uploads/sites/3/2022/09/Medi-Cal-Reprocurement-Letter-of-Support-for-CHG-1.pdf\">who sent a letter to Baass\u003c/a> saying they were “shocked, concerned, and very disappointed” by the state’s decision. They called Community Health Group “our strongest partner of 40 years,” for whom “equity is not a buzzword or a new priority,” noting that more than 85% of its staff is bilingual and multicultural.\u003c/p>\n\u003cp>Community Health Group noted in its appeal that it had lost by less than a point to Health Net, which won a San Diego contract — “a minuscule difference that in itself resulted from deeply flawed scoring.”\u003c/p>\n\u003cp>Garcia said that if Community Health Group loses its appeal, it will “absolutely” sue in state court. A hearing officer appointed by Baass to consider the appeals has set deadlines to receive written responses and rebuttals by October 7.\u003c/p>\n\u003cp>There is ample precedent for protracted legal battles in bidding for Medicaid contracts. In Louisiana, Centene and Aetna \u003ca href=\"https://www.thecentersquare.com/louisiana/rejected-bidders-for-louisiana-medicaid-contracts-file-protests-alleging-bias/article_2fe6ecec-c44c-11e9-833d-331f84e9c8f0.html\">protested the results of a 2019 rebidding process\u003c/a>, which led the state to nullify its awards and restart the bidding. The \u003ca href=\"https://ldh.la.gov/news/ldh-mco-contracts\">new results\u003c/a> were announced this year, with Centene and Aetna among the winners. In Kentucky, the state court of appeals \u003ca href=\"https://www.courier-journal.com/story/news/local/2022/09/15/kentucky-medicaid-contracts-upheld-by-court-anthem-is-out-as-mco/69494863007/\">issued a ruling\u003c/a> this month in a contested Medicaid procurement that had been held two years earlier.\u003c/p>\n\u003cp>Another factor could delay the new contract: California is juggling several massive Medi-Cal changes at the same time. Among them are the implementation of CalAIM and the \u003ca href=\"https://lao.ca.gov/Publications/Report/4423\">anticipated enrollment of nearly 700,000 unauthorized immigrants age 26-49\u003c/a> by January 2024, on top of nearly a quarter-million unauthorized immigrants age 50 and older who \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-older-unauthorized-immigrants/\">became eligible this year\u003c/a>. And then there’s the recalculation of enrollees’ eligibility, which will take place whenever the federal COVID-19-related public health emergency ends. That could push \u003ca href=\"https://www.dhcs.ca.gov/Documents/PHE-UOP/Medi-Cal-COVID-19-PHE-Unwinding-Plan.pdf\">2 million to 3 million\u003c/a> Californians out of Medi-Cal.\u003c/p>\n\u003cp>“Just hearing you list all those things gave me a minor panic attack,” said Abigail Coursolle, a senior attorney at the National Health Law Program. “They are making a lot of work for themselves in a short amount of time.”\u003c/p>\n\u003cp>But, Coursolle added, the state has “a very positive vision for improving access and improving the quality of services that people in Medi-Cal receive, and that’s very important.”\u003c/p>\n\u003cp>\u003cem>California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Although more than three-quarters of California adults are vaccinated against COVID-19, opinions are more divided when it comes to vaccinating children. That sentiment played out Thursday when first, the author of a bill that would have mandated vaccines for all children pulled the legislation, and then again when state health officials pushed back the date of their student vaccine mandate.\u003c/p>\n\u003cp>It was a striking shift for a state that had been \u003ca href=\"https://www.latimes.com/california/story/2021-10-01/newsom-sets-covid-vaccine-mandate-across-california-schools\">the nation’s first to announce a planned K-12 COVID-19 mandate\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB871\">Senate Bill 871\u003c/a> by Sen. Richard Pan, a Sacramento Democrat who chairs the Senate Health Committee, would have added COVID-19 vaccines to the list of inoculations California students are required to get in order to attend K-12 schools. The bill would have precluded personal belief exemptions, allowing only students with a rare medical exemption from a doctor to avoid getting the shot.\u003c/p>\n\u003cp>In sidelining his own bill, Pan said the focus needs to be on making sure families can access the vaccine for their children.\u003c/p>\n\u003cp>Within hours, the California Department of Public Health announced it would not begin the process of adding the COVID-19 vaccine to the list of mandated childhood vaccines for K-12 public and private school students because it has not yet been fully approved by the federal Food and Drug Administration. Previously the state \u003ca href=\"https://www.gov.ca.gov/2021/10/01/california-becomes-first-state-in-nation-to-announce-covid-19-vaccine-requirements-for-schools/\">had intended to require it for the upcoming 2022-23 school year\u003c/a>, but now that won’t happen until at least July 1, 2023.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The health department said in a statement that even after COVID vaccines for kids receive full approval, it would also consider the recommendations of a Centers for Disease Control and Prevention vaccine advisory committee and the American Academy of Pediatrics and American Academy of Family Physicians before issuing a school vaccine requirement.\u003c/p>\n\u003cp>Support for Pan’s bill has been wavering for several weeks. Last month, another member of the Senate Health Committee, Democratic Sen. Connie Leyva of Chino, told the group Stand Up Ontario, in the Inland Empire, that \u003ca href=\"https://www.instagram.com/tv/CbB869zFrvi/?utm_source=ig_web_button_share_sheet\">she was not going to vote for the bill\u003c/a>.\u003c/p>\n\u003cp>She said she told Pan, “I just don’t think it’s the right time. We are too divided in the community. I think this bill is too divisive.”\u003c/p>\n\u003cp>GOP political consultant Mike Madrid said legislators pull bills for many reasons, including a lack of support or because there is another way to reach the same goal.\u003c/p>\n\u003cp>[aside label=\"related coverage\" tag=\"vaccine-mandates\"]“If a better way to solve it is access without the acrimony of mandate, that is fine,” he said. “The point isn’t to disagree, it’s to get to a point where we have public health protections.”\u003c/p>\n\u003cp>Pan’s bill was one of \u003ca href=\"https://calmatters.org/health/coronavirus/2022/03/california-vaccine-laws/\">eight aggressive COVID-19-related bills\u003c/a> introduced as part of a slate from the Legislature’s vaccine working group, made up of Democratic lawmakers. Among the bills still alive in the Legislature are proposals that would punish doctors who share misinformation, require schools to \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202120220SB1479\">continue regular COVID testing\u003c/a>, and change how the state’s vaccination registry works. Also still in play: a bill that would allow 12- to 17-year-olds to get \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202120220SB866\">vaccinated without parental consent\u003c/a>.\u003c/p>\n\u003cp>In August, the COVID vaccine received full approval from the FDA for people 16 and older. Children as young as 5 also can receive it, but only under the FDA’s emergency use authorization. \u003ca href=\"https://covid19.ca.gov/vaccination-progress-data/#age-ethnicity\">About two-thirds\u003c/a> of 12- to 17-year-olds in California have been vaccinated, but the numbers are much lower for kids 5 to 11, with only about one-third vaccinated.\u003c/p>\n\u003cp>Citing the low COVID vaccination rate among younger children, Pan said a mandate is not a priority until the state can make the vaccine more accessible. He said that in his experience, as a pediatrician, when parents ask about vaccinations they want to see their child’s doctor. But many doctor’s offices don’t offer the COVID vaccine and have instead been referring families to drug stores or vaccination sites that are often not child-centric.\u003c/p>\n\u003cp>“The challenge is that we are not getting vaccines into essentially the places where people normally get vaccines for their children,” he said, referring to pediatricians’ offices. “We still have a long way to go.”\u003c/p>\n\u003cp>A \u003ca href=\"https://escholarship.org/uc/item/0669t7s7\">Berkeley IGS poll released in late February\u003c/a> found that two-thirds of California voters supported requiring the COVID-19 vaccine for K-12 students. But there is a big split along party lines: Democrats and liberals overwhelmingly support a mandate while only about a quarter of conservatives and Republicans do.\u003c/p>\n\u003cp>Among parents, two-thirds said they felt having their kids vaccinated was essential or important, while 26% percent said it was “either not too or not at all important.” This question did not address the mandate.\u003c/p>\n\u003cp>Pan’s legislation was the second of the working group’s bills to be sidelined by its original author. A proposal to require all people who work, including contractors, to be vaccinated also was pulled.\u003c/p>\n\u003cp>Critics have been pushing back, arguing that the bills are burdensome and infringe on health and privacy rights — and no bill was more controversial than Pan’s. Many parents who opposed it said that parents should get to choose whether to vaccinate their children, especially when the vaccine does not fully prevent transmission and it’s still unclear how long it remains effective against the virus.\u003c/p>\n\u003cp>“We did not feel it was the appropriate policy for children with respect to COVID-19 at this time,” said Christina Hildebrand, head of A Voice for Choice. The group advocates for parental choice and has worked since 2015 to keep personal belief exemptions for various vaccines in place. She points to the low rate of COVID vaccination among 5- to 11-year-olds as a reason to hold off on a mandate.\u003c/p>\n\u003cp>“Those parents have had ample opportunity to get their children vaccinated, but the parents are hesitant,” she said.\u003c/p>\n\u003cp>Pan said it’s difficult to require something that two-thirds of young children have yet to receive. “Mandates are good at getting you to that final bit when we are at 80% and have to get to 90, not when you are below half,” he said. “If you are that far behind, there’s a reason. Some of it is people have questions and want to get them answered, and they want to hear from the person they have been going to for a long time to get vaccinated.”\u003c/p>\n\u003cp>Pan, though, said his bill is certainly not dead. He intends to watch vaccination rates and said it could be something he brings back later.\u003c/p>\n\u003cp>Madrid, the GOP consultant, said the bills signal the possibility of future vaccine mandates as the world becomes more globalized and pandemics happen more frequently.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“There is an appetite to have more protection for public health and not less,” he said. “You give it a year and study how you can make it work if you are going to pass legislation this broad and sweeping. You have to make sure you get it right the first time.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Although more than three-quarters of California adults are vaccinated against COVID-19, opinions are more divided when it comes to vaccinating children. That sentiment played out Thursday when first, the author of a bill that would have mandated vaccines for all children pulled the legislation, and then again when state health officials pushed back the date of their student vaccine mandate.\u003c/p>\n\u003cp>It was a striking shift for a state that had been \u003ca href=\"https://www.latimes.com/california/story/2021-10-01/newsom-sets-covid-vaccine-mandate-across-california-schools\">the nation’s first to announce a planned K-12 COVID-19 mandate\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB871\">Senate Bill 871\u003c/a> by Sen. Richard Pan, a Sacramento Democrat who chairs the Senate Health Committee, would have added COVID-19 vaccines to the list of inoculations California students are required to get in order to attend K-12 schools. The bill would have precluded personal belief exemptions, allowing only students with a rare medical exemption from a doctor to avoid getting the shot.\u003c/p>\n\u003cp>In sidelining his own bill, Pan said the focus needs to be on making sure families can access the vaccine for their children.\u003c/p>\n\u003cp>Within hours, the California Department of Public Health announced it would not begin the process of adding the COVID-19 vaccine to the list of mandated childhood vaccines for K-12 public and private school students because it has not yet been fully approved by the federal Food and Drug Administration. Previously the state \u003ca href=\"https://www.gov.ca.gov/2021/10/01/california-becomes-first-state-in-nation-to-announce-covid-19-vaccine-requirements-for-schools/\">had intended to require it for the upcoming 2022-23 school year\u003c/a>, but now that won’t happen until at least July 1, 2023.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The health department said in a statement that even after COVID vaccines for kids receive full approval, it would also consider the recommendations of a Centers for Disease Control and Prevention vaccine advisory committee and the American Academy of Pediatrics and American Academy of Family Physicians before issuing a school vaccine requirement.\u003c/p>\n\u003cp>Support for Pan’s bill has been wavering for several weeks. Last month, another member of the Senate Health Committee, Democratic Sen. Connie Leyva of Chino, told the group Stand Up Ontario, in the Inland Empire, that \u003ca href=\"https://www.instagram.com/tv/CbB869zFrvi/?utm_source=ig_web_button_share_sheet\">she was not going to vote for the bill\u003c/a>.\u003c/p>\n\u003cp>She said she told Pan, “I just don’t think it’s the right time. We are too divided in the community. I think this bill is too divisive.”\u003c/p>\n\u003cp>GOP political consultant Mike Madrid said legislators pull bills for many reasons, including a lack of support or because there is another way to reach the same goal.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“If a better way to solve it is access without the acrimony of mandate, that is fine,” he said. “The point isn’t to disagree, it’s to get to a point where we have public health protections.”\u003c/p>\n\u003cp>Pan’s bill was one of \u003ca href=\"https://calmatters.org/health/coronavirus/2022/03/california-vaccine-laws/\">eight aggressive COVID-19-related bills\u003c/a> introduced as part of a slate from the Legislature’s vaccine working group, made up of Democratic lawmakers. Among the bills still alive in the Legislature are proposals that would punish doctors who share misinformation, require schools to \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202120220SB1479\">continue regular COVID testing\u003c/a>, and change how the state’s vaccination registry works. Also still in play: a bill that would allow 12- to 17-year-olds to get \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202120220SB866\">vaccinated without parental consent\u003c/a>.\u003c/p>\n\u003cp>In August, the COVID vaccine received full approval from the FDA for people 16 and older. Children as young as 5 also can receive it, but only under the FDA’s emergency use authorization. \u003ca href=\"https://covid19.ca.gov/vaccination-progress-data/#age-ethnicity\">About two-thirds\u003c/a> of 12- to 17-year-olds in California have been vaccinated, but the numbers are much lower for kids 5 to 11, with only about one-third vaccinated.\u003c/p>\n\u003cp>Citing the low COVID vaccination rate among younger children, Pan said a mandate is not a priority until the state can make the vaccine more accessible. He said that in his experience, as a pediatrician, when parents ask about vaccinations they want to see their child’s doctor. But many doctor’s offices don’t offer the COVID vaccine and have instead been referring families to drug stores or vaccination sites that are often not child-centric.\u003c/p>\n\u003cp>“The challenge is that we are not getting vaccines into essentially the places where people normally get vaccines for their children,” he said, referring to pediatricians’ offices. “We still have a long way to go.”\u003c/p>\n\u003cp>A \u003ca href=\"https://escholarship.org/uc/item/0669t7s7\">Berkeley IGS poll released in late February\u003c/a> found that two-thirds of California voters supported requiring the COVID-19 vaccine for K-12 students. But there is a big split along party lines: Democrats and liberals overwhelmingly support a mandate while only about a quarter of conservatives and Republicans do.\u003c/p>\n\u003cp>Among parents, two-thirds said they felt having their kids vaccinated was essential or important, while 26% percent said it was “either not too or not at all important.” This question did not address the mandate.\u003c/p>\n\u003cp>Pan’s legislation was the second of the working group’s bills to be sidelined by its original author. A proposal to require all people who work, including contractors, to be vaccinated also was pulled.\u003c/p>\n\u003cp>Critics have been pushing back, arguing that the bills are burdensome and infringe on health and privacy rights — and no bill was more controversial than Pan’s. Many parents who opposed it said that parents should get to choose whether to vaccinate their children, especially when the vaccine does not fully prevent transmission and it’s still unclear how long it remains effective against the virus.\u003c/p>\n\u003cp>“We did not feel it was the appropriate policy for children with respect to COVID-19 at this time,” said Christina Hildebrand, head of A Voice for Choice. The group advocates for parental choice and has worked since 2015 to keep personal belief exemptions for various vaccines in place. She points to the low rate of COVID vaccination among 5- to 11-year-olds as a reason to hold off on a mandate.\u003c/p>\n\u003cp>“Those parents have had ample opportunity to get their children vaccinated, but the parents are hesitant,” she said.\u003c/p>\n\u003cp>Pan said it’s difficult to require something that two-thirds of young children have yet to receive. “Mandates are good at getting you to that final bit when we are at 80% and have to get to 90, not when you are below half,” he said. “If you are that far behind, there’s a reason. Some of it is people have questions and want to get them answered, and they want to hear from the person they have been going to for a long time to get vaccinated.”\u003c/p>\n\u003cp>Pan, though, said his bill is certainly not dead. He intends to watch vaccination rates and said it could be something he brings back later.\u003c/p>\n\u003cp>Madrid, the GOP consultant, said the bills signal the possibility of future vaccine mandates as the world becomes more globalized and pandemics happen more frequently.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“There is an appetite to have more protection for public health and not less,” he said. “You give it a year and study how you can make it work if you are going to pass legislation this broad and sweeping. You have to make sure you get it right the first time.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>In his multiple attempts to overcome a methamphetamine addiction that ground through two decades of his life, Tyrone Clifford Jr. remembers well the closest he came. “The most success I had,” he said, “is when my dealer was in jail.”\u003c/p>\n\u003cp>Then, Clifford walked into a rehab clinic in San Francisco called PROP, the Positive Reinforcement Opportunity Project. There, he encountered an approach so simple he sounds slightly bemused explaining it. The secret? The program paid him to show up and stay clean.\u003c/p>\n\u003cp>“It wasn’t much money — very little, in fact, and I didn’t really need it,” said Clifford, 52. “But I did need the support. I did need the connection. I was doing something positive for the first time in a long, long time, and it changed my outlook.”\u003c/p>\n\u003cp>The concept of a reward for sobriety — known as contingency management — lies at the heart of many an addiction therapy success story. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3083448/#ref1\">Research\u003c/a> showing it’s a highly effective tool for managing substance use disorder, especially for stimulants, goes back decades.\u003c/p>\n\u003cp>[aside tag=\"methamphetamine\" label=\"Related Stories\"]\u003c/p>\n\u003cp>The Department of Veterans Affairs has \u003ca href=\"https://blogs.va.gov/VAntage/64870/how-va-uses-contingency-management-help-veterans-stay-drug-free/\">long employed\u003c/a> the therapy, providing it to more than 5,600 veterans. Some 92% of the 72,000 urine samples collected during treatment tested negative for the targeted drug, said Dominick DePhilippis, a clinical psychologist and researcher who helped launch the VA’s program in 2011.\u003c/p>\n\u003cp>But outside of the VA? “It is used almost zero,” said Richard Rawson, a professor emeritus at UCLA who has researched the therapy for \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/7931857/\">nearly 30 years\u003c/a>. Providers worry that by paying patients they’ll violate \u003ca href=\"https://www.healthaffairs.org/do/10.1377/hblog20200305.965186/full/\">anti-kickback regulations\u003c/a> and thus jeopardize their federal funding through Medicaid.\u003c/p>\n\u003cp>But California appears poised to challenge the regulations. On June 1, the state Senate \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB110\">unanimously passed\u003c/a> Senate Bill 110, introduced by state Sen. Scott Wiener, D-San Francisco, which declares contingency management (CM) a legal practice and authorizes its funding by adding it to the list of drug treatment services offered through Medi-Cal, the state’s version of Medicaid. The price tag for the bill depends on how many patients use the therapy, but it would cost only about $179,000 a year to include the approach in treatment for 1,000 people trying to kick stimulant use, according to a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=202120220SB110\">financial analysis\u003c/a>.\u003c/p>\n\u003cp>California’s latest budget, passed by the state Legislature in late June but subject to continuing modifications, may ultimately include money for a CM pilot program for next year. Wiener’s standalone bill would provide permanent funding — if, that is, Medi-Cal can get federal signoff on the practice.\u003c/p>\n\u003cp>The federal anti-kickback statute prohibits offering an inducement to a patient to choose a specific program or type of treatment. The Department of Health and Human Services’ Office of the Inspector General has to this point agreed with the Centers for Medicare & Medicaid Services that a violation would occur at any monetary incentive beyond $75 a year, which contingency management experts say isn’t enough to get results.\u003c/p>\n\u003cp>More than a dozen organizations have written to the Department of Health and Human Services to ask for a waiver of the anti-kickback statute as it pertains to the therapy. A group led by Dr. Westley Clark, former director of the federal Center for Substance Abuse Treatment, is asking Congress to instruct HHS to allow the treatment in Medicaid programs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In response to questions from Kaiser Health News, a spokesman for the HHS Office of the Inspector General declined to comment on specific “waivers in development,” but said the OIG “recognizes that contingency management interventions are the most effective currently available treatment for stimulant use disorders.” Any CM program put in place would be evaluated on a case-by-case basis, he said, and going over the $75 annual limit “does not mean that such incentive automatically violates the statute and is illegal.”\u003c/p>\n\u003cp>The VA can ignore the OIG’s interpretation of the rule because the department’s budget covers all its costs. “VA is in many ways the ideal setting for [the therapy’s] implementation,” said DePhilippis. “We’re not subject to the funding concerns that I hear expressed by my colleagues in programs outside of the VA.”\u003c/p>\n\u003cp>As the name implies, patients in a CM program are rewarded on a contingency basis for modifying their behavior — specifically, by not missing recovery meetings or failing a drug test. While the approach can be employed to treat any type of substance addiction, it’s been especially useful for stimulants like meth and cocaine, for which there is no well-established addiction-combating medication, such as methadone for an addiction to opioids.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Tyrone Clifford Jr., 52, attended the Positive Reinforcement Opportunity Project (PROP) clinic in San Francisco\"]‘It wasn’t much money — very little, in fact, and I didn’t really need it. But I did need the support. I did need the connection. I was doing something positive for the first time in a long, long time, and it changed my outlook.’[/pullquote]\u003c/p>\n\u003cp>Patients at VA recovery sessions draw from a plastic fishbowl that holds 500 slips of paper. Half of those slips contain positive messages: “Good job.” “Way to go.” Another 209 slips are worth $1, while 40 are worth $20 and one “jumbo” prize of $100 lurks in every bowl. As patients continue to stay clean, the number of slips they get to draw increases, to a maximum of eight. If they skip meetings or test positive, they go back to drawing a single slip. The money is paid in the form of vouchers that can be used through the VA’s canteen system to buy food and other items, but not alcohol or tobacco.\u003c/p>\n\u003cp>In other programs that employ the approach, including the one Tyrone Clifford Jr. found in San Francisco in 2011, patients receive gift cards worth $300 to $400 over 12 weeks in exchange for regularly attending meetings and producing clean tests. Most of the incentive programs are designed to end after three months, on the theory that patients have used the time to regularly attend counseling and therapy sessions and kick-start their recoveries.\u003c/p>\n\u003cp>That is what happened to Clifford, who fell into meth use after learning he was HIV-positive at age 21. He and his partner (now husband) soon moved from Georgia to San Francisco, where his use spiraled out of control until he was advised to visit PROP, administered through the San Francisco AIDS Foundation.\u003c/p>\n\u003cp>“The money wasn’t the main thing for me — but it is for some of the guys who come in here,” Clifford said. “They may need that small amount to keep a cellphone bill paid. They may need that for a doctor. I hear people say, ‘Why should we pay a drug user to stop using drugs?’ My answer is that it works. You keep coming in, week after week, and pretty soon you’re back on your feet.”\u003c/p>\n\u003cp>Some critics have moral qualms about paying a patient for good behavior, and therapists are sometimes wary of the approach. But effective approaches are needed. In San Francisco, the meth overdose death rate \u003ca href=\"https://www.sfdph.org/dph/comupg/knowlcol/MethTaskForce/default.asp\">has increased more than 500%\u003c/a> since 2008, and half of all psychiatric emergency room admissions at San Francisco General Hospital are now meth-related.\u003c/p>\n\u003cp>“As a gay man in San Francisco, my community has been deeply affected by meth use,” Wiener said. Meth use \u003ca href=\"https://thehill.com/policy/healthcare/public-global-health/515530-meth-use-rose-across-us-during-pandemics-early-days\">spiked 20% nationally\u003c/a> among those tested in the early months of the pandemic.\u003c/p>\n\u003cp>Those who’ve seen the approach used successfully in treating meth addiction are befuddled by its unavailability, especially now that states \u003ca href=\"https://www.nga.org/center/publications/covid-19-vaccine-incentives/\">offer everything\u003c/a> from marijuana to Yankees tickets to persuade people to get vaccinated against COVID-19.\u003c/p>\n\u003cp>Still, Rawson said he doubts California’s bill can override the HHS restrictions as currently written. Wiener, on the other hand, doesn’t believe the use of therapy was ever in violation of anti-kickback statutes.\u003c/p>\n\u003cp>Clifford simply knows it works.\u003c/p>\n\u003cp>“I see it now from the other side,” said Clifford, who is 10 years sober and now counsels those trying to kick meth addiction through the San Francisco AIDS Foundation. “Guys keep coming back. You can see it building every week.”\u003c/p>\n\u003cp>\u003cem>Update: A response from the HHS Office of the Inspector General has been added to this story.\u003c/em>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"https://californiahealthline.org/news/article/california-lawmakers-push-feds-to-allow-a-therapy-that-pays-meth-users-to-abstain/\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"https://californiahealthline.org/news/article/california-lawmakers-push-feds-to-allow-a-therapy-that-pays-meth-users-to-abstain/\">California Healthline\u003c/a>, an editorially independent service of the California Health Care Foundation.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In his multiple attempts to overcome a methamphetamine addiction that ground through two decades of his life, Tyrone Clifford Jr. remembers well the closest he came. “The most success I had,” he said, “is when my dealer was in jail.”\u003c/p>\n\u003cp>Then, Clifford walked into a rehab clinic in San Francisco called PROP, the Positive Reinforcement Opportunity Project. There, he encountered an approach so simple he sounds slightly bemused explaining it. The secret? The program paid him to show up and stay clean.\u003c/p>\n\u003cp>“It wasn’t much money — very little, in fact, and I didn’t really need it,” said Clifford, 52. “But I did need the support. I did need the connection. I was doing something positive for the first time in a long, long time, and it changed my outlook.”\u003c/p>\n\u003cp>The concept of a reward for sobriety — known as contingency management — lies at the heart of many an addiction therapy success story. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3083448/#ref1\">Research\u003c/a> showing it’s a highly effective tool for managing substance use disorder, especially for stimulants, goes back decades.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The Department of Veterans Affairs has \u003ca href=\"https://blogs.va.gov/VAntage/64870/how-va-uses-contingency-management-help-veterans-stay-drug-free/\">long employed\u003c/a> the therapy, providing it to more than 5,600 veterans. Some 92% of the 72,000 urine samples collected during treatment tested negative for the targeted drug, said Dominick DePhilippis, a clinical psychologist and researcher who helped launch the VA’s program in 2011.\u003c/p>\n\u003cp>But outside of the VA? “It is used almost zero,” said Richard Rawson, a professor emeritus at UCLA who has researched the therapy for \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/7931857/\">nearly 30 years\u003c/a>. Providers worry that by paying patients they’ll violate \u003ca href=\"https://www.healthaffairs.org/do/10.1377/hblog20200305.965186/full/\">anti-kickback regulations\u003c/a> and thus jeopardize their federal funding through Medicaid.\u003c/p>\n\u003cp>But California appears poised to challenge the regulations. On June 1, the state Senate \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB110\">unanimously passed\u003c/a> Senate Bill 110, introduced by state Sen. Scott Wiener, D-San Francisco, which declares contingency management (CM) a legal practice and authorizes its funding by adding it to the list of drug treatment services offered through Medi-Cal, the state’s version of Medicaid. The price tag for the bill depends on how many patients use the therapy, but it would cost only about $179,000 a year to include the approach in treatment for 1,000 people trying to kick stimulant use, according to a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=202120220SB110\">financial analysis\u003c/a>.\u003c/p>\n\u003cp>California’s latest budget, passed by the state Legislature in late June but subject to continuing modifications, may ultimately include money for a CM pilot program for next year. Wiener’s standalone bill would provide permanent funding — if, that is, Medi-Cal can get federal signoff on the practice.\u003c/p>\n\u003cp>The federal anti-kickback statute prohibits offering an inducement to a patient to choose a specific program or type of treatment. The Department of Health and Human Services’ Office of the Inspector General has to this point agreed with the Centers for Medicare & Medicaid Services that a violation would occur at any monetary incentive beyond $75 a year, which contingency management experts say isn’t enough to get results.\u003c/p>\n\u003cp>More than a dozen organizations have written to the Department of Health and Human Services to ask for a waiver of the anti-kickback statute as it pertains to the therapy. A group led by Dr. Westley Clark, former director of the federal Center for Substance Abuse Treatment, is asking Congress to instruct HHS to allow the treatment in Medicaid programs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In response to questions from Kaiser Health News, a spokesman for the HHS Office of the Inspector General declined to comment on specific “waivers in development,” but said the OIG “recognizes that contingency management interventions are the most effective currently available treatment for stimulant use disorders.” Any CM program put in place would be evaluated on a case-by-case basis, he said, and going over the $75 annual limit “does not mean that such incentive automatically violates the statute and is illegal.”\u003c/p>\n\u003cp>The VA can ignore the OIG’s interpretation of the rule because the department’s budget covers all its costs. “VA is in many ways the ideal setting for [the therapy’s] implementation,” said DePhilippis. “We’re not subject to the funding concerns that I hear expressed by my colleagues in programs outside of the VA.”\u003c/p>\n\u003cp>As the name implies, patients in a CM program are rewarded on a contingency basis for modifying their behavior — specifically, by not missing recovery meetings or failing a drug test. While the approach can be employed to treat any type of substance addiction, it’s been especially useful for stimulants like meth and cocaine, for which there is no well-established addiction-combating medication, such as methadone for an addiction to opioids.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Patients at VA recovery sessions draw from a plastic fishbowl that holds 500 slips of paper. Half of those slips contain positive messages: “Good job.” “Way to go.” Another 209 slips are worth $1, while 40 are worth $20 and one “jumbo” prize of $100 lurks in every bowl. As patients continue to stay clean, the number of slips they get to draw increases, to a maximum of eight. If they skip meetings or test positive, they go back to drawing a single slip. The money is paid in the form of vouchers that can be used through the VA’s canteen system to buy food and other items, but not alcohol or tobacco.\u003c/p>\n\u003cp>In other programs that employ the approach, including the one Tyrone Clifford Jr. found in San Francisco in 2011, patients receive gift cards worth $300 to $400 over 12 weeks in exchange for regularly attending meetings and producing clean tests. Most of the incentive programs are designed to end after three months, on the theory that patients have used the time to regularly attend counseling and therapy sessions and kick-start their recoveries.\u003c/p>\n\u003cp>That is what happened to Clifford, who fell into meth use after learning he was HIV-positive at age 21. He and his partner (now husband) soon moved from Georgia to San Francisco, where his use spiraled out of control until he was advised to visit PROP, administered through the San Francisco AIDS Foundation.\u003c/p>\n\u003cp>“The money wasn’t the main thing for me — but it is for some of the guys who come in here,” Clifford said. “They may need that small amount to keep a cellphone bill paid. They may need that for a doctor. I hear people say, ‘Why should we pay a drug user to stop using drugs?’ My answer is that it works. You keep coming in, week after week, and pretty soon you’re back on your feet.”\u003c/p>\n\u003cp>Some critics have moral qualms about paying a patient for good behavior, and therapists are sometimes wary of the approach. But effective approaches are needed. In San Francisco, the meth overdose death rate \u003ca href=\"https://www.sfdph.org/dph/comupg/knowlcol/MethTaskForce/default.asp\">has increased more than 500%\u003c/a> since 2008, and half of all psychiatric emergency room admissions at San Francisco General Hospital are now meth-related.\u003c/p>\n\u003cp>“As a gay man in San Francisco, my community has been deeply affected by meth use,” Wiener said. Meth use \u003ca href=\"https://thehill.com/policy/healthcare/public-global-health/515530-meth-use-rose-across-us-during-pandemics-early-days\">spiked 20% nationally\u003c/a> among those tested in the early months of the pandemic.\u003c/p>\n\u003cp>Those who’ve seen the approach used successfully in treating meth addiction are befuddled by its unavailability, especially now that states \u003ca href=\"https://www.nga.org/center/publications/covid-19-vaccine-incentives/\">offer everything\u003c/a> from marijuana to Yankees tickets to persuade people to get vaccinated against COVID-19.\u003c/p>\n\u003cp>Still, Rawson said he doubts California’s bill can override the HHS restrictions as currently written. Wiener, on the other hand, doesn’t believe the use of therapy was ever in violation of anti-kickback statutes.\u003c/p>\n\u003cp>Clifford simply knows it works.\u003c/p>\n\u003cp>“I see it now from the other side,” said Clifford, who is 10 years sober and now counsels those trying to kick meth addiction through the San Francisco AIDS Foundation. “Guys keep coming back. You can see it building every week.”\u003c/p>\n\u003cp>\u003cem>Update: A response from the HHS Office of the Inspector General has been added to this story.\u003c/em>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"https://californiahealthline.org/news/article/california-lawmakers-push-feds-to-allow-a-therapy-that-pays-meth-users-to-abstain/\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"https://californiahealthline.org/news/article/california-lawmakers-push-feds-to-allow-a-therapy-that-pays-meth-users-to-abstain/\">California Healthline\u003c/a>, an editorially independent service of the California Health Care Foundation.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Trump Administration Proposal Would Undo Health Care Protections for LGBTQ Patients",
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"content": "\u003cp>A new Trump administration proposal would change the civil rights rules dictating whether providers must care for patients who are transgender or have had an abortion. Supporters of the approach say it protects the freedom of conscience, but opponents say it encourages discrimination.\u003c/p>\n\u003cp>The sweeping proposal has implications for all Americans, though, because the Department of Health and Human Services seeks to change how far civil rights protections extend and how those protections are enforced.\u003c/p>\n\u003cp>[aside label=\"The Trump Administration Rule\" postID=\"news_11749672,news_11752360\"]\u003c/p>\n\u003cp>Roger Severino, the director of the HHS Office for Civil Rights, has been candid about his intentions to overturn an Obama-era rule that prohibited discrimination based on gender identity and termination of a pregnancy. In 2016, while at the conservative Heritage Foundation, he \u003ca href=\"https://www.heritage.org/health-care-reform/report/proposed-obamacare-gender-identity-mandate-threatens-freedom-conscience\">co-authored a paper\u003c/a> arguing the restrictions threaten the independence of physicians to follow their religious or moral beliefs.\u003c/p>\n\u003cp>His office unveiled the \u003ca href=\"https://www.hhs.gov/about/news/2019/05/24/hhs-proposes-to-revise-aca-section-1557-rule.html\">proposed rule\u003c/a> on May 24, when many people were focused on the start of the long Memorial Day holiday weekend.\u003c/p>\n\u003cp>It's the latest Trump administration proposal to strip protections for transgender Americans, coming the same week another \u003ca href=\"https://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201904&RIN=2506-AC53\">directive\u003c/a> was proposed by the Department of Housing and Urban Development that would allow homeless shelters to turn away people based on their gender identity.\u003c/p>\n\u003cp>California has the second-highest percentage of transgender adults of any state, after Hawaii, according to \u003ca href=\"https://williamsinstitute.law.ucla.edu/wp-content/uploads/How-Many-Adults-Identify-as-Transgender-in-the-United-States.pdf\">a 2016 report\u003c/a> from the Williams Institute on Sexual Orientation and Gender Identity Law and Public Policy at UCLA’s law school.\u003c/p>\n\u003cp>The public was given 60 days to comment on the HHS proposal. Here's a rundown of what you need to know about it.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003ch3>What would this proposal do?\u003c/h3>\n\u003cp>Fundamentally, the proposed rule would overturn a \u003ca href=\"https://khn.org/news/hhs-unveils-civil-rights-protections-for-transgender-patients-health-services/\">previous rule\u003c/a> that forbids health care providers who receive federal funding from discriminating against patients on the basis of their gender identity or whether they have terminated a pregnancy.\u003c/p>\n\u003cp>The Trump administration proposal would eliminate those protections, enabling providers to deny these groups care or insurance coverage without having to pay a fine or suffer other federal consequences.\u003c/p>\n\u003cp>[pullquote citation=\"Jocelyn Samuels\"]\"The administration should be in the business of expanding access to health care and health coverage. And my fear is that this rule does just the opposite.\"[/pullquote]That may mean refusing a transgender patient mental health care or gender-confirming surgery. But it may also mean denying patients care that has nothing to do with gender identity, such as a regular office visit for a bad cold or ongoing treatment for chronic conditions like diabetes.\u003c/p>\n\u003cp>\"What it does, from a very practical point of view, is that it empowers bad actors to be bad actors,\" Mara Keisling, executive director of the National Center for Transgender Equality, told reporters.\u003c/p>\n\u003cp>The proposal would also eliminate protections based on sexual orientation and gender identity from several other health care regulations, like non-discrimination guidelines for the health care insurance marketplaces.\u003c/p>\n\u003ch3>Does it affect only LGBTQ people?\u003c/h3>\n\u003cp>The proposal goes beyond removing protections for the LGBTQ community and those who have had an abortion.\u003c/p>\n\u003cp>It appears to weaken other protections, such as those based on race or age, by limiting who must abide by the rules. The Trump proposal would scrap the Obama-era rule's broad definition of which providers can be punished by federal health officials for discrimination, a complicated change critics have said could ease requirements for insurance companies, for instance, as well as the agency itself.\u003c/p>\n\u003cp>And the proposal erases many of the enforcement procedures outlined in the earlier rule, including its explicit ban on intimidation or retaliation. It also delegates to Severino, as the office's director, full enforcement authority when it comes to things like opening investigations into complaints lodged under the non-discrimination rule.\u003c/p>\n\u003ch3>Why did HHS decide to change the rule?\u003c/h3>\n\u003cp>The Obama and Trump administrations have \u003ca href=\"https://khn.org/news/transgender-health-care-targeted-in-crusade-to-undo-aca/\">different opinions\u003c/a> about whether a health care provider should be able to refuse service to patients because they are transgender or have had an abortion.\u003c/p>\n\u003cp>It all goes back to a section in the Affordable Care Act barring discrimination on the basis of race, color, national origin, age, disability or sex. President Barack Obama's health officials said it is discrimination to treat someone differently based on gender identity or stereotypes.\u003c/p>\n\u003cp>It was the first time Americans who are transgender were protected from discrimination in health care.\u003c/p>\n\u003cp>But President Trump's health officials said that definition of sex discrimination misinterprets civil rights laws, particularly a religious freedom law used to shield providers who object to performing certain procedures, such as abortions, or treating certain patients because they conflict with their religious convictions.\u003c/p>\n\u003cp>[aside postID=\"news_11713470\"]\"When Congress prohibited sex discrimination, it did so according to the plain meaning of the term, and we are making our regulations conform,\" Severino said in a statement. \"The American people want vigorous protection of civil rights and faithfulness to the text of the laws passed by their representatives.\"\u003c/p>\n\u003cp>Much of what the Office for Civil Rights has done under \u003ca href=\"https://khn.org/news/at-new-health-office-civil-rights-means-doctors-right-to-say-no-to-patients/\">Severino's leadership\u003c/a> is to emphasize and strengthen so-called conscience protections for health care providers, many of which existed well before Trump was sworn in. Last year, Severino unveiled a Conscience and Religious Freedom Division, and his office \u003ca href=\"https://www.hhs.gov/about/news/2019/05/02/hhs-announces-final-conscience-rule-protecting-health-care-entities-and-individuals.html\">recently finalized another rule\u003c/a> detailing those protections and their enforcement.\u003c/p>\n\u003cp>The office also said the proposed rule \u003ca href=\"https://www.hhs.gov/sites/default/files/1557-nprm-hhs.pdf\">would save about $3.6 billion over five years\u003c/a>. Most of that would come from eliminating requirements for providers to post notices about discrimination, as well as other measures that cater to those with disabilities and limited English proficiency.\u003c/p>\n\u003cp>The rule would also save providers money that might instead be spent handling grievances from those no longer protected.\u003c/p>\n\u003cp>The office \"considers this a benefit of the rule,\" \u003ca href=\"https://www.healthaffairs.org/do/10.1377/hblog20190525.831858/full/\">said\u003c/a> Katie Keith, co-founder of Out2Enroll, an organization that helps the LGBTQ community obtain health insurance. \"Organizations will have lower labor costs and lower litigation costs because they will no longer have to process grievances or defend against lawsuits brought by transgender people.\"\u003c/p>\n\u003ch3>Why does this matter?\u003c/h3>\n\u003cp>\u003ca href=\"https://www.kff.org/report-section/health-and-access-to-care-and-coverage-lgbt-individuals-in-the-us-health-challenges/\">Research shows\u003c/a> the LGBTQ community faces greater health challenges and higher rates of illness than other groups, making access to equitable treatment in health care all the more important.\u003c/p>\n\u003cp>[aside label=\"Discrimination in Health Care\" link1=\"https://www.npr.org/sections/health-shots/2018/03/21/594030154/forum-how-discrimination-damages-health-in-lgbtq-communities,How Discrimination Damages Health In LGBTQ Communities\" link2=\"https://www.npr.org/sections/health-shots/2019/01/20/683216767/medical-students-push-for-more-lgbt-health-training-to-address-disparities,Medical Students Push For More LGBT Health Training To Address Disparities\"]Discrimination, from the misuse of pronouns to denials of care, is \"commonplace\" for transgender patients, according to a \u003ca href=\"https://www.transequality.org/sites/default/files/docs/resources/NTDS_Report.pdf\">2011 report\u003c/a> by advocacy groups. The report found that 28% of the 6,450 transgender and gender non-conforming people interviewed said they had experienced verbal harassment in a health care setting, while 19% said they had been refused care due to their gender identity.\u003c/p>\n\u003cp>The report said 28% had postponed seeking medical attention when they were sick or injured because of discrimination.\u003c/p>\n\u003cp>Critics fear the rule would muddy the waters, giving patients less clarity on what is and is not permissible and how to get help when they have been the victims of discrimination.\u003c/p>\n\u003cp>Jocelyn Samuels, the Obama administration official who oversaw the implementation of the Obama-era rule, said that for now, even though the Trump administration's HHS will not pursue complaints against those providers, Americans still have the right to challenge this treatment in court. Multiple courts have said the prohibition on sex discrimination includes gender identity.\u003c/p>\n\u003cp>\"The administration should be in the business of expanding access to health care and health coverage,\" Samuels told reporters on a conference call after the rule's release. \"And my fear is that this rule does just the opposite.\"\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"https://www.kff.org/\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A new Trump administration proposal would change the civil rights rules dictating whether providers must care for patients who are transgender or have had an abortion. Supporters of the approach say it protects the freedom of conscience, but opponents say it encourages discrimination.\u003c/p>\n\u003cp>The sweeping proposal has implications for all Americans, though, because the Department of Health and Human Services seeks to change how far civil rights protections extend and how those protections are enforced.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Roger Severino, the director of the HHS Office for Civil Rights, has been candid about his intentions to overturn an Obama-era rule that prohibited discrimination based on gender identity and termination of a pregnancy. In 2016, while at the conservative Heritage Foundation, he \u003ca href=\"https://www.heritage.org/health-care-reform/report/proposed-obamacare-gender-identity-mandate-threatens-freedom-conscience\">co-authored a paper\u003c/a> arguing the restrictions threaten the independence of physicians to follow their religious or moral beliefs.\u003c/p>\n\u003cp>His office unveiled the \u003ca href=\"https://www.hhs.gov/about/news/2019/05/24/hhs-proposes-to-revise-aca-section-1557-rule.html\">proposed rule\u003c/a> on May 24, when many people were focused on the start of the long Memorial Day holiday weekend.\u003c/p>\n\u003cp>It's the latest Trump administration proposal to strip protections for transgender Americans, coming the same week another \u003ca href=\"https://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201904&RIN=2506-AC53\">directive\u003c/a> was proposed by the Department of Housing and Urban Development that would allow homeless shelters to turn away people based on their gender identity.\u003c/p>\n\u003cp>California has the second-highest percentage of transgender adults of any state, after Hawaii, according to \u003ca href=\"https://williamsinstitute.law.ucla.edu/wp-content/uploads/How-Many-Adults-Identify-as-Transgender-in-the-United-States.pdf\">a 2016 report\u003c/a> from the Williams Institute on Sexual Orientation and Gender Identity Law and Public Policy at UCLA’s law school.\u003c/p>\n\u003cp>The public was given 60 days to comment on the HHS proposal. Here's a rundown of what you need to know about it.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003ch3>What would this proposal do?\u003c/h3>\n\u003cp>Fundamentally, the proposed rule would overturn a \u003ca href=\"https://khn.org/news/hhs-unveils-civil-rights-protections-for-transgender-patients-health-services/\">previous rule\u003c/a> that forbids health care providers who receive federal funding from discriminating against patients on the basis of their gender identity or whether they have terminated a pregnancy.\u003c/p>\n\u003cp>The Trump administration proposal would eliminate those protections, enabling providers to deny these groups care or insurance coverage without having to pay a fine or suffer other federal consequences.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>That may mean refusing a transgender patient mental health care or gender-confirming surgery. But it may also mean denying patients care that has nothing to do with gender identity, such as a regular office visit for a bad cold or ongoing treatment for chronic conditions like diabetes.\u003c/p>\n\u003cp>\"What it does, from a very practical point of view, is that it empowers bad actors to be bad actors,\" Mara Keisling, executive director of the National Center for Transgender Equality, told reporters.\u003c/p>\n\u003cp>The proposal would also eliminate protections based on sexual orientation and gender identity from several other health care regulations, like non-discrimination guidelines for the health care insurance marketplaces.\u003c/p>\n\u003ch3>Does it affect only LGBTQ people?\u003c/h3>\n\u003cp>The proposal goes beyond removing protections for the LGBTQ community and those who have had an abortion.\u003c/p>\n\u003cp>It appears to weaken other protections, such as those based on race or age, by limiting who must abide by the rules. The Trump proposal would scrap the Obama-era rule's broad definition of which providers can be punished by federal health officials for discrimination, a complicated change critics have said could ease requirements for insurance companies, for instance, as well as the agency itself.\u003c/p>\n\u003cp>And the proposal erases many of the enforcement procedures outlined in the earlier rule, including its explicit ban on intimidation or retaliation. It also delegates to Severino, as the office's director, full enforcement authority when it comes to things like opening investigations into complaints lodged under the non-discrimination rule.\u003c/p>\n\u003ch3>Why did HHS decide to change the rule?\u003c/h3>\n\u003cp>The Obama and Trump administrations have \u003ca href=\"https://khn.org/news/transgender-health-care-targeted-in-crusade-to-undo-aca/\">different opinions\u003c/a> about whether a health care provider should be able to refuse service to patients because they are transgender or have had an abortion.\u003c/p>\n\u003cp>It all goes back to a section in the Affordable Care Act barring discrimination on the basis of race, color, national origin, age, disability or sex. President Barack Obama's health officials said it is discrimination to treat someone differently based on gender identity or stereotypes.\u003c/p>\n\u003cp>It was the first time Americans who are transgender were protected from discrimination in health care.\u003c/p>\n\u003cp>But President Trump's health officials said that definition of sex discrimination misinterprets civil rights laws, particularly a religious freedom law used to shield providers who object to performing certain procedures, such as abortions, or treating certain patients because they conflict with their religious convictions.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\"When Congress prohibited sex discrimination, it did so according to the plain meaning of the term, and we are making our regulations conform,\" Severino said in a statement. \"The American people want vigorous protection of civil rights and faithfulness to the text of the laws passed by their representatives.\"\u003c/p>\n\u003cp>Much of what the Office for Civil Rights has done under \u003ca href=\"https://khn.org/news/at-new-health-office-civil-rights-means-doctors-right-to-say-no-to-patients/\">Severino's leadership\u003c/a> is to emphasize and strengthen so-called conscience protections for health care providers, many of which existed well before Trump was sworn in. Last year, Severino unveiled a Conscience and Religious Freedom Division, and his office \u003ca href=\"https://www.hhs.gov/about/news/2019/05/02/hhs-announces-final-conscience-rule-protecting-health-care-entities-and-individuals.html\">recently finalized another rule\u003c/a> detailing those protections and their enforcement.\u003c/p>\n\u003cp>The office also said the proposed rule \u003ca href=\"https://www.hhs.gov/sites/default/files/1557-nprm-hhs.pdf\">would save about $3.6 billion over five years\u003c/a>. Most of that would come from eliminating requirements for providers to post notices about discrimination, as well as other measures that cater to those with disabilities and limited English proficiency.\u003c/p>\n\u003cp>The rule would also save providers money that might instead be spent handling grievances from those no longer protected.\u003c/p>\n\u003cp>The office \"considers this a benefit of the rule,\" \u003ca href=\"https://www.healthaffairs.org/do/10.1377/hblog20190525.831858/full/\">said\u003c/a> Katie Keith, co-founder of Out2Enroll, an organization that helps the LGBTQ community obtain health insurance. \"Organizations will have lower labor costs and lower litigation costs because they will no longer have to process grievances or defend against lawsuits brought by transgender people.\"\u003c/p>\n\u003ch3>Why does this matter?\u003c/h3>\n\u003cp>\u003ca href=\"https://www.kff.org/report-section/health-and-access-to-care-and-coverage-lgbt-individuals-in-the-us-health-challenges/\">Research shows\u003c/a> the LGBTQ community faces greater health challenges and higher rates of illness than other groups, making access to equitable treatment in health care all the more important.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"link1": "https://www.npr.org/sections/health-shots/2018/03/21/594030154/forum-how-discrimination-damages-health-in-lgbtq-communities,How Discrimination Damages Health In LGBTQ Communities",
"link2": "https://www.npr.org/sections/health-shots/2019/01/20/683216767/medical-students-push-for-more-lgbt-health-training-to-address-disparities,Medical Students Push For More LGBT Health Training To Address Disparities"
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"content": "\u003cdiv class=\"post-body\">\u003cp>Discrimination, from the misuse of pronouns to denials of care, is \"commonplace\" for transgender patients, according to a \u003ca href=\"https://www.transequality.org/sites/default/files/docs/resources/NTDS_Report.pdf\">2011 report\u003c/a> by advocacy groups. The report found that 28% of the 6,450 transgender and gender non-conforming people interviewed said they had experienced verbal harassment in a health care setting, while 19% said they had been refused care due to their gender identity.\u003c/p>\n\u003cp>The report said 28% had postponed seeking medical attention when they were sick or injured because of discrimination.\u003c/p>\n\u003cp>Critics fear the rule would muddy the waters, giving patients less clarity on what is and is not permissible and how to get help when they have been the victims of discrimination.\u003c/p>\n\u003cp>Jocelyn Samuels, the Obama administration official who oversaw the implementation of the Obama-era rule, said that for now, even though the Trump administration's HHS will not pursue complaints against those providers, Americans still have the right to challenge this treatment in court. Multiple courts have said the prohibition on sex discrimination includes gender identity.\u003c/p>\n\u003cp>\"The administration should be in the business of expanding access to health care and health coverage,\" Samuels told reporters on a conference call after the rule's release. \"And my fear is that this rule does just the opposite.\"\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"https://www.kff.org/\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Gregory Andrews, 60, sleeps in his Chevy Malibu just outside a health clinic on the west side of Los Angeles. In the morning, he lines up there for a free shower.\u003c/p>\n\u003cp>“Besides trying to find something healthy to eat, the next most important thing is to take a shower,” Andrews said. “It keeps your self-esteem up.”\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch4 style=\"text-align: center\">\u003ca href=\"https://www.kqed.org/news/series/sf-homeless-project\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"color: #000000\">Read More of KQED’s Coverage for the SF Homeless Project\u003c/span>\u003c/a>\u003c/h4>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/news/series/sf-homeless-project\" target=\"_blank\" rel=\"noopener\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2016/06/SFHomeless_long_Horizontal-02-e1467163328567.png\" alt=\"\">\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>Not many health clinics offer showers, but Saban Community Clinic, where Andrews goes, has been doing it for about three decades. The clinic serves an urgent need, given L.A. County’s growing homeless population, which is up almost 50 percent in the past six years to roughly 53,000, though it dipped slightly this year, according to the annual \u003ca href=\"https://www.lahsa.org/news?article=410-2018-homeless-count-results\">homeless count.\u003c/a>\u003c/p>\n\u003cp>About two dozen people line up at the Saban clinic each weekday morning, waiting for the showers. They come with backpacks, shopping carts and folded-up tents.\u003c/p>\n\u003cp>Clinic staff also help them find temporary lodging and get health insurance, as they did for Andrews.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“They just told me at the front desk, ‘Do you know you qualify for Medi-Cal?’ ” Andrews said. “I went upstairs, talked to one person, and within 30 days I had Medi-Cal.”\u003c/p>\n\u003cfigure id=\"attachment_11676515\" class=\"wp-caption alignnone\" style=\"max-width: 4608px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11676515\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/06/Shower2.jpg\" alt=\"\" width=\"4608\" height=\"2592\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower2.jpg 4608w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower2-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower2-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower2-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower2-1200x675.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower2-1920x1080.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower2-1180x664.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower2-960x540.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower2-240x135.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower2-375x211.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower2-520x293.jpg 520w\" sizes=\"auto, (max-width: 4608px) 100vw, 4608px\">\u003cfigcaption class=\"wp-caption-text\">Adam Henderson has been homeless for more than a decade. He uses the showers and has been cared for by the dentist at Saban Community Clinic but says he’s reluctant to see the doctor. His basketball injuries are nothing “ibuprofen can’t take care of,” he says. \u003ccite>(Anna Gorman/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cfigure id=\"attachment_11676528\" class=\"wp-caption alignnone\" style=\"max-width: 4608px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11676528\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/06/Shower1.jpg\" alt=\"\" width=\"4608\" height=\"2592\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower1.jpg 4608w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower1-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower1-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower1-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower1-1200x675.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower1-1920x1080.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower1-1180x664.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower1-960x540.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower1-240x135.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower1-375x211.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower1-520x293.jpg 520w\" sizes=\"auto, (max-width: 4608px) 100vw, 4608px\">\u003cfigcaption class=\"wp-caption-text\">Kevin Bloom packs up his tent after spending the night just outside the Saban Community Clinic in Los Angeles. Bloom takes showers at the clinic on weekday mornings and meets with doctors and mental health counselors there. \u003ccite>( Anna Gorman/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Saban’s free showers are a gateway to other services it offers homeless people, who sometimes resist seeking medical care, said Adam Friedman, the clinic’s chief marketing officer. About a third of the people who take showers at Saban also see doctors there. Some of the patients have untreated mental illnesses and chronic diseases. Others have injuries from living on the street.\u003c/p>\n\u003cp>“The whole goal is to build trust so … they will be open to seeing a therapist, going to the dentist, getting their medical needs taken care of,” Friedman said.\u003c/p>\n\u003cp>Adam Henderson, a 46-year-old who has been homeless for more than a decade, said finding a shower on this relatively affluent side of town wasn’t easy. It is easier to find one in downtown L.A. or other parts of the city, he said. “In other areas, like the beach, there’s not only a shelter shower but … also the showers on the sand.”\u003c/p>\n\u003cp>Henderson said he was glad to find the showers at Saban and to see the dentist upstairs. But he generally avoids the doctor. “I’m reluctant,” he said. “If I’m in pain I’ll go see the doctor, but normally the pains that I have are from basketball injuries so I know how to deal with those.”\u003c/p>\n\u003cp>Andrews, who stands over 6 feet tall and walks with a cane — started seeing the doctor and the dentist soon after going to Saban for a shower.\u003c/p>\n\u003cfigure id=\"attachment_11676523\" class=\"wp-caption alignnone\" style=\"max-width: 4608px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11676523\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/06/Shower7.jpg\" alt=\"\" width=\"4608\" height=\"2592\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower7.jpg 4608w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower7-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower7-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower7-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower7-1200x675.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower7-1920x1080.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower7-1180x664.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower7-960x540.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower7-240x135.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower7-375x211.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower7-520x293.jpg 520w\" sizes=\"auto, (max-width: 4608px) 100vw, 4608px\">\u003cfigcaption class=\"wp-caption-text\">Gregory Andrews takes showers at the clinic and has seen doctors and dentists there. The clinic also helped him get temporary shelter and health insurance. \u003ccite>(Anna Gorman/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Friedman said that with the growth of the homeless population, he expects even more people will need a place to shower. The clinic also offers showers at its Hollywood location three days a week.\u003c/p>\n\u003cp>Even for those who don’t seek medical care, showering itself has health benefits, such as keeping wounds clean and avoiding infections.\u003c/p>\n\u003cp>At precisely 7:30 a.m., the doors open. Caseworker Chenelle Groomes greets people by name and hands out towels and soap. If anyone needs socks or underwear, she has a closet filled with donations. Groomes keeps track of who is next with a sign-up sheet and a clipboard. And she helps schedule same-day medical appointments for those who want them.\u003c/p>\n\u003cfigure id=\"attachment_11676521\" class=\"wp-caption alignnone\" style=\"max-width: 4608px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11676521\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/06/Shower5.jpg\" alt=\"\" width=\"4608\" height=\"2592\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower5.jpg 4608w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower5-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower5-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower5-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower5-1200x675.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower5-1920x1080.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower5-1180x664.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower5-960x540.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower5-240x135.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower5-375x211.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower5-520x293.jpg 520w\" sizes=\"auto, (max-width: 4608px) 100vw, 4608px\">\u003cfigcaption class=\"wp-caption-text\">Staff at the clinic hand out towels to participants. Soap and shampoo are also available. \u003ccite>(Anna Gorman/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Some of the regulars said they take showers at the clinic because they don’t want to look homeless. Kevin Bloom, 30, said he wouldn’t know what to do without the showers. He sleeps in a tent near the front door of the Saban clinic, and he also sees doctors and mental health counselors there.\u003c/p>\n\u003cp>While they wait their turn in the shower, participants pass the time reading books or looking at their phones. A few close their eyes. Sometimes, arguments break out, and there’s rarely a dull moment for Groomes.\u003c/p>\n\u003cp>“We keep her busy,” Andrews said. “She keeps us out of trouble. Some of us.”\u003c/p>\n\u003cp>He said taking a shower is just a good way to start the day.\u003c/p>\n\u003cp>“A nice warm shower? Makes anybody feel good.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003c/em>\u003ca href=\"http://khn.org/\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem> (KHN), which publishes \u003c/em>\u003ca href=\"http://californiahealthline.org/\">\u003cem>California Healthline\u003c/em>\u003c/a>\u003cem>, an editorially independent service of the \u003c/em>\u003ca href=\"https://www.chcf.org/\">\u003cem>California Health Care Foundation\u003c/em>\u003c/a>\u003cem>. KHN is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Gregory Andrews, 60, sleeps in his Chevy Malibu just outside a health clinic on the west side of Los Angeles. In the morning, he lines up there for a free shower.\u003c/p>\n\u003cp>“Besides trying to find something healthy to eat, the next most important thing is to take a shower,” Andrews said. “It keeps your self-esteem up.”\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch4 style=\"text-align: center\">\u003ca href=\"https://www.kqed.org/news/series/sf-homeless-project\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"color: #000000\">Read More of KQED’s Coverage for the SF Homeless Project\u003c/span>\u003c/a>\u003c/h4>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/news/series/sf-homeless-project\" target=\"_blank\" rel=\"noopener\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2016/06/SFHomeless_long_Horizontal-02-e1467163328567.png\" alt=\"\">\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>Not many health clinics offer showers, but Saban Community Clinic, where Andrews goes, has been doing it for about three decades. The clinic serves an urgent need, given L.A. County’s growing homeless population, which is up almost 50 percent in the past six years to roughly 53,000, though it dipped slightly this year, according to the annual \u003ca href=\"https://www.lahsa.org/news?article=410-2018-homeless-count-results\">homeless count.\u003c/a>\u003c/p>\n\u003cp>About two dozen people line up at the Saban clinic each weekday morning, waiting for the showers. They come with backpacks, shopping carts and folded-up tents.\u003c/p>\n\u003cp>Clinic staff also help them find temporary lodging and get health insurance, as they did for Andrews.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“They just told me at the front desk, ‘Do you know you qualify for Medi-Cal?’ ” Andrews said. “I went upstairs, talked to one person, and within 30 days I had Medi-Cal.”\u003c/p>\n\u003cfigure id=\"attachment_11676515\" class=\"wp-caption alignnone\" style=\"max-width: 4608px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11676515\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/06/Shower2.jpg\" alt=\"\" width=\"4608\" height=\"2592\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower2.jpg 4608w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower2-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower2-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower2-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower2-1200x675.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower2-1920x1080.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower2-1180x664.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower2-960x540.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower2-240x135.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower2-375x211.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower2-520x293.jpg 520w\" sizes=\"auto, (max-width: 4608px) 100vw, 4608px\">\u003cfigcaption class=\"wp-caption-text\">Adam Henderson has been homeless for more than a decade. He uses the showers and has been cared for by the dentist at Saban Community Clinic but says he’s reluctant to see the doctor. His basketball injuries are nothing “ibuprofen can’t take care of,” he says. \u003ccite>(Anna Gorman/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cfigure id=\"attachment_11676528\" class=\"wp-caption alignnone\" style=\"max-width: 4608px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11676528\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/06/Shower1.jpg\" alt=\"\" width=\"4608\" height=\"2592\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower1.jpg 4608w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower1-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower1-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower1-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower1-1200x675.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower1-1920x1080.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower1-1180x664.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower1-960x540.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower1-240x135.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower1-375x211.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower1-520x293.jpg 520w\" sizes=\"auto, (max-width: 4608px) 100vw, 4608px\">\u003cfigcaption class=\"wp-caption-text\">Kevin Bloom packs up his tent after spending the night just outside the Saban Community Clinic in Los Angeles. Bloom takes showers at the clinic on weekday mornings and meets with doctors and mental health counselors there. \u003ccite>( Anna Gorman/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Saban’s free showers are a gateway to other services it offers homeless people, who sometimes resist seeking medical care, said Adam Friedman, the clinic’s chief marketing officer. About a third of the people who take showers at Saban also see doctors there. Some of the patients have untreated mental illnesses and chronic diseases. Others have injuries from living on the street.\u003c/p>\n\u003cp>“The whole goal is to build trust so … they will be open to seeing a therapist, going to the dentist, getting their medical needs taken care of,” Friedman said.\u003c/p>\n\u003cp>Adam Henderson, a 46-year-old who has been homeless for more than a decade, said finding a shower on this relatively affluent side of town wasn’t easy. It is easier to find one in downtown L.A. or other parts of the city, he said. “In other areas, like the beach, there’s not only a shelter shower but … also the showers on the sand.”\u003c/p>\n\u003cp>Henderson said he was glad to find the showers at Saban and to see the dentist upstairs. But he generally avoids the doctor. “I’m reluctant,” he said. “If I’m in pain I’ll go see the doctor, but normally the pains that I have are from basketball injuries so I know how to deal with those.”\u003c/p>\n\u003cp>Andrews, who stands over 6 feet tall and walks with a cane — started seeing the doctor and the dentist soon after going to Saban for a shower.\u003c/p>\n\u003cfigure id=\"attachment_11676523\" class=\"wp-caption alignnone\" style=\"max-width: 4608px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11676523\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/06/Shower7.jpg\" alt=\"\" width=\"4608\" height=\"2592\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower7.jpg 4608w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower7-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower7-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower7-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower7-1200x675.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower7-1920x1080.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower7-1180x664.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower7-960x540.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower7-240x135.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower7-375x211.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower7-520x293.jpg 520w\" sizes=\"auto, (max-width: 4608px) 100vw, 4608px\">\u003cfigcaption class=\"wp-caption-text\">Gregory Andrews takes showers at the clinic and has seen doctors and dentists there. The clinic also helped him get temporary shelter and health insurance. \u003ccite>(Anna Gorman/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Friedman said that with the growth of the homeless population, he expects even more people will need a place to shower. The clinic also offers showers at its Hollywood location three days a week.\u003c/p>\n\u003cp>Even for those who don’t seek medical care, showering itself has health benefits, such as keeping wounds clean and avoiding infections.\u003c/p>\n\u003cp>At precisely 7:30 a.m., the doors open. Caseworker Chenelle Groomes greets people by name and hands out towels and soap. If anyone needs socks or underwear, she has a closet filled with donations. Groomes keeps track of who is next with a sign-up sheet and a clipboard. And she helps schedule same-day medical appointments for those who want them.\u003c/p>\n\u003cfigure id=\"attachment_11676521\" class=\"wp-caption alignnone\" style=\"max-width: 4608px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11676521\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/06/Shower5.jpg\" alt=\"\" width=\"4608\" height=\"2592\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower5.jpg 4608w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower5-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower5-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower5-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower5-1200x675.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower5-1920x1080.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower5-1180x664.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower5-960x540.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower5-240x135.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower5-375x211.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/06/Shower5-520x293.jpg 520w\" sizes=\"auto, (max-width: 4608px) 100vw, 4608px\">\u003cfigcaption class=\"wp-caption-text\">Staff at the clinic hand out towels to participants. Soap and shampoo are also available. \u003ccite>(Anna Gorman/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Some of the regulars said they take showers at the clinic because they don’t want to look homeless. Kevin Bloom, 30, said he wouldn’t know what to do without the showers. He sleeps in a tent near the front door of the Saban clinic, and he also sees doctors and mental health counselors there.\u003c/p>\n\u003cp>While they wait their turn in the shower, participants pass the time reading books or looking at their phones. A few close their eyes. Sometimes, arguments break out, and there’s rarely a dull moment for Groomes.\u003c/p>\n\u003cp>“We keep her busy,” Andrews said. “She keeps us out of trouble. Some of us.”\u003c/p>\n\u003cp>He said taking a shower is just a good way to start the day.\u003c/p>\n\u003cp>“A nice warm shower? Makes anybody feel good.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003c/em>\u003ca href=\"http://khn.org/\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem> (KHN), which publishes \u003c/em>\u003ca href=\"http://californiahealthline.org/\">\u003cem>California Healthline\u003c/em>\u003c/a>\u003cem>, an editorially independent service of the \u003c/em>\u003ca href=\"https://www.chcf.org/\">\u003cem>California Health Care Foundation\u003c/em>\u003c/a>\u003cem>. KHN is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
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"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
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"onourwatch": {
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"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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"pbs-newshour": {
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},
"perspectives": {
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"order": 14
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
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"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
"link": "/radio/program/possible",
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
"pri-the-world": {
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"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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},
"reveal": {
"id": "reveal",
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"link": "/voterguide",
"imageURL": "https://cdn.kqed.org/wp-content/uploads/2026/10/Nav-News-Nov2026ElectionCoverage@2x-7bd4aad4.png",
"description": "Get informed in minutes with our Voter Guide for California’s November 3 election."
},
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"video-tv": {},
"events": {},
"support": {}
}
}
}