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"content": "\u003cp>\u003cem>Updated at 2:32 p.m. ET Thursday\u003c/em>\u003c/p>\n\u003cp>Senate Republicans unveiled \u003ca href=\"https://www.documentcloud.org/documents/3872487-SenateHCBill.html\" target=\"_blank\" rel=\"noopener noreferrer\">their long-awaited health care overhaul proposal\u003c/a> on Thursday. The Senate bill, called the \"Better Care Reconciliation Act,\" would repeal major parts of the Affordable Care Act, also known as Obamacare. The broad outlines of it look a lot like the House bill, the American Health Care Act, which was passed in May.\u003c/p>\n\u003cp>In a lot of ways, the Senate's bill looks like the House bill: It rolls back the ACA's Medicaid expansion — making for deep spending cuts to that program, compared to current law. The Senate bill also proposes eliminating many ACA taxes, and the employer penalties associated with the employer and individual mandates would be repealed retroactively, dating back to the start of 2016. And like the House bill, young adults up to the age of 26 could stay on their parents' health care plans.\u003c/p>\n\u003cp>Larry Levitt, a health policy expert at the Kaiser Family Foundation, \u003ca href=\"https://twitter.com/larry_levitt/status/877910700315729920\" target=\"_blank\" rel=\"noopener noreferrer\">summed up his thoughts on the bill\u003c/a> on Twitter on Thursday: \"In broad strokes, the Senate bill is just like the House: Big tax cuts, big cut in federal heath spending, big increase in the uninsured.\"\u003c/p>\n\u003cp>As with the House bill, the Senate proposal also allows insurance companies to charge older people five times more than younger people — under the ACA, that ratio is 3 to 1. That's just one provision that could hit older Americans hard.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A small group of Republican senators has written the bill in secret in recent weeks, with many Americans and even some fellow Republicans eagerly awaiting details about what's in the bill. After the bill was released on Thursday, protesters gathered outside Senate Majority Leader Mitch McConnell's office. \u003ca href=\"https://twitter.com/NBCNightlyNews/status/877915310526939136\" target=\"_blank\" rel=\"noopener noreferrer\">Video from NBC\u003c/a> showed police removing some of those protesters from the hallway.\u003c/p>\n\u003cp>https://twitter.com/NBCNightlyNews/status/877915310526939136\u003c/p>\n\u003ch3>Big Changes to Medicaid\u003c/h3>\n\u003cp>Some of the biggest changes this bill makes are to Medicaid, the entitlement program that provides health care to low-income Americans. In that sense, it looks like the House bill, which the CBO said would cut Medicaid by $834 billion over a decade (relative to current law), with a loss of 14 million beneficiaries.\u003c/p>\n\u003cp>Both bills roll back a Medicaid expansion undertaken under the Affordable Care Act. That law extended the program to some low-income Americans above the poverty level. The Senate proposal would roll back that expansion, though it would do so more slowly than the House bill proposes.\u003c/p>\n\u003cp>As with the House, the Senate also proposes giving states either a per capita cap on Medicaid spending or a block grant of funds. That's a fundamental change; currently the program is \"\u003ca href=\"http://www.commonwealthfund.org/publications/newsletters/headlines-in-health-policy/2017/jan/january-23-2017/medicaid\" target=\"_blank\" rel=\"noopener noreferrer\">open-ended\u003c/a>,\" meaning funding increases as need increases.\u003c/p>\n\u003cp>But there's another change on top of that. Those caps would vary based on the rate of inflation, and the inflation rate the Senate would attach to those caps is one that is lower than the inflation rate the House attached.\u003c/p>\n\u003cp>That might sound like a minor wonky change, but it's not, says one former Medicaid administrator.\u003c/p>\n\u003cp>\"That's a big deal. It's a big shift,\" said John Corlett, president of the Center for Community Solutions who also served as a director of Ohio's Medicaid program. \"It means billions of dollars less in federal aid to states for their Medicaid programs.\"\u003c/p>\n\u003ch3>Tax Cuts for Richer Americans\u003c/h3>\n\u003cp>The Senate bill is also much like the House bill in that it would repeal most of the taxes associated with Obamacare. (It would bump out the implementation of the so-called \"Cadillac Tax\" on expensive, employer-sponsored health care plans, from 2025 to 2026.)\u003c/p>\n\u003cp>Repealing those taxes, as the \u003ca href=\"http://www.taxpolicycenter.org/taxvox/new-cbo-ahca-score-confirms-what-we-already-knew\" target=\"_blank\" rel=\"noopener noreferrer\">Tax Policy Center reported\u003c/a> in May (regarding the AHCA), would overwhelmingly benefit higher-income Americans. The taxes in Obamacare were largely progressive, as Kyle Pomerleau of the right-leaning Tax Foundation told NPR.\u003c/p>\n\u003cp>To one health policy expert, those tax cuts, combined with the cuts to Medicaid, mean the bill isn't a health care overhaul.\u003c/p>\n\u003cp>\"It is a tax cut bill, and they had to find a way to finance it, and Medicaid beneficiaries are going to be the ones who hurt,\" said Nicholas Bagley, a University of Michigan Law School professor who specializes in health law.\u003c/p>\n\u003cp>There are a few other ways the Senate bill mirrors the House bill. It bans the use of any federal funds for any health care plan that covers abortion, except in the cases of rape, incest or where the pregnancy puts the mother's life in danger.\u003c/p>\n\u003cp>As of 2020, the bill also eliminates cost-sharing subsidies that help low-income Americans pay for their insurance.\u003c/p>\n\u003cp>But it also has some key differences from the House bill. For example, it cuts the upper-income limit that determines who gets premium tax credits. Currently, that upper limit is at 400 percent of the poverty level. This bill would limit that to 350 percent.\u003c/p>\n\u003cp>The Senate's proposal allows states substantial freedom in determining their own health care programs — even more freedom than the House bill allows for. Under the Affordable Care Act, states can apply for \"innovation waivers\" exempting them from parts of the law and allowing them to determine their own health care systems, to an extent.\u003c/p>\n\u003cp>However, there are strict rules in place stating that states getting those waivers must provide coverage that is \"at least as comprehensive\" as they would be otherwise, as the \u003ca href=\"https://www.cms.gov/CCIIO/Programs-and-Initiatives/State-Innovation-Waivers/Section_1332_State_Innovation_Waivers-.html\" target=\"_blank\" rel=\"noopener noreferrer\">Centers for Medicare and Medicaid Services\u003c/a> explains.\u003c/p>\n\u003cp>The Senate proposal greatly widens that loophole, saying that states can get those waivers, provided their alternate plans simply don't grow the deficit.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[documentcloud url=\"https://www.documentcloud.org/documents/3872487-SenateHCBill\" notes=\"true\" text=\"true\" search=\"true\" sidebar=\"true\" pdf=\"true\" responsive=\"true\" page=\"1\"]\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Senate+Republicans+Reveal+Long-Awaited+Affordable+Care+Act+Repeal+Bill&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Updated at 2:32 p.m. ET Thursday\u003c/em>\u003c/p>\n\u003cp>Senate Republicans unveiled \u003ca href=\"https://www.documentcloud.org/documents/3872487-SenateHCBill.html\" target=\"_blank\" rel=\"noopener noreferrer\">their long-awaited health care overhaul proposal\u003c/a> on Thursday. The Senate bill, called the \"Better Care Reconciliation Act,\" would repeal major parts of the Affordable Care Act, also known as Obamacare. The broad outlines of it look a lot like the House bill, the American Health Care Act, which was passed in May.\u003c/p>\n\u003cp>In a lot of ways, the Senate's bill looks like the House bill: It rolls back the ACA's Medicaid expansion — making for deep spending cuts to that program, compared to current law. The Senate bill also proposes eliminating many ACA taxes, and the employer penalties associated with the employer and individual mandates would be repealed retroactively, dating back to the start of 2016. And like the House bill, young adults up to the age of 26 could stay on their parents' health care plans.\u003c/p>\n\u003cp>Larry Levitt, a health policy expert at the Kaiser Family Foundation, \u003ca href=\"https://twitter.com/larry_levitt/status/877910700315729920\" target=\"_blank\" rel=\"noopener noreferrer\">summed up his thoughts on the bill\u003c/a> on Twitter on Thursday: \"In broad strokes, the Senate bill is just like the House: Big tax cuts, big cut in federal heath spending, big increase in the uninsured.\"\u003c/p>\n\u003cp>As with the House bill, the Senate proposal also allows insurance companies to charge older people five times more than younger people — under the ACA, that ratio is 3 to 1. That's just one provision that could hit older Americans hard.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003ch3>Big Changes to Medicaid\u003c/h3>\n\u003cp>Some of the biggest changes this bill makes are to Medicaid, the entitlement program that provides health care to low-income Americans. In that sense, it looks like the House bill, which the CBO said would cut Medicaid by $834 billion over a decade (relative to current law), with a loss of 14 million beneficiaries.\u003c/p>\n\u003cp>Both bills roll back a Medicaid expansion undertaken under the Affordable Care Act. That law extended the program to some low-income Americans above the poverty level. The Senate proposal would roll back that expansion, though it would do so more slowly than the House bill proposes.\u003c/p>\n\u003cp>As with the House, the Senate also proposes giving states either a per capita cap on Medicaid spending or a block grant of funds. That's a fundamental change; currently the program is \"\u003ca href=\"http://www.commonwealthfund.org/publications/newsletters/headlines-in-health-policy/2017/jan/january-23-2017/medicaid\" target=\"_blank\" rel=\"noopener noreferrer\">open-ended\u003c/a>,\" meaning funding increases as need increases.\u003c/p>\n\u003cp>But there's another change on top of that. Those caps would vary based on the rate of inflation, and the inflation rate the Senate would attach to those caps is one that is lower than the inflation rate the House attached.\u003c/p>\n\u003cp>That might sound like a minor wonky change, but it's not, says one former Medicaid administrator.\u003c/p>\n\u003cp>\"That's a big deal. It's a big shift,\" said John Corlett, president of the Center for Community Solutions who also served as a director of Ohio's Medicaid program. \"It means billions of dollars less in federal aid to states for their Medicaid programs.\"\u003c/p>\n\u003ch3>Tax Cuts for Richer Americans\u003c/h3>\n\u003cp>The Senate bill is also much like the House bill in that it would repeal most of the taxes associated with Obamacare. (It would bump out the implementation of the so-called \"Cadillac Tax\" on expensive, employer-sponsored health care plans, from 2025 to 2026.)\u003c/p>\n\u003cp>Repealing those taxes, as the \u003ca href=\"http://www.taxpolicycenter.org/taxvox/new-cbo-ahca-score-confirms-what-we-already-knew\" target=\"_blank\" rel=\"noopener noreferrer\">Tax Policy Center reported\u003c/a> in May (regarding the AHCA), would overwhelmingly benefit higher-income Americans. The taxes in Obamacare were largely progressive, as Kyle Pomerleau of the right-leaning Tax Foundation told NPR.\u003c/p>\n\u003cp>To one health policy expert, those tax cuts, combined with the cuts to Medicaid, mean the bill isn't a health care overhaul.\u003c/p>\n\u003cp>\"It is a tax cut bill, and they had to find a way to finance it, and Medicaid beneficiaries are going to be the ones who hurt,\" said Nicholas Bagley, a University of Michigan Law School professor who specializes in health law.\u003c/p>\n\u003cp>There are a few other ways the Senate bill mirrors the House bill. It bans the use of any federal funds for any health care plan that covers abortion, except in the cases of rape, incest or where the pregnancy puts the mother's life in danger.\u003c/p>\n\u003cp>As of 2020, the bill also eliminates cost-sharing subsidies that help low-income Americans pay for their insurance.\u003c/p>\n\u003cp>But it also has some key differences from the House bill. For example, it cuts the upper-income limit that determines who gets premium tax credits. Currently, that upper limit is at 400 percent of the poverty level. This bill would limit that to 350 percent.\u003c/p>\n\u003cp>The Senate's proposal allows states substantial freedom in determining their own health care programs — even more freedom than the House bill allows for. Under the Affordable Care Act, states can apply for \"innovation waivers\" exempting them from parts of the law and allowing them to determine their own health care systems, to an extent.\u003c/p>\n\u003cp>However, there are strict rules in place stating that states getting those waivers must provide coverage that is \"at least as comprehensive\" as they would be otherwise, as the \u003ca href=\"https://www.cms.gov/CCIIO/Programs-and-Initiatives/State-Innovation-Waivers/Section_1332_State_Innovation_Waivers-.html\" target=\"_blank\" rel=\"noopener noreferrer\">Centers for Medicare and Medicaid Services\u003c/a> explains.\u003c/p>\n\u003cp>The Senate proposal greatly widens that loophole, saying that states can get those waivers, provided their alternate plans simply don't grow the deficit.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>One of the biggest budget fights unfolding behind closed doors in Sacramento this week is over how to spend the $1.2 billion raised by the state’s new tobacco tax, with dentists, doctors, gynecologists, and podiatrists all vying for a cut.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The biggest ask comes from the California Medical Association, which wants at least half of the money, $610 million a year, to increase payments to doctors who treat low-income patients on Medi-Cal. The group has long argued that low reimbursement rates force doctors to limit the number of Medi-Cal patients they can see, making it harder for some patients to find care. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We’ve let this program atrophy for so long, you have to put a substantial amount toward it to make a difference in access to care,” says Dustin Corcoran, CEO of the \u003ca href=\"https://www.cmanet.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Medical Association\u003c/a>. “It’s been a systemic problem for years, and Prop 56 was an important investment in that.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The 2016 \u003ca href=\"http://vig.cdn.sos.ca.gov/2016/general/en/pdf/text-proposed-laws.pdf#prop56\" target=\"_blank\" rel=\"noopener noreferrer\">ballot initiative\u003c/a> that raised the tobacco tax earmarked the revenue to \"augment spending on health care for low–income Californians,” in part, by \"providing improved payments for all healthcare.\" That fuels the medical association's argument that increasing Medi-Cal payments to doctors should be the first priority. Other health advocates say California should also bring back services Medi-Cal used to cover before the recession (hearing tests, vision care, podiatry exams); and, allow undocumented immigrant young adults to receive Medi-Cal coverage until age 26. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the loudest fight over the money has revolved around the payments for doctors. The California Medical Association has been highly critical of Gov. Jerry Brown, who has routinely refused to increase doctors’ payments in years past, and whose draft budget again snubbed doctors, allocating the entirety of the tobacco tax proceeds to cover the general costs of the Medi-Cal program in the next fiscal year, namely, new patients coming on to the Medi-Cal rolls. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The thinking behind this is simple, says H.D. Palmer, the governor’s spokesman on finance and the budget. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Eighty percent of Medi-Cal patients are covered by managed care plans, Palmer explains. These insurance companies, contracted by the state to run the Medi-Cal program, are the ones who negotiate payment rates with doctors, not the governor. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Four out of every five participants in the Medi-Cal program are in managed care,” Palmer says repeatedly. “Rates are specifically negotiated between the plans and their network of providers. That’s not a negotiation that the state is in the middle of.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state can only raise reimbursement rates for doctors with whom it contracts directly in “fee-for-service” arrangements. Those doctors serve just one out of five Medi-Cal patients. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Managed care plans may look to the state rates when setting payment rates for doctors in their own networks. But insurance experts say that only happens to a minor extent. Plans rely more on a range of actuarial risk data to set rates, and increasingly, plans are paying doctors a fixed, “capitated” payment to manage each patient’s overall health for the year, rather than paying for individual appointments or medical procedures.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Fight with Governor\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Nonetheless, both the state Senate and Assembly have rejected the governor’s spending plan for the tobacco tax. Instead, each house has proposed setting aside hundreds of millions of dollars to fund provider rate increases that would directly benefit doctors who serve the 20 percent of Medi-Cal patients not covered by managed-care.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That’s still three million people,” says Anthony Wright, executive director of \u003ca href=\"http://www.health-access.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Health Access\u003c/a>, a patient advocacy group. “There is a rationale to do this.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Wright points to dental care and family planning services as two specialties that mainly operate outside managed care plans, and have a “demonstrated need” for improved access.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2013-125.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">state audit\u003c/a> found 16 counties in California had no dentists accepting new Medi-Cal patients, while Planned Parenthood recently announced it will close three of its reproductive health clinics in Northern California, and Women’s Health Specialists \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/19/womens-health-clinics-in-california-struggle-in-a-shifting-healthcare-landscape/\" target=\"_blank\" rel=\"noopener noreferrer\">closed another two\u003c/a>. Both clinic operators cited low Medi-Cal reimbursement rates for family planning services as the main reason for the closures.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">More than half of Planned Parenthood’s patients are covered by fee-for-service contracts with the state, and the Medi-Cal managed care contracts it does have, covering 31 percent of patients, specifically set fees to match the state rate, says Beth Parker, chief legal counsel for Planned Parenthood. A fee bump could help prevent more clinic closures. Also, making it easy for women to get contraception saves the state more money in the long run.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“California pays for \u003ca href=\"https://www.guttmacher.org/fact-sheet/state-facts-about-unintended-pregnancy-california\" target=\"_blank\" rel=\"noopener noreferrer\">64 percent of unplanned births\u003c/a> in the state through the Medi-Cal program,\" she says. \"So every time an unplanned pregnancy is averted, it saves the state a tremendous amount of money, not just in the maternity costs, but also all the social services costs that come after.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state Senate and Assembly are both proposing giving a small portion of the tobacco tax money specifically to family planning providers ($50 million) and dentists (up to $247 million). Up to $700 million would go to other doctors to increase payments.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the bigger question is whether or not raising rates for doctors actually prods them to accept more Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“There’s always a question of whether or not physicians respond to economic stimuli that simply,” said Suzanne Delbanco, executive director for \u003ca href=\"https://www.catalyze.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Catalyst for Payment Reform\u003c/a>. “If an increase in fee schedules will make them take more patients, it’s hard to say what the right level of increase would be to lead to that scenario.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For example, after Tennessee’s Medicaid program increased reimbursement rates for dentists, the number of dentists participating in the program more than doubled. But the number of children who got dental care only went up by 38 percent, according to\u003c/span>\u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=DgRDGvMxpSQbiM7sxd2OnXy3MuxXAq4cOeo1xBbuoleVreZvnazUCA..&URL=http%3a%2f%2fwww.nashp.org%2fsites%2fdefault%2ffiles%2fCHCF_dental_rates.pdf\">\u003cspan style=\"font-weight: 400\"> a study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> by the National Academy for State Health Policy.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The federal government tried it, too: The Affordable Care Act mandated an increase in Medicaid payments to primary care doctors for two years. In California, doctors got paid 136 percent more, but state health officials say they don't know if the increase affected the rate of patients accessing primary care in the state at all.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>California proposals\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">That’s why the California Medical Association developed a plan, taken up by the state Assembly, to give supplemental payments to doctors based on the percentage of Medi-Cal patients they see in their practice. Doctors would get extra money if 5 percent of their patients were on Medi-Cal; they'd get more if the proportion were 10 percent, and more at 15 percent, and so on up to 30 percent.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">All doctors would be eligible for these lump sums, whether they’re contracted by the state or by managed care plans.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Many physicians have to severely limit their patient population on Medi-Cal because they lose money on each patient,” says Dustin Corcoran, the California Medical Association’s CEO. “If we can improve that and incentivize physicians to enter the space, we think that would do a lot to improve access.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But patient advocate Anthony Wright says this plan amounts to giving doctors a “bonus” for work they’ve already done, and in some cases, arguably, would have done anyway.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Instead, Wright’s group has convinced the Senate to advocate for rate increases based on data, carefully evaluating geographic regions and medical specialties for shortages, then directing money where the need is most acute. Again, these rate increases would apply to doctors seeing 20 percent of Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We think that would be a more targeted and data-driven way to make an impact on access to care,” Wright said. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Legislature must pass a final budget by June 15, and whether lawmakers unite behind the Assembly plan, the Senate plan, or a compromise plan, they still have to convince the governor. With the number of people enrolling in Medi-Cal increasing every year, and federal funding for the program uncertain because of political infighting in D.C., Jerry Brown seems more skeptical than ever of spending new money.\u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>One of the biggest budget fights unfolding behind closed doors in Sacramento this week is over how to spend the $1.2 billion raised by the state’s new tobacco tax, with dentists, doctors, gynecologists, and podiatrists all vying for a cut.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The biggest ask comes from the California Medical Association, which wants at least half of the money, $610 million a year, to increase payments to doctors who treat low-income patients on Medi-Cal. The group has long argued that low reimbursement rates force doctors to limit the number of Medi-Cal patients they can see, making it harder for some patients to find care. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We’ve let this program atrophy for so long, you have to put a substantial amount toward it to make a difference in access to care,” says Dustin Corcoran, CEO of the \u003ca href=\"https://www.cmanet.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Medical Association\u003c/a>. “It’s been a systemic problem for years, and Prop 56 was an important investment in that.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The 2016 \u003ca href=\"http://vig.cdn.sos.ca.gov/2016/general/en/pdf/text-proposed-laws.pdf#prop56\" target=\"_blank\" rel=\"noopener noreferrer\">ballot initiative\u003c/a> that raised the tobacco tax earmarked the revenue to \"augment spending on health care for low–income Californians,” in part, by \"providing improved payments for all healthcare.\" That fuels the medical association's argument that increasing Medi-Cal payments to doctors should be the first priority. Other health advocates say California should also bring back services Medi-Cal used to cover before the recession (hearing tests, vision care, podiatry exams); and, allow undocumented immigrant young adults to receive Medi-Cal coverage until age 26. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the loudest fight over the money has revolved around the payments for doctors. The California Medical Association has been highly critical of Gov. Jerry Brown, who has routinely refused to increase doctors’ payments in years past, and whose draft budget again snubbed doctors, allocating the entirety of the tobacco tax proceeds to cover the general costs of the Medi-Cal program in the next fiscal year, namely, new patients coming on to the Medi-Cal rolls. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The thinking behind this is simple, says H.D. Palmer, the governor’s spokesman on finance and the budget. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Eighty percent of Medi-Cal patients are covered by managed care plans, Palmer explains. These insurance companies, contracted by the state to run the Medi-Cal program, are the ones who negotiate payment rates with doctors, not the governor. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Four out of every five participants in the Medi-Cal program are in managed care,” Palmer says repeatedly. “Rates are specifically negotiated between the plans and their network of providers. That’s not a negotiation that the state is in the middle of.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state can only raise reimbursement rates for doctors with whom it contracts directly in “fee-for-service” arrangements. Those doctors serve just one out of five Medi-Cal patients. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Managed care plans may look to the state rates when setting payment rates for doctors in their own networks. But insurance experts say that only happens to a minor extent. Plans rely more on a range of actuarial risk data to set rates, and increasingly, plans are paying doctors a fixed, “capitated” payment to manage each patient’s overall health for the year, rather than paying for individual appointments or medical procedures.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Fight with Governor\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Nonetheless, both the state Senate and Assembly have rejected the governor’s spending plan for the tobacco tax. Instead, each house has proposed setting aside hundreds of millions of dollars to fund provider rate increases that would directly benefit doctors who serve the 20 percent of Medi-Cal patients not covered by managed-care.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That’s still three million people,” says Anthony Wright, executive director of \u003ca href=\"http://www.health-access.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Health Access\u003c/a>, a patient advocacy group. “There is a rationale to do this.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Wright points to dental care and family planning services as two specialties that mainly operate outside managed care plans, and have a “demonstrated need” for improved access.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2013-125.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">state audit\u003c/a> found 16 counties in California had no dentists accepting new Medi-Cal patients, while Planned Parenthood recently announced it will close three of its reproductive health clinics in Northern California, and Women’s Health Specialists \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/19/womens-health-clinics-in-california-struggle-in-a-shifting-healthcare-landscape/\" target=\"_blank\" rel=\"noopener noreferrer\">closed another two\u003c/a>. Both clinic operators cited low Medi-Cal reimbursement rates for family planning services as the main reason for the closures.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">More than half of Planned Parenthood’s patients are covered by fee-for-service contracts with the state, and the Medi-Cal managed care contracts it does have, covering 31 percent of patients, specifically set fees to match the state rate, says Beth Parker, chief legal counsel for Planned Parenthood. A fee bump could help prevent more clinic closures. Also, making it easy for women to get contraception saves the state more money in the long run.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“California pays for \u003ca href=\"https://www.guttmacher.org/fact-sheet/state-facts-about-unintended-pregnancy-california\" target=\"_blank\" rel=\"noopener noreferrer\">64 percent of unplanned births\u003c/a> in the state through the Medi-Cal program,\" she says. \"So every time an unplanned pregnancy is averted, it saves the state a tremendous amount of money, not just in the maternity costs, but also all the social services costs that come after.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state Senate and Assembly are both proposing giving a small portion of the tobacco tax money specifically to family planning providers ($50 million) and dentists (up to $247 million). Up to $700 million would go to other doctors to increase payments.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the bigger question is whether or not raising rates for doctors actually prods them to accept more Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“There’s always a question of whether or not physicians respond to economic stimuli that simply,” said Suzanne Delbanco, executive director for \u003ca href=\"https://www.catalyze.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Catalyst for Payment Reform\u003c/a>. “If an increase in fee schedules will make them take more patients, it’s hard to say what the right level of increase would be to lead to that scenario.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For example, after Tennessee’s Medicaid program increased reimbursement rates for dentists, the number of dentists participating in the program more than doubled. But the number of children who got dental care only went up by 38 percent, according to\u003c/span>\u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=DgRDGvMxpSQbiM7sxd2OnXy3MuxXAq4cOeo1xBbuoleVreZvnazUCA..&URL=http%3a%2f%2fwww.nashp.org%2fsites%2fdefault%2ffiles%2fCHCF_dental_rates.pdf\">\u003cspan style=\"font-weight: 400\"> a study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> by the National Academy for State Health Policy.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The federal government tried it, too: The Affordable Care Act mandated an increase in Medicaid payments to primary care doctors for two years. In California, doctors got paid 136 percent more, but state health officials say they don't know if the increase affected the rate of patients accessing primary care in the state at all.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>California proposals\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">That’s why the California Medical Association developed a plan, taken up by the state Assembly, to give supplemental payments to doctors based on the percentage of Medi-Cal patients they see in their practice. Doctors would get extra money if 5 percent of their patients were on Medi-Cal; they'd get more if the proportion were 10 percent, and more at 15 percent, and so on up to 30 percent.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">All doctors would be eligible for these lump sums, whether they’re contracted by the state or by managed care plans.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Many physicians have to severely limit their patient population on Medi-Cal because they lose money on each patient,” says Dustin Corcoran, the California Medical Association’s CEO. “If we can improve that and incentivize physicians to enter the space, we think that would do a lot to improve access.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But patient advocate Anthony Wright says this plan amounts to giving doctors a “bonus” for work they’ve already done, and in some cases, arguably, would have done anyway.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Instead, Wright’s group has convinced the Senate to advocate for rate increases based on data, carefully evaluating geographic regions and medical specialties for shortages, then directing money where the need is most acute. Again, these rate increases would apply to doctors seeing 20 percent of Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We think that would be a more targeted and data-driven way to make an impact on access to care,” Wright said. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Legislature must pass a final budget by June 15, and whether lawmakers unite behind the Assembly plan, the Senate plan, or a compromise plan, they still have to convince the governor. With the number of people enrolling in Medi-Cal increasing every year, and federal funding for the program uncertain because of political infighting in D.C., Jerry Brown seems more skeptical than ever of spending new money.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "What Happens to Elder Care With Proposed Caps to Medi-Cal?",
"title": "What Happens to Elder Care With Proposed Caps to Medi-Cal?",
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"content": "\u003cp>It’s a Sunday evening at the home of Marc and Charlotte Altieri of Long Beach, and that means bath time for the couple’s children -- 2-year-old Gino and 5-month-old Jessie.\u003c/p>\n\u003cp>And for this moment at least, Charlotte, 39, is able to focus on her children rather than worrying about her mother, 71-year-old Carmencita Misa. Three years ago, a debilitating stroke stole Misa’s short-term memory, her sight and her mobility.\u003c/p>\n\u003cp>“Before my mom had a stroke, she always made sure that she danced,” Charlotte says. “She would work regularly, like 60 hours or so a week, but no matter what, she would make (sure) that (there was) at least one night a week where she could go dancing. That was her thing.”\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcr/2017/03/20170314gtcr.mp3\" program=\"The California Report\" image=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/03/RS24616_Brian-McGee-Carmencita-Misa-and-Charlotte-Altieri.jpeg\"]\u003c/p>\n\u003cp>But since the spring of 2014, Misa has required 24-hour care, which she now gets at a nearby nursing home. Charlotte says she wishes she could provide it herself -- but she can’t.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s not just physically having the logistics of two kids and their energies, and if they're hungry and if they’re sleepy,” Charlotte says. “It’s me trying to get my brain and heart together to go visit my mom, who’s not my mom. She’s just laying there.”\u003c/p>\n\u003cp>Initially, it was \u003ca href=\"https://www.medicare.gov/\" target=\"_blank\">Medicare\u003c/a>, the federal insurance program for those 65 and older, that paid for Misa’s nursing home care. But unbeknown to many, that program limits care to only 100 days. When Charlotte learned of the Medicare cutoff, she scrambled to figure out how to pay her mom’s monthly nursing home bill.\u003c/p>\n\u003cp>“The $5,000 -- we were wondering where it was going to come from,” she says.\u003c/p>\n\u003cp>For Misa, and for the tens of thousands of low-income Californians who need ongoing long-term services and support, there is one source of aid: the joint federal-state Medicaid program, known here in the Golden State as \u003ca href=\"https://www.medi-cal.ca.gov/\" target=\"_blank\">Medi-Cal\u003c/a>. Medicaid covers nursing home care if seniors can't pay for it themselves.\u003c/p>\n\u003cp>“Most people, when they think about Medicaid, they think of it as sort of a low-income, working population welfare health care program,” says Matt Salo, executive director of the National Association of Medicaid Directors. “But what really comes as a big surprise to almost everybody is that that’s not where Medicaid spends most of its dollars.”\u003c/p>\n\u003cp>Salo says Medicaid spends about two-thirds of its annual budget on the elderly and those with disabilities. And that’s why patient advocates say they’re worried about the Medicaid provision contained in the newly released \u003ca href=\"https://www.cbo.gov/publication/52486\" target=\"_blank\">GOP plan \u003c/a>to replace and repeal Obamacare.\u003c/p>\n\u003cp>That \u003ca href=\"http://www.foxnews.com/politics/interactive/2017/03/06/text-american-health-care-act/\" target=\"_blank\">legislation\u003c/a> would impose per-person limits on federal Medicaid spending, known as \"per capita caps.\" Those fixed spending limits would replace the existing funding approach in which the federal government provides matching funds of $1 to $3 for every $1 the state spends.\u003c/p>\n\u003cp>Eric Carlson is an attorney for the nonprofit advocacy group \u003ca href=\"http://www.justiceinaging.org/\" target=\"_blank\">Justice in Aging\u003c/a>. He’s also co-author of a new \u003ca href=\"http://www.justiceinaging.org/wp-content/uploads/2017/02/Medicaid-Funding-Caps-Would-Harm-Older-Americans.pdf\" target=\"_blank\">report\u003c/a> by the group , which says the proposed spending caps are certain to hurt older Americans who rely on Medicaid.\u003c/p>\n\u003cp>“It’s really a form of rationing where you have the care based on the money that’s budgeted rather than on the needs of the people,” Carlson says. “And that’s entirely backwards.”\u003c/p>\n\u003cp>But Oren Cass, a senior fellow with the \u003ca href=\"https://www.manhattan-institute.org/\" target=\"_blank\">Manhattan Institute, \u003c/a>disagrees.\u003c/p>\n\u003cp>“It just forces states to work within the budget constraints of a fixed amount of federal money, which, by the way, is how every other part of our federal government already works,” Cass says.\u003c/p>\n\u003cp>He says the GOP plan would also remove some federal rules now imposed on states and give them more flexibility in how they spend their Medicaid dollars. He and other supporters of that approach say it will allow states to better serve their Medicaid enrollees — while patient advocates argue it would harm them.\u003c/p>\n\u003cp>“Every time I see the words ‘program flexibility’ or ‘state flexibility,’ it makes us cringe,” says Pat McGinnis, executive director of \u003ca href=\"http://www.canhr.org/\" target=\"_blank\">California Advocates for Nursing Home Reform\u003c/a>. “Because there are so many federal protections under the current Medicaid system, and I think most of those would be gone.”\u003c/p>\n\u003cp>As Congress continues hammering out the details of the GOP plan to revamp Obamacare and Medicaid, Charlotte Altieri hopes her mother's long-term care coverage will be spared any cuts.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“My mom is getting the most basic of basic [care],” she says. “If they cut it, I don’t know what I’d do.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It’s a Sunday evening at the home of Marc and Charlotte Altieri of Long Beach, and that means bath time for the couple’s children -- 2-year-old Gino and 5-month-old Jessie.\u003c/p>\n\u003cp>And for this moment at least, Charlotte, 39, is able to focus on her children rather than worrying about her mother, 71-year-old Carmencita Misa. Three years ago, a debilitating stroke stole Misa’s short-term memory, her sight and her mobility.\u003c/p>\n\u003cp>“Before my mom had a stroke, she always made sure that she danced,” Charlotte says. “She would work regularly, like 60 hours or so a week, but no matter what, she would make (sure) that (there was) at least one night a week where she could go dancing. That was her thing.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But since the spring of 2014, Misa has required 24-hour care, which she now gets at a nearby nursing home. Charlotte says she wishes she could provide it herself -- but she can’t.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s not just physically having the logistics of two kids and their energies, and if they're hungry and if they’re sleepy,” Charlotte says. “It’s me trying to get my brain and heart together to go visit my mom, who’s not my mom. She’s just laying there.”\u003c/p>\n\u003cp>Initially, it was \u003ca href=\"https://www.medicare.gov/\" target=\"_blank\">Medicare\u003c/a>, the federal insurance program for those 65 and older, that paid for Misa’s nursing home care. But unbeknown to many, that program limits care to only 100 days. When Charlotte learned of the Medicare cutoff, she scrambled to figure out how to pay her mom’s monthly nursing home bill.\u003c/p>\n\u003cp>“The $5,000 -- we were wondering where it was going to come from,” she says.\u003c/p>\n\u003cp>For Misa, and for the tens of thousands of low-income Californians who need ongoing long-term services and support, there is one source of aid: the joint federal-state Medicaid program, known here in the Golden State as \u003ca href=\"https://www.medi-cal.ca.gov/\" target=\"_blank\">Medi-Cal\u003c/a>. Medicaid covers nursing home care if seniors can't pay for it themselves.\u003c/p>\n\u003cp>“Most people, when they think about Medicaid, they think of it as sort of a low-income, working population welfare health care program,” says Matt Salo, executive director of the National Association of Medicaid Directors. “But what really comes as a big surprise to almost everybody is that that’s not where Medicaid spends most of its dollars.”\u003c/p>\n\u003cp>Salo says Medicaid spends about two-thirds of its annual budget on the elderly and those with disabilities. And that’s why patient advocates say they’re worried about the Medicaid provision contained in the newly released \u003ca href=\"https://www.cbo.gov/publication/52486\" target=\"_blank\">GOP plan \u003c/a>to replace and repeal Obamacare.\u003c/p>\n\u003cp>That \u003ca href=\"http://www.foxnews.com/politics/interactive/2017/03/06/text-american-health-care-act/\" target=\"_blank\">legislation\u003c/a> would impose per-person limits on federal Medicaid spending, known as \"per capita caps.\" Those fixed spending limits would replace the existing funding approach in which the federal government provides matching funds of $1 to $3 for every $1 the state spends.\u003c/p>\n\u003cp>Eric Carlson is an attorney for the nonprofit advocacy group \u003ca href=\"http://www.justiceinaging.org/\" target=\"_blank\">Justice in Aging\u003c/a>. He’s also co-author of a new \u003ca href=\"http://www.justiceinaging.org/wp-content/uploads/2017/02/Medicaid-Funding-Caps-Would-Harm-Older-Americans.pdf\" target=\"_blank\">report\u003c/a> by the group , which says the proposed spending caps are certain to hurt older Americans who rely on Medicaid.\u003c/p>\n\u003cp>“It’s really a form of rationing where you have the care based on the money that’s budgeted rather than on the needs of the people,” Carlson says. “And that’s entirely backwards.”\u003c/p>\n\u003cp>But Oren Cass, a senior fellow with the \u003ca href=\"https://www.manhattan-institute.org/\" target=\"_blank\">Manhattan Institute, \u003c/a>disagrees.\u003c/p>\n\u003cp>“It just forces states to work within the budget constraints of a fixed amount of federal money, which, by the way, is how every other part of our federal government already works,” Cass says.\u003c/p>\n\u003cp>He says the GOP plan would also remove some federal rules now imposed on states and give them more flexibility in how they spend their Medicaid dollars. He and other supporters of that approach say it will allow states to better serve their Medicaid enrollees — while patient advocates argue it would harm them.\u003c/p>\n\u003cp>“Every time I see the words ‘program flexibility’ or ‘state flexibility,’ it makes us cringe,” says Pat McGinnis, executive director of \u003ca href=\"http://www.canhr.org/\" target=\"_blank\">California Advocates for Nursing Home Reform\u003c/a>. “Because there are so many federal protections under the current Medicaid system, and I think most of those would be gone.”\u003c/p>\n\u003cp>As Congress continues hammering out the details of the GOP plan to revamp Obamacare and Medicaid, Charlotte Altieri hopes her mother's long-term care coverage will be spared any cuts.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“My mom is getting the most basic of basic [care],” she says. “If they cut it, I don’t know what I’d do.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>House Republicans are debating a plan to replace the Affordable Care Act that would give consumers tax credits to buy insurance, cut back on Medicaid and allow people to save their own money to pay for health care costs.\u003c/p>\n\u003cp>The outline plan is likely to take away some of the financial help low-income families get through Obamacare subsidies, and also result in fewer people being covered under the Medicaid health care program for the poor.\u003c/p>\n\u003cp>\"In general this is going to result in fewer people covered nationwide,\" says \u003ca href=\"http://avalere.com/team#!/CarolineF-Pearson\">Caroline Pearson\u003c/a>, a senior vice president at Avalere, a health care consulting group.\u003c/p>\n\u003cp>Republican leaders distributed the skeleton proposal at a meeting of the House Republican Conference in the Capitol on Thursday. Lawmakers now have an outline to bring with them to their districts for the Presidents Day holiday weekend, where they may face constituents with questions about what is going to happen to their health care. The plan is based on \u003ca href=\"http://www.npr.org/sections/health-shots/2016/11/21/502612264/if-republicans-repeal-obamacare-ryan-has-replacement-blueprint\">one outlined last summer \u003c/a>by House Speaker Paul Ryan.\u003c/p>\n\u003cp>Rep. \u003ca href=\"https://huizenga.house.gov/\">Bill Huizenga\u003c/a>, R-Mich., called the 18-page outline \"guideposts and a road map.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We know the direction we want to go and sort of the destination,\" Huizenga said outside the meeting.\u003c/p>\n\u003cp>[contextly_sidebar id=\"sRJxQM0P8BvLJlS9QdKFt49Wzeme9VV0\"]\u003c/p>\n\u003cp>Lawmakers who attended the meeting said the plan is to repeal the Affordable Care Act with a bill similar to one that passed in 2015 but was vetoed by then-President Barack Obama. That proposal would have repealed all the taxes and subsidies associated with the health care law and would have killed the mandate for individuals to buy health insurance by getting rid of the tax penalty used to enforce it.\u003c/p>\n\u003cp>This Congress could either first pass a repeal bill and then a replacement bill, or include replacement elements in the repeal.\u003c/p>\n\u003cp>The meeting Thursday centered on \"principles and goals on where we're going in patient-centered care,\" said House Ways and Means Committee Chairman Kevin Brady, R-La., after the meeting.\u003c/p>\n\u003cp>\"We're talking about repealing, replacing and starting to return control of health care and restoring the free market,\" he said.\u003c/p>\n\u003cp>Most of the plan is silent on how much money lawmakers want to put behind their proposals, so it's impossible to know exactly how generous the plan is and how many people it would cover.\u003c/p>\n\u003cp>The elements of the plan include replacing the subsidies that help people buy insurance through Obamacare exchanges with fixed tax credits to buy coverage on the open market.\u003c/p>\n\u003cp>The major difference between the two is that the Obamacare subsidies increase as premiums rise so that consumers are responsible for the same premium amount, which is tied to their income. The tax credits proposed by Ryan are not tied to income but rise as a person ages and insurance rates increase.\u003c/p>\n\u003cp>\"The important thing on the tax credits is that they're not income adjusted and we don't know how big they are,\" Pearson says.\u003c/p>\n\u003cp>She says it's unlikely they'll be as generous as the Obamacare subsidies.\u003c/p>\n\u003cp>\"This likely means that low-income people will have difficulty affording individual insurance,\" she says.\u003c/p>\n\u003cp>The outline distributed by Republicans repeatedly mentions that people will be able to buy so-called catastrophic coverage, which has limited day-to-day benefits but protects people when they have a serious illness or accident that requires a lot of health care.\u003c/p>\n\u003cp>The plan also calls for expanding health savings accounts, which allow people to save their own money tax-free to pay for health care costs. It calls for the limits on HSA savings to rise from $6,750 per family to $13,100.\u003c/p>\n\u003cp>HSAs are a favorite among conservatives because they encourage people to save and plan for their health spending and to shop around for price.\u003c/p>\n\u003cp>Democrats have criticized the focus on HSAs because they help only people who have extra money to put away and give a bigger tax cut to people with higher incomes.\u003c/p>\n\u003cp>The Republicans' plan also calls for a major restructuring of the Medicaid health care program for the poor. It would repeal the Medicaid expansion that most states adopted under the Affordable Care Act, which allowed able-bodied people with incomes just above the poverty line to become eligible for Medicaid coverage.\u003c/p>\n\u003cp>And it would cap how much the federal government spends per person per year. Right now, Medicaid pays all health care costs for those who are eligible.\u003c/p>\n\u003cp>\"This is a potentially significant incentive for states to get serious about efficiency,\" says \u003ca href=\"https://www.manhattan-institute.org/expert/paul-howard\">Paul Howard\u003c/a>, director of health policy at the Manhattan Institute, a conservative think tank.\u003c/p>\n\u003cp>Howard says states currently have an incentive to increase their spending on Medicaid, because it boosts the amount of federal money they get.\u003c/p>\n\u003cp>Ryan's plan would make Medicaid either a block grant program, where states receive a fixed amount of money, or it would be a per capita benefit, where the federal government would give the states a set amount for each beneficiary.\u003c/p>\n\u003cp>States could still offer Medicaid to those who became eligible under expansion, but the states' share of the costs would be higher than it is under the Affordable Care Act, likely making it too expensive for many states to do so.\u003c/p>\n\u003cp>Finally, the Republican plan would offer states pools of cash to come up with ways to expand insurance access to more people.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Copyright 2017 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\">NPR.org\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>House Republicans are debating a plan to replace the Affordable Care Act that would give consumers tax credits to buy insurance, cut back on Medicaid and allow people to save their own money to pay for health care costs.\u003c/p>\n\u003cp>The outline plan is likely to take away some of the financial help low-income families get through Obamacare subsidies, and also result in fewer people being covered under the Medicaid health care program for the poor.\u003c/p>\n\u003cp>\"In general this is going to result in fewer people covered nationwide,\" says \u003ca href=\"http://avalere.com/team#!/CarolineF-Pearson\">Caroline Pearson\u003c/a>, a senior vice president at Avalere, a health care consulting group.\u003c/p>\n\u003cp>Republican leaders distributed the skeleton proposal at a meeting of the House Republican Conference in the Capitol on Thursday. Lawmakers now have an outline to bring with them to their districts for the Presidents Day holiday weekend, where they may face constituents with questions about what is going to happen to their health care. The plan is based on \u003ca href=\"http://www.npr.org/sections/health-shots/2016/11/21/502612264/if-republicans-repeal-obamacare-ryan-has-replacement-blueprint\">one outlined last summer \u003c/a>by House Speaker Paul Ryan.\u003c/p>\n\u003cp>Rep. \u003ca href=\"https://huizenga.house.gov/\">Bill Huizenga\u003c/a>, R-Mich., called the 18-page outline \"guideposts and a road map.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We know the direction we want to go and sort of the destination,\" Huizenga said outside the meeting.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Lawmakers who attended the meeting said the plan is to repeal the Affordable Care Act with a bill similar to one that passed in 2015 but was vetoed by then-President Barack Obama. That proposal would have repealed all the taxes and subsidies associated with the health care law and would have killed the mandate for individuals to buy health insurance by getting rid of the tax penalty used to enforce it.\u003c/p>\n\u003cp>This Congress could either first pass a repeal bill and then a replacement bill, or include replacement elements in the repeal.\u003c/p>\n\u003cp>The meeting Thursday centered on \"principles and goals on where we're going in patient-centered care,\" said House Ways and Means Committee Chairman Kevin Brady, R-La., after the meeting.\u003c/p>\n\u003cp>\"We're talking about repealing, replacing and starting to return control of health care and restoring the free market,\" he said.\u003c/p>\n\u003cp>Most of the plan is silent on how much money lawmakers want to put behind their proposals, so it's impossible to know exactly how generous the plan is and how many people it would cover.\u003c/p>\n\u003cp>The elements of the plan include replacing the subsidies that help people buy insurance through Obamacare exchanges with fixed tax credits to buy coverage on the open market.\u003c/p>\n\u003cp>The major difference between the two is that the Obamacare subsidies increase as premiums rise so that consumers are responsible for the same premium amount, which is tied to their income. The tax credits proposed by Ryan are not tied to income but rise as a person ages and insurance rates increase.\u003c/p>\n\u003cp>\"The important thing on the tax credits is that they're not income adjusted and we don't know how big they are,\" Pearson says.\u003c/p>\n\u003cp>She says it's unlikely they'll be as generous as the Obamacare subsidies.\u003c/p>\n\u003cp>\"This likely means that low-income people will have difficulty affording individual insurance,\" she says.\u003c/p>\n\u003cp>The outline distributed by Republicans repeatedly mentions that people will be able to buy so-called catastrophic coverage, which has limited day-to-day benefits but protects people when they have a serious illness or accident that requires a lot of health care.\u003c/p>\n\u003cp>The plan also calls for expanding health savings accounts, which allow people to save their own money tax-free to pay for health care costs. It calls for the limits on HSA savings to rise from $6,750 per family to $13,100.\u003c/p>\n\u003cp>HSAs are a favorite among conservatives because they encourage people to save and plan for their health spending and to shop around for price.\u003c/p>\n\u003cp>Democrats have criticized the focus on HSAs because they help only people who have extra money to put away and give a bigger tax cut to people with higher incomes.\u003c/p>\n\u003cp>The Republicans' plan also calls for a major restructuring of the Medicaid health care program for the poor. It would repeal the Medicaid expansion that most states adopted under the Affordable Care Act, which allowed able-bodied people with incomes just above the poverty line to become eligible for Medicaid coverage.\u003c/p>\n\u003cp>And it would cap how much the federal government spends per person per year. Right now, Medicaid pays all health care costs for those who are eligible.\u003c/p>\n\u003cp>\"This is a potentially significant incentive for states to get serious about efficiency,\" says \u003ca href=\"https://www.manhattan-institute.org/expert/paul-howard\">Paul Howard\u003c/a>, director of health policy at the Manhattan Institute, a conservative think tank.\u003c/p>\n\u003cp>Howard says states currently have an incentive to increase their spending on Medicaid, because it boosts the amount of federal money they get.\u003c/p>\n\u003cp>Ryan's plan would make Medicaid either a block grant program, where states receive a fixed amount of money, or it would be a per capita benefit, where the federal government would give the states a set amount for each beneficiary.\u003c/p>\n\u003cp>States could still offer Medicaid to those who became eligible under expansion, but the states' share of the costs would be higher than it is under the Affordable Care Act, likely making it too expensive for many states to do so.\u003c/p>\n\u003cp>Finally, the Republican plan would offer states pools of cash to come up with ways to expand insurance access to more people.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Copyright 2017 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\">NPR.org\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California’s Undocumented Kids—Why They Could be First to Lose Medical Care Under Trump",
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"content": "\u003cp>On a recent rainy morning in Los Angeles, Maria Bernal’s stove clicks to life with a bright blue flame to toast bread on a griddle for her 9-year-old son Edwin to smear with peanut butter. As she scoops papaya chunks into the blender for a smoothie, she recalls her worry during all the years when she couldn’t afford health care and he suffered painful ear infections.\u003c/p>\n\u003cp>The waiting six months to get an appointment for Edwin at a county facility. The nights trying to calm him as he cried in constant pain. The months-long wait for each of three surgeries to insert tubes into his ears. The fear when the medical bills arrived.\u003c/p>\n\u003cp>At the time, she couldn’t afford health care, and he wasn't eligible for regular government-funded Medi-Cal coverage because she had brought Edwin to the United States illegally from Mexico when he was 1. He qualified for a local program and emergency Medi-Cal, but that didn’t provide all the care he needed. Then last year, she heard on TV that California was \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Documents/SB75/SB75_EE_Plan_032116_Final.PDF\" target=\"_blank\">creating a new program\u003c/a> under Medi-Cal to fully cover poor undocumented children. Relieved, she rushed to sign Edwin up. As a result, she says, “I can take him in whenever he needs to go.”\u003c/p>\n\u003cp>Now, however, the ability of Edwin and some 164,000 poor undocumented California children to see a doctor for regular medical care hangs in the balance—with several experts predicting they could be among the first to lose health coverage if the Trump administration carries out its promise to end much of Obamacare, leaving California to try to make up the difference.\u003c/p>\n\u003cp>To be clear, the federal government does pay \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Medi-CalFAQs2014b.aspx\" target=\"_blank\">limited medical costs\u003c/a> for kids in the country illegally under the restricted-scope Medi-Cal program, which is available to anyone regardless of immigration status for emergency and prenatal services only. Last May, however, California became one of a handful of states to provide \u003ca href=\"http://www.scpr.org/programs/take-two/2016/04/21/48148/medi-cal-for-immigrant-kids-in-us-illegally-starts/\" target=\"_blank\">state-funded full-scope Medi-Cal\u003c/a>, California’s Medicaid program. About 71 percent of the program is funded by the state, according to the state \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/SB-75.aspx\" target=\"_blank\">Department of Health Care Services\u003c/a>, with 29 percent paid for out of \u003ca href=\"https://www.medicaid.gov/medicaid/outreach-and-enrollment/downloads/overview-of-eligibility-for-non-citizens-in-medicaid-and-chip.pdf\" target=\"_blank\">federal funds\u003c/a> for emergency coverage. Also of note: Because the federal government funds emergency services, the state shares enrollee information with federal health officials.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In his most recent \u003ca href=\"http://www.ebudget.ca.gov/2017-18/pdf/BudgetSummary/FullBudgetSummary.pdf\" target=\"_blank\">budget proposal\u003c/a>, Gov. Jerry Brown allocated $279.5 million to cover approximately 185,000 kids in the coming year in what the state has dubbed its Health for All Kids program—double what the program was estimated to cost when it was approved.\u003c/p>\n\u003cp>With the election of Donald Trump, who took office last week, some health policy experts and advocates say the fledgling program is in danger. Assuming the new administration carries out plans to change how Medicaid is funded, California could stand to lose $17 billion the federal government currently provides for the Medi-Cal expansion that California adopted under the Affordable Care Act.\u003c/p>\n\u003cp>Such a cut would leave state leaders unable to fully make up the funding difference—and could force them to revisit a decades-old debate over whether the state has an obligation to care for sick children regardless of their immigration status, or should focus limited resources on citizens and legal residents.\u003c/p>\n\u003cp>It’s impossible to precisely predict the ripple effects. But, said Nancy Gomez, organizing director of the health advocacy organization \u003ca href=\"http://Health%20Access%20California\" target=\"_blank\">Health Access California\u003c/a>: “The first things that are going to go are these optional programs. They are not optional to us. But Health for All Kids are discretionary funds and they may be the first to go.”\u003c/p>\n\u003cp>Trying to make up the gap will be nearly impossible, experts say.\u003c/p>\n\u003cp>“These federal cuts to the broader Medi-Cal program would force California policymakers to make some difficult decisions—raise revenue by unprecedented amounts to maintain the current program, cut benefits, reduce eligibility, or make other cuts to the program,” said Laurel Lucia, manager of the Health Care Program at the UC Berkeley \u003ca href=\"http://laborcenter.berkeley.edu/\" target=\"_blank\">Center for Labor Research and Education\u003c/a>. But, she acknowledged, “if the Legislature decides to take a 'last in, first out' approach to making eligibility cuts in response to federal cuts, state-funded Medi-Cal for undocumented kids would especially be at risk because the expansion started less than one year ago.”\u003c/p>\n\u003cp>That’s as is should be, according to those who insist that anyone in the country illegally should not receive state resources—especially if funding is cut short.\u003c/p>\n\u003cp>“Sacramento should be focused on helping American citizens,” said Robin Hvidston, executive director of \u003ca href=\"https://wethepeoplerising.wordpress.com/\" target=\"_blank\">We The People Rising\u003c/a>, a Claremont-based organization that fights against legislation that it says promotes illegal immigration. The group opposed the expansion, which she contends is merely an open invitation for illegal immigration.\u003c/p>\n\u003cp>“It’s a program our state cannot afford,” she said. “We have a burgeoning homeless crisis in this state, we have disabled people in this state that need help. This energy and our tax dollars should be going to help our suffering American citizens in this state and not those here illegally.”\u003c/p>\n\u003cp>Nonetheless, the lawmaker who \u003ca href=\"https://calmatters.org/articles/californias-undocumented-kidswhy-they-could-be-first-to-lose-medical-care-under-trump/\" target=\"_blank\">authored\u003c/a> the expansion to cover undocumented children, Democratic Sen. Ricardo Lara of Los Angeles, has vowed to protect them.\u003c/p>\n\u003cp>“I will fight to ensure that they remain a priority population in terms of receiving adequate healthcare and meeting their health needs,” Lara said. “It makes economic sense, it’s the moral thing to do.”\u003c/p>\n\u003cp>But in an unmistakable sign that the Democratic-controlled state is changing tactics in response to a less receptive White House, California recently \u003ca href=\"http://khn.org/news/california-withdraws-bid-to-allow-undocumented-immigrants-to-buy-unsubsidized-obamacare-plans/\" target=\"_blank\">retracted\u003c/a> its request for a federal waiver that it had hoped would allow undocumented immigrants of all ages to buy unsubsidized health care via California’s Affordable Care Act exchange. Lara labeled it the “first California casualty of the Trump presidency.”\u003c/p>\n\u003cp>He said the state could always renew its quest for such a waiver, but won’t until it first ensures that the state can protect the data immigrants would be sharing with the federal government by using the health exchange.\u003c/p>\n\u003cp>“It’s very clear and apparent that we are dealing with a hostile administration toward our immigration community,” Lara said. “Given the fact that we are working currently on legislation to protect the privacy of the immigrant communities, we felt that it was appropriate to pull the waiver and focus on the fights ahead with the incoming administration.”\u003c/p>\n\u003cp>President Trump and the Republican-controlled Congress favor establishing caps on Medicaid and changing funding to a block grant formula that sets limits on total spending per state regardless of how many people are in the program. Currently it is funded as an entitlement for all enrollees who qualify.\u003c/p>\n\u003cp>Medicaid is the largest insurer in the country, with 73 million people enrolled, mostly low-income or disabled. In California, 13.5 million people are on Medi-Cal, or roughly one in three Californians. The program grew by 3.6 million people when it was expanded under the Affordable Care Act.\u003c/p>\n\u003cp>A study by the Center on Budget and Policy Priorities found that the proposals to reorganize Medicaid funding would decrease funding by one-third to one-half within a decade.\u003c/p>\n\u003cp>Such federal cuts would trigger a cascade of effects, said Senate President Pro Tem Kevin de Leon (D-Los Angeles).\u003c/p>\n\u003cp>“If the Trump administration decides to remove and take away access to quality healthcare that could possibly drive a budget deficit—and if you drive a budget deficit that means cuts would have to be made,” he said at a health care rally in Los Angeles after the November election. “If cuts have to be made that means other people could be hurt.”\u003c/p>\n\u003cp>But others aren’t ready to concede that outcome, and say there are likely alternatives the state can employ to keep as many people covered as possible.\u003c/p>\n\u003cp>“The reality is if Congress has enough votes to change the Medicaid program into a block grant program, California will struggle to maintain its commitment to the 13.5 million people currently covered,” said Gerald Kominski, director of the UCLA Center for Health Policy Research. “I suspect the governor and Legislature will give higher priority to cutting covered services rather than cutting the number of beneficiaries.”\u003c/p>\n\u003cp>Sen. Lara said he hopes the state resists choosing one group over another—adding that he plans to suggest cutting coverage, as the state has done during lean times, or increasing eligibility thresholds in his fight to keep health care for the neediest across all groups, including undocumented children.\u003c/p>\n\u003cp>As for 9-year-old Edwin Bernal, he says going to the doctor more often is good for him because of his hearing challenges and ear tubes.\u003c/p>\n\u003cfigure id=\"attachment_287952\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-800x533.jpg\" alt=\"Maria Bernal, 30, cooks breakfast for her son Edwin Bernal, 9, before school at their home in Los Angeles. His mother fears that under the Trump administration the program will be in danger.\" width=\"800\" height=\"533\" class=\"size-medium wp-image-287952\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Maria Bernal, 30, cooks breakfast for her son Edwin Bernal, 9, before school at their home in Los Angeles. His mother fears that under the Trump administration the program will be in danger. \u003ccite>(Maria J. Avila/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“My friends talk to me and I’m like ‘what, what,’ because I can’t hear them that good,” he said. “Same with my mom, she tells me something and I don’t really hear her and I don’t do the stuff she tells me because I can’t hear. So it’s better, I can hear her and I’m not getting in more trouble.”\u003c/p>\n\u003cp>If kids like Edwin lose Medi-Cal overage, their health care will depend largely on where they live. \u003c/p>\n\u003cp>In Los Angeles, the county offers a basic low-cost program to everyone regardless of immigration status and emergency Medi-Cal is expected to still be available. Private insurer Kaiser Permanente also offers a community benefit program for kids without legal status who live near their facilities.\u003c/p>\n\u003cp>“It’s going to be a challenge for us and the patients,” said Chona de Leon, senior vice president and chief operating officer at Eisner Pediatric & Family Center, in downtown Los Angeles, where Edwin has received care since he was a baby. \u003c/p>\n\u003cp>Clinics like Eisner would lose the increased funding that has come from previously uninsured patients getting access through the Affordable Care Act. de Leon says they would continue to serve uninsured patients as they always have, although they would have to work hard to find outside funding and donations.\u003c/p>\n\u003cp>But in 11 California counties, including Orange and San Diego, there are no programs for undocumented families to find care for their children outside of charitable clinics and hospital emergency rooms.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://CALmatters.org\" target=\"_blank\">CALmatters.org\u003c/a> is a nonprofit, nonpartisan media venture explaining California’s policies and politics.\u003cbr>\n\u003c/em>\u003c/p>\n\n",
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"excerpt": "A medical plan covering some 164,000 poor undocumented California children hangs in the balance. Both experts and families fear a cut-off if the Trump administration carries out its promise to end much of Obamacare. ",
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"nprByline": "\u003ca href=\"https://calmatters.org/about/staff/elizabeth-aguilera/\">\u003cstrong>Elizabeth Aguilera\u003c/a>\u003c/strong>\u003cbr/>\u003ca href=\"https://calmatters.org/\">CALmatters\u003c/a>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>On a recent rainy morning in Los Angeles, Maria Bernal’s stove clicks to life with a bright blue flame to toast bread on a griddle for her 9-year-old son Edwin to smear with peanut butter. As she scoops papaya chunks into the blender for a smoothie, she recalls her worry during all the years when she couldn’t afford health care and he suffered painful ear infections.\u003c/p>\n\u003cp>The waiting six months to get an appointment for Edwin at a county facility. The nights trying to calm him as he cried in constant pain. The months-long wait for each of three surgeries to insert tubes into his ears. The fear when the medical bills arrived.\u003c/p>\n\u003cp>At the time, she couldn’t afford health care, and he wasn't eligible for regular government-funded Medi-Cal coverage because she had brought Edwin to the United States illegally from Mexico when he was 1. He qualified for a local program and emergency Medi-Cal, but that didn’t provide all the care he needed. Then last year, she heard on TV that California was \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Documents/SB75/SB75_EE_Plan_032116_Final.PDF\" target=\"_blank\">creating a new program\u003c/a> under Medi-Cal to fully cover poor undocumented children. Relieved, she rushed to sign Edwin up. As a result, she says, “I can take him in whenever he needs to go.”\u003c/p>\n\u003cp>Now, however, the ability of Edwin and some 164,000 poor undocumented California children to see a doctor for regular medical care hangs in the balance—with several experts predicting they could be among the first to lose health coverage if the Trump administration carries out its promise to end much of Obamacare, leaving California to try to make up the difference.\u003c/p>\n\u003cp>To be clear, the federal government does pay \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Medi-CalFAQs2014b.aspx\" target=\"_blank\">limited medical costs\u003c/a> for kids in the country illegally under the restricted-scope Medi-Cal program, which is available to anyone regardless of immigration status for emergency and prenatal services only. Last May, however, California became one of a handful of states to provide \u003ca href=\"http://www.scpr.org/programs/take-two/2016/04/21/48148/medi-cal-for-immigrant-kids-in-us-illegally-starts/\" target=\"_blank\">state-funded full-scope Medi-Cal\u003c/a>, California’s Medicaid program. About 71 percent of the program is funded by the state, according to the state \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/SB-75.aspx\" target=\"_blank\">Department of Health Care Services\u003c/a>, with 29 percent paid for out of \u003ca href=\"https://www.medicaid.gov/medicaid/outreach-and-enrollment/downloads/overview-of-eligibility-for-non-citizens-in-medicaid-and-chip.pdf\" target=\"_blank\">federal funds\u003c/a> for emergency coverage. Also of note: Because the federal government funds emergency services, the state shares enrollee information with federal health officials.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In his most recent \u003ca href=\"http://www.ebudget.ca.gov/2017-18/pdf/BudgetSummary/FullBudgetSummary.pdf\" target=\"_blank\">budget proposal\u003c/a>, Gov. Jerry Brown allocated $279.5 million to cover approximately 185,000 kids in the coming year in what the state has dubbed its Health for All Kids program—double what the program was estimated to cost when it was approved.\u003c/p>\n\u003cp>With the election of Donald Trump, who took office last week, some health policy experts and advocates say the fledgling program is in danger. Assuming the new administration carries out plans to change how Medicaid is funded, California could stand to lose $17 billion the federal government currently provides for the Medi-Cal expansion that California adopted under the Affordable Care Act.\u003c/p>\n\u003cp>Such a cut would leave state leaders unable to fully make up the funding difference—and could force them to revisit a decades-old debate over whether the state has an obligation to care for sick children regardless of their immigration status, or should focus limited resources on citizens and legal residents.\u003c/p>\n\u003cp>It’s impossible to precisely predict the ripple effects. But, said Nancy Gomez, organizing director of the health advocacy organization \u003ca href=\"http://Health%20Access%20California\" target=\"_blank\">Health Access California\u003c/a>: “The first things that are going to go are these optional programs. They are not optional to us. But Health for All Kids are discretionary funds and they may be the first to go.”\u003c/p>\n\u003cp>Trying to make up the gap will be nearly impossible, experts say.\u003c/p>\n\u003cp>“These federal cuts to the broader Medi-Cal program would force California policymakers to make some difficult decisions—raise revenue by unprecedented amounts to maintain the current program, cut benefits, reduce eligibility, or make other cuts to the program,” said Laurel Lucia, manager of the Health Care Program at the UC Berkeley \u003ca href=\"http://laborcenter.berkeley.edu/\" target=\"_blank\">Center for Labor Research and Education\u003c/a>. But, she acknowledged, “if the Legislature decides to take a 'last in, first out' approach to making eligibility cuts in response to federal cuts, state-funded Medi-Cal for undocumented kids would especially be at risk because the expansion started less than one year ago.”\u003c/p>\n\u003cp>That’s as is should be, according to those who insist that anyone in the country illegally should not receive state resources—especially if funding is cut short.\u003c/p>\n\u003cp>“Sacramento should be focused on helping American citizens,” said Robin Hvidston, executive director of \u003ca href=\"https://wethepeoplerising.wordpress.com/\" target=\"_blank\">We The People Rising\u003c/a>, a Claremont-based organization that fights against legislation that it says promotes illegal immigration. The group opposed the expansion, which she contends is merely an open invitation for illegal immigration.\u003c/p>\n\u003cp>“It’s a program our state cannot afford,” she said. “We have a burgeoning homeless crisis in this state, we have disabled people in this state that need help. This energy and our tax dollars should be going to help our suffering American citizens in this state and not those here illegally.”\u003c/p>\n\u003cp>Nonetheless, the lawmaker who \u003ca href=\"https://calmatters.org/articles/californias-undocumented-kidswhy-they-could-be-first-to-lose-medical-care-under-trump/\" target=\"_blank\">authored\u003c/a> the expansion to cover undocumented children, Democratic Sen. Ricardo Lara of Los Angeles, has vowed to protect them.\u003c/p>\n\u003cp>“I will fight to ensure that they remain a priority population in terms of receiving adequate healthcare and meeting their health needs,” Lara said. “It makes economic sense, it’s the moral thing to do.”\u003c/p>\n\u003cp>But in an unmistakable sign that the Democratic-controlled state is changing tactics in response to a less receptive White House, California recently \u003ca href=\"http://khn.org/news/california-withdraws-bid-to-allow-undocumented-immigrants-to-buy-unsubsidized-obamacare-plans/\" target=\"_blank\">retracted\u003c/a> its request for a federal waiver that it had hoped would allow undocumented immigrants of all ages to buy unsubsidized health care via California’s Affordable Care Act exchange. Lara labeled it the “first California casualty of the Trump presidency.”\u003c/p>\n\u003cp>He said the state could always renew its quest for such a waiver, but won’t until it first ensures that the state can protect the data immigrants would be sharing with the federal government by using the health exchange.\u003c/p>\n\u003cp>“It’s very clear and apparent that we are dealing with a hostile administration toward our immigration community,” Lara said. “Given the fact that we are working currently on legislation to protect the privacy of the immigrant communities, we felt that it was appropriate to pull the waiver and focus on the fights ahead with the incoming administration.”\u003c/p>\n\u003cp>President Trump and the Republican-controlled Congress favor establishing caps on Medicaid and changing funding to a block grant formula that sets limits on total spending per state regardless of how many people are in the program. Currently it is funded as an entitlement for all enrollees who qualify.\u003c/p>\n\u003cp>Medicaid is the largest insurer in the country, with 73 million people enrolled, mostly low-income or disabled. In California, 13.5 million people are on Medi-Cal, or roughly one in three Californians. The program grew by 3.6 million people when it was expanded under the Affordable Care Act.\u003c/p>\n\u003cp>A study by the Center on Budget and Policy Priorities found that the proposals to reorganize Medicaid funding would decrease funding by one-third to one-half within a decade.\u003c/p>\n\u003cp>Such federal cuts would trigger a cascade of effects, said Senate President Pro Tem Kevin de Leon (D-Los Angeles).\u003c/p>\n\u003cp>“If the Trump administration decides to remove and take away access to quality healthcare that could possibly drive a budget deficit—and if you drive a budget deficit that means cuts would have to be made,” he said at a health care rally in Los Angeles after the November election. “If cuts have to be made that means other people could be hurt.”\u003c/p>\n\u003cp>But others aren’t ready to concede that outcome, and say there are likely alternatives the state can employ to keep as many people covered as possible.\u003c/p>\n\u003cp>“The reality is if Congress has enough votes to change the Medicaid program into a block grant program, California will struggle to maintain its commitment to the 13.5 million people currently covered,” said Gerald Kominski, director of the UCLA Center for Health Policy Research. “I suspect the governor and Legislature will give higher priority to cutting covered services rather than cutting the number of beneficiaries.”\u003c/p>\n\u003cp>Sen. Lara said he hopes the state resists choosing one group over another—adding that he plans to suggest cutting coverage, as the state has done during lean times, or increasing eligibility thresholds in his fight to keep health care for the neediest across all groups, including undocumented children.\u003c/p>\n\u003cp>As for 9-year-old Edwin Bernal, he says going to the doctor more often is good for him because of his hearing challenges and ear tubes.\u003c/p>\n\u003cfigure id=\"attachment_287952\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-800x533.jpg\" alt=\"Maria Bernal, 30, cooks breakfast for her son Edwin Bernal, 9, before school at their home in Los Angeles. His mother fears that under the Trump administration the program will be in danger.\" width=\"800\" height=\"533\" class=\"size-medium wp-image-287952\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Maria Bernal, 30, cooks breakfast for her son Edwin Bernal, 9, before school at their home in Los Angeles. His mother fears that under the Trump administration the program will be in danger. \u003ccite>(Maria J. Avila/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“My friends talk to me and I’m like ‘what, what,’ because I can’t hear them that good,” he said. “Same with my mom, she tells me something and I don’t really hear her and I don’t do the stuff she tells me because I can’t hear. So it’s better, I can hear her and I’m not getting in more trouble.”\u003c/p>\n\u003cp>If kids like Edwin lose Medi-Cal overage, their health care will depend largely on where they live. \u003c/p>\n\u003cp>In Los Angeles, the county offers a basic low-cost program to everyone regardless of immigration status and emergency Medi-Cal is expected to still be available. Private insurer Kaiser Permanente also offers a community benefit program for kids without legal status who live near their facilities.\u003c/p>\n\u003cp>“It’s going to be a challenge for us and the patients,” said Chona de Leon, senior vice president and chief operating officer at Eisner Pediatric & Family Center, in downtown Los Angeles, where Edwin has received care since he was a baby. \u003c/p>\n\u003cp>Clinics like Eisner would lose the increased funding that has come from previously uninsured patients getting access through the Affordable Care Act. de Leon says they would continue to serve uninsured patients as they always have, although they would have to work hard to find outside funding and donations.\u003c/p>\n\u003cp>But in 11 California counties, including Orange and San Diego, there are no programs for undocumented families to find care for their children outside of charitable clinics and hospital emergency rooms.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Obamacare Repeal Could Punch $15 Billion Hole in State Budget",
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"content": "\u003cp>When Gov. Jerry Brown unveils his 2017-18 budget Tuesday, there will be one huge question mark hanging over the proposal: What will it cost California when congressional Republicans follow through on their promise to dismantle Obamacare?\u003c/p>\n\u003cp>GOP lawmakers, along with President-elect Donald Trump, have \u003ca href=\"https://ww2.kqed.org/news/2017/01/03/republicans-take-the-first-step-to-repeal-obamacare/\">vowed to repeal the landmark health care law\u003c/a> and replace it with something. But what that something will be is still unknown -- and since California wholeheartedly embraced the Affordable Care Act and insured millions of poor residents through its Medicaid program, Medi-Cal, any rollback is likely to punch a huge hole in the state budget.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/301686124\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Since 2014, Medi-Cal rolls have swelled from about 8 million Californians to about 14 million. One reason: the Affordable Care Act greatly expanded Medicaid eligibility for childless, low-income adults -- more than 3 million new Medi-Cal enrollees have qualified because of that change since 2014. Along with the expanded eligibility came expanded federal funding for Medi-Cal, to the tune of more than $15 billion this fiscal year alone.\u003c/p>\n\u003cp>Now, there are huge questions for both state leaders, who have depended on that federal funding, and the millions of Californians who have benefitted from the expansion of Medi-Cal.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"(I'm) really worried,\" said UC Berkeley graduate student Rebecca Fritton, who enrolled in Medi-Cal last summer when she turned 26 and could no longer get coverage from her mother's insurance plan.\u003c/p>\n\u003caside class=\"pullquote alignright\">'If they got rid of that funding, you would have 3 million people on the streets without health insurance, and we would be dead in the water.'\u003ccite>State Sen. Ed Hernandez\u003c/cite>\u003c/aside>\n\u003cp>Fritton wouldn't have been eligible to join Medi-Cal before Obamacare. But after the health care law? Fritton said enrolling was a breeze -- she was even able to keep her primary care doctor at UCSF when she made the switch.\u003c/p>\n\u003cp>\"This has proven to be such a helpful resource for me ... so it’s just a little scary that it could be taken away.\"\u003c/p>\n\u003cp>But Fritton considers herself lucky -- she has another option.\u003c/p>\n\u003cp>\"We get offered health insurance through Berkeley, but it’s pretty expensive and I already have lots of student loans out,\" she said.\u003c/p>\n\u003cp>That's not the case for many other Medi-Cal recipients, said state Sen. Ed Hernandez, who is an optometrist and chairs the Senate's Health Committee. He said there's no way California could keep those millions of new people insured if federal funding disappeared.\u003c/p>\n\u003cp>\"If they got rid of that funding, you would have 3 million people on the streets without health insurance, and we would be dead in the water. That is my biggest concern,\" he said. \"I mean, we don't have the additional dollars, so if that money is not available, patients won't get access to health care. That's the bottom line.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"UgPaWX92hhGiw9hvTFk5GdsgL7J6tRrH\"]\u003c/p>\n\u003cp>The governor is well aware that funding could disappear, said H.D. Palmer, a spokesman for the Department of Finance. But since the Republican plan is still unclear, California can only budget based on current law, he said.\u003c/p>\n\u003cp>\"We don't know yet what changes are in the works specifically for the Affordable Care Act -- but we know there is a very high likelihood that they will happen, so we recognize it as a broad fiscal pressure on state government,\" Palmer said. \"Until and unless there is a change, however, the ACA constitutes the rules of the road -- those are the governing statutes that we budget by and abide by.\"\u003c/p>\n\u003cp>He said the governor's annual budget revision in May will offer the state an opportunity to tweak Brown's proposal if Republicans have made any concrete decisions by then. In general, he said, Brown's administration is trying to keep costs down because of a number of unknown factors, including potential Obamacare changes and whether California's economy will remain strong.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"One of the things that we are doing is make sure the state doesn't overcommit itself to ongoing levels of spending that may not be sustainable,\" he said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Gov. Jerry Brown unveils his 2017-18 budget Tuesday, there will be one huge question mark hanging over the proposal: What will it cost California when congressional Republicans follow through on their promise to dismantle Obamacare?\u003c/p>\n\u003cp>GOP lawmakers, along with President-elect Donald Trump, have \u003ca href=\"https://ww2.kqed.org/news/2017/01/03/republicans-take-the-first-step-to-repeal-obamacare/\">vowed to repeal the landmark health care law\u003c/a> and replace it with something. But what that something will be is still unknown -- and since California wholeheartedly embraced the Affordable Care Act and insured millions of poor residents through its Medicaid program, Medi-Cal, any rollback is likely to punch a huge hole in the state budget.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/301686124&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/301686124'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Since 2014, Medi-Cal rolls have swelled from about 8 million Californians to about 14 million. One reason: the Affordable Care Act greatly expanded Medicaid eligibility for childless, low-income adults -- more than 3 million new Medi-Cal enrollees have qualified because of that change since 2014. Along with the expanded eligibility came expanded federal funding for Medi-Cal, to the tune of more than $15 billion this fiscal year alone.\u003c/p>\n\u003cp>Now, there are huge questions for both state leaders, who have depended on that federal funding, and the millions of Californians who have benefitted from the expansion of Medi-Cal.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"(I'm) really worried,\" said UC Berkeley graduate student Rebecca Fritton, who enrolled in Medi-Cal last summer when she turned 26 and could no longer get coverage from her mother's insurance plan.\u003c/p>\n\u003caside class=\"pullquote alignright\">'If they got rid of that funding, you would have 3 million people on the streets without health insurance, and we would be dead in the water.'\u003ccite>State Sen. Ed Hernandez\u003c/cite>\u003c/aside>\n\u003cp>Fritton wouldn't have been eligible to join Medi-Cal before Obamacare. But after the health care law? Fritton said enrolling was a breeze -- she was even able to keep her primary care doctor at UCSF when she made the switch.\u003c/p>\n\u003cp>\"This has proven to be such a helpful resource for me ... so it’s just a little scary that it could be taken away.\"\u003c/p>\n\u003cp>But Fritton considers herself lucky -- she has another option.\u003c/p>\n\u003cp>\"We get offered health insurance through Berkeley, but it’s pretty expensive and I already have lots of student loans out,\" she said.\u003c/p>\n\u003cp>That's not the case for many other Medi-Cal recipients, said state Sen. Ed Hernandez, who is an optometrist and chairs the Senate's Health Committee. He said there's no way California could keep those millions of new people insured if federal funding disappeared.\u003c/p>\n\u003cp>\"If they got rid of that funding, you would have 3 million people on the streets without health insurance, and we would be dead in the water. That is my biggest concern,\" he said. \"I mean, we don't have the additional dollars, so if that money is not available, patients won't get access to health care. That's the bottom line.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The governor is well aware that funding could disappear, said H.D. Palmer, a spokesman for the Department of Finance. But since the Republican plan is still unclear, California can only budget based on current law, he said.\u003c/p>\n\u003cp>\"We don't know yet what changes are in the works specifically for the Affordable Care Act -- but we know there is a very high likelihood that they will happen, so we recognize it as a broad fiscal pressure on state government,\" Palmer said. \"Until and unless there is a change, however, the ACA constitutes the rules of the road -- those are the governing statutes that we budget by and abide by.\"\u003c/p>\n\u003cp>He said the governor's annual budget revision in May will offer the state an opportunity to tweak Brown's proposal if Republicans have made any concrete decisions by then. In general, he said, Brown's administration is trying to keep costs down because of a number of unknown factors, including potential Obamacare changes and whether California's economy will remain strong.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"One of the things that we are doing is make sure the state doesn't overcommit itself to ongoing levels of spending that may not be sustainable,\" he said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "what-happens-to-medi-cal-under-a-trump-administration",
"title": "What Happens to Medi-Cal Under a Trump Administration?",
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"content": "\u003cp>President-elect Donald Trump has vowed that he will repeal Obamacare and replace it with something “better.” Specifics are scarce, but one plan Trump has outlined is to change how the federal government funds Medicaid, health coverage for low-income people.\u003c/p>\n\u003cp>Under the Affordable Care Act, 32 states expanded Medicaid, so that more people would qualify for the benefits. Health policy experts say states that embraced it the most could feel the changes the worst.\u003c/p>\n\u003cp>“Winding back the clock would create all kinds of turbulence and disruption,” says Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation.\u003c/p>\n\u003cp>[soundcloud url=”https://api.soundcloud.com/tracks/292468414″ params=”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false” width=”100%” height=”166″ iframe=”true” /]\u003c/p>\n\u003cp>Twenty million Americans now have health coverage because of Obamacare. A full quarter of them are in California. And most of them are covered by Medi-Cal, California’s Medicaid program.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Right now, the federal government shares the cost of Medicaid with the states, no matter how many people are enrolled. But Trump wants to cap that funding, and just give states one fixed grant.\u003c/p>\n\u003cp>“A block grant would give California greater flexibility in running the Medi-Cal program, but it would also give the state less money,” Levitt says.\u003c/p>\n\u003cp>In California, 62 percent of new Medi-Cal enrollees are Latino, African-American or Asian-American.\u003c/p>\n\u003cp>“The effect is magnified in California in part because the state has been so successful in getting people signed up for coverage,” Levitt says.\u003c/p>\n\u003cp>Some states could pay doctors and hospitals less to save money. But in California, payment rates are already the second lowest in the country.\u003c/p>\n\u003cp>“California can’t really pay much less than it does to providers,” says Gerald Kominski, UCLA health policy professor. “These are going to be very, very difficult choices.”\u003c/p>\n\u003cp>Under one Republican plan, the amount of block grants would be based on Medi-Cal enrollment levels before the Affordable Care Act was implemented. Kominski says, in that scenario, the only choice California really would have is to reduce services or reduce the number of people who get Medi-Cal.\u003c/p>\n\u003cp>“That would have a devastating consequence on the Medicaid expansion population in California, and would basically put everyone who’s been newly enrolled in the program back off the program,” he says.\u003c/p>\n\u003cp>It’s unclear how soon a Trump administration would change Medicaid funding, so health advocates are encouraging people to continue signing up for Medicaid and other coverage during the current Obamacare open enrollment season.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“California is not an island,” says Anthony Wright, executive director of Health Access, adding that the state “must engage fully in the coming national debate on the future of health reform — especially as an example of what has been achieved, and what we can’t give up.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>President-elect Donald Trump has vowed that he will repeal Obamacare and replace it with something “better.” Specifics are scarce, but one plan Trump has outlined is to change how the federal government funds Medicaid, health coverage for low-income people.\u003c/p>\n\u003cp>Under the Affordable Care Act, 32 states expanded Medicaid, so that more people would qualify for the benefits. Health policy experts say states that embraced it the most could feel the changes the worst.\u003c/p>\n\u003cp>“Winding back the clock would create all kinds of turbulence and disruption,” says Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='”100%”' height='”166″'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=”https://api.soundcloud.com/tracks/292468414″&visual=true&”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false”'\n title='”https://api.soundcloud.com/tracks/292468414″'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Twenty million Americans now have health coverage because of Obamacare. A full quarter of them are in California. And most of them are covered by Medi-Cal, California’s Medicaid program.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Right now, the federal government shares the cost of Medicaid with the states, no matter how many people are enrolled. But Trump wants to cap that funding, and just give states one fixed grant.\u003c/p>\n\u003cp>“A block grant would give California greater flexibility in running the Medi-Cal program, but it would also give the state less money,” Levitt says.\u003c/p>\n\u003cp>In California, 62 percent of new Medi-Cal enrollees are Latino, African-American or Asian-American.\u003c/p>\n\u003cp>“The effect is magnified in California in part because the state has been so successful in getting people signed up for coverage,” Levitt says.\u003c/p>\n\u003cp>Some states could pay doctors and hospitals less to save money. But in California, payment rates are already the second lowest in the country.\u003c/p>\n\u003cp>“California can’t really pay much less than it does to providers,” says Gerald Kominski, UCLA health policy professor. “These are going to be very, very difficult choices.”\u003c/p>\n\u003cp>Under one Republican plan, the amount of block grants would be based on Medi-Cal enrollment levels before the Affordable Care Act was implemented. Kominski says, in that scenario, the only choice California really would have is to reduce services or reduce the number of people who get Medi-Cal.\u003c/p>\n\u003cp>“That would have a devastating consequence on the Medicaid expansion population in California, and would basically put everyone who’s been newly enrolled in the program back off the program,” he says.\u003c/p>\n\u003cp>It’s unclear how soon a Trump administration would change Medicaid funding, so health advocates are encouraging people to continue signing up for Medicaid and other coverage during the current Obamacare open enrollment season.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“California is not an island,” says Anthony Wright, executive director of Health Access, adding that the state “must engage fully in the coming national debate on the future of health reform — especially as an example of what has been achieved, and what we can’t give up.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cem>This post has been updated with the final vote count.\u003c/em>\u003c/p>\n\u003cp>California voters have approved Proposition 52, a ballot measure that makes permanent a fee on hospitals that helps fund Medi-Cal, the state’s health insurance plan for low-income Californians.\u003c/p>\n\u003cp>The measure was proposed by hospitals, who spent more than $60 million to promote it. Dignity Health alone spent $8,478,390 to promote the proposition. With all precincts reporting, the measure passed 70-30 percent in unofficial results.\u003c/p>\n\u003cp>The fee currently draws $3.5 billion a year in federal matching funds. Hospitals say the fee system provides a major source of funding for Medi-Cal patients.\u003c/p>\n\u003cp>The fee system is routinely renewed by the Legislature but requires support from a two-thirds super-majority of lawmakers. Hospitals say permanently extending it ensures the funding source is protected from politics.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>A union representing health care workers opposed the measure, saying it benefits wealthy hospital executives.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>This post has been updated with the final vote count.\u003c/em>\u003c/p>\n\u003cp>California voters have approved Proposition 52, a ballot measure that makes permanent a fee on hospitals that helps fund Medi-Cal, the state’s health insurance plan for low-income Californians.\u003c/p>\n\u003cp>The measure was proposed by hospitals, who spent more than $60 million to promote it. Dignity Health alone spent $8,478,390 to promote the proposition. With all precincts reporting, the measure passed 70-30 percent in unofficial results.\u003c/p>\n\u003cp>The fee currently draws $3.5 billion a year in federal matching funds. Hospitals say the fee system provides a major source of funding for Medi-Cal patients.\u003c/p>\n\u003cp>The fee system is routinely renewed by the Legislature but requires support from a two-thirds super-majority of lawmakers. Hospitals say permanently extending it ensures the funding source is protected from politics.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Even with Insurance, Family of Medically Fragile Child Struggles to Find Home Health Care",
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"content": "\u003cp>The number of people at Brian and Laura Smart’s San Jose home has been steadily growing since February.\u003c/p>\n\u003cp>By June, it reached six adults: Brian's parents, Laura's mother and an au pair. They're all part of a makeshift medical team aimed at keeping Noah, Brian and Laura's one-year-old son, alive.\u003c/p>\n\u003cp>Last July, Noah was born with \u003ca href=\"http://www.pted.org/?id=shones1\" target=\"_blank\">Shone’s Complex,\u003c/a> a rare congenital heart disease. In February, he suffered a stroke during a surgical procedure, which further disabled him. Noah is now dependent on a ventilator and a gastric tube, and he takes nine medications every day.\u003c/p>\n\u003cp>“We had this little boy who was rolling over and playing with us and now we have this body that vomits and cries, and it’s torture.” Brian says.\u003c/p>\n\u003cfigure id=\"attachment_218054\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-218054 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/NoahSmart-400x250.jpg\" alt=\"Noah Smart was born in July 2015 with a severe congenital heart disease. \" width=\"400\" height=\"250\">\u003cfigcaption class=\"wp-caption-text\">Noah Smart was born in July 2015 with a severe congenital heart disease. \u003ccite>(Jordan Katz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“What Noah was up until then, Noah is not anymore,” says \u003ca href=\"http://www.stanfordchildrens.org/en/doctor/default?id=meera-sukumaran\" target=\"_blank\">Dr. Meera Sukumaran\u003c/a>. She specializes in pediatric neurodevelopmental disabilities at Stanford, where she treats Noah. After Noah suffered the stroke, he started having seizures and muscles spasms, Sukumaran says. “He would cry out, be very distressed. ... He was having a harder time digesting his milk, so he was throwing up 10 to 20 times a day.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Noah has a feeding pump, a suction machine, and needs oxygen, his father says. These needs are highly complex, and while some members of Noah's makeshift support system have medical skills -- Brian's mother is a retired registered nurse, the au pair has a nursing license from the Philippines -- everyone agrees this care system is not sustainable.\u003c/p>\n\u003cp>\"Ideally, we would want a nurse 24 hours a day,” Brian says, although he also says they’d take even 8-hour support. But trying to access that level of care has been a months-long odyssey.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Brian and Laura are both employed full time and have health insurance with United Healthcare through Laura's job at Apple. Despite the insurance, they estimate they're paying $5,000 a month, out-of-pocket, for hired care and copays.\u003c/span>\u003c/p>\n\u003cp>The Smarts applied to get an in-home nurse covered by United Healthcare and were denied. The insurance company claimed the care Noah needed was custodial, meaning it was the same as the care that comes with having any baby. They appealed, and were denied again, even though a home nurse would help them avoid emergency room visits that would quickly cost the insurer more than a home nurse.\u003c/p>\n\u003cfigure id=\"attachment_215866\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-215866\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/SyringesCU-400x267.jpg\" alt=\"Part of the 15 doses of medication Noah Smart will need each day. \" width=\"400\" height=\"267\">\u003cfigcaption class=\"wp-caption-text\">Part of the 15 doses of medication Noah Smart will need each day. \u003ccite>(Jordan Katz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Smarts next turned to Medi-Cal, the state's health insurance generally for people who are low income. Severely disabled children can be deemed eligible for the program, even if their parents’ income exceeds usual limits. This was a waiver the Smarts sought for Noah.\u003c/p>\n\u003cp>But getting a waiver is just the first hurdle and no guarantee Noah will actually be able to get the nursing care he needs. The problem is home health agencies that provide the care have trouble attracting nurses to meet the pressing demand by families, and they blame low Medi-Cal reimbursement rates.\u003c/p>\n\u003cp>“On paper, there are all these pediatric home health agencies,\" says Sherri Sager, chief government and community relations officer of Lucile Packard Children's Hospital at Stanford. “To meet the demand for pediatric home health nurses, the supply is nowhere near what we need.\"\u003c/p>\n\u003cp>At Maxim Healthcare Services, a home health agency that connects families with nurses, Kris Frank says he is finding it harder and harder to recruit and retain registered nurses, because the rates they offer are so low compared to what nurses can earn at hospitals or other skilled nursing facilities.\u003c/p>\n\u003cp>Currently, the average hourly rate for a registered nurse working in the Bay Area is around $65 an hour, according to the \u003ca href=\"http://www.bls.gov/oes/current/oes_41884.htm\" target=\"_blank\">Bureau of Labor Statistics\u003c/a>. The reimbursement rate Maxim says it receives for a registered nurse caring for a Medi-Cal patient is $40.16 an hour.\u003c/p>\n\u003cp>Though Frank says Maxim pays all its nurses the same rate whether the agency is reimbursed by Medi-Cal or another insurer, the net effect of a lower Medi-Cal reimbursement rates to the home health agency is a lower rate overall.\u003c/p>\n\u003cp>“We blend the rates,” Frank explains. \"but costs go up, and we just can’t continue to pay enough for us to fill all the approved shifts.\"\u003c/p>\n\u003cp>Barbara Crane, Maxim's director of clinical services, first came to the agency as a home health nurse after she and her husband moved to the Bay Area from New York. When she arrived, she says she was “taken aback” by the difference in wages.\u003c/p>\n\u003cp>“It was less than half of what I had been making ten years ago in New York,” Crane says. “Caring in the home, where you don’t have other doctors or other nurses around to support your assessment and your decisions, is a bit of a daunting task.\"\u003c/p>\n\u003cp>\"I know this is a different state, but the rates for nursing to be done in the home are just so sub-standard,” she says.\u003c/p>\n\u003cp>Now her job is to convince nurses to work in home health.\u003c/p>\n\u003cp>\"I am in the predicament of trying to get nurses to come here and get them to understand how important home health is, even though it’s not financially rewarding,” Crane says.\u003c/p>\n\u003cp>What’s more, Frank says, the nurses that agencies like Maxim need to recruit are highly-skilled, almost to the level of a hospital neo-natal intensive care unit. “But we’re bringing them in-home,\" he says, \"and some nurses don’t want to work in the home.\" Then when he tells them the rate, he says, they balk. \"They think, ‘Well, heck. I could be making more working as a waitress, or a waiter—a lot more.’”\u003c/p>\n\u003cp>Maxim has been working with Sen. Mike McGuire, D-Healdsburg, to pass legislation that addresses the issue. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160SB1401\" target=\"_blank\">Senate Bill 1401\u003c/a>, first introduced in March, would establish a three-year pilot program in three regions around California— including the Bay Area. Under the pilot, Medi-Cal reimbursement rates for registered nurses and licensed vocational nurses would be increased 20 percent.\u003c/p>\n\u003cp>In a statement, McGuire pointed out that in-home nursing is cost-effective. “It costs 10 times more each day to care for a child in a hospital,\" he said, \"than it does to care for that child at home.”\u003c/p>\n\u003cp>Tony Cava, spokesman for the Department of Health Care Services which oversees Medi-Cal, said that the agency was \"not aware of any significant access issues\" with home health care for Medi-Cal recipients.\u003c/p>\n\u003cp>If a family is unable to find a home health agency -- or HHA -- to provide prescribed nursing service, Cava said that \"DHCS nurses [would] provide assistance to the family by referring them to other Medi-Cal-approved HHAs, individual nurse providers, and pediatric day health care centers.”\u003c/p>\n\u003cp>But implementing SB 1401 would cost more than $20 million to implement, according to \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=201520160SB1401\" target=\"_blank\">an analysis \u003c/a>presented to the Senate Committee on Appropriations. The bill was ultimately held in the committee earlier this year and cannot be re-introduced until next January.\u003c/p>\n\u003cp>Meanwhile, home health agencies struggle to fill the hours that patients need. “We should be filling 100 percent,\" Frank says, but even when nurses call in sick, \"we have no backup nurses.\"\u003c/p>\n\u003cp>As for the Smarts—after months of phone calls and paperwork, Noah is on track to get Medi-Cal coverage. What's unclear is whether that coverage will make a difference, given the shortage of in-home pediatric nurses.\u003c/p>\n\u003cp>Brian Smart knew that even with coverage, Noah's name might linger on a wait list for care for a year—or more. Still, he decided it was worth a shot.\u003c/p>\n\u003cp>\"I filled out the paperwork as a just-in-case,” Brian says. Even the program coordinator told him it would be a \"long shot\" that he would get an in-home nurse.\u003c/p>\n\u003cp>\"Even if it’s a one-in-a-million chance, at least it’s a chance.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>For now, the Smarts will have to keep waiting.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The number of people at Brian and Laura Smart’s San Jose home has been steadily growing since February.\u003c/p>\n\u003cp>By June, it reached six adults: Brian's parents, Laura's mother and an au pair. They're all part of a makeshift medical team aimed at keeping Noah, Brian and Laura's one-year-old son, alive.\u003c/p>\n\u003cp>Last July, Noah was born with \u003ca href=\"http://www.pted.org/?id=shones1\" target=\"_blank\">Shone’s Complex,\u003c/a> a rare congenital heart disease. In February, he suffered a stroke during a surgical procedure, which further disabled him. Noah is now dependent on a ventilator and a gastric tube, and he takes nine medications every day.\u003c/p>\n\u003cp>“We had this little boy who was rolling over and playing with us and now we have this body that vomits and cries, and it’s torture.” Brian says.\u003c/p>\n\u003cfigure id=\"attachment_218054\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-218054 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/NoahSmart-400x250.jpg\" alt=\"Noah Smart was born in July 2015 with a severe congenital heart disease. \" width=\"400\" height=\"250\">\u003cfigcaption class=\"wp-caption-text\">Noah Smart was born in July 2015 with a severe congenital heart disease. \u003ccite>(Jordan Katz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“What Noah was up until then, Noah is not anymore,” says \u003ca href=\"http://www.stanfordchildrens.org/en/doctor/default?id=meera-sukumaran\" target=\"_blank\">Dr. Meera Sukumaran\u003c/a>. She specializes in pediatric neurodevelopmental disabilities at Stanford, where she treats Noah. After Noah suffered the stroke, he started having seizures and muscles spasms, Sukumaran says. “He would cry out, be very distressed. ... He was having a harder time digesting his milk, so he was throwing up 10 to 20 times a day.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Noah has a feeding pump, a suction machine, and needs oxygen, his father says. These needs are highly complex, and while some members of Noah's makeshift support system have medical skills -- Brian's mother is a retired registered nurse, the au pair has a nursing license from the Philippines -- everyone agrees this care system is not sustainable.\u003c/p>\n\u003cp>\"Ideally, we would want a nurse 24 hours a day,” Brian says, although he also says they’d take even 8-hour support. But trying to access that level of care has been a months-long odyssey.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Brian and Laura are both employed full time and have health insurance with United Healthcare through Laura's job at Apple. Despite the insurance, they estimate they're paying $5,000 a month, out-of-pocket, for hired care and copays.\u003c/span>\u003c/p>\n\u003cp>The Smarts applied to get an in-home nurse covered by United Healthcare and were denied. The insurance company claimed the care Noah needed was custodial, meaning it was the same as the care that comes with having any baby. They appealed, and were denied again, even though a home nurse would help them avoid emergency room visits that would quickly cost the insurer more than a home nurse.\u003c/p>\n\u003cfigure id=\"attachment_215866\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-215866\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/SyringesCU-400x267.jpg\" alt=\"Part of the 15 doses of medication Noah Smart will need each day. \" width=\"400\" height=\"267\">\u003cfigcaption class=\"wp-caption-text\">Part of the 15 doses of medication Noah Smart will need each day. \u003ccite>(Jordan Katz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Smarts next turned to Medi-Cal, the state's health insurance generally for people who are low income. Severely disabled children can be deemed eligible for the program, even if their parents’ income exceeds usual limits. This was a waiver the Smarts sought for Noah.\u003c/p>\n\u003cp>But getting a waiver is just the first hurdle and no guarantee Noah will actually be able to get the nursing care he needs. The problem is home health agencies that provide the care have trouble attracting nurses to meet the pressing demand by families, and they blame low Medi-Cal reimbursement rates.\u003c/p>\n\u003cp>“On paper, there are all these pediatric home health agencies,\" says Sherri Sager, chief government and community relations officer of Lucile Packard Children's Hospital at Stanford. “To meet the demand for pediatric home health nurses, the supply is nowhere near what we need.\"\u003c/p>\n\u003cp>At Maxim Healthcare Services, a home health agency that connects families with nurses, Kris Frank says he is finding it harder and harder to recruit and retain registered nurses, because the rates they offer are so low compared to what nurses can earn at hospitals or other skilled nursing facilities.\u003c/p>\n\u003cp>Currently, the average hourly rate for a registered nurse working in the Bay Area is around $65 an hour, according to the \u003ca href=\"http://www.bls.gov/oes/current/oes_41884.htm\" target=\"_blank\">Bureau of Labor Statistics\u003c/a>. The reimbursement rate Maxim says it receives for a registered nurse caring for a Medi-Cal patient is $40.16 an hour.\u003c/p>\n\u003cp>Though Frank says Maxim pays all its nurses the same rate whether the agency is reimbursed by Medi-Cal or another insurer, the net effect of a lower Medi-Cal reimbursement rates to the home health agency is a lower rate overall.\u003c/p>\n\u003cp>“We blend the rates,” Frank explains. \"but costs go up, and we just can’t continue to pay enough for us to fill all the approved shifts.\"\u003c/p>\n\u003cp>Barbara Crane, Maxim's director of clinical services, first came to the agency as a home health nurse after she and her husband moved to the Bay Area from New York. When she arrived, she says she was “taken aback” by the difference in wages.\u003c/p>\n\u003cp>“It was less than half of what I had been making ten years ago in New York,” Crane says. “Caring in the home, where you don’t have other doctors or other nurses around to support your assessment and your decisions, is a bit of a daunting task.\"\u003c/p>\n\u003cp>\"I know this is a different state, but the rates for nursing to be done in the home are just so sub-standard,” she says.\u003c/p>\n\u003cp>Now her job is to convince nurses to work in home health.\u003c/p>\n\u003cp>\"I am in the predicament of trying to get nurses to come here and get them to understand how important home health is, even though it’s not financially rewarding,” Crane says.\u003c/p>\n\u003cp>What’s more, Frank says, the nurses that agencies like Maxim need to recruit are highly-skilled, almost to the level of a hospital neo-natal intensive care unit. “But we’re bringing them in-home,\" he says, \"and some nurses don’t want to work in the home.\" Then when he tells them the rate, he says, they balk. \"They think, ‘Well, heck. I could be making more working as a waitress, or a waiter—a lot more.’”\u003c/p>\n\u003cp>Maxim has been working with Sen. Mike McGuire, D-Healdsburg, to pass legislation that addresses the issue. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160SB1401\" target=\"_blank\">Senate Bill 1401\u003c/a>, first introduced in March, would establish a three-year pilot program in three regions around California— including the Bay Area. Under the pilot, Medi-Cal reimbursement rates for registered nurses and licensed vocational nurses would be increased 20 percent.\u003c/p>\n\u003cp>In a statement, McGuire pointed out that in-home nursing is cost-effective. “It costs 10 times more each day to care for a child in a hospital,\" he said, \"than it does to care for that child at home.”\u003c/p>\n\u003cp>Tony Cava, spokesman for the Department of Health Care Services which oversees Medi-Cal, said that the agency was \"not aware of any significant access issues\" with home health care for Medi-Cal recipients.\u003c/p>\n\u003cp>If a family is unable to find a home health agency -- or HHA -- to provide prescribed nursing service, Cava said that \"DHCS nurses [would] provide assistance to the family by referring them to other Medi-Cal-approved HHAs, individual nurse providers, and pediatric day health care centers.”\u003c/p>\n\u003cp>But implementing SB 1401 would cost more than $20 million to implement, according to \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=201520160SB1401\" target=\"_blank\">an analysis \u003c/a>presented to the Senate Committee on Appropriations. The bill was ultimately held in the committee earlier this year and cannot be re-introduced until next January.\u003c/p>\n\u003cp>Meanwhile, home health agencies struggle to fill the hours that patients need. “We should be filling 100 percent,\" Frank says, but even when nurses call in sick, \"we have no backup nurses.\"\u003c/p>\n\u003cp>As for the Smarts—after months of phone calls and paperwork, Noah is on track to get Medi-Cal coverage. What's unclear is whether that coverage will make a difference, given the shortage of in-home pediatric nurses.\u003c/p>\n\u003cp>Brian Smart knew that even with coverage, Noah's name might linger on a wait list for care for a year—or more. Still, he decided it was worth a shot.\u003c/p>\n\u003cp>\"I filled out the paperwork as a just-in-case,” Brian says. Even the program coordinator told him it would be a \"long shot\" that he would get an in-home nurse.\u003c/p>\n\u003cp>\"Even if it’s a one-in-a-million chance, at least it’s a chance.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For now, the Smarts will have to keep waiting.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Teresa Lopez is a single mother of three. Two of her kids are undocumented.\u003c/p>\n\u003cp>She says within her own family, there’s inequality when it comes to health care.\u003c/p>\n\u003cp>“It’s very difficult to find help for my kids who weren’t born here,” she says in Spanish. “I feel bad that one of them has good benefits and the others don’t.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"eZYFaTAYe3DNzEiruyuujW3GRB3mylY4\"]But that will change on Monday, when 170,000 undocumented children in California become eligible for comprehensive health care through the state’s Medi-Cal program for people who are low income.\u003c/p>\n\u003cp>Then, all of Lopez’ kids will have the same access to routine doctor visits, dental, and mental health care.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Some parents have been reluctant to sign up their kids, for fear of exposing other adult family members to risk of deportation, or of compromising future efforts to obtain legal status.\u003c/p>\n\u003cp>Lawmakers are touring the state through the weekend, stopping in Los Angeles, Fresno, and Orange County to dispel those fears. They’re reassuring families that no information used to enroll children in coverage will be shared with immigration officials. And they’re touting the benefits of coverage.\u003c/p>\n\u003cp>They say children who have health insurance \u003ca href=\"http://kff.org/report-section/the-impact-of-the-childrens-health-insurance-program-chip-issue-brief/\" target=\"_blank\">do better in school\u003c/a>, are more likely to get a high school diploma, and are less likely to become entwined in the criminal justice system.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/263963780\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Sen. Ricardo Lara, D-Long Beach, the author of the bill that expanded full Medi-Cal coverage to undocumented children, said kids will no longer have to forgo care for a broken arm or hospitalization because their parents can’t pay for it.\u003c/p>\n\u003cp>“Children shouldn’t be worrying about how their parents are going to afford their health care,” he said Thursday at the Mission Neighborhood Health Center, a community clinic in San Francisco. “Children should be focused on their education.”\u003c/p>\n\u003cp>The expanded Medi-Cal program will cost the state $40 million this year and $132 million each year after that.\u003c/p>\n\u003cp>[contextly_sidebar id=\"CVDfpcHl6Kir3c9SbM58GhGyS9oG1LmJ\"]Critics say the program is too expensive and will allow families who are here illegally to set down deeper roots.\u003c/p>\n\u003cp>Sen. Lara said the program will be a test for that. He wants to demonstrate that offering health insurance to kids will have overall benefits for the economy, so that he can make a case for extending health insurance to undocumented adults, too.\u003c/p>\n\u003cp>He is sponsoring two bills this year. One of them, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160SB10\" target=\"_blank\">SB 10\u003c/a>, would allow undocumented adults to buy unsubsidized health plans through the state exchange, Covered California. Another,\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160SB1418\" target=\"_blank\"> SB 1418\u003c/a>, would extend Medi-Cal benefits to income-eligible adults, regardless of immigration status.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We’re going to be able to take care of our abuelitos and abuelitas, our aunts and uncles, who have sacrificed their entire lives in this country and in this state to make it a better place, ensuring they also have some sort of care,” Lara said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Teresa Lopez is a single mother of three. Two of her kids are undocumented.\u003c/p>\n\u003cp>She says within her own family, there’s inequality when it comes to health care.\u003c/p>\n\u003cp>“It’s very difficult to find help for my kids who weren’t born here,” she says in Spanish. “I feel bad that one of them has good benefits and the others don’t.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But that will change on Monday, when 170,000 undocumented children in California become eligible for comprehensive health care through the state’s Medi-Cal program for people who are low income.\u003c/p>\n\u003cp>Then, all of Lopez’ kids will have the same access to routine doctor visits, dental, and mental health care.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Some parents have been reluctant to sign up their kids, for fear of exposing other adult family members to risk of deportation, or of compromising future efforts to obtain legal status.\u003c/p>\n\u003cp>Lawmakers are touring the state through the weekend, stopping in Los Angeles, Fresno, and Orange County to dispel those fears. They’re reassuring families that no information used to enroll children in coverage will be shared with immigration officials. And they’re touting the benefits of coverage.\u003c/p>\n\u003cp>They say children who have health insurance \u003ca href=\"http://kff.org/report-section/the-impact-of-the-childrens-health-insurance-program-chip-issue-brief/\" target=\"_blank\">do better in school\u003c/a>, are more likely to get a high school diploma, and are less likely to become entwined in the criminal justice system.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/263963780&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/263963780'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Sen. Ricardo Lara, D-Long Beach, the author of the bill that expanded full Medi-Cal coverage to undocumented children, said kids will no longer have to forgo care for a broken arm or hospitalization because their parents can’t pay for it.\u003c/p>\n\u003cp>“Children shouldn’t be worrying about how their parents are going to afford their health care,” he said Thursday at the Mission Neighborhood Health Center, a community clinic in San Francisco. “Children should be focused on their education.”\u003c/p>\n\u003cp>The expanded Medi-Cal program will cost the state $40 million this year and $132 million each year after that.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Critics say the program is too expensive and will allow families who are here illegally to set down deeper roots.\u003c/p>\n\u003cp>Sen. Lara said the program will be a test for that. He wants to demonstrate that offering health insurance to kids will have overall benefits for the economy, so that he can make a case for extending health insurance to undocumented adults, too.\u003c/p>\n\u003cp>He is sponsoring two bills this year. One of them, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160SB10\" target=\"_blank\">SB 10\u003c/a>, would allow undocumented adults to buy unsubsidized health plans through the state exchange, Covered California. Another,\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160SB1418\" target=\"_blank\"> SB 1418\u003c/a>, would extend Medi-Cal benefits to income-eligible adults, regardless of immigration status.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We’re going to be able to take care of our abuelitos and abuelitas, our aunts and uncles, who have sacrificed their entire lives in this country and in this state to make it a better place, ensuring they also have some sort of care,” Lara said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "State Junks $179 Million Medi-Cal IT System, Will Start from Scratch",
"title": "State Junks $179 Million Medi-Cal IT System, Will Start from Scratch",
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"content": "\u003cp>Combine years of delay, ever-changing rules and requirements, state and federal red tape, and a once mighty company now in deep financial trouble, and what do you get?\u003c/p>\n\u003cp>In California’s case, the junking of a $179 million computer modernization project to process claims for Medi-Cal, the state’s health-payment program for low-income residents.\u003c/p>\n\u003cp>The project, put out to bid in 2007 and still far from completion, was finally put to rest on Monday when the state Department of Health Care Services announced a \u003ca href=\"http://www.dhcs.ca.gov/provgovpart/Documents/Settlement%20Agreement%2003212016%201930%20FINAL%20web.pdf\" target=\"_blank\">legal settlement\u003c/a> with Xerox Corp., the project contractor, under which Xerox will pay the state approximately $120 million.\u003c/p>\n\u003cp>That means Medi-Cal’s existing computer system – creaky, patched-together, and decades old - will continue to operate for however long it takes the state to contract out and build a replacement.\u003c/p>\n\u003cp>According to the settlement, Xerox will continue to run the existing system until 2019.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The DHCS is putting a bright face on the project’s demise, calling it, in a \u003ca href=\"http://www.dhcs.ca.gov/provgovpart/Pages/Xerox_Settlement.aspx\" target=\"_blank\">press release\u003c/a> issued Monday, an “opportunity” to reevaluate current needs. A fresh start, it went on, will ensure “modern, robust and sustainable system.”\u003c/p>\n\u003cp>DHCS noted it's not the only state with such problems: “Many other states … have adjusted their strategies” toward their Medicaid computer systems, the release said. (Medi-Cal is California’s version of Medicaid.)\u003c/p>\n\u003cp>Indeed, several parties in Texas and Alaska, both public and private, have sued the Xerox subsidiary Xerox State Healthcare over contract problems.\u003c/p>\n\u003cp>The department declined to comment beyond the press release. The settlement requires that DHCS and Xerox both approve in advance any public statement for the next 30 days.\u003c/p>\n\u003cp>In a statement, Xerox said the settlement agreement finalizes the announcement it made last fall \"that it did not expect to complete implementation of the Health Enterprise Platform in California.\" Xerox added that it is \"pleased to work with DHCS to continue processing Medi-Cal claims through September 2019.\"\u003c/p>\n\u003cp>California’s drawn-out competition for the project began in 2007. Xerox won the contract in 2010. By 2012, the project was already in trouble. Delays caused the state to impose on Xerox a “\u003ca href=\"http://www.dhcs.ca.gov/formsandpubs/Documents/Legislative%20Reports/CAMMIS_Quarterly_July-2012.pdf\" target=\"_blank\">corrective action plan\u003c/a>.”\u003c/p>\n\u003cp>Originally scheduled for completion by the end of this year, the project isn’t close to done, the settlement indicates.\u003c/p>\n\u003cp>Whenever government computer systems fall behind schedule, which is common, critics blame red tape. In this case, the massive Medi-Cal replacement contract with Xerox was inked just five days before President Obama signed the Affordable Care Act into law. As new regulations under the law worked their way through the health care system, requirements for the Medi-Cal project continued to change.\u003c/p>\n\u003cp>Compounding matters, Xerox fell into deep trouble. Its stock has lagged far behind the market in general. The company is under pressure from investor activist Carl Icahn. Late last year, Xerox said it would wind down its Medicaid computer systems business in California and Montana, take a $385 million charge against earnings, and “focus on profitable market segments.” That meant the end of the California project.\u003c/p>\n\u003cp>\u003ca href=\"https://www.medicaid.gov/medicaid-chip-program-information/by-topics/data-and-systems/downloads/mmisfacsr.pdf\" target=\"_blank\">Several companies \u003c/a>compete in the Medicaid system market. As of February, Xerox was the number-two provider, covering 11 states. The leader, HP Enterprise Systems, covers 18.\u003c/p>\n\u003cp>Xerox will pay about $103 million in cash, provide computer hardware and software worth $15 million, and abandon payment claims worth roughly $5 million more.\u003c/p>\n\u003cp>DHCS has reported it had paid Xerox $9 million for the replacement system, $8.1 million of that with federal funds.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>, which publishes California Healthline, a service of the California Health Care Foundation.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Combine years of delay, ever-changing rules and requirements, state and federal red tape, and a once mighty company now in deep financial trouble, and what do you get?\u003c/p>\n\u003cp>In California’s case, the junking of a $179 million computer modernization project to process claims for Medi-Cal, the state’s health-payment program for low-income residents.\u003c/p>\n\u003cp>The project, put out to bid in 2007 and still far from completion, was finally put to rest on Monday when the state Department of Health Care Services announced a \u003ca href=\"http://www.dhcs.ca.gov/provgovpart/Documents/Settlement%20Agreement%2003212016%201930%20FINAL%20web.pdf\" target=\"_blank\">legal settlement\u003c/a> with Xerox Corp., the project contractor, under which Xerox will pay the state approximately $120 million.\u003c/p>\n\u003cp>That means Medi-Cal’s existing computer system – creaky, patched-together, and decades old - will continue to operate for however long it takes the state to contract out and build a replacement.\u003c/p>\n\u003cp>According to the settlement, Xerox will continue to run the existing system until 2019.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The DHCS is putting a bright face on the project’s demise, calling it, in a \u003ca href=\"http://www.dhcs.ca.gov/provgovpart/Pages/Xerox_Settlement.aspx\" target=\"_blank\">press release\u003c/a> issued Monday, an “opportunity” to reevaluate current needs. A fresh start, it went on, will ensure “modern, robust and sustainable system.”\u003c/p>\n\u003cp>DHCS noted it's not the only state with such problems: “Many other states … have adjusted their strategies” toward their Medicaid computer systems, the release said. (Medi-Cal is California’s version of Medicaid.)\u003c/p>\n\u003cp>Indeed, several parties in Texas and Alaska, both public and private, have sued the Xerox subsidiary Xerox State Healthcare over contract problems.\u003c/p>\n\u003cp>The department declined to comment beyond the press release. The settlement requires that DHCS and Xerox both approve in advance any public statement for the next 30 days.\u003c/p>\n\u003cp>In a statement, Xerox said the settlement agreement finalizes the announcement it made last fall \"that it did not expect to complete implementation of the Health Enterprise Platform in California.\" Xerox added that it is \"pleased to work with DHCS to continue processing Medi-Cal claims through September 2019.\"\u003c/p>\n\u003cp>California’s drawn-out competition for the project began in 2007. Xerox won the contract in 2010. By 2012, the project was already in trouble. Delays caused the state to impose on Xerox a “\u003ca href=\"http://www.dhcs.ca.gov/formsandpubs/Documents/Legislative%20Reports/CAMMIS_Quarterly_July-2012.pdf\" target=\"_blank\">corrective action plan\u003c/a>.”\u003c/p>\n\u003cp>Originally scheduled for completion by the end of this year, the project isn’t close to done, the settlement indicates.\u003c/p>\n\u003cp>Whenever government computer systems fall behind schedule, which is common, critics blame red tape. In this case, the massive Medi-Cal replacement contract with Xerox was inked just five days before President Obama signed the Affordable Care Act into law. As new regulations under the law worked their way through the health care system, requirements for the Medi-Cal project continued to change.\u003c/p>\n\u003cp>Compounding matters, Xerox fell into deep trouble. Its stock has lagged far behind the market in general. The company is under pressure from investor activist Carl Icahn. Late last year, Xerox said it would wind down its Medicaid computer systems business in California and Montana, take a $385 million charge against earnings, and “focus on profitable market segments.” That meant the end of the California project.\u003c/p>\n\u003cp>\u003ca href=\"https://www.medicaid.gov/medicaid-chip-program-information/by-topics/data-and-systems/downloads/mmisfacsr.pdf\" target=\"_blank\">Several companies \u003c/a>compete in the Medicaid system market. As of February, Xerox was the number-two provider, covering 11 states. The leader, HP Enterprise Systems, covers 18.\u003c/p>\n\u003cp>Xerox will pay about $103 million in cash, provide computer hardware and software worth $15 million, and abandon payment claims worth roughly $5 million more.\u003c/p>\n\u003cp>DHCS has reported it had paid Xerox $9 million for the replacement system, $8.1 million of that with federal funds.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>, which publishes California Healthline, a service of the California Health Care Foundation.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Medi-Cal Expands to Undocumented Children. Here's How It Works",
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"content": "\u003cp>\u003cem>Lea este artículo en español : \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/04/22/medi-cal-se-expande-para-los-ninos-inmigrantes-asi-es-como-funciona/\" target=\"_blank\">“Medi-Cal se expande para los niños inmigrantes. Así es como funciona”\u003c/a>\u003c/em>\u003c/p>\n\u003cp>In a few months, California will begin providing full Medi-Cal coverage to all low-income children — regardless of their immigration status.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/02/09/states-medi-cal-bill-for-undocumented-children-could-go-up/\" target=\"_blank\">Depending on whom you ask\u003c/a>, anywhere from 170,000 to \u003ca href=\"http://www.blueshieldcafoundation.org/sites/default/files/covers/undocumented%20children%20transition%20memo%20final%20101615.pdf\" target=\"_blank\">250,000\u003c/a> children who live in California and are in the country illegally will qualify.\u003c/p>\n\u003caside class=\"pullquote alignright\">Take action now, sign up today, say health advocates\u003c/aside>\n\u003cp>If you think your child will, or know a parent whose child will, state officials and health care advocates have a simple message for you: Take action now. “Sign up today,” says Rachel Vizcarra, a program assistant with the \u003ca href=\"http://www.ufwfoundation.org/\" target=\"_blank\">UFW Foundation\u003c/a> in Bakersfield, which is helping families pre-enroll. “If you do, your kids will be automatically enrolled into the program.”\u003c/p>\n\u003cp>State officials expect coverage to start May 16. But because the policy shift requires complex programming changes to state and county computer systems, implementation may be delayed, says Tony Cava of the \u003ca href=\"http://www.dhcs.ca.gov/Pages/default.aspx\" target=\"_blank\">state Department of Health Care Services\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>No matter when it occurs, eligible children will gain coverage retroactive to the first day of that month, he says. For example, if the change takes place on May 16, coverage will extend back to May 1.\u003c/p>\n\u003cp>Carolina Moran of Canoga Park looks forward to taking her 14-year-old daughter Lizeth to the doctor once she becomes eligible for full Medi-Cal benefits.\u003c/p>\n\u003cp>A concussion on the soccer field sent Lizeth to the emergency room in January, but she couldn’t see a doctor for a follow-up visit because “we couldn’t afford it. We would have to pay out of pocket,” Moran says.\u003c/p>\n\u003cp>The first thing Moran will do is take Lizeth for a physical “and make sure her vaccinations are up to date,” she says. “She also needs fillings for five cavities.”\u003c/p>\n\u003cp>Medi-Cal eligibility is based on household income, and children under the age of 19 qualify at a higher income level than adults. They’re eligible for Medi-Cal if the family’s household income is less than 266 percent of the \u003ca href=\"https://aspe.hhs.gov/poverty-guidelines\" target=\"_blank\">Federal Poverty Level\u003c/a>, or about $53,600 for a family of three and $75,650 for a family of five.\u003c/p>\n\u003cp>Currently, children and adults in the country illegally qualify for limited Medi-Cal coverage, called restricted-scope, which covers emergency and pregnancy-related services.\u003c/p>\n\u003cp>Though this may sound counter-intuitive, health care advocates and the state want you to sign your kids up for restricted Medi-Cal now in preparation for the availability of full Medi-Cal benefits.\u003c/p>\n\u003caside class=\"pullquote alignright\">Be warned: the Medi-Cal application is long and complicated, but free help is available to help with enrollment\u003c/aside>\n\u003cp>The idea is that when the change occurs, qualified children \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Documents/SB75/SB75_EE_Plan_032116_Final.PDF\" target=\"_blank\">will automatically transition\u003c/a> into full-scope Medi-Cal “within a few days” and without an additional application, Cava says.\u003c/p>\n\u003cp>The state estimates that there are about 115,000 unauthorized immigrant children who already have restricted Medi-Cal.\u003c/p>\n\u003cp>If your child is uninsured, sign up for restricted-scope Medi-Cal now. Even if your child has coverage through another existing program — such as Kaiser Permanente’s \u003ca href=\"http://info.kaiserpermanente.org/html/child_health_plan/index.html\" target=\"_blank\">Child Health Program\u003c/a> or county-based health coverage — you should still sign your child up for restricted Medi-Cal now, says Mark Diel, CEO of \u003ca href=\"http://cchi4families.org/\" target=\"_blank\">California Coverage & Health Initiatives\u003c/a> (CCHI), a statewide outreach and enrollment network.\u003c/p>\n\u003cp>That’s because those kids will eventually become ineligible for those programs after they become eligible for full Medi-Cal, he says. (Don’t drop out of another program until you confirm that your child’s full-scope Medi-Cal has been approved, he says.)\u003c/p>\n\u003cp>But be warned: The Medi-Cal application is long and complicated. To complete it, you’ll need to provide a birth certificate, proof of local address, proof of identity and income information, Vizcarra says. Foreign passports and birth certificates can be used.\u003c/p>\n\u003cp>“Work with a local enroller instead of trying to do it on your own,” Diel says. “You’re much more likely to get the application approved.”\u003c/p>\n\u003cp>Help from local health clinics and community groups is free. Online, visit \u003ca href=\"http://www.cchi4families.org/find-help\" target=\"_blank\">www.cchi4families.org/find-help\u003c/a> for local resources.\u003c/p>\n\u003cp>Advocates and state officials also want you to know that enrolling your kids shouldn’t lead to negative immigration consequences for you — or other members of your family — who may not have legal status.\u003c/p>\n\u003cp>“None of the information being collected is shared with immigration authorities,” says Maria Romero-Mora of CCHI.\u003c/p>\n\u003cp>Once you get your kids into restricted-scope Medi-Cal, and eventually into full Medi-Cal, you’ll need to take action.\u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/SB75_FAQ_1.aspx\" target=\"_blank\"> Look for letters in the mail\u003c/a> before and after the transition explaining your options.\u003c/p>\n\u003cp>\u003cstrong>CHOOSE A PLAN\u003c/strong>: Once the transition to full Medi-Cal occurs, you will have 60 days to choose a managed care health plan for children already enrolled in restricted-scope Medi-Cal. If you don’t choose a plan, the state will assign one, Cava says.\u003c/p>\n\u003cp>Parents of kids who are not in restricted-scope Medi-Cal at the time of the change and who enroll them afterward will have 30 days to choose a plan, he says.\u003c/p>\n\u003cp>If you live in one of 22 counties where Medi-Cal managed care is operated by a single \u003ca href=\"http://www.healthconsumer.org/092914-ManagedCareinCaliforniaSeries-3-COHSMediCalPlans.pdf\" target=\"_blank\">County Organized Health System\u003c/a>, children will be automatically enrolled in that plan, Cava says.\u003c/p>\n\u003cp>In all cases, until a plan is chosen — or assigned — children will receive coverage through Medi-Cal’s fee-for-service program.\u003c/p>\n\u003cp>\u003cstrong>PAY PREMIUMS\u003c/strong>: Medi-Cal is premium-free for kids up to 160 percent of the Federal Poverty Level, but you will owe a premium if your family income falls between 160 percent and 266 percent. The premium is $13 a month for each child, with a $39 family maximum.\u003c/p>\n\u003cp>Children in Medi-Cal plans don’t have co-payments for medical care.\u003c/p>\n\u003cp>\u003cstrong>RENEW\u003c/strong>: You will need to participate in Medi-Cal’s annual renewal process to ensure your children remain eligible and enrolled.\u003c/p>\n\u003cp>Finally, if you don’t sign your child up for restricted Medi-Cal before the change, you can apply for full benefits afterward — anytime of year — at your county human services office, through a community organization or via the \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">Covered California\u003c/a> website, \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">www.CoveredCA.com\u003c/a>.\u003c/p>\n\u003cp>In Canoga Park, Moran says getting Lizeth on Medi-Cal will give her family greater financial security. Lizeth agrees.\u003c/p>\n\u003cp>“I worry that if I have to go to a checkup, it’s going to cost my parents money, and sometimes they don’t have the money to pay for it,” the ninth-grader says.\u003c/p>\n\u003cp>\u003cem>This story is part of California Healthline's \u003ca href=\"http://californiahealthline.org/news/author/emily-bazar/\" target=\"_blank\">Ask Emily\u003c/a>, a series of Q&A columns answering consumers’ questions about California’s new medical world. It was produced by Kaiser Health News which publishes California Healthline, a service of the California Health Care Foundation.”\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Send questions for Emily to AskEmily@kff.org\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Lea este artículo en español : \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/04/22/medi-cal-se-expande-para-los-ninos-inmigrantes-asi-es-como-funciona/\" target=\"_blank\">“Medi-Cal se expande para los niños inmigrantes. Así es como funciona”\u003c/a>\u003c/em>\u003c/p>\n\u003cp>In a few months, California will begin providing full Medi-Cal coverage to all low-income children — regardless of their immigration status.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/02/09/states-medi-cal-bill-for-undocumented-children-could-go-up/\" target=\"_blank\">Depending on whom you ask\u003c/a>, anywhere from 170,000 to \u003ca href=\"http://www.blueshieldcafoundation.org/sites/default/files/covers/undocumented%20children%20transition%20memo%20final%20101615.pdf\" target=\"_blank\">250,000\u003c/a> children who live in California and are in the country illegally will qualify.\u003c/p>\n\u003caside class=\"pullquote alignright\">Take action now, sign up today, say health advocates\u003c/aside>\n\u003cp>If you think your child will, or know a parent whose child will, state officials and health care advocates have a simple message for you: Take action now. “Sign up today,” says Rachel Vizcarra, a program assistant with the \u003ca href=\"http://www.ufwfoundation.org/\" target=\"_blank\">UFW Foundation\u003c/a> in Bakersfield, which is helping families pre-enroll. “If you do, your kids will be automatically enrolled into the program.”\u003c/p>\n\u003cp>State officials expect coverage to start May 16. But because the policy shift requires complex programming changes to state and county computer systems, implementation may be delayed, says Tony Cava of the \u003ca href=\"http://www.dhcs.ca.gov/Pages/default.aspx\" target=\"_blank\">state Department of Health Care Services\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>No matter when it occurs, eligible children will gain coverage retroactive to the first day of that month, he says. For example, if the change takes place on May 16, coverage will extend back to May 1.\u003c/p>\n\u003cp>Carolina Moran of Canoga Park looks forward to taking her 14-year-old daughter Lizeth to the doctor once she becomes eligible for full Medi-Cal benefits.\u003c/p>\n\u003cp>A concussion on the soccer field sent Lizeth to the emergency room in January, but she couldn’t see a doctor for a follow-up visit because “we couldn’t afford it. We would have to pay out of pocket,” Moran says.\u003c/p>\n\u003cp>The first thing Moran will do is take Lizeth for a physical “and make sure her vaccinations are up to date,” she says. “She also needs fillings for five cavities.”\u003c/p>\n\u003cp>Medi-Cal eligibility is based on household income, and children under the age of 19 qualify at a higher income level than adults. They’re eligible for Medi-Cal if the family’s household income is less than 266 percent of the \u003ca href=\"https://aspe.hhs.gov/poverty-guidelines\" target=\"_blank\">Federal Poverty Level\u003c/a>, or about $53,600 for a family of three and $75,650 for a family of five.\u003c/p>\n\u003cp>Currently, children and adults in the country illegally qualify for limited Medi-Cal coverage, called restricted-scope, which covers emergency and pregnancy-related services.\u003c/p>\n\u003cp>Though this may sound counter-intuitive, health care advocates and the state want you to sign your kids up for restricted Medi-Cal now in preparation for the availability of full Medi-Cal benefits.\u003c/p>\n\u003caside class=\"pullquote alignright\">Be warned: the Medi-Cal application is long and complicated, but free help is available to help with enrollment\u003c/aside>\n\u003cp>The idea is that when the change occurs, qualified children \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Documents/SB75/SB75_EE_Plan_032116_Final.PDF\" target=\"_blank\">will automatically transition\u003c/a> into full-scope Medi-Cal “within a few days” and without an additional application, Cava says.\u003c/p>\n\u003cp>The state estimates that there are about 115,000 unauthorized immigrant children who already have restricted Medi-Cal.\u003c/p>\n\u003cp>If your child is uninsured, sign up for restricted-scope Medi-Cal now. Even if your child has coverage through another existing program — such as Kaiser Permanente’s \u003ca href=\"http://info.kaiserpermanente.org/html/child_health_plan/index.html\" target=\"_blank\">Child Health Program\u003c/a> or county-based health coverage — you should still sign your child up for restricted Medi-Cal now, says Mark Diel, CEO of \u003ca href=\"http://cchi4families.org/\" target=\"_blank\">California Coverage & Health Initiatives\u003c/a> (CCHI), a statewide outreach and enrollment network.\u003c/p>\n\u003cp>That’s because those kids will eventually become ineligible for those programs after they become eligible for full Medi-Cal, he says. (Don’t drop out of another program until you confirm that your child’s full-scope Medi-Cal has been approved, he says.)\u003c/p>\n\u003cp>But be warned: The Medi-Cal application is long and complicated. To complete it, you’ll need to provide a birth certificate, proof of local address, proof of identity and income information, Vizcarra says. Foreign passports and birth certificates can be used.\u003c/p>\n\u003cp>“Work with a local enroller instead of trying to do it on your own,” Diel says. “You’re much more likely to get the application approved.”\u003c/p>\n\u003cp>Help from local health clinics and community groups is free. Online, visit \u003ca href=\"http://www.cchi4families.org/find-help\" target=\"_blank\">www.cchi4families.org/find-help\u003c/a> for local resources.\u003c/p>\n\u003cp>Advocates and state officials also want you to know that enrolling your kids shouldn’t lead to negative immigration consequences for you — or other members of your family — who may not have legal status.\u003c/p>\n\u003cp>“None of the information being collected is shared with immigration authorities,” says Maria Romero-Mora of CCHI.\u003c/p>\n\u003cp>Once you get your kids into restricted-scope Medi-Cal, and eventually into full Medi-Cal, you’ll need to take action.\u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/SB75_FAQ_1.aspx\" target=\"_blank\"> Look for letters in the mail\u003c/a> before and after the transition explaining your options.\u003c/p>\n\u003cp>\u003cstrong>CHOOSE A PLAN\u003c/strong>: Once the transition to full Medi-Cal occurs, you will have 60 days to choose a managed care health plan for children already enrolled in restricted-scope Medi-Cal. If you don’t choose a plan, the state will assign one, Cava says.\u003c/p>\n\u003cp>Parents of kids who are not in restricted-scope Medi-Cal at the time of the change and who enroll them afterward will have 30 days to choose a plan, he says.\u003c/p>\n\u003cp>If you live in one of 22 counties where Medi-Cal managed care is operated by a single \u003ca href=\"http://www.healthconsumer.org/092914-ManagedCareinCaliforniaSeries-3-COHSMediCalPlans.pdf\" target=\"_blank\">County Organized Health System\u003c/a>, children will be automatically enrolled in that plan, Cava says.\u003c/p>\n\u003cp>In all cases, until a plan is chosen — or assigned — children will receive coverage through Medi-Cal’s fee-for-service program.\u003c/p>\n\u003cp>\u003cstrong>PAY PREMIUMS\u003c/strong>: Medi-Cal is premium-free for kids up to 160 percent of the Federal Poverty Level, but you will owe a premium if your family income falls between 160 percent and 266 percent. The premium is $13 a month for each child, with a $39 family maximum.\u003c/p>\n\u003cp>Children in Medi-Cal plans don’t have co-payments for medical care.\u003c/p>\n\u003cp>\u003cstrong>RENEW\u003c/strong>: You will need to participate in Medi-Cal’s annual renewal process to ensure your children remain eligible and enrolled.\u003c/p>\n\u003cp>Finally, if you don’t sign your child up for restricted Medi-Cal before the change, you can apply for full benefits afterward — anytime of year — at your county human services office, through a community organization or via the \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">Covered California\u003c/a> website, \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">www.CoveredCA.com\u003c/a>.\u003c/p>\n\u003cp>In Canoga Park, Moran says getting Lizeth on Medi-Cal will give her family greater financial security. Lizeth agrees.\u003c/p>\n\u003cp>“I worry that if I have to go to a checkup, it’s going to cost my parents money, and sometimes they don’t have the money to pay for it,” the ninth-grader says.\u003c/p>\n\u003cp>\u003cem>This story is part of California Healthline's \u003ca href=\"http://californiahealthline.org/news/author/emily-bazar/\" target=\"_blank\">Ask Emily\u003c/a>, a series of Q&A columns answering consumers’ questions about California’s new medical world. It was produced by Kaiser Health News which publishes California Healthline, a service of the California Health Care Foundation.”\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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}
