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"content": "\u003cp>California voters next spring will get to decide on a ballot measure to create housing and treatment options for unhoused individuals with serious mental illness. If it passes, the measure championed by Gov. Gavin Newsom would mark the first major overhaul of the state’s community mental health system in 20 years.\u003c/p>\n\u003cp>The two-pronged proposition on the March primary election ballot includes a nearly $6.4 billion bond to build 10,000 psychiatric treatment units. It also asks voters to redefine how counties spend money collected from a special “millionaire’s tax” to allocate a share of it for housing.\u003c/p>\n\u003cp>Newsom and supporters have promoted Proposition 1 as a way to help address the state’s deteriorating homelessness and addiction crises. They contend that increased investment and an update to the state’s Mental Health Services Act are “long overdue.”\u003c/p>\n\u003cp>The Legislature on Thursday overwhelmingly backed his proposal, with lopsided votes to place it on the 2024 ballot. Newsom still must sign the bills, and he said he would in a written statement after a late-night vote in the Assembly.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“These measures represent a key part of the solution to our homelessness crisis, and improving mental health for kids and families,” Newsom said. “Now, it will be up to voters to ratify the most significant changes to California’s mental health system in more than 50 years.”\u003c/p>\n\u003cp>Opponents of the ballot measure say diverting money in the Mental Health Services Act for housing will result in up to $1 billion in cuts to\u003ca href=\"https://lao.ca.gov/Publications/Report/4782\"> current mental health programs\u003c/a> like outpatient care and crisis response. Other advocates criticize the governor for making last-minute changes to the bond, allowing the money to be spent on involuntary treatment institutions.\u003c/p>\n\u003cp>So what exactly are voters being asked to consider? Here’s how the proposal breaks down.\u003c/p>\n\u003ch2>What is the Mental Health Services Act?\u003c/h2>\n\u003cp>The Mental Health Services Act, which voters passed as a ballot measure in 2004, levies a 1% tax on personal income over $1 million. It passed at a time when the state’s mental health system was severely underfunded. Since then, the tax has generated an estimated $26 billion for county mental health programs. Last year the tax garnered more than $3 billion. It supports roughly one-third of the state’s mental health system. [pullquote size=\"medium\" align=\"right\" citation=\"Gov. Gavin Newsom\"]‘These measures represent a key part of the solution to our homelessness crisis, and improving mental health for kids and families.’[/pullquote] The tax is not California’s only source of revenue for mental health programs. The state also receives money from Medi-Cal, and it spends a portion of its general fund on those services. Those sources come with strict spending limitations. For example, Medi-Cal primarily pays for treatment of mental health disorders but will not cover prevention programs. It also will not pay for inpatient treatment at a facility with more than 16 beds.\u003c/p>\n\u003cp>Counties have come to rely on the relative flexibility of Mental Health Services Act dollars to pay for core services like outpatient care, outreach and engagement, school-based counseling, youth wellness programs, family resource centers, and crisis response teams.\u003c/p>\n\u003ch2>What does Newsom want to do?\u003c/h2>\n\u003cp>The most significant change put forth by the governor is a requirement that counties invest 30% of their Mental Health Services Act tax dollars — roughly $1 billion based on last year’s revenue — in housing programs, including rental subsidies and navigation services. Counties would have to spend half this money on people who are chronically homeless or living in encampments. They could also use up to one-quarter of the money to build or purchase housing units.\u003c/p>\n\u003cp>Sacramento Mayor Darrell Steinberg has been a staunch supporter of Newsom’s proposal. Steinberg was one of the co-authors of the Mental Health Services Act when he was an Assembly member in 2004.\u003c/p>\n\u003cp>“To put it plainly, not enough of the Mental Health Services Act dollars are getting out to the people with the most persistent mental illnesses, specifically people who are chronically homeless and living with those underlying conditions,” Steinberg said during a press call in August. “So that’s where you start.”\u003c/p>\n\u003cp>The ballot measure puts counties on the hook for paying for substance use disorder treatment with Mental Health Services Act money. Counties have historically paid for addiction treatment with other funding.\u003c/p>\n\u003cp>And, it\u003cstrong> \u003c/strong>renames the program as the Behavioral Health Services Act.\u003c/p>\n\u003cfigure id=\"attachment_11961360\" class=\"wp-caption aligncenter\" style=\"max-width: 2400px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11961360\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/09/CMNewsom02.jpeg\" alt=\"Gov. Gavin Newsom is pictured with his hands out as he speak to many folks in a warehouse in front of a microphone.\" width=\"2400\" height=\"1600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/09/CMNewsom02.jpeg 2400w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/09/CMNewsom02-800x533.jpeg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/09/CMNewsom02-1020x680.jpeg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/09/CMNewsom02-160x107.jpeg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/09/CMNewsom02-1536x1024.jpeg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/09/CMNewsom02-2048x1365.jpeg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/09/CMNewsom02-1920x1280.jpeg 1920w\" sizes=\"auto, (max-width: 2400px) 100vw, 2400px\">\u003cfigcaption class=\"wp-caption-text\">Flanked by state and local politicians, Newsom announced the state’s plan to address homelessness across the state at Cal Expo in Sacramento, on March 16, 2023. \u003ccite>(Miguel Gutierrez Jr./CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch2>What will the bond measure do?\u003c/h2>\n\u003cp>The second half of Newsom’s proposal places a $6.4 billion general obligation bond before voters to dramatically expand the state’s psychiatric and addiction treatment infrastructure. [pullquote size=\"medium\" align=\"right\" citation=\"Sacramento Mayor Darrell Steinberg\"]‘To put it plainly, not enough of the Mental Health Services Act dollars are getting out to the people with the most persistent mental illnesses, specifically people who are chronically homeless and living with those underlying conditions.’[/pullquote] Nearly $4.4 billion would go toward building inpatient and residential treatment beds and could serve 100,000 people annually, officials said. California faces a shortage of \u003ca href=\"https://www.rand.org/content/dam/rand/pubs/testimonies/CTA2700/CTA2742-1/RAND_CTA2742-1.pdf\">nearly 8,000 adult psychiatric beds (PDF)\u003c/a>, said Nicole Eberhart, senior behavioral health scientist for the RAND Corporation, during testimony to an Assembly budget subcommittee in May. Long waitlists plague the state’s inpatient mental health system, and doctors say there’s nowhere to send stable patients who need long-term treatment focused on recovery.\u003c/p>\n\u003cp>Another $2 billion will go toward building permanent supportive housing, with half set aside for veterans with mental health diagnoses or addiction disorders.\u003c/p>\n\u003ch2>How many people are unhoused in California?\u003c/h2>\n\u003cp>More than 170,000 Californians are unhoused, the vast majority of whom live in street encampments. California has the highest homeless rate per 10,000 people, second only to the District of Columbia, and the highest proportion of unsheltered homeless individuals in the country, according to federal data.\u003c/p>\n\u003cp>A \u003ca href=\"https://calmatters.org/housing/2023/06/california-homeless-growth-report/\">landmark study by the UCSF Benioff Homelessness and Housing Initiative\u003c/a> found about two-thirds of unhoused Californians surveyed suffered from a mental health disorder but only 19% had received recent treatment. The driving force behind homelessness, however, was most often income loss, not mental illness or addiction, \u003ca href=\"https://homelessness.ucsf.edu/our-impact/our-studies/california-statewide-study-people-experiencing-homelessness\">according to the study\u003c/a>. [aside label='More Around California' tag='california-law']\u003c/p>\n\u003ch2>Who are the supporters?\u003c/h2>\n\u003cp>Sen. Susan Talamantes-Eggman, a Democrat from Stockton, carried the proposed reform of the Mental Health Services Act in the Legislature. During Thursday’s Senate concurrence vote, Talamantes-Eggman said the way counties spend state mental health funding needs to address changes that have happened in the two decades since the act was first designed.\u003c/p>\n\u003cp>Assemblymember Jacqui Irwin, a Democrat from Thousand Oaks, carried the bond proposal in the Legislature.\u003c/p>\n\u003cp>Mayors and county supervisors from eight major regions, including San Francisco and Los Angeles, successfully lobbied to increase funding for the bond measure by $1.5 billion. City leaders were early supporters of the measure with more than two dozen submitting letters of support along with housing and homeless advocates and the National Alliance on Mental Illness California.\u003c/p>\n\u003ch2>Who are the opponents?\u003c/h2>\n\u003cp>Peer-run and disability organizations have been the staunchest opponents of the changes proposed in the ballot measure. They argue current clients will lose treatment options and accuse Newsom’s administration of using the proposal to fund his \u003ca href=\"https://calmatters.org/housing/2023/08/care-court-california-start/\">CARE Court initiative\u003c/a> that passed last year. That law allows a court to place someone with a serious mental illness into an involuntary treatment program. [pullquote size=\"medium\" align=\"right\" citation=\"Paul Simmons, executive director, Depression and Bipolar Support Alliance\"]‘This is a really tough time for our communities. Our concern with [the proposition] is massive increases in involuntary and forced treatment.’[/pullquote] Groups representing people of color and LGBTQ+ communities also oppose the measure. They say it will eliminate prevention resources and worsen already stark disparities in access to treatment. Resource centers that target these populations are among the services most likely to get cut, county behavioral health leaders have said in public hearing.\u003c/p>\n\u003cp>The bond measure, which previously faced no opposition, drew fierce criticism from peer and disability advocates after last-minute amendments \u003ca href=\"https://calmatters.org/health/mental-health/2023/09/mental-health-bond-gavin-newsom-amendments/\">allowed the money to be used on involuntary treatment facilities\u003c/a>.\u003c/p>\n\u003cp>“This is a really tough time for our communities,” said Paul Simmons, executive director of the Depression and Bipolar Support Alliance. “Our concern with [the proposition] is massive increases in involuntary and forced treatment.”\u003c/p>\n\u003cp>Children and family advocates withdrew previous opposition after securing significant concessions from the governor requiring 51% of spending on early intervention be targeted toward children and youth.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California voters next spring will get to decide on a ballot measure to create housing and treatment options for unhoused individuals with serious mental illness. If it passes, the measure championed by Gov. Gavin Newsom would mark the first major overhaul of the state’s community mental health system in 20 years.\u003c/p>\n\u003cp>The two-pronged proposition on the March primary election ballot includes a nearly $6.4 billion bond to build 10,000 psychiatric treatment units. It also asks voters to redefine how counties spend money collected from a special “millionaire’s tax” to allocate a share of it for housing.\u003c/p>\n\u003cp>Newsom and supporters have promoted Proposition 1 as a way to help address the state’s deteriorating homelessness and addiction crises. They contend that increased investment and an update to the state’s Mental Health Services Act are “long overdue.”\u003c/p>\n\u003cp>The Legislature on Thursday overwhelmingly backed his proposal, with lopsided votes to place it on the 2024 ballot. Newsom still must sign the bills, and he said he would in a written statement after a late-night vote in the Assembly.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“These measures represent a key part of the solution to our homelessness crisis, and improving mental health for kids and families,” Newsom said. “Now, it will be up to voters to ratify the most significant changes to California’s mental health system in more than 50 years.”\u003c/p>\n\u003cp>Opponents of the ballot measure say diverting money in the Mental Health Services Act for housing will result in up to $1 billion in cuts to\u003ca href=\"https://lao.ca.gov/Publications/Report/4782\"> current mental health programs\u003c/a> like outpatient care and crisis response. Other advocates criticize the governor for making last-minute changes to the bond, allowing the money to be spent on involuntary treatment institutions.\u003c/p>\n\u003cp>So what exactly are voters being asked to consider? Here’s how the proposal breaks down.\u003c/p>\n\u003ch2>What is the Mental Health Services Act?\u003c/h2>\n\u003cp>The Mental Health Services Act, which voters passed as a ballot measure in 2004, levies a 1% tax on personal income over $1 million. It passed at a time when the state’s mental health system was severely underfunded. Since then, the tax has generated an estimated $26 billion for county mental health programs. Last year the tax garnered more than $3 billion. It supports roughly one-third of the state’s mental health system. \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp> The tax is not California’s only source of revenue for mental health programs. The state also receives money from Medi-Cal, and it spends a portion of its general fund on those services. Those sources come with strict spending limitations. For example, Medi-Cal primarily pays for treatment of mental health disorders but will not cover prevention programs. It also will not pay for inpatient treatment at a facility with more than 16 beds.\u003c/p>\n\u003cp>Counties have come to rely on the relative flexibility of Mental Health Services Act dollars to pay for core services like outpatient care, outreach and engagement, school-based counseling, youth wellness programs, family resource centers, and crisis response teams.\u003c/p>\n\u003ch2>What does Newsom want to do?\u003c/h2>\n\u003cp>The most significant change put forth by the governor is a requirement that counties invest 30% of their Mental Health Services Act tax dollars — roughly $1 billion based on last year’s revenue — in housing programs, including rental subsidies and navigation services. Counties would have to spend half this money on people who are chronically homeless or living in encampments. They could also use up to one-quarter of the money to build or purchase housing units.\u003c/p>\n\u003cp>Sacramento Mayor Darrell Steinberg has been a staunch supporter of Newsom’s proposal. Steinberg was one of the co-authors of the Mental Health Services Act when he was an Assembly member in 2004.\u003c/p>\n\u003cp>“To put it plainly, not enough of the Mental Health Services Act dollars are getting out to the people with the most persistent mental illnesses, specifically people who are chronically homeless and living with those underlying conditions,” Steinberg said during a press call in August. “So that’s where you start.”\u003c/p>\n\u003cp>The ballot measure puts counties on the hook for paying for substance use disorder treatment with Mental Health Services Act money. Counties have historically paid for addiction treatment with other funding.\u003c/p>\n\u003cp>And, it\u003cstrong> \u003c/strong>renames the program as the Behavioral Health Services Act.\u003c/p>\n\u003cfigure id=\"attachment_11961360\" class=\"wp-caption aligncenter\" style=\"max-width: 2400px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11961360\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/09/CMNewsom02.jpeg\" alt=\"Gov. Gavin Newsom is pictured with his hands out as he speak to many folks in a warehouse in front of a microphone.\" width=\"2400\" height=\"1600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/09/CMNewsom02.jpeg 2400w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/09/CMNewsom02-800x533.jpeg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/09/CMNewsom02-1020x680.jpeg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/09/CMNewsom02-160x107.jpeg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/09/CMNewsom02-1536x1024.jpeg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/09/CMNewsom02-2048x1365.jpeg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/09/CMNewsom02-1920x1280.jpeg 1920w\" sizes=\"auto, (max-width: 2400px) 100vw, 2400px\">\u003cfigcaption class=\"wp-caption-text\">Flanked by state and local politicians, Newsom announced the state’s plan to address homelessness across the state at Cal Expo in Sacramento, on March 16, 2023. \u003ccite>(Miguel Gutierrez Jr./CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch2>What will the bond measure do?\u003c/h2>\n\u003cp>The second half of Newsom’s proposal places a $6.4 billion general obligation bond before voters to dramatically expand the state’s psychiatric and addiction treatment infrastructure. \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp> Nearly $4.4 billion would go toward building inpatient and residential treatment beds and could serve 100,000 people annually, officials said. California faces a shortage of \u003ca href=\"https://www.rand.org/content/dam/rand/pubs/testimonies/CTA2700/CTA2742-1/RAND_CTA2742-1.pdf\">nearly 8,000 adult psychiatric beds (PDF)\u003c/a>, said Nicole Eberhart, senior behavioral health scientist for the RAND Corporation, during testimony to an Assembly budget subcommittee in May. Long waitlists plague the state’s inpatient mental health system, and doctors say there’s nowhere to send stable patients who need long-term treatment focused on recovery.\u003c/p>\n\u003cp>Another $2 billion will go toward building permanent supportive housing, with half set aside for veterans with mental health diagnoses or addiction disorders.\u003c/p>\n\u003ch2>How many people are unhoused in California?\u003c/h2>\n\u003cp>More than 170,000 Californians are unhoused, the vast majority of whom live in street encampments. California has the highest homeless rate per 10,000 people, second only to the District of Columbia, and the highest proportion of unsheltered homeless individuals in the country, according to federal data.\u003c/p>\n\u003cp>A \u003ca href=\"https://calmatters.org/housing/2023/06/california-homeless-growth-report/\">landmark study by the UCSF Benioff Homelessness and Housing Initiative\u003c/a> found about two-thirds of unhoused Californians surveyed suffered from a mental health disorder but only 19% had received recent treatment. The driving force behind homelessness, however, was most often income loss, not mental illness or addiction, \u003ca href=\"https://homelessness.ucsf.edu/our-impact/our-studies/california-statewide-study-people-experiencing-homelessness\">according to the study\u003c/a>. \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003ch2>Who are the supporters?\u003c/h2>\n\u003cp>Sen. Susan Talamantes-Eggman, a Democrat from Stockton, carried the proposed reform of the Mental Health Services Act in the Legislature. During Thursday’s Senate concurrence vote, Talamantes-Eggman said the way counties spend state mental health funding needs to address changes that have happened in the two decades since the act was first designed.\u003c/p>\n\u003cp>Assemblymember Jacqui Irwin, a Democrat from Thousand Oaks, carried the bond proposal in the Legislature.\u003c/p>\n\u003cp>Mayors and county supervisors from eight major regions, including San Francisco and Los Angeles, successfully lobbied to increase funding for the bond measure by $1.5 billion. City leaders were early supporters of the measure with more than two dozen submitting letters of support along with housing and homeless advocates and the National Alliance on Mental Illness California.\u003c/p>\n\u003ch2>Who are the opponents?\u003c/h2>\n\u003cp>Peer-run and disability organizations have been the staunchest opponents of the changes proposed in the ballot measure. They argue current clients will lose treatment options and accuse Newsom’s administration of using the proposal to fund his \u003ca href=\"https://calmatters.org/housing/2023/08/care-court-california-start/\">CARE Court initiative\u003c/a> that passed last year. That law allows a court to place someone with a serious mental illness into an involuntary treatment program. \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp> Groups representing people of color and LGBTQ+ communities also oppose the measure. They say it will eliminate prevention resources and worsen already stark disparities in access to treatment. Resource centers that target these populations are among the services most likely to get cut, county behavioral health leaders have said in public hearing.\u003c/p>\n\u003cp>The bond measure, which previously faced no opposition, drew fierce criticism from peer and disability advocates after last-minute amendments \u003ca href=\"https://calmatters.org/health/mental-health/2023/09/mental-health-bond-gavin-newsom-amendments/\">allowed the money to be used on involuntary treatment facilities\u003c/a>.\u003c/p>\n\u003cp>“This is a really tough time for our communities,” said Paul Simmons, executive director of the Depression and Bipolar Support Alliance. “Our concern with [the proposition] is massive increases in involuntary and forced treatment.”\u003c/p>\n\u003cp>Children and family advocates withdrew previous opposition after securing significant concessions from the governor requiring 51% of spending on early intervention be targeted toward children and youth.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>San Francisco is poised to pay $2.2 million to settle a lawsuit over a \u003ca href=\"https://www.kqed.org/news/11782161/newly-uncovered-cases-of-patient-abuse-at-laguna-honda-bring-incident-count-to-130\">patient abuse scandal at Laguna Honda Hospital and Rehabilitation Center\u003c/a>, where a group of nurses were found to have taken nude photos of some patients and drugged and abused others between 2016 and 2019.\u003c/p>\n\u003cp>The lawsuit involved 11 older residents at the city-run hospital who were under conservatorship, in which a court-appointed family member or other individual was charged with overseeing their finances and medical care. Each of the victims will be compensated based on the extent of abuses they suffered.\u003c/p>\n\u003cp>The settlement amount was agreed to Thursday by the Board of Supervisors’ Government Audit and Oversight Committee and now heads to the full board and mayor for final approval.\u003c/p>\n\u003cp>“We believe this is an appropriate resolution given all of the circumstances,” said Jen Kwart, spokesperson for the City Attorney’s Office. “Laguna Honda Hospital is committed to providing excellent care and treating all residents with dignity.”\u003c/p>\n\u003cp>The lawsuit stems from a \u003ca href=\"https://www.documentcloud.org/documents/23831881-laguna-honda-2567-1\">2019 California Department of Public Health investigation (PDF)\u003c/a> that confirmed multiple claims of patient abuse by six former nurses at the hospital.\u003c/p>\n\u003cp>[aside label=\"related coverage\" tag=\"laguna-honda\"]“This first settlement is really a step in the direction to try to get justice for those people who have been experiencing neglect and, in my own opinion, still experiencing neglect up at Laguna Honda,” said Kathryn Stebner, an attorney who represented the plaintiffs and is pursuing two other pending cases against the city related to abuses at the hospital.\u003c/p>\n\u003cp>“One of the women had a gag over her mouth and part of her breasts were showing,” she added. “Other people were given medications without their consent.”\u003c/p>\n\u003cp>The 2021 lawsuit was filed just months before the hospital — one of the country’s oldest and largest skilled nursing and rehabilitation centers — reported two nonfatal patient overdoses involving smuggled methamphetamine and fentanyl. That disclosure triggered a series of on-site inspections from state and federal officials, which eventually resulted in regulators decertifying the 157-year-old hospital.\u003c/p>\n\u003cp>Last year, Laguna Honda was found to still be out of compliance on a number of safety issues, \u003ca href=\"https://www.kqed.org/news/11950092/san-francisco-laguna-honda-hospital-granted-extension\">prompting federal regulators to cut Medicare and Medi-Cal funding\u003c/a>, which covers the majority of its mostly lower-income patients. The hospital was also required to draft a closure plan and begin discharging or relocating patients by September 2022.\u003c/p>\n\u003cp>But of the 57 patients who were initially transferred or discharged, 12 died shortly after being relocated. San Francisco subsequently sued the federal government, temporarily halting the transfer process.\u003c/p>\n\u003cp>Last month, \u003ca href=\"https://www.kqed.org/news/11950092/san-francisco-laguna-honda-hospital-granted-extension\">regulators again postponed the transfer deadline\u003c/a>, to Sept. 19, 2023, and have allowed subsidized Medicare and Medi-Cal payments for remaining patients at the hospital to continue through March 2024.\u003c/p>\n\u003cp>Stebner’s firm is also representing families of patients — as part of a class-action suit against the city — who died after being discharged in 2022.\u003c/p>\n\u003cp>“This is a good start,” Stebner said of the most recent settlement. But, she added, “we still have a lot of work to do.”\u003cbr>\n[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n",
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"excerpt": "The lawsuit stems from a 2019 state report that found six former nurses at the hospital took nude photos of some elderly patients, and drugged and physically assaulted others. It is the first of at least three pending cases against the city related to abuses at the facility.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>San Francisco is poised to pay $2.2 million to settle a lawsuit over a \u003ca href=\"https://www.kqed.org/news/11782161/newly-uncovered-cases-of-patient-abuse-at-laguna-honda-bring-incident-count-to-130\">patient abuse scandal at Laguna Honda Hospital and Rehabilitation Center\u003c/a>, where a group of nurses were found to have taken nude photos of some patients and drugged and abused others between 2016 and 2019.\u003c/p>\n\u003cp>The lawsuit involved 11 older residents at the city-run hospital who were under conservatorship, in which a court-appointed family member or other individual was charged with overseeing their finances and medical care. Each of the victims will be compensated based on the extent of abuses they suffered.\u003c/p>\n\u003cp>The settlement amount was agreed to Thursday by the Board of Supervisors’ Government Audit and Oversight Committee and now heads to the full board and mayor for final approval.\u003c/p>\n\u003cp>“We believe this is an appropriate resolution given all of the circumstances,” said Jen Kwart, spokesperson for the City Attorney’s Office. “Laguna Honda Hospital is committed to providing excellent care and treating all residents with dignity.”\u003c/p>\n\u003cp>The lawsuit stems from a \u003ca href=\"https://www.documentcloud.org/documents/23831881-laguna-honda-2567-1\">2019 California Department of Public Health investigation (PDF)\u003c/a> that confirmed multiple claims of patient abuse by six former nurses at the hospital.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“This first settlement is really a step in the direction to try to get justice for those people who have been experiencing neglect and, in my own opinion, still experiencing neglect up at Laguna Honda,” said Kathryn Stebner, an attorney who represented the plaintiffs and is pursuing two other pending cases against the city related to abuses at the hospital.\u003c/p>\n\u003cp>“One of the women had a gag over her mouth and part of her breasts were showing,” she added. “Other people were given medications without their consent.”\u003c/p>\n\u003cp>The 2021 lawsuit was filed just months before the hospital — one of the country’s oldest and largest skilled nursing and rehabilitation centers — reported two nonfatal patient overdoses involving smuggled methamphetamine and fentanyl. That disclosure triggered a series of on-site inspections from state and federal officials, which eventually resulted in regulators decertifying the 157-year-old hospital.\u003c/p>\n\u003cp>Last year, Laguna Honda was found to still be out of compliance on a number of safety issues, \u003ca href=\"https://www.kqed.org/news/11950092/san-francisco-laguna-honda-hospital-granted-extension\">prompting federal regulators to cut Medicare and Medi-Cal funding\u003c/a>, which covers the majority of its mostly lower-income patients. The hospital was also required to draft a closure plan and begin discharging or relocating patients by September 2022.\u003c/p>\n\u003cp>But of the 57 patients who were initially transferred or discharged, 12 died shortly after being relocated. San Francisco subsequently sued the federal government, temporarily halting the transfer process.\u003c/p>\n\u003cp>Last month, \u003ca href=\"https://www.kqed.org/news/11950092/san-francisco-laguna-honda-hospital-granted-extension\">regulators again postponed the transfer deadline\u003c/a>, to Sept. 19, 2023, and have allowed subsidized Medicare and Medi-Cal payments for remaining patients at the hospital to continue through March 2024.\u003c/p>\n\u003cp>Stebner’s firm is also representing families of patients — as part of a class-action suit against the city — who died after being discharged in 2022.\u003c/p>\n\u003cp>“This is a good start,” Stebner said of the most recent settlement. But, she added, “we still have a lot of work to do.”\u003cbr>\n\u003c/p>\u003c/div>",
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"title": "Feds Grant SF’s Laguna Honda Hospital New Extension, Delaying Involuntary Patient Transfers",
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"content": "\u003cp>Federal regulators have agreed to again put off involuntarily transferring residents at \u003ca href=\"https://www.kqed.org/news/11939987/feds-grant-reprieve-on-laguna-honda-patient-transfers-until-may\">Laguna Honda\u003c/a>, the state’s largest public nursing facility, which fell out of compliance in 2022.\u003c/p>\n\u003cp>The reprieve came just one day before the hospital would have been forced to implement a closure plan that involves assessing and discharging the facility’s more than 500 medically fragile patients in preparation for a possible closure.\u003c/p>\n\u003cp>Laguna Honda now has until Sept. 19, 2023, before involuntary transfers could resume, according to a letter from interim CEO Roland Pickens. In addition, health insurance coverage for the hospital’s majority of patients who are on Medi-Cal and Medicare will continue through March 19, 2024.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Today’s good news is the result of positive changes taking place at Laguna Honda,” said Pickens in a note to families on Thursday. “The additional time provided by the extension allows us the opportunity we need [to] be in the best position to apply for recertification.”\u003c/p>\n\u003cp>The hospital is now working to regain certification with the Centers for Medicare and Medicaid Services, the federal regulatory body that Laguna Honda fell out of compliance with in April 2022.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Roland Pickens, interim CEO, Laguna Honda Hospital\"]‘The additional time provided by the extension allows us the opportunity we need [to] be in the best position to apply for recertification.’[/pullquote]\u003c/p>\n\u003cp>The hospital was cited for a number of safety issues across multiple regulatory surveys that were triggered after \u003ca href=\"https://www.kqed.org/news/11949515/laguna-honda-faces-covid-outbreak-amid-looming-patient-transfer-deadline\">Laguna Honda self-reported two nonfatal overdoses\u003c/a> that occurred on-site.\u003c/p>\n\u003cp>As a result, federal regulators stripped Laguna Honda from Medicare and Medi-Cal, subsidized health care plans that cover the vast majority of residents at the facility, most of whom have extremely low incomes.\u003c/p>\n\u003cp>While Laguna Honda works to address its citations, CMS has simultaneously required that the hospital craft a closure plan to continue its health care funding. That plan involved assessing and relocating as many patients as possible in 2022.\u003c/p>\n\u003cfigure id=\"attachment_11950111\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11950111\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/05/RS62460_007_KQED_LagunaHondaHospital_01312023-qut.jpg\" alt='An outdoor shot of a big tan hospital building surrounded by tall trees, succulents and other green plants. The words \"Laguna Honda Hospital\" are seen over the main entryway.' width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/05/RS62460_007_KQED_LagunaHondaHospital_01312023-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/05/RS62460_007_KQED_LagunaHondaHospital_01312023-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/05/RS62460_007_KQED_LagunaHondaHospital_01312023-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/05/RS62460_007_KQED_LagunaHondaHospital_01312023-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/05/RS62460_007_KQED_LagunaHondaHospital_01312023-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">The Laguna Honda Hospital administration building in San Francisco on Jan. 31, 2023. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Of 57 residents who were transferred or discharged during that process, 12 died shortly after their relocations. The city sued the federal government in response, and the transfer process was paused temporarily as part of a settlement agreement.\u003c/p>\n\u003cp>“Involuntary transfers caused our residents, their families, and our staff a great deal of distress. Laguna Honda and City leadership, as well as residents, families, and advocates, have strongly advocated against the involuntary transfers,” a spokesperson for the hospital wrote Tuesday in a media release. “This is the humane and compassionate path forward for our residents, their families, our staff, and all those who care about Laguna Honda.”\u003c/p>\n\u003cp>Following the city’s lawsuit in November 2022, the city and CMS reached a settlement agreement to pause the involuntary transfers until February 2023 and to continue health care payments through November 2023.\u003c/p>\n\u003cp>In February 2023, regulators agreed to extend the pause on transfers to May 19.\u003c/p>\n\u003cp>Today’s update moves the deadline yet again to Sept. 19, 2023, and payments will continue through March 19, 2024.[pullquote size=\"medium\" align=\"right\" citation=\"City Attorney David Chiu\"]‘The city and Laguna Honda have done a tremendous amount of work to come into compliance with the hundreds of requirements that have been asked of us and we believe we are in a good spot.’[/pullquote]“The city and Laguna Honda have done a tremendous amount of work to come into compliance with the hundreds of requirements that have been asked of us and we believe we are in a good spot,” said City Attorney David Chiu, whose office led the lawsuit against the federal regulators in 2022.\u003c/p>\n\u003cp>The hospital can apply for recertification after it successfully completes its next monitoring survey with CMS, which hospital officials say they expect to happen by the end of May or in June of this year.\u003c/p>\n\u003cp>“Laguna Honda is working diligently to make and sustain improvements that will serve our current residents and ensure Laguna Honda remains an essential part of the City and County of San Francisco’s commitment to public health,” the spokesperson said. “We remain confident that Laguna Honda is the best place for our residents to receive care.”[aside postID=news_11940765 hero='https://ww2.kqed.org/app/uploads/sites/10/2023/02/RS62526_02022023_lagunahondapresser-308-qut-1-1020x678.jpg']Meanwhile, senior and disability advocates have raised the alarm over the back-and-forth messaging that the hospital’s more than 500 residents and their families have endured throughout the regulatory spiral.\u003c/p>\n\u003cp>“Resuming evictions or whatever you want to call them is extremely dangerous,” said Teresa Palmer, who previously worked at Laguna Honda, in a recent town hall meeting about patients’ rights ahead of the looming discharges. “I don’t see how evictions and transfers can be resumed without severe consequences, not only to patients, but to the government agencies that are forcing them.”\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The hospital was cited for a number of safety issues across multiple regulatory surveys that were triggered after \u003ca href=\"https://www.kqed.org/news/11949515/laguna-honda-faces-covid-outbreak-amid-looming-patient-transfer-deadline\">Laguna Honda self-reported two nonfatal overdoses\u003c/a> that occurred on-site.\u003c/p>\n\u003cp>As a result, federal regulators stripped Laguna Honda from Medicare and Medi-Cal, subsidized health care plans that cover the vast majority of residents at the facility, most of whom have extremely low incomes.\u003c/p>\n\u003cp>While Laguna Honda works to address its citations, CMS has simultaneously required that the hospital craft a closure plan to continue its health care funding. That plan involved assessing and relocating as many patients as possible in 2022.\u003c/p>\n\u003cfigure id=\"attachment_11950111\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11950111\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/05/RS62460_007_KQED_LagunaHondaHospital_01312023-qut.jpg\" alt='An outdoor shot of a big tan hospital building surrounded by tall trees, succulents and other green plants. The words \"Laguna Honda Hospital\" are seen over the main entryway.' width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/05/RS62460_007_KQED_LagunaHondaHospital_01312023-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/05/RS62460_007_KQED_LagunaHondaHospital_01312023-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/05/RS62460_007_KQED_LagunaHondaHospital_01312023-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/05/RS62460_007_KQED_LagunaHondaHospital_01312023-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/05/RS62460_007_KQED_LagunaHondaHospital_01312023-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">The Laguna Honda Hospital administration building in San Francisco on Jan. 31, 2023. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Of 57 residents who were transferred or discharged during that process, 12 died shortly after their relocations. The city sued the federal government in response, and the transfer process was paused temporarily as part of a settlement agreement.\u003c/p>\n\u003cp>“Involuntary transfers caused our residents, their families, and our staff a great deal of distress. Laguna Honda and City leadership, as well as residents, families, and advocates, have strongly advocated against the involuntary transfers,” a spokesperson for the hospital wrote Tuesday in a media release. “This is the humane and compassionate path forward for our residents, their families, our staff, and all those who care about Laguna Honda.”\u003c/p>\n\u003cp>Following the city’s lawsuit in November 2022, the city and CMS reached a settlement agreement to pause the involuntary transfers until February 2023 and to continue health care payments through November 2023.\u003c/p>\n\u003cp>In February 2023, regulators agreed to extend the pause on transfers to May 19.\u003c/p>\n\u003cp>Today’s update moves the deadline yet again to Sept. 19, 2023, and payments will continue through March 19, 2024.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“The city and Laguna Honda have done a tremendous amount of work to come into compliance with the hundreds of requirements that have been asked of us and we believe we are in a good spot,” said City Attorney David Chiu, whose office led the lawsuit against the federal regulators in 2022.\u003c/p>\n\u003cp>The hospital can apply for recertification after it successfully completes its next monitoring survey with CMS, which hospital officials say they expect to happen by the end of May or in June of this year.\u003c/p>\n\u003cp>“Laguna Honda is working diligently to make and sustain improvements that will serve our current residents and ensure Laguna Honda remains an essential part of the City and County of San Francisco’s commitment to public health,” the spokesperson said. “We remain confident that Laguna Honda is the best place for our residents to receive care.”\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Meanwhile, senior and disability advocates have raised the alarm over the back-and-forth messaging that the hospital’s more than 500 residents and their families have endured throughout the regulatory spiral.\u003c/p>\n\u003cp>“Resuming evictions or whatever you want to call them is extremely dangerous,” said Teresa Palmer, who previously worked at Laguna Honda, in a recent town hall meeting about patients’ rights ahead of the looming discharges. “I don’t see how evictions and transfers can be resumed without severe consequences, not only to patients, but to the government agencies that are forcing them.”\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"title": "Gov. Newsom's Prescription Housing Plan Would Cover 6 Months' Rent Through Medi-Cal",
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"content": "\u003cp>Gov. Gavin Newsom, whose administration is struggling to contain a worsening homelessness crisis despite \u003ca href=\"https://khn.org/news/article/california-homeless-crisis-governor-gavin-newsom-political-future/\">record spending\u003c/a>, is trying something bold: tapping federal health care funding to cover rent for unhoused people and those at risk of losing their housing.\u003c/p>\n\u003cp>States are barred from using federal Medicaid dollars to pay directly for rent, but California’s governor is asking the administration of President Joe Biden, a fellow Democrat, to authorize a new program called “\u003ca href=\"https://ebudget.ca.gov/2023-24/pdf/BudgetSummary/HealthandHumanServices.pdf\">transitional rent (PDF)\u003c/a>,” which would provide up to six months of rent or temporary housing for\u003ca href=\"https://khn.org/news/article/californias-massive-medicaid-program-works-for-some-but-fails-many-others/\"> enrollees with \u003c/a>\u003ca href=\"https://khn.org/news/article/californias-massive-medicaid-program-works-for-some-but-fails-many-others/\">lower incomes\u003c/a> who rely on the state’s health care safety net — a new initiative to fight and prevent homelessness.\u003c/p>\n\u003cp>“I’ve been talking to the president. We cannot do this alone,” Newsom told California Healthline.\u003c/p>\n\u003cp>The governor is pushing California’s version of Medicaid, called Medi-Cal, to fund experimental housing subsidies for people experiencing homelessness, betting that it’s cheaper for taxpayers to cover rent than to allow people to fall into crisis or costly institutional care in hospitals, nursing homes and jails. Early in his tenure, \u003ca href=\"https://www.gov.ca.gov/2020/02/19/governor-newsom-delivers-state-of-the-state-address-on-homelessness/\">Newsom proclaimed\u003c/a> that “doctors should be able to write prescriptions for housing the same way they do for insulin or antibiotics.”\u003c/p>\n\u003cp>But it’s a risky endeavor in a high-cost state where \u003ca href=\"https://www.zillow.com/rental-manager/market-trends/ca/\">median rent is nearly $3,000 a month\u003c/a>, and even higher in coastal regions, where most of California’s unhoused people reside. Experts expect the Biden administration to scrutinize the plan to use health care money to pay rent, and also question its potential effectiveness in light of the state’s \u003ca href=\"https://calmatters.org/housing/2022/10/newsom-california-housing-crisis/\">housing crisis\u003c/a>.\u003c/p>\n\u003cp>“Part of the question is whether this is really Medicaid’s job,” said \u003ca href=\"https://counciloncj.org/vikki-wachino/\">Vikki Wachino\u003c/a>, who served as national Medicaid director in the Obama administration. “But there is a recognition that social factors like inadequate housing are driving health outcomes, and I think the federal government is open to developing approaches to try and address that.”\u003c/p>\n\u003cp>Bruce Alexander, spokesperson for the Centers for Medicare and Medicaid Services, declined to say whether the federal government would approve California’s request. Yet, Biden’s Medicaid officials have approved similar experimental programs in \u003ca href=\"https://www.oregon.gov/oha/HSD/Medicaid-Policy/Pages/Changes.aspx\">Oregon\u003c/a> and \u003ca href=\"https://www.hhs.gov/about/news/2022/10/14/hhs-approves-arizonas-medicaid-interventions-target-health-related-social-needs.html\">Arizona\u003c/a>, and California is modeling its program after them.[aside label=\"Related Stories\" postID=\"news_11934623,news_11932895,news_11927968\"]\u003ca href=\"https://www.ppic.org/blog/homeless-populations-are-rising-around-california/#:~:text=As%20of%202022%2C%2030%25%20of,of%20the%20nation's%20homeless%20population\">California is home to an estimated 30% of unhoused people in the U.S.\u003c/a>, despite representing just 12% of the country’s overall population. And Newsom has acknowledged that the numbers are likely far greater than official homelessness tallies show. Top health officials say that, to contain soaring safety-net spending and to help unhoused people get healthy, Medi-Cal has no choice but to combine social services with housing.\u003c/p>\n\u003cp>Statewide, 5% of Medi-Cal patients account for a staggering 44% of the program’s spending, according to state data. And many of the costliest patients lack stable housing: Nearly half of patients experiencing homelessness visited the emergency room four times or more in 2019 and were more likely than other adults with lower incomes to be admitted to the hospital, and a large majority of visits were covered by Medi-Cal, \u003ca href=\"https://www.ppic.org/publication/how-hospital-discharge-data-can-inform-state-homelessness-policy/\">according to the Public Policy Institute of California\u003c/a>.\u003c/p>\n\u003cp>“What we have today doesn’t work,” said \u003ca href=\"https://www.chhs.ca.gov/about/#secretary\">Dr. Mark Ghaly\u003c/a>, secretary of the California Health and Human Services Agency, explaining his argument that housing is a critical component of health care. “Why do we have to wait so long for people to be so sick?”\u003c/p>\n\u003cp>The federal government has already approved \u003ca href=\"https://khn.org/news/article/california-medicaid-makeover-newsom-california-medi-cal-homeless-public-funds/\">a massive social experiment in California\u003c/a>, known as \u003ca href=\"https://www.dhcs.ca.gov/calaim\">CalAIM\u003c/a>, which is transforming Medi-Cal. Over five years, the initiative is expected to pour $12 billion into new Medi-Cal services delivered outside of traditional health care. In communities across the state, it is already funding services for some patients with lower income, including paying rental security deposits for unhoused people and those facing eviction; \u003ca href=\"https://khn.org/news/article/california-medicaid-medically-tailored-meal-delivery-experiment/\">delivering prepared healthy meals\u003c/a> for people with diabetes; and helping formerly incarcerated people find jobs.\u003c/p>\n\u003cp>The transitional rent program would add another service to \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCQMD/Community-Supports-Elections-by-MCP-and-County.pdf\">those already available (PDF)\u003c/a>, though \u003ca href=\"https://khn.org/news/article/california-governor-newsom-pricey-medicaid-reforms-leave-most-patients-behind/\">only a sliver of the 15.4 million Medi-Cal enrollees\u003c/a> actually receive those new and expensive social services.\u003c/p>\n\u003cp>Rent payments could begin as soon as 2025 and cost roughly $117 million per year once fully implemented. And while state officials say anyone who is homeless or at risk of becoming homeless would be eligible, not everyone who qualifies will receive new services due to capacity limits. Among those who stand to benefit are nearly 11,000 people already enrolled in \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/CalAIM-HHI-a11y.pdf\">Medi-Cal housing services (PDF)\u003c/a>.\u003c/p>\n\u003cp>“The ongoing conversation is how do we convince the federal government that housing is a health care issue,” said \u003ca href=\"https://www.sellersdorsey.com/team-member/cantwell-mari/\">Mari Cantwell\u003c/a>, who served as Medi-Cal director from 2015 to 2020. “You have to convince them that you’re going to save money because you’re not going to have as many people showing up at the emergency room and in long-term hospitalizations.”\u003c/p>\n\u003cp>Health care experiments in California and around the country that funded housing supports have demonstrated early success in reducing costs and making people healthier. But while some programs paid for housing security deposits or participants’ first month of rent, none directly covered rent for an extended period.[pullquote align=\"right\" size=\"medium\" citation=\"Vikki Wachino, former national director, Medicaid\"]‘Part of the question is whether this is really Medicaid’s job. But there is a recognition that social factors like inadequate housing are driving health outcomes, and I think the federal government is open to developing approaches to try and address that.’[/pullquote]“Without that foundational support, we are playing in the margins,” Newsom said.\u003c/p>\n\u003cp>State health officials argue that paying for six months of rent will be even more successful at reducing health care costs and improving enrollees’ health, but experts say that, to work, the initiative must have strict accountability and be bundled with an array of social services.\u003c/p>\n\u003cp>In a precursor to the state’s current initiative, California experimented with a mix of housing assistance programs and social services through its “\u003ca href=\"https://apnews.com/article/california-health-8e353e5539ce36c9068a78f6ee7baeb7\">Whole Person Care\u003c/a>” pilot program. \u003ca href=\"https://healthpolicy.ucla.edu/about/staff/pages/detail.aspx?StaffID=94\">Nadereh Pourat\u003c/a>, of the UCLA Center for Health Policy Research, \u003ca href=\"https://healthpolicy.ucla.edu/publications/search/pages/detail.aspx?PubID=2385\">evaluated the program\u003c/a> for the state concluding that local trials reduced emergency visits and hospitalizations, saving an average of $383 per Medi-Cal beneficiary per year — a meager amount compared with the program’s cost.\u003c/p>\n\u003cp>Over five years, the state spent \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2023/Final-Evaluation-of-CA-Whole-Person-Care-Report.pdf#page=31\">$3.6 billion (PDF)\u003c/a> serving about 250,000 patients enrolled in \u003ca href=\"https://www.dhcs.ca.gov/services/Pages/WholePersonCarePilots.aspx\">local experiments\u003c/a>, Pourat said.\u003c/p>\n\u003cp>And \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/32976633/\">a randomized control trial\u003c/a> in Santa Clara County that provided supportive housing for unhoused people showed reductions in psychiatric emergency room visits and improvements in care. “Lives stabilized and we saw a huge uptick in substance-use care and mental health care, the things that everybody wants people to use to get healthier,” said \u003ca href=\"https://profiles.ucsf.edu/margot.kushel\">Dr. Margot Kushel\u003c/a>, director of the University of California-San Francisco’s Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, who worked on the study.\u003c/p>\n\u003cp>But insurers implementing the broader Medi-Cal initiative say they are skeptical that spending health care money on housing will save the system money. And health care experts say that, while six months of rent can be a bridge while people wait for permanent housing, there’s a bigger obstacle: California’s affordable-housing shortage.\u003c/p>\n\u003cp>“We can design incredible Medicaid policies to alleviate homelessness and pay for all the necessary supportive services, but without the adequate housing, frankly, it’s not going to work,” Kushel said.\u003c/p>\n\u003cp>Newsom acknowledges that criticism. “The crisis of homelessness will never be solved without first solving the crisis of housing,” he said last week, arguing California should plow more money into housing for homeless people with severe mental health conditions or addiction disorders.[pullquote align=\"right\" size=\"medium\" citation=\"Dr. Margot Kushel, UCSF Center for Vulnerable Populations director, ZSFGH\"]‘We can design incredible Medicaid policies to alleviate homelessness and pay for all the necessary supportive services, but without the adequate housing, frankly, it’s not going to work.’[/pullquote]He will ask the legislature to put before voters a \u003ca href=\"https://www.latimes.com/california/story/2023-03-19/newsom-mental-health-housing-bond-measure-services-counties-substance-use-treatment\">2024 ballot initiative\u003c/a> that would infuse California’s mental health system with at least 6,000 new treatment beds and supportive housing units for people struggling with mental health and addiction disorders, \u003ca href=\"https://capitolweekly.net/newsom-takes-another-swing-at-getting-mentally-ill-homeless-off-the-streets/\">many of whom are experiencing homelessness\u003c/a>. The proposed bond measure would generate from $3 billion to $5 billion for psychiatric housing and treatment villages aimed at serving more than 10,000 additional people a year. The initiative also would ask voters to set aside at least $1 billion a year for supportive housing from an \u003ca href=\"https://www.dhcs.ca.gov/services/MH/Pages/MH_Prop63.aspx\">existing tax on California millionaires\u003c/a> that funds local mental health programs.\u003c/p>\n\u003cp>“People who are struggling with these issues, especially those who are on the streets or in other vulnerable conditions, will have more resources to get the help they need,” Newsom said.\u003c/p>\n\u003cp>For transitional rent, six months of payments would be available for select high-need residents enrolled in Medi-Cal, particularly those who are unhoused or at risk of becoming unhoused — and those transitioning from more costly institutions such as mental health crisis centers, jails and prisons, and foster care. Medi-Cal patients at risk of inpatient hospitalization or who frequent the emergency room would also be eligible.\u003c/p>\n\u003cp>“It’s a pretty big challenge; I’m not going to lie,” said \u003ca href=\"https://conference.healthmanagement.com/jacey-cooper/\">Jacey Cooper\u003c/a>, the Medi-Cal director. “But we know that people experiencing homelessness cycle in and out of emergency rooms, so we have a real role to play in both preventing and ending homelessness.”\u003c/p>\n\u003cp>Public health experts say the \u003ca href=\"https://khn.org/news/article/california-homeless-crisis-governor-gavin-newsom-political-future/\">problem will continue to explode\u003c/a> without creative thinking about how to fund housing in health care, but they warn the state must be wary of potential abuses of the program.\u003c/p>\n\u003cp>“It has to be designed carefully because, unfortunately, there are always people looking to game the system,” said \u003ca href=\"https://www.calendow.org/leadership/\">Dr. Tony Iton\u003c/a>, a public health expert who is now a senior vice president at the California Endowment. “Decisions must be made by clinicians — not housing organizations just looking for another source of revenue.”\u003c/p>\n\u003cp>For Stephen Morton, who lives in the Orange County community of Laguna Woods, the journey from homelessness into permanent housing illustrates the amount of public spending it can take for the effort to pay off.\u003c/p>\n\u003cfigure id=\"attachment_11944656\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11944656\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-800x533.jpg\" alt=\"A white middle aged man combs his hair in front of a mirror in a bedroom with a lamp, a speaker, a bottle of eau de toilette anfd a box with a card on a dresser in front of the mirror.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-1920x1280.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy.jpg 2048w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Stephen Morton, who lived in shelters and sometimes in his car for almost 2 years before finding permanent housing, receives weekly deliveries of medically tailored meals as part of a Medi-Cal initiative. Since getting his apartment, Morton says he’s been able to stop taking one diabetes medication and lose weight. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Morton, 60, bounced between shelters and his car for nearly two years and racked up extraordinary Medi-Cal costs due to prolonged hospitalizations and repeated emergency room trips to treat chronic heart disease, asthma and diabetes.\u003c/p>\n\u003cp>Medi-Cal covered Morton’s open-heart surgery and hospital stays, which lasted weeks. He landed temporary housing through a state-sponsored program called \u003ca href=\"https://www.cdss.ca.gov/inforesources/cdss-programs/housing-programs/project-roomkey\">Project Roomkey\u003c/a> before getting permanent housing through a federal low-income housing voucher — an ongoing benefit that covers all but $50 of his rent.\u003c/p>\n\u003cp>Since getting his apartment, Morton said, he’s been able to stop taking one diabetes medication and lose weight. He attributes improvements in his blood sugar levels to his housing and the healthy, home-delivered meals he receives via Medi-Cal.\u003c/p>\n\u003cp>“It’s usually scrambled eggs for breakfast and the fish menu for dinner. I’m shocked it’s so good,” Morton said. “Now I have a microwave and I’m indoors. I’m so grateful and so much healthier.”\u003c/p>\n\u003cp>\u003cem>California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "California's bold new 'transitional rent' plan would save costs from frequent ER visits and lengthy hospital stays for Medi-Cal patients, but Newsom needs to convince Biden, saying, 'We cannot do this alone,' and lack of affordable housing across the state remains a concern.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Gov. Gavin Newsom, whose administration is struggling to contain a worsening homelessness crisis despite \u003ca href=\"https://khn.org/news/article/california-homeless-crisis-governor-gavin-newsom-political-future/\">record spending\u003c/a>, is trying something bold: tapping federal health care funding to cover rent for unhoused people and those at risk of losing their housing.\u003c/p>\n\u003cp>States are barred from using federal Medicaid dollars to pay directly for rent, but California’s governor is asking the administration of President Joe Biden, a fellow Democrat, to authorize a new program called “\u003ca href=\"https://ebudget.ca.gov/2023-24/pdf/BudgetSummary/HealthandHumanServices.pdf\">transitional rent (PDF)\u003c/a>,” which would provide up to six months of rent or temporary housing for\u003ca href=\"https://khn.org/news/article/californias-massive-medicaid-program-works-for-some-but-fails-many-others/\"> enrollees with \u003c/a>\u003ca href=\"https://khn.org/news/article/californias-massive-medicaid-program-works-for-some-but-fails-many-others/\">lower incomes\u003c/a> who rely on the state’s health care safety net — a new initiative to fight and prevent homelessness.\u003c/p>\n\u003cp>“I’ve been talking to the president. We cannot do this alone,” Newsom told California Healthline.\u003c/p>\n\u003cp>The governor is pushing California’s version of Medicaid, called Medi-Cal, to fund experimental housing subsidies for people experiencing homelessness, betting that it’s cheaper for taxpayers to cover rent than to allow people to fall into crisis or costly institutional care in hospitals, nursing homes and jails. Early in his tenure, \u003ca href=\"https://www.gov.ca.gov/2020/02/19/governor-newsom-delivers-state-of-the-state-address-on-homelessness/\">Newsom proclaimed\u003c/a> that “doctors should be able to write prescriptions for housing the same way they do for insulin or antibiotics.”\u003c/p>\n\u003cp>But it’s a risky endeavor in a high-cost state where \u003ca href=\"https://www.zillow.com/rental-manager/market-trends/ca/\">median rent is nearly $3,000 a month\u003c/a>, and even higher in coastal regions, where most of California’s unhoused people reside. Experts expect the Biden administration to scrutinize the plan to use health care money to pay rent, and also question its potential effectiveness in light of the state’s \u003ca href=\"https://calmatters.org/housing/2022/10/newsom-california-housing-crisis/\">housing crisis\u003c/a>.\u003c/p>\n\u003cp>“Part of the question is whether this is really Medicaid’s job,” said \u003ca href=\"https://counciloncj.org/vikki-wachino/\">Vikki Wachino\u003c/a>, who served as national Medicaid director in the Obama administration. “But there is a recognition that social factors like inadequate housing are driving health outcomes, and I think the federal government is open to developing approaches to try and address that.”\u003c/p>\n\u003cp>Bruce Alexander, spokesperson for the Centers for Medicare and Medicaid Services, declined to say whether the federal government would approve California’s request. Yet, Biden’s Medicaid officials have approved similar experimental programs in \u003ca href=\"https://www.oregon.gov/oha/HSD/Medicaid-Policy/Pages/Changes.aspx\">Oregon\u003c/a> and \u003ca href=\"https://www.hhs.gov/about/news/2022/10/14/hhs-approves-arizonas-medicaid-interventions-target-health-related-social-needs.html\">Arizona\u003c/a>, and California is modeling its program after them.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003ca href=\"https://www.ppic.org/blog/homeless-populations-are-rising-around-california/#:~:text=As%20of%202022%2C%2030%25%20of,of%20the%20nation's%20homeless%20population\">California is home to an estimated 30% of unhoused people in the U.S.\u003c/a>, despite representing just 12% of the country’s overall population. And Newsom has acknowledged that the numbers are likely far greater than official homelessness tallies show. Top health officials say that, to contain soaring safety-net spending and to help unhoused people get healthy, Medi-Cal has no choice but to combine social services with housing.\u003c/p>\n\u003cp>Statewide, 5% of Medi-Cal patients account for a staggering 44% of the program’s spending, according to state data. And many of the costliest patients lack stable housing: Nearly half of patients experiencing homelessness visited the emergency room four times or more in 2019 and were more likely than other adults with lower incomes to be admitted to the hospital, and a large majority of visits were covered by Medi-Cal, \u003ca href=\"https://www.ppic.org/publication/how-hospital-discharge-data-can-inform-state-homelessness-policy/\">according to the Public Policy Institute of California\u003c/a>.\u003c/p>\n\u003cp>“What we have today doesn’t work,” said \u003ca href=\"https://www.chhs.ca.gov/about/#secretary\">Dr. Mark Ghaly\u003c/a>, secretary of the California Health and Human Services Agency, explaining his argument that housing is a critical component of health care. “Why do we have to wait so long for people to be so sick?”\u003c/p>\n\u003cp>The federal government has already approved \u003ca href=\"https://khn.org/news/article/california-medicaid-makeover-newsom-california-medi-cal-homeless-public-funds/\">a massive social experiment in California\u003c/a>, known as \u003ca href=\"https://www.dhcs.ca.gov/calaim\">CalAIM\u003c/a>, which is transforming Medi-Cal. Over five years, the initiative is expected to pour $12 billion into new Medi-Cal services delivered outside of traditional health care. In communities across the state, it is already funding services for some patients with lower income, including paying rental security deposits for unhoused people and those facing eviction; \u003ca href=\"https://khn.org/news/article/california-medicaid-medically-tailored-meal-delivery-experiment/\">delivering prepared healthy meals\u003c/a> for people with diabetes; and helping formerly incarcerated people find jobs.\u003c/p>\n\u003cp>The transitional rent program would add another service to \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCQMD/Community-Supports-Elections-by-MCP-and-County.pdf\">those already available (PDF)\u003c/a>, though \u003ca href=\"https://khn.org/news/article/california-governor-newsom-pricey-medicaid-reforms-leave-most-patients-behind/\">only a sliver of the 15.4 million Medi-Cal enrollees\u003c/a> actually receive those new and expensive social services.\u003c/p>\n\u003cp>Rent payments could begin as soon as 2025 and cost roughly $117 million per year once fully implemented. And while state officials say anyone who is homeless or at risk of becoming homeless would be eligible, not everyone who qualifies will receive new services due to capacity limits. Among those who stand to benefit are nearly 11,000 people already enrolled in \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/CalAIM-HHI-a11y.pdf\">Medi-Cal housing services (PDF)\u003c/a>.\u003c/p>\n\u003cp>“The ongoing conversation is how do we convince the federal government that housing is a health care issue,” said \u003ca href=\"https://www.sellersdorsey.com/team-member/cantwell-mari/\">Mari Cantwell\u003c/a>, who served as Medi-Cal director from 2015 to 2020. “You have to convince them that you’re going to save money because you’re not going to have as many people showing up at the emergency room and in long-term hospitalizations.”\u003c/p>\n\u003cp>Health care experiments in California and around the country that funded housing supports have demonstrated early success in reducing costs and making people healthier. But while some programs paid for housing security deposits or participants’ first month of rent, none directly covered rent for an extended period.\u003c/p>\u003c/div>",
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"content": "‘Part of the question is whether this is really Medicaid’s job. But there is a recognition that social factors like inadequate housing are driving health outcomes, and I think the federal government is open to developing approaches to try and address that.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“Without that foundational support, we are playing in the margins,” Newsom said.\u003c/p>\n\u003cp>State health officials argue that paying for six months of rent will be even more successful at reducing health care costs and improving enrollees’ health, but experts say that, to work, the initiative must have strict accountability and be bundled with an array of social services.\u003c/p>\n\u003cp>In a precursor to the state’s current initiative, California experimented with a mix of housing assistance programs and social services through its “\u003ca href=\"https://apnews.com/article/california-health-8e353e5539ce36c9068a78f6ee7baeb7\">Whole Person Care\u003c/a>” pilot program. \u003ca href=\"https://healthpolicy.ucla.edu/about/staff/pages/detail.aspx?StaffID=94\">Nadereh Pourat\u003c/a>, of the UCLA Center for Health Policy Research, \u003ca href=\"https://healthpolicy.ucla.edu/publications/search/pages/detail.aspx?PubID=2385\">evaluated the program\u003c/a> for the state concluding that local trials reduced emergency visits and hospitalizations, saving an average of $383 per Medi-Cal beneficiary per year — a meager amount compared with the program’s cost.\u003c/p>\n\u003cp>Over five years, the state spent \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2023/Final-Evaluation-of-CA-Whole-Person-Care-Report.pdf#page=31\">$3.6 billion (PDF)\u003c/a> serving about 250,000 patients enrolled in \u003ca href=\"https://www.dhcs.ca.gov/services/Pages/WholePersonCarePilots.aspx\">local experiments\u003c/a>, Pourat said.\u003c/p>\n\u003cp>And \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/32976633/\">a randomized control trial\u003c/a> in Santa Clara County that provided supportive housing for unhoused people showed reductions in psychiatric emergency room visits and improvements in care. “Lives stabilized and we saw a huge uptick in substance-use care and mental health care, the things that everybody wants people to use to get healthier,” said \u003ca href=\"https://profiles.ucsf.edu/margot.kushel\">Dr. Margot Kushel\u003c/a>, director of the University of California-San Francisco’s Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, who worked on the study.\u003c/p>\n\u003cp>But insurers implementing the broader Medi-Cal initiative say they are skeptical that spending health care money on housing will save the system money. And health care experts say that, while six months of rent can be a bridge while people wait for permanent housing, there’s a bigger obstacle: California’s affordable-housing shortage.\u003c/p>\n\u003cp>“We can design incredible Medicaid policies to alleviate homelessness and pay for all the necessary supportive services, but without the adequate housing, frankly, it’s not going to work,” Kushel said.\u003c/p>\n\u003cp>Newsom acknowledges that criticism. “The crisis of homelessness will never be solved without first solving the crisis of housing,” he said last week, arguing California should plow more money into housing for homeless people with severe mental health conditions or addiction disorders.\u003c/p>\u003c/div>",
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"content": "‘We can design incredible Medicaid policies to alleviate homelessness and pay for all the necessary supportive services, but without the adequate housing, frankly, it’s not going to work.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>He will ask the legislature to put before voters a \u003ca href=\"https://www.latimes.com/california/story/2023-03-19/newsom-mental-health-housing-bond-measure-services-counties-substance-use-treatment\">2024 ballot initiative\u003c/a> that would infuse California’s mental health system with at least 6,000 new treatment beds and supportive housing units for people struggling with mental health and addiction disorders, \u003ca href=\"https://capitolweekly.net/newsom-takes-another-swing-at-getting-mentally-ill-homeless-off-the-streets/\">many of whom are experiencing homelessness\u003c/a>. The proposed bond measure would generate from $3 billion to $5 billion for psychiatric housing and treatment villages aimed at serving more than 10,000 additional people a year. The initiative also would ask voters to set aside at least $1 billion a year for supportive housing from an \u003ca href=\"https://www.dhcs.ca.gov/services/MH/Pages/MH_Prop63.aspx\">existing tax on California millionaires\u003c/a> that funds local mental health programs.\u003c/p>\n\u003cp>“People who are struggling with these issues, especially those who are on the streets or in other vulnerable conditions, will have more resources to get the help they need,” Newsom said.\u003c/p>\n\u003cp>For transitional rent, six months of payments would be available for select high-need residents enrolled in Medi-Cal, particularly those who are unhoused or at risk of becoming unhoused — and those transitioning from more costly institutions such as mental health crisis centers, jails and prisons, and foster care. Medi-Cal patients at risk of inpatient hospitalization or who frequent the emergency room would also be eligible.\u003c/p>\n\u003cp>“It’s a pretty big challenge; I’m not going to lie,” said \u003ca href=\"https://conference.healthmanagement.com/jacey-cooper/\">Jacey Cooper\u003c/a>, the Medi-Cal director. “But we know that people experiencing homelessness cycle in and out of emergency rooms, so we have a real role to play in both preventing and ending homelessness.”\u003c/p>\n\u003cp>Public health experts say the \u003ca href=\"https://khn.org/news/article/california-homeless-crisis-governor-gavin-newsom-political-future/\">problem will continue to explode\u003c/a> without creative thinking about how to fund housing in health care, but they warn the state must be wary of potential abuses of the program.\u003c/p>\n\u003cp>“It has to be designed carefully because, unfortunately, there are always people looking to game the system,” said \u003ca href=\"https://www.calendow.org/leadership/\">Dr. Tony Iton\u003c/a>, a public health expert who is now a senior vice president at the California Endowment. “Decisions must be made by clinicians — not housing organizations just looking for another source of revenue.”\u003c/p>\n\u003cp>For Stephen Morton, who lives in the Orange County community of Laguna Woods, the journey from homelessness into permanent housing illustrates the amount of public spending it can take for the effort to pay off.\u003c/p>\n\u003cfigure id=\"attachment_11944656\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11944656\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-800x533.jpg\" alt=\"A white middle aged man combs his hair in front of a mirror in a bedroom with a lamp, a speaker, a bottle of eau de toilette anfd a box with a card on a dresser in front of the mirror.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-1920x1280.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy.jpg 2048w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Stephen Morton, who lived in shelters and sometimes in his car for almost 2 years before finding permanent housing, receives weekly deliveries of medically tailored meals as part of a Medi-Cal initiative. Since getting his apartment, Morton says he’s been able to stop taking one diabetes medication and lose weight. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Morton, 60, bounced between shelters and his car for nearly two years and racked up extraordinary Medi-Cal costs due to prolonged hospitalizations and repeated emergency room trips to treat chronic heart disease, asthma and diabetes.\u003c/p>\n\u003cp>Medi-Cal covered Morton’s open-heart surgery and hospital stays, which lasted weeks. He landed temporary housing through a state-sponsored program called \u003ca href=\"https://www.cdss.ca.gov/inforesources/cdss-programs/housing-programs/project-roomkey\">Project Roomkey\u003c/a> before getting permanent housing through a federal low-income housing voucher — an ongoing benefit that covers all but $50 of his rent.\u003c/p>\n\u003cp>Since getting his apartment, Morton said, he’s been able to stop taking one diabetes medication and lose weight. He attributes improvements in his blood sugar levels to his housing and the healthy, home-delivered meals he receives via Medi-Cal.\u003c/p>\n\u003cp>“It’s usually scrambled eggs for breakfast and the fish menu for dinner. I’m shocked it’s so good,” Morton said. “Now I have a microwave and I’m indoors. I’m so grateful and so much healthier.”\u003c/p>\n\u003cp>\u003cem>California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"slug": "on-medi-cal-eligibility-changes-starting-in-april-could-mean-you-lose-coverage-heres-what-to-do",
"title": "On Medi-Cal? Eligibility Changes Starting in April Could Mean You Lose Coverage. Here's What to Do",
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"headTitle": "On Medi-Cal? Eligibility Changes Starting in April Could Mean You Lose Coverage. Here’s What to Do | KQED",
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"content": "\u003cp>Starting April 1, Californians who depend on \u003ca href=\"https://www.dhcs.ca.gov/Pages/myMedi-Cal.aspx\">Medi-Cal\u003c/a> — the state’s Medicaid health care program — for their health care expenses will need to once again \u003ca href=\"https://www.dhcs.ca.gov/Pages/Keep-Your-Medi-Cal.aspx\">go through a redetermination process to renew their eligibility and keep their Medi-Cal coverage\u003c/a>.\u003c/p>\n\u003cp>Thanks to \u003ca href=\"https://www.hhs.gov/about/news/2023/02/09/fact-sheet-covid-19-public-health-emergency-transition-roadmap.html\">the federal COVID Public Health Emergency (PHE)\u003c/a> declared in 2020, Medicaid programs around the nation like Medi-Cal have been able to waive annual eligibility requirements. This means that for the past three years, Medicaid beneficiaries had their health care costs covered without having to go through an annual renewal process, which could have found them no longer eligible to receive Medicaid.\u003c/p>\n\u003cp>But at the end of last year, Congress approved the Consolidated Appropriations Act — putting \u003ca href=\"https://www.hhs.gov/about/news/2023/02/09/fact-sheet-covid-19-public-health-emergency-transition-roadmap.html\">an end date of March 31 on automatic Medicaid renewal\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Jump to:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>\u003ca href=\"#keepmedicaid\">What do I need to do to keep my Medi-Cal coverage?\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"#helpmedicaid\">Find my Bay Area county’s Medi-Cal office\u003c/a>\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003ch2>Who will be affected by these Medi-Cal changes?\u003c/h2>\n\u003cp>This change will affect the millions of people nationwide who depend on Medicaid to cover essential care, prescriptions and other health care services, including the 12 million people enrolled in Medi-Cal within California.\u003c/p>\n\u003cp>The Urban Institute, a public policy think tank, released a study at the end of 2022 that estimates that \u003ca href=\"https://www.urban.org/research/publication/impact-covid-19-public-health-emergency-expiration-all-types-health-coverage\">18 million people nationwide may lose their Medicaid\u003c/a> coverage during a 14-month period following the end of the PHE — either because they are found to no longer qualify for Medi-Cal, or because they fail to renew on time. \u003ca href=\"https://www.dhcs.ca.gov/Documents/PHE-UOP/Medi-Cal-COVID-19-PHE-Unwinding-Plan.pdf\">In California, that number could be as high as 3 million.\u003c/a>\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>\u003ca href=\"#tellus\">Tell us: What else do you need information about right now?\u003c/a>\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003cp>Disability rights advocates also worry that the renewal process could leave people without health coverage. “Administrative and procedural barriers can also lead to someone being dis-enrolled, with \u003ca href=\"https://www.teenvogue.com/story/medicaid-coverage-covid\">low-income people and people of color disproportionately at higher risk due to structural inequities\u003c/a>,” wrote San Francisco disability rights activist Alice Wong in a recent column for \u003cem>Teen Vogue.\u003c/em>\u003c/p>\n\u003cp>Individuals who received Medi-Cal benefits before the pandemic began may remember what it’s like to renew eligibility: Your county’s health and human services agency sends to your mailbox a thick packet full of forms to fill out and verify your residency, income, health information and other personal details.\u003c/p>\n\u003cp>But regardless of whether you have been on Medi-Cal for decades, or joined far more recently during the pandemic, \u003ca href=\"https://www.dhcs.ca.gov/Pages/Keep-Your-Medi-Cal.aspx\">the redetermination process will be required for all Medi-Cal beneficiaries\u003c/a>. This means that every single person on Medi-Cal needs to be aware of the coming changes starting in April, to make sure they keep health care coverage in some form.\u003c/p>\n\u003cp>Keep reading for what you need to know.\u003c/p>\n\u003cfigure id=\"attachment_11944676\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11944676\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577.jpg\" alt=\"A photograph shot from behind of two people, whose faces we can't see, operating a laptop to fill out a form.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Changes are coming to Medi-Cal eligibility, and you’ll have to act to keep coverage. \u003ccite>(RODNAE Productions/Pexels)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch2>\u003ca id=\"keepmedicaid\">\u003c/a>On Medi-Cal? Here’s what to expect starting April 1\u003c/h2>\n\u003cp>Nobody will be automatically dropped from their Medi-Cal coverage on April 1, says María Reyes, community health education manager for La Clínica de la Raza, which provides health services to lower-income communities in Alameda, Contra Costa and Solano counties.\u003c/p>\n\u003cp>Instead, that date marks the start of the process to reenroll people on Medi-Cal.\u003c/p>\n\u003cp>Once the Medi-Cal renewal waiver ends on March 31, there will be two ways people can renew their benefits: through the mail or \u003ca href=\"https://www.dhcs.ca.gov/Pages/Keep-Your-Medi-Cal.aspx\">online at the Medi-Cal website\u003c/a>. But it’s important to remember that the deadline to renew will be different for everyone, says Reyes.\u003c/p>\n\u003cp>The deadline to renew your personal coverage, she says, is based on your Medi-Cal “anniversary”:\u003c/p>\n\u003cul>\n\u003cli>If you had Medi-Cal \u003cstrong>before 2020\u003c/strong>, your anniversary is the date when you last renewed your coverage before the pandemic, but:\u003c/li>\n\u003cli>If you enrolled \u003cstrong>after 2020\u003c/strong> and haven’t gone through the renewal process yet, your anniversary falls on the date you first applied.\u003c/li>\n\u003c/ul>\n\u003cp>Reyes recommends that you confirm the exact date of your coverage anniversary — because you should receive a renewal packet in the mail ahead of this date.\u003c/p>\n\u003cp>\u003cstrong>Option 1: Renew your Medi-Cal coverage by mail\u003c/strong>\u003c/p>\n\u003cp>“As people meet their anniversary date, they’ll be getting these packets,” she says, adding that the packets will include a letter with information specific to your coverage. “This letter will let you know you have X amount of time, from the time you receive the letter, to submit your renewal packet and the documents they are requesting from you.”\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org/health/2023/03/medi-cal-eligibility-2/\">These packets will be going out in phases monthly up through June 2024\u003c/a>, and will include \u003ca href=\"https://www.dhcs.ca.gov/formsandpubs/forms/Forms/mc210rv-eng.pdf\">an annual redetermination form (PDF)\u003c/a> which asks for information about a beneficiary’s income, living situation and disability status, among other factors. You may be asked to submit additional documents depending on your circumstances. You should fill it out and return it as soon as possible, if you don’t plan on renewing your Medi-Cal online (see Option 2).\u003c/p>\n\u003cp>“If, for some reason, your county office doesn’t get the packet by the deadline, they’ll send another reminder letter letting you know they haven’t received your documents,” Reyes said, adding that there may be a \u003cem>third\u003c/em> letter in the mail if a beneficiary misses the second deadline. There should, she assures, be several opportunities for people to be reminded of this deadline. “It’s not going to be a sudden stop of services,” she said.\u003c/p>\n\u003cp>\u003cstrong>Option 2: Renew your Medi-Cal coverage online\u003c/strong>\u003c/p>\n\u003cp>In some cases, you may be able to renew online. In the Bay Area, counties use either one of two renewal portals:\u003c/p>\n\u003cul>\n\u003cli>If you live in Alameda, San Francisco, San Mateo, Solano and Sonoma counties, visit \u003ca href=\"https://www.mybenefitscalwin.org/#/home\">MyBenefitsCalWin\u003c/a> to renew your Medi-Cal.\u003c/li>\n\u003cli>If you live in Contra Costa, Marin, Napa or Santa Clara counties, visit \u003ca href=\"https://benefitscal.com/\">BenefitsCal\u003c/a> to renew your Medi-Cal.\u003c/li>\n\u003c/ul>\n\u003cp>If you live somewhere else in California, \u003ca href=\"https://www.dhcs.ca.gov/Pages/Keep-Your-Medi-Cal.aspx\">see which website your county uses for your to renew your Medi-Cal\u003c/a>.\u003c/p>\n\u003ch2>What if I am found to no longer be eligible for Medi-Cal?\u003c/h2>\n\u003cp>If you don’t renew your Medi-Cal by the deadline (see Options 1 and 2, in the previous section), or are found to no longer be eligible, you’ll be removed from Medi-Cal coverage. And if that happens, you’ll have other options for subsidized health care coverage — but at a cost.\u003c/p>\n\u003cp>Yingjia Huang, assistant deputy director for health care benefits and eligibility at the Department of Health Care Services, told CalMatters that \u003ca href=\"https://calmatters.org/health/2023/03/medi-cal-eligibility-2/\">if you no longer qualify for Medi-Cal because your income has gone up, you’ll be “automatically” transitioned\u003c/a> into a similar plan through Covered California. “The system automatically will review their eligibility for Covered California, and Covered California will send out the enrollment notice to the member, informing them of their options and to pay the plan premium,” said Huang. There’ll be “no administrative burden on a member,” she stressed.\u003c/p>\n\u003cp>But of course, this may come with a new monthly premium that many folks on Medi-Cal haven’t had to pay before — and might not feel able to when factoring in their other expenses.\u003c/p>\n\u003cp>The state emphasizes that \u003ca href=\"https://www.coveredca.com/marketing-blog/health-insurance-costs-less-thanks-to-the-inflation-reduction-act/\">nearly half of people getting health care through Covered California pay less than $50\u003c/a>, while nearly a quarter of people don’t pay a monthly premium at all.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003ch2>What happens if I don’t get my renewal packet in the mail?\u003c/h2>\n\u003cp>Reyes is keen to reiterate that no one will be automatically dropped from their Medi-Cal coverage on April 1. “Starting on that date, people should be on the lookout for these renewal packages that they will need to complete,” she said.\u003c/p>\n\u003cp>If your coverage anniversary rolls around and you have not received a renewal packet, there may be several possibilities to explain why:\u003c/p>\n\u003cul>\n\u003cli>You may have the wrong date on file for your anniversary, or:\u003c/li>\n\u003cli>Your county may be sending the packet to an old address (more likely \u003ca href=\"https://www.sfhsa.org/services/health/medi-cal/renew-your-medi-cal-coverage\">if you moved during the pandemic\u003c/a>).\u003c/li>\n\u003c/ul>\n\u003cp>In either case, you should confirm your information with your county directly. You can do this online:\u003c/p>\n\u003cul>\n\u003cli>If you live in Alameda, San Francisco, San Mateo, Solano and Sonoma counties, visit \u003ca href=\"https://www.mybenefitscalwin.org/#/home\">MyBenefitsCalWin\u003c/a> to update your Medi-Cal contact information.\u003c/li>\n\u003cli>If you live in Contra Costa, Marin, Napa or Santa Clara counties, visit \u003ca href=\"https://benefitscal.com/\">BenefitsCal\u003c/a> to update your Medi-Cal contact information.\u003c/li>\n\u003c/ul>\n\u003cp>You can also contact the office in your county that manages Medi-Cal enrollment. Find your county in the list below.\u003c/p>\n\u003ch2>\u003ca id=\"helpmedicaid\">\u003c/a>Get direct assistance with Medi-Cal and update your contact details\u003c/h2>\n\u003cp>\u003cstrong>Alameda County\u003c/strong>: \u003ca href=\"https://www.alamedacountysocialservices.org/our-services/Health-and-Food/Medi-Cal/index\">Social Services Agency\u003c/a>, 24100 Amador Street, Hayward; call (888) 999-4772.\u003c/p>\n\u003cp>\u003cstrong>Contra Costa County\u003c/strong>: \u003ca href=\"https://ehsd.org/benefits/medi-cal-and-health-coverage-options/\">Employment and Human Services\u003c/a>, multiple addresses; call (866) 663-3225.\u003c/p>\n\u003cp>\u003cstrong>Marin County\u003c/strong>: \u003ca href=\"https://www.marinhhs.org/medi-cal\">Health and Human Services\u003c/a>, 120 N. Redwood Drive, San Rafael; call (877) 410-8817.\u003c/p>\n\u003cp>\u003cstrong>Napa County\u003c/strong>: \u003ca href=\"https://www.countyofnapa.org/3304/Self-Sufficiency-Services\">Health and Human Services\u003c/a>, 2751 Napa Valley Corporate Drive, Napa; call (707) 253-4511.\u003c/p>\n\u003cp>\u003cstrong>San Francisco\u003c/strong>: \u003ca href=\"https://www.sfhsa.org/services/health/medi-cal/renew-your-medi-cal-coverage\">Human Services Agency\u003c/a>, 1440 Harrison Street, San Francisco; call (415) 558-4700.\u003c/p>\n\u003cp>\u003cstrong>San Mateo County\u003c/strong>: \u003ca href=\"https://www.smcgov.org/hsa/health-coverage\">Human Services\u003c/a>, 400 Harbor Boulevard, Building B, Belmont; call (800) 223-8383.\u003c/p>\n\u003cp>\u003cstrong>Santa Clara County\u003c/strong>: \u003ca href=\"https://socialservices.sccgov.org/health-coverage\">Social Services Agency\u003c/a>, 1867 Senter Road, San José; call (408) 758-3800.\u003c/p>\n\u003cp>\u003cstrong>Solano County\u003c/strong>: \u003ca href=\"https://www.solanocounty.com/depts/hss/ees/medical/default.asp\">Health and Social Services\u003c/a>, multiple addresses; call (707) 784-3900.\u003c/p>\n\u003cp>\u003cstrong>Sonoma County\u003c/strong>: \u003ca href=\"https://sonomacounty.ca.gov/health-and-human-services/human-services/divisions-and-services/economic-assistance/health-care-benefits/medi-cal-and-county-medical-services-program\">Department of Human Services\u003c/a>, 2550 Paulin Drive, Santa Rosa, or 5350 Old Redwood Highway, Suite 100, Petaluma; call (877) 699-6868.\u003c/p>\n\u003ch2>Remember, you don’t have to go through this alone\u003c/h2>\n\u003cp>If you are a parent or caregiver and managing a family all by yourself, working multiple jobs or managing a chronic illness, the Medi-Cal renewal process is another item on a long list of responsibilities you are already juggling. You might also be facing \u003ca href=\"https://www.kqed.org/news/11943420/your-calfresh-benefits-will-drop-in-april-heres-what-you-can-do\">a drop in your CalFresh benefits (SNAP, or food stamps)\u003c/a> at the same time as this Medi-Cal renewal, starting in April.\u003c/p>\n\u003cp>Many organizations across California are helping folks send their renewal packets in on time and keep their coverage. One of them is La Clínica de la Raza, which has set up a service that provides individual assistance to Medi-Cal recipients living in Alameda, Contra Costa or Solano counties while completing the renewal requirements.\u003c/p>\n\u003cp>“We don’t want people to lose coverage, especially because preventative services are important — particularly for those who have chronic conditions,” said Reyes, from La Clínica. “We want to make sure that they’re not at risk of losing coverage, not being able to see their provider, not able to refill their prescriptions. So taking action as soon as possible is important.”\u003c/p>\n\u003cp>If you are on Medi-Cal and live in Alameda, Contra Costa or Solano counties, contact La Clínica de la Raza at (855) 494-4658. Help is available in both English and Spanish.\u003c/p>\n\u003cp>Reyes adds that your county’s social services agency is also a helpful resource when navigating the renewal process and some counties have even set up service centers to answer reenrollment questions in person. \u003ca href=\"#helpmedicaid\">Find contact information for your county’s social services agency (above).\u003c/a>\u003c/p>\n\u003ch2>\u003ca id=\"tellus\">\u003c/a>Tell us: What else do you need information about?\u003c/h2>\n\u003cp>At KQED News, we know that it can sometimes be hard to track down the answers to navigate life in the Bay Area in 2023. We’ve published \u003ca href=\"https://www.kqed.org/news/tag/coronavirus-resources-and-explainers\">clear, helpful explainers and guides about issues like COVID\u003c/a>, \u003ca href=\"https://www.kqed.org/news/11936674/how-to-prepare-for-this-weeks-atmospheric-river-storm-sandbags-emergency-kits-and-more\">how to cope with intense winter weather\u003c/a> and \u003ca href=\"https://www.kqed.org/news/11821950/how-to-safely-attend-a-protest-in-the-bay-area\">how to exercise your right to protest safely\u003c/a>.\u003c/p>\n\u003cp>So tell us: What do you need to know more about? Tell us, and you could see your question answered online or on social media. What you submit will make our reporting stronger, and help us decide what to cover here on our site, and on KQED Public Radio, too.\u003c/p>\n\u003cp>[hearken id=\"10483\" src=\"https://modules.wearehearken.com/kqed/embed/10483.js\"]\u003c/p>\n\u003cp>\u003cem>KQED’s Carly Severn contributed to this story.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Starting in April, Californians who depend on Medi-Cal will need to once again renew their eligibility. Here's what you need to know.",
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"title": "On Medi-Cal? Eligibility Changes Starting in April Could Mean You Lose Coverage. Here's What to Do | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Starting April 1, Californians who depend on \u003ca href=\"https://www.dhcs.ca.gov/Pages/myMedi-Cal.aspx\">Medi-Cal\u003c/a> — the state’s Medicaid health care program — for their health care expenses will need to once again \u003ca href=\"https://www.dhcs.ca.gov/Pages/Keep-Your-Medi-Cal.aspx\">go through a redetermination process to renew their eligibility and keep their Medi-Cal coverage\u003c/a>.\u003c/p>\n\u003cp>Thanks to \u003ca href=\"https://www.hhs.gov/about/news/2023/02/09/fact-sheet-covid-19-public-health-emergency-transition-roadmap.html\">the federal COVID Public Health Emergency (PHE)\u003c/a> declared in 2020, Medicaid programs around the nation like Medi-Cal have been able to waive annual eligibility requirements. This means that for the past three years, Medicaid beneficiaries had their health care costs covered without having to go through an annual renewal process, which could have found them no longer eligible to receive Medicaid.\u003c/p>\n\u003cp>But at the end of last year, Congress approved the Consolidated Appropriations Act — putting \u003ca href=\"https://www.hhs.gov/about/news/2023/02/09/fact-sheet-covid-19-public-health-emergency-transition-roadmap.html\">an end date of March 31 on automatic Medicaid renewal\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Jump to:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>\u003ca href=\"#keepmedicaid\">What do I need to do to keep my Medi-Cal coverage?\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"#helpmedicaid\">Find my Bay Area county’s Medi-Cal office\u003c/a>\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003ch2>Who will be affected by these Medi-Cal changes?\u003c/h2>\n\u003cp>This change will affect the millions of people nationwide who depend on Medicaid to cover essential care, prescriptions and other health care services, including the 12 million people enrolled in Medi-Cal within California.\u003c/p>\n\u003cp>The Urban Institute, a public policy think tank, released a study at the end of 2022 that estimates that \u003ca href=\"https://www.urban.org/research/publication/impact-covid-19-public-health-emergency-expiration-all-types-health-coverage\">18 million people nationwide may lose their Medicaid\u003c/a> coverage during a 14-month period following the end of the PHE — either because they are found to no longer qualify for Medi-Cal, or because they fail to renew on time. \u003ca href=\"https://www.dhcs.ca.gov/Documents/PHE-UOP/Medi-Cal-COVID-19-PHE-Unwinding-Plan.pdf\">In California, that number could be as high as 3 million.\u003c/a>\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>\u003ca href=\"#tellus\">Tell us: What else do you need information about right now?\u003c/a>\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003cp>Disability rights advocates also worry that the renewal process could leave people without health coverage. “Administrative and procedural barriers can also lead to someone being dis-enrolled, with \u003ca href=\"https://www.teenvogue.com/story/medicaid-coverage-covid\">low-income people and people of color disproportionately at higher risk due to structural inequities\u003c/a>,” wrote San Francisco disability rights activist Alice Wong in a recent column for \u003cem>Teen Vogue.\u003c/em>\u003c/p>\n\u003cp>Individuals who received Medi-Cal benefits before the pandemic began may remember what it’s like to renew eligibility: Your county’s health and human services agency sends to your mailbox a thick packet full of forms to fill out and verify your residency, income, health information and other personal details.\u003c/p>\n\u003cp>But regardless of whether you have been on Medi-Cal for decades, or joined far more recently during the pandemic, \u003ca href=\"https://www.dhcs.ca.gov/Pages/Keep-Your-Medi-Cal.aspx\">the redetermination process will be required for all Medi-Cal beneficiaries\u003c/a>. This means that every single person on Medi-Cal needs to be aware of the coming changes starting in April, to make sure they keep health care coverage in some form.\u003c/p>\n\u003cp>Keep reading for what you need to know.\u003c/p>\n\u003cfigure id=\"attachment_11944676\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11944676\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577.jpg\" alt=\"A photograph shot from behind of two people, whose faces we can't see, operating a laptop to fill out a form.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Changes are coming to Medi-Cal eligibility, and you’ll have to act to keep coverage. \u003ccite>(RODNAE Productions/Pexels)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch2>\u003ca id=\"keepmedicaid\">\u003c/a>On Medi-Cal? Here’s what to expect starting April 1\u003c/h2>\n\u003cp>Nobody will be automatically dropped from their Medi-Cal coverage on April 1, says María Reyes, community health education manager for La Clínica de la Raza, which provides health services to lower-income communities in Alameda, Contra Costa and Solano counties.\u003c/p>\n\u003cp>Instead, that date marks the start of the process to reenroll people on Medi-Cal.\u003c/p>\n\u003cp>Once the Medi-Cal renewal waiver ends on March 31, there will be two ways people can renew their benefits: through the mail or \u003ca href=\"https://www.dhcs.ca.gov/Pages/Keep-Your-Medi-Cal.aspx\">online at the Medi-Cal website\u003c/a>. But it’s important to remember that the deadline to renew will be different for everyone, says Reyes.\u003c/p>\n\u003cp>The deadline to renew your personal coverage, she says, is based on your Medi-Cal “anniversary”:\u003c/p>\n\u003cul>\n\u003cli>If you had Medi-Cal \u003cstrong>before 2020\u003c/strong>, your anniversary is the date when you last renewed your coverage before the pandemic, but:\u003c/li>\n\u003cli>If you enrolled \u003cstrong>after 2020\u003c/strong> and haven’t gone through the renewal process yet, your anniversary falls on the date you first applied.\u003c/li>\n\u003c/ul>\n\u003cp>Reyes recommends that you confirm the exact date of your coverage anniversary — because you should receive a renewal packet in the mail ahead of this date.\u003c/p>\n\u003cp>\u003cstrong>Option 1: Renew your Medi-Cal coverage by mail\u003c/strong>\u003c/p>\n\u003cp>“As people meet their anniversary date, they’ll be getting these packets,” she says, adding that the packets will include a letter with information specific to your coverage. “This letter will let you know you have X amount of time, from the time you receive the letter, to submit your renewal packet and the documents they are requesting from you.”\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org/health/2023/03/medi-cal-eligibility-2/\">These packets will be going out in phases monthly up through June 2024\u003c/a>, and will include \u003ca href=\"https://www.dhcs.ca.gov/formsandpubs/forms/Forms/mc210rv-eng.pdf\">an annual redetermination form (PDF)\u003c/a> which asks for information about a beneficiary’s income, living situation and disability status, among other factors. You may be asked to submit additional documents depending on your circumstances. You should fill it out and return it as soon as possible, if you don’t plan on renewing your Medi-Cal online (see Option 2).\u003c/p>\n\u003cp>“If, for some reason, your county office doesn’t get the packet by the deadline, they’ll send another reminder letter letting you know they haven’t received your documents,” Reyes said, adding that there may be a \u003cem>third\u003c/em> letter in the mail if a beneficiary misses the second deadline. There should, she assures, be several opportunities for people to be reminded of this deadline. “It’s not going to be a sudden stop of services,” she said.\u003c/p>\n\u003cp>\u003cstrong>Option 2: Renew your Medi-Cal coverage online\u003c/strong>\u003c/p>\n\u003cp>In some cases, you may be able to renew online. In the Bay Area, counties use either one of two renewal portals:\u003c/p>\n\u003cul>\n\u003cli>If you live in Alameda, San Francisco, San Mateo, Solano and Sonoma counties, visit \u003ca href=\"https://www.mybenefitscalwin.org/#/home\">MyBenefitsCalWin\u003c/a> to renew your Medi-Cal.\u003c/li>\n\u003cli>If you live in Contra Costa, Marin, Napa or Santa Clara counties, visit \u003ca href=\"https://benefitscal.com/\">BenefitsCal\u003c/a> to renew your Medi-Cal.\u003c/li>\n\u003c/ul>\n\u003cp>If you live somewhere else in California, \u003ca href=\"https://www.dhcs.ca.gov/Pages/Keep-Your-Medi-Cal.aspx\">see which website your county uses for your to renew your Medi-Cal\u003c/a>.\u003c/p>\n\u003ch2>What if I am found to no longer be eligible for Medi-Cal?\u003c/h2>\n\u003cp>If you don’t renew your Medi-Cal by the deadline (see Options 1 and 2, in the previous section), or are found to no longer be eligible, you’ll be removed from Medi-Cal coverage. And if that happens, you’ll have other options for subsidized health care coverage — but at a cost.\u003c/p>\n\u003cp>Yingjia Huang, assistant deputy director for health care benefits and eligibility at the Department of Health Care Services, told CalMatters that \u003ca href=\"https://calmatters.org/health/2023/03/medi-cal-eligibility-2/\">if you no longer qualify for Medi-Cal because your income has gone up, you’ll be “automatically” transitioned\u003c/a> into a similar plan through Covered California. “The system automatically will review their eligibility for Covered California, and Covered California will send out the enrollment notice to the member, informing them of their options and to pay the plan premium,” said Huang. There’ll be “no administrative burden on a member,” she stressed.\u003c/p>\n\u003cp>But of course, this may come with a new monthly premium that many folks on Medi-Cal haven’t had to pay before — and might not feel able to when factoring in their other expenses.\u003c/p>\n\u003cp>The state emphasizes that \u003ca href=\"https://www.coveredca.com/marketing-blog/health-insurance-costs-less-thanks-to-the-inflation-reduction-act/\">nearly half of people getting health care through Covered California pay less than $50\u003c/a>, while nearly a quarter of people don’t pay a monthly premium at all.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003ch2>What happens if I don’t get my renewal packet in the mail?\u003c/h2>\n\u003cp>Reyes is keen to reiterate that no one will be automatically dropped from their Medi-Cal coverage on April 1. “Starting on that date, people should be on the lookout for these renewal packages that they will need to complete,” she said.\u003c/p>\n\u003cp>If your coverage anniversary rolls around and you have not received a renewal packet, there may be several possibilities to explain why:\u003c/p>\n\u003cul>\n\u003cli>You may have the wrong date on file for your anniversary, or:\u003c/li>\n\u003cli>Your county may be sending the packet to an old address (more likely \u003ca href=\"https://www.sfhsa.org/services/health/medi-cal/renew-your-medi-cal-coverage\">if you moved during the pandemic\u003c/a>).\u003c/li>\n\u003c/ul>\n\u003cp>In either case, you should confirm your information with your county directly. You can do this online:\u003c/p>\n\u003cul>\n\u003cli>If you live in Alameda, San Francisco, San Mateo, Solano and Sonoma counties, visit \u003ca href=\"https://www.mybenefitscalwin.org/#/home\">MyBenefitsCalWin\u003c/a> to update your Medi-Cal contact information.\u003c/li>\n\u003cli>If you live in Contra Costa, Marin, Napa or Santa Clara counties, visit \u003ca href=\"https://benefitscal.com/\">BenefitsCal\u003c/a> to update your Medi-Cal contact information.\u003c/li>\n\u003c/ul>\n\u003cp>You can also contact the office in your county that manages Medi-Cal enrollment. Find your county in the list below.\u003c/p>\n\u003ch2>\u003ca id=\"helpmedicaid\">\u003c/a>Get direct assistance with Medi-Cal and update your contact details\u003c/h2>\n\u003cp>\u003cstrong>Alameda County\u003c/strong>: \u003ca href=\"https://www.alamedacountysocialservices.org/our-services/Health-and-Food/Medi-Cal/index\">Social Services Agency\u003c/a>, 24100 Amador Street, Hayward; call (888) 999-4772.\u003c/p>\n\u003cp>\u003cstrong>Contra Costa County\u003c/strong>: \u003ca href=\"https://ehsd.org/benefits/medi-cal-and-health-coverage-options/\">Employment and Human Services\u003c/a>, multiple addresses; call (866) 663-3225.\u003c/p>\n\u003cp>\u003cstrong>Marin County\u003c/strong>: \u003ca href=\"https://www.marinhhs.org/medi-cal\">Health and Human Services\u003c/a>, 120 N. Redwood Drive, San Rafael; call (877) 410-8817.\u003c/p>\n\u003cp>\u003cstrong>Napa County\u003c/strong>: \u003ca href=\"https://www.countyofnapa.org/3304/Self-Sufficiency-Services\">Health and Human Services\u003c/a>, 2751 Napa Valley Corporate Drive, Napa; call (707) 253-4511.\u003c/p>\n\u003cp>\u003cstrong>San Francisco\u003c/strong>: \u003ca href=\"https://www.sfhsa.org/services/health/medi-cal/renew-your-medi-cal-coverage\">Human Services Agency\u003c/a>, 1440 Harrison Street, San Francisco; call (415) 558-4700.\u003c/p>\n\u003cp>\u003cstrong>San Mateo County\u003c/strong>: \u003ca href=\"https://www.smcgov.org/hsa/health-coverage\">Human Services\u003c/a>, 400 Harbor Boulevard, Building B, Belmont; call (800) 223-8383.\u003c/p>\n\u003cp>\u003cstrong>Santa Clara County\u003c/strong>: \u003ca href=\"https://socialservices.sccgov.org/health-coverage\">Social Services Agency\u003c/a>, 1867 Senter Road, San José; call (408) 758-3800.\u003c/p>\n\u003cp>\u003cstrong>Solano County\u003c/strong>: \u003ca href=\"https://www.solanocounty.com/depts/hss/ees/medical/default.asp\">Health and Social Services\u003c/a>, multiple addresses; call (707) 784-3900.\u003c/p>\n\u003cp>\u003cstrong>Sonoma County\u003c/strong>: \u003ca href=\"https://sonomacounty.ca.gov/health-and-human-services/human-services/divisions-and-services/economic-assistance/health-care-benefits/medi-cal-and-county-medical-services-program\">Department of Human Services\u003c/a>, 2550 Paulin Drive, Santa Rosa, or 5350 Old Redwood Highway, Suite 100, Petaluma; call (877) 699-6868.\u003c/p>\n\u003ch2>Remember, you don’t have to go through this alone\u003c/h2>\n\u003cp>If you are a parent or caregiver and managing a family all by yourself, working multiple jobs or managing a chronic illness, the Medi-Cal renewal process is another item on a long list of responsibilities you are already juggling. You might also be facing \u003ca href=\"https://www.kqed.org/news/11943420/your-calfresh-benefits-will-drop-in-april-heres-what-you-can-do\">a drop in your CalFresh benefits (SNAP, or food stamps)\u003c/a> at the same time as this Medi-Cal renewal, starting in April.\u003c/p>\n\u003cp>Many organizations across California are helping folks send their renewal packets in on time and keep their coverage. One of them is La Clínica de la Raza, which has set up a service that provides individual assistance to Medi-Cal recipients living in Alameda, Contra Costa or Solano counties while completing the renewal requirements.\u003c/p>\n\u003cp>“We don’t want people to lose coverage, especially because preventative services are important — particularly for those who have chronic conditions,” said Reyes, from La Clínica. “We want to make sure that they’re not at risk of losing coverage, not being able to see their provider, not able to refill their prescriptions. So taking action as soon as possible is important.”\u003c/p>\n\u003cp>If you are on Medi-Cal and live in Alameda, Contra Costa or Solano counties, contact La Clínica de la Raza at (855) 494-4658. Help is available in both English and Spanish.\u003c/p>\n\u003cp>Reyes adds that your county’s social services agency is also a helpful resource when navigating the renewal process and some counties have even set up service centers to answer reenrollment questions in person. \u003ca href=\"#helpmedicaid\">Find contact information for your county’s social services agency (above).\u003c/a>\u003c/p>\n\u003ch2>\u003ca id=\"tellus\">\u003c/a>Tell us: What else do you need information about?\u003c/h2>\n\u003cp>At KQED News, we know that it can sometimes be hard to track down the answers to navigate life in the Bay Area in 2023. We’ve published \u003ca href=\"https://www.kqed.org/news/tag/coronavirus-resources-and-explainers\">clear, helpful explainers and guides about issues like COVID\u003c/a>, \u003ca href=\"https://www.kqed.org/news/11936674/how-to-prepare-for-this-weeks-atmospheric-river-storm-sandbags-emergency-kits-and-more\">how to cope with intense winter weather\u003c/a> and \u003ca href=\"https://www.kqed.org/news/11821950/how-to-safely-attend-a-protest-in-the-bay-area\">how to exercise your right to protest safely\u003c/a>.\u003c/p>\n\u003cp>So tell us: What do you need to know more about? Tell us, and you could see your question answered online or on social media. What you submit will make our reporting stronger, and help us decide what to cover here on our site, and on KQED Public Radio, too.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>KQED’s Carly Severn contributed to this story.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "California's Massive Medicaid Program Works for Some, but Fails Many Others",
"headTitle": "California Healthline | KQED News",
"content": "\u003cp>Newborns. Formerly incarcerated people. College students. Pregnant people. People with disabilities. Foster kids. Unhoused people. Single dads.\u003c/p>\n\u003cp>Your neighbor. Your co-worker.\u003c/p>\n\u003cp>You.\u003c/p>\n\u003cp>California’s Medicaid program, called Medi-Cal, serves a whopping 15.4 million people, offering care from cradle to grave: \u003ca href=\"https://www.chcf.org/publication/2021-edition-medi-cal-facts-figures/\">Half of all births are covered by Medi-Cal\u003c/a>, as are more than half of all stays in nursing homes.\u003c/p>\n\u003cp>Everything about Medi-Cal is massive, from its \u003ca href=\"https://ebudget.ca.gov/2023-24/pdf/BudgetSummary/HealthandHumanServices.pdf\">upcoming fiscal year budget of $139 billion (PDF)\u003c/a> to the expansive list of benefits and services it offers. The way the program works — or doesn’t — could spell life or death for many enrollees.\u003c/p>\n\u003cp>“It’s critical, from the single pregnant mom, to the extremely frail elderly population that needs a nursing home,” said Jennifer Kent, former director of the state Department of Health Care Services, which administers Medi-Cal. “If it weren’t for Medi-Cal, so many people would either be dead or would be severely compromised.”\u003c/p>\n\u003cp>In a new series, California Healthline will shed light on Medi-Cal’s successes and failures through the experiences of its enrollees. They include Stephanie Lammers, who can’t get her troubling abdominal symptoms checked at a clinic 50 miles from her small Calaveras County town because the transportation Medi-Cal is supposed to provide isn’t trustworthy; Carolina Morga Tapia, a Fresno woman who credits Medi-Cal with helping her have five healthy children; and Lucas Moreno Ramirez, a Los Angeles County man with stage 4 lung cancer who had to fight to keep his treatment going.\u003c/p>\n\u003cp>Medi-Cal is at a critical juncture as it attempts to serve the needs of a diverse patient population with a dizzying array of medical needs — from childhood vaccinations and cancer screenings to state-of-the-art care for rare genetic disorders. \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/statistics/Documents/FastFacts-March2022.pdf\">Roughly half of enrollees are Hispanic (PDF)\u003c/a>, and, next year, \u003ca href=\"https://californiahealthline.org/news/article/covered-california-bill-undocumented-immigrant-health-insurance/\">California will become the first state to expand eligibility to all immigrants who qualify, regardless of their legal status\u003c/a>.[aside postID=news_11926757 hero='https://ww2.kqed.org/app/uploads/sites/10/2022/09/GettyImages-1340030341.jpg']Medi-Cal is also undertaking several new initiatives that aim to save taxpayer money and improve quality. State \u003ca href=\"https://khn.org/news/article/californias-reboot-of-troubled-medi-cal-puts-pressure-on-health-plans/\">officials are demanding that the 23 health insurers that serve most Medi-Cal patients provide better care\u003c/a> — or face significant penalties, including potential expulsion from the program.\u003c/p>\n\u003cp>The state is also \u003ca href=\"https://khn.org/news/article/california-medicaid-makeover-newsom-california-medi-cal-homeless-public-funds/\">adding innovative social services\u003c/a> that fall outside the traditional realm of medicine, including helping some enrollees pay for rent and buy groceries.\u003c/p>\n\u003cp>“People are watching California,” said Cindy Mann, who served as federal Medicaid director under former President Barack Obama. “What the state is doing is ambitious and very aggressive. It makes a significant mark on health care and health policy, not just because of the size and breadth of its program, but by being very comprehensive.”\u003c/p>\n\u003cp>But only a sliver of enrollees will get the new social services, even as \u003ca href=\"https://khn.org/news/article/california-governor-newsom-pricey-medicaid-reforms-leave-most-patients-behind/\">many patients struggle to obtain basic care\u003c/a> or get in to see their doctors. In reality, the type of care you get in Medi-Cal depends on where you live and which insurer provides your benefits.\u003c/p>\n\u003cp>That means the program is working for some, but failing for many others.\u003c/p>\n\u003cp>If you are in Medi-Cal, \u003ca href=\"https://californiahealthline.org/faces-of-medi-cal-submissions/\">we would like to hear from you\u003c/a>, whether you live in a big city or a rural region, regardless of your age, race or ethnicity, and whatever your medical, dental or mental health condition. Have you had difficulty seeing the right doctor for what ails you, even to the point of putting your life at risk? Or did Medi-Cal provide good care, perhaps sparing you serious harm or disability? Either way, \u003ca href=\"https://californiahealthline.org/faces-of-medi-cal-submissions/\">please consider sharing your experience with us\u003c/a>.\u003c/p>\n\u003cp>Here are snapshots of patients who have used the program at a critical time in their lives.\u003c/p>\n\u003ch2>'I just don't go to the doctor anymore'\u003c/h2>\n\u003cp>When Stephanie Lammers leans over to put on her shoes, it feels as if she’s squishing something inside her abdomen, she said.\u003c/p>\n\u003cp>Lammers, 53, has been suffering from frequent bouts of nausea, pain and bloating for six months.\u003c/p>\n\u003cp>Her gastroenterologist wants to perform diagnostic procedures, including a colonoscopy and, if anything shows up, a biopsy. But Lammers, who lives in a motel with her boyfriend and teenage daughter in the Gold Rush town of San Andreas, doesn’t have a working car and can’t readily get to the clinic — which is 50 miles away.\u003c/p>\n\u003cfigure id=\"attachment_11942519\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942519 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-800x548.jpg\" alt=\"A middle-aged white woman with a long-sleeved shirt with horizontal blue-and-white stripes, with one shoulder pulled down to reveal a tattoo of an eye, looks at the camera as she leans against a door jamb. To her left, a white husky dog looks out from a window.\" width=\"800\" height=\"548\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-800x548.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-1020x699.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-160x110.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-1536x1052.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-2048x1402.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-1920x1315.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Stephanie Lammers says the ride service provided by her Medi-Cal health plan is so bad that she stopped trying to use it about a year ago, after it left her in the lurch multiple times. 'I just don't go to the doctor anymore,' she says. \u003ccite>(Rich Pedroncelli/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For Lammers, like many Medi-Cal enrollees who live in rural areas, lack of transportation is a major impediment to obtaining care. The problem is particularly acute for patients who need to see specialists.\u003c/p>\n\u003cp>Lammers’ dermatologist and eye doctor are over an hour away from San Andreas, the county seat of Calaveras County, about 125 miles northeast of San Francisco. She isn’t seeing a neurologist, despite a series of mini-strokes and stress-related seizures. And she hasn’t been to a podiatrist in two years, even though her toes are twisted over one another and hang down, causing her to trip. She’s often in excruciating pain when she walks.\u003c/p>\n\u003cp>Medi-Cal is supposed to provide \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/Pages/Transportation.aspx\">free transportation to enrollees\u003c/a> who can’t otherwise get to their appointments.\u003c/p>\n\u003cp>But Lammers — whose health plan is California Health and Wellness, owned by Centene, \u003ca href=\"https://khn.org/news/article/centene-political-donations-medicaid-contracts-overbilling-allegations/\">the nation’s largest commercial Medicaid insurer\u003c/a> — stopped using its ride service nearly a year ago, after she missed dozens of appointments because drivers just didn’t show up, she said. She was getting threatening letters from doctors’ offices over the no-shows.\u003c/p>\n\u003cp>Once, she had to hitchhike more than 30 miles home from a counseling appointment. On other occasions, Lammers said, she did not receive the reimbursement she was owed for arranging her own rides.\u003c/p>\n\u003cp>“I just don’t go to the doctor anymore,” Lammers said. “If I go to the doctor, my boyfriend has to take the day off work, and if he takes the day off work, we have no money.”\u003c/p>\n\u003cp>During the last three months of 2022, Lammers canceled five appointments she had scheduled for the diagnostic abdominal procedures because her boyfriend had to work each time and couldn’t take her. She finally stopped rescheduling.\u003c/p>\n\u003cp>California Health and Wellness contracts with ModivCare, a Denver-based medical transportation company that is no stranger to \u003ca href=\"https://khn.org/news/article/medicaid-transportation-nonemergency-benefit-patients-stranded/\">patient complaints and lawsuits\u003c/a>.\u003c/p>\n\u003cp>Before she gave up on the ride service, Lammers said, she would call California Health and Wellness to try to resolve the issue, only to be told that ModivCare was a separate company. “I’m like, ‘If you guys hired them and put them in charge of transportation, who oversees their screwups?,’” she said.\u003c/p>\n\u003cfigure id=\"attachment_11942520\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942520 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-800x614.jpg\" alt=\"A white woman, standing in a crowded room of unmade beds, dishes potatoes onto a plate of biscuits and gravy from a hot plate on a cabinet next to a fridge. \" width=\"800\" height=\"614\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-800x614.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-1020x783.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-160x123.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-1536x1180.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-2048x1573.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-1920x1475.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Stephanie Lammers has serious abdominal symptoms, and her gastroenterologist wants to run diagnostic tests, but she had to cancel five appointments in the last three months of 2022 because she didn't have transportation. \u003ccite>(Rich Pedroncelli/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Courtney Schwyzer, a member of a legal aid team representing Lammers on various Medi-Cal matters, said the failure of medical ride services is a systemic problem. In late February, Schwyzer and her fellow attorneys filed a petition in court that she hopes will force the state Department of Health Care Services to address the problem.\u003c/p>\n\u003cp>California Health and Wellness spokesperson Darrel Ng said the company monitors the quality of its contractors, but a shortage of transportation providers in rural areas “has created unique challenges.”\u003c/p>\n\u003cp>ModivCare provides more than 4 million rides for Medi-Cal recipients annually, and more than 99% are without complaint, said Melody Lai, a company spokesperson.\u003c/p>\n\u003cp>Lammers, who is unemployed and trying to start a custom craft business called Stuff by Steph, said doctors have warned her that if she doesn’t reduce her stress level, it could shorten her life. But arranging medical care is the most stressful thing in her life right now, so she doesn’t try anymore.\u003c/p>\n\u003cp>“In order to keep from dying, I have to not go to the doctor,” she said.\u003c/p>\n\u003ch2>'It's a blessing'\u003c/h2>\n\u003cp>Medi-Cal helped save the life of Carolina Morga Tapia, a 30-year-old full-time mother of five who lives with her family amid almond groves in an agricultural enclave of Fresno.\u003c/p>\n\u003cp>Nine years ago, a bacterial infection triggered premature labor during the 25th week of her second pregnancy, and Morga Tapia almost died. She spiked a fever, bled profusely and needed immediate transfusions and emergency surgery. After several days in critical care, she fully recovered.\u003c/p>\n\u003cfigure id=\"attachment_11942521\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942521 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-800x534.jpg\" alt=\"A Latina woman with a blue cardigan and a black shirt looks at the camera, arms akimbo, standing in a leafless orchard.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-1536x1025.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-2048x1367.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-1920x1281.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Carolina Morga Tapia stands amid almond trees outside her home in Fresno. She, her husband and their five children are enrolled in Medi-Cal, and she says she is very happy with the care it has provided, including emergency surgery that saved her life after she fell gravely ill during her second pregnancy. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But the doctors could not stop the premature birth, and her baby came out weighing just 1 pound. She and her husband, David Nuñez, named her Milagros Guadalupe, and she died four days later, on Sept. 13, 2013.\u003c/p>\n\u003cp>In each of her subsequent pregnancies, Medi-Cal paid for Morga Tapia to get shots of synthetic progesterone, intended to prevent another preterm birth. Those shots — one a week for about 20 weeks — can cost an average of \u003ca href=\"https://www.npr.org/sections/health-shots/2020/01/24/798731110/drug-to-prevent-premature-birth-divides-doctors-insurers-and-fda-experts\">more than $10,000 per pregnancy\u003c/a>.\u003c/p>\n\u003cp>Morga Tapia and Nuñez, a construction worker, signed up for Medi-Cal when she was pregnant with her first child more than a decade ago. They’ve been on the same Anthem Blue Cross Medi-Cal plan ever since.\u003c/p>\n\u003cp>The plan paid for prenatal care through all six of Morga Tapia’s pregnancies, and it has provided all the medical and dental care the family needs, she said.\u003c/p>\n\u003cp>“Without Medi-Cal, we would have to be paying for all of our children,” said Morga Tapia. “It saves a lot of money, and it’s a blessing to have that extra help.”\u003c/p>\n\u003cp>Her children, four girls and a boy, range in age from 1 to 10. They all go to the same children’s clinic and see the same pediatrician.[pullquote align=\"right\" size=\"medium\" citation=\"Carolina Morga Tapia\"]'Without Medi-Cal, we would have to be paying for all of our children. It saves a lot of money, and it's a blessing to have that extra help.'[/pullquote]The kids, all in good health, get routine checkups, vaccinations and other preventive care, Morga Tapia said. She gets appointment reminders via text and cards in the mail notifying her when it’s time for the kids’ vaccinations and wellness checks, as well as her Pap smears, she said.\u003c/p>\n\u003cp>Her family’s experience contrasts sharply with the state’s assessment of their health plan, according to a \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/reports/Documents/Enhancing-Quality-for-Medi-Cal-Members.pdf\">report on quality of care in Medi-Cal issued late last year (PDF)\u003c/a>. The report, which evaluated Medi-Cal health plans on pediatric care, women’s health and chronic disease management, put Anthem Blue Cross in the lowest tier, and below par on multiple measures in numerous counties, including Fresno.\u003c/p>\n\u003cp>Another state report, released in late January, detailed how quickly insurers provide appointments for their patients, and put \u003ca href=\"https://www.dmhc.ca.gov/Portals/0/Docs/OPM/MY2021TAR.pdf\">Anthem Blue Cross’ Medi-Cal plan near the bottom of the heap (PDF)\u003c/a>.\u003c/p>\n\u003cp>Anthem Blue Cross spokesperson Michael Bowman said in a statement that the period covered in the reports coincide with the COVID-19 pandemic, “when our safety net providers dealt with significant challenges with workforce and appointment availability.”\u003c/p>\n\u003cp>Morga Tapia doesn’t give the insurer low marks. “It’s different for everybody. I have a good, healthy family, and what Medi-Cal covers is really fortunate for us,” she said.\u003c/p>\n\u003ch2>'I don't want to die yet'\u003c/h2>\n\u003cp>In late 2021, doctors gave Lucas Moreno Ramirez a few months to live.\u003c/p>\n\u003cp>Struggling with diabetes and late-stage lung cancer, Moreno Ramirez suffered debilitating pain as he hacked and labored for breath. His doctors recommended that he stop treatment and start hospice care.\u003c/p>\n\u003cp>He felt as if they were giving up on him.\u003c/p>\n\u003cp>“They said they’re going to give me opioids for my pain and help me have a comfortable death,” said Moreno Ramirez, 68, who lives in Norwalk, in Los Angeles County. “I told them I don’t believe in that. I don’t want to die yet.”\u003c/p>\n\u003cfigure id=\"attachment_11942525\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942525 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-800x534.jpg\" alt=\"A middle-aged Latino man, with a bushy gray mustache and thick gray hair combed back from his forehead, sits at a long table along a wall, on the other side of which a gauzy white curtain blows inward. He rests his right arm on the table, holding a blue-and-white mug. He looks at the camera, and is surrounded by cabinets with CDs, a massive water bottle, salt-and-pepper shakers, a clock on the wall and a nearby wind chime, and other homey detritus.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-1536x1025.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-2048x1367.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-1920x1281.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Lucas Moreno Ramirez, a former landscaper and factory worker, has been diagnosed with both diabetes and lung cancer. Working alongside a care manager through his Medi-Cal managed-care plan, he has fought for better care and treatment for both conditions. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A former landscaper and factory worker, Moreno Ramirez learned he had to be his own advocate, fighting for the care he believed he deserved from Medi-Cal.\u003c/p>\n\u003cp>He said his Christian faith gave him strength, and over the next few months, he pushed the program and his doctors to keep battling his cancer, using a different treatment with fewer side effects than chemotherapy.\u003c/p>\n\u003cp>“I believe in prayer,” he said. “But I believe in science and medication, too.”\u003c/p>\n\u003cp>Moreno Ramirez is one of the \u003ca href=\"https://www.chcf.org/publication/in-alignment-calaims-plan-coordinate-care-dual-enrollees-medicare-medi-cal/\">roughly 1.6 million Californians enrolled in both Medicare, which covers people who are 65 and older or have disabilities, and Medi-Cal\u003c/a>, which \u003ca href=\"https://www.kff.org/medicare/issue-brief/a-profile-of-medicare-medicaid-enrollees-dual-eligibles/?utm_campaign=KFF-2023-Medicaid&utm_medium=email&_hsmi=243959452&_hsenc=p2ANqtz--_YdJIpoiPQ6BsTqKV7XWKRpOoR_sJTFFsZI7MrJWw-BvXTcEh0PRgAq42XpbIvOpISMXOG8GW_lDUH-w2IgL2Syf6YA&utm_content=243959452&utm_source=hs_email\">kicks in to cover the costs and benefits that Medicare doesn’t\u003c/a>.\u003c/p>\n\u003cp>He also relies on his Medi-Cal insurer to help him navigate the Byzantine system. L.A. Care, the largest Medi-Cal plan with nearly 2.6 million members, connected him with a care manager who worked with him to identify \u003ca href=\"https://www.cancer.gov/publications/dictionaries/cancer-terms/def/tagrisso\">a different treatment called Tagrisso\u003c/a> and advocated for him to get it.[aside label=\"Related Stories\" postID=\"news_11940023,news_11941075,news_1981588\"]Even with the new medication, Moreno Ramirez’s coughing fits returned last year, and his symptoms grew so painful he suspected the cancer was growing. He asked to see his pulmonologist but was told the first appointment would be in June 2023. So he switched doctors and scored an appointment nearly six months sooner.\u003c/p>\n\u003cp>“My old doctor didn’t help me. I didn’t trust him,” Moreno Ramirez said. “He was always too busy for me. I told my doctors, ‘Give me a chance.’”\u003c/p>\n\u003cp>Having taken his care into his own hands, he says he’s not in pain, his cough has subsided and he feels hopeful for the future. “Now I feel good,” he said.\u003c/p>\n\u003cp>He has also sought more attention for his diabetes and received a continuous glucose monitor to measure his blood sugar. It’s better controlled now than it has been in decades, he said.\u003c/p>\n\u003cp>“You have to stand up for yourself and advocate,” said Joann Pacelo, the care manager who helped Moreno Ramirez change doctors, get quicker referrals to specialists and get approved for in-home nursing visits.\u003c/p>\n\u003cp>“A lot of times, it’s difficult with Medi-Cal because the doctors are busy and the reimbursements are so low, but no one should be denied the care they deserve.”\u003c/p>\n\u003cp>\u003cem>California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Serving over 15 million people and with an annual budget of $139 billion, California's massive Medicaid program — Medi-Cal — is at a critical juncture as it attempts to serve the needs of a diverse patient population with a dizzying array of medical needs.",
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"nprByline": "\u003ca href=\"https://californiahealthline.org/news/author/angela-hart/\">Angela Hart\u003c/a> and \u003ca href=\"https://californiahealthline.org/news/author/bernard-j-wolfson/\">Bernard J. Wolfson\u003c/a>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Newborns. Formerly incarcerated people. College students. Pregnant people. People with disabilities. Foster kids. Unhoused people. Single dads.\u003c/p>\n\u003cp>Your neighbor. Your co-worker.\u003c/p>\n\u003cp>You.\u003c/p>\n\u003cp>California’s Medicaid program, called Medi-Cal, serves a whopping 15.4 million people, offering care from cradle to grave: \u003ca href=\"https://www.chcf.org/publication/2021-edition-medi-cal-facts-figures/\">Half of all births are covered by Medi-Cal\u003c/a>, as are more than half of all stays in nursing homes.\u003c/p>\n\u003cp>Everything about Medi-Cal is massive, from its \u003ca href=\"https://ebudget.ca.gov/2023-24/pdf/BudgetSummary/HealthandHumanServices.pdf\">upcoming fiscal year budget of $139 billion (PDF)\u003c/a> to the expansive list of benefits and services it offers. The way the program works — or doesn’t — could spell life or death for many enrollees.\u003c/p>\n\u003cp>“It’s critical, from the single pregnant mom, to the extremely frail elderly population that needs a nursing home,” said Jennifer Kent, former director of the state Department of Health Care Services, which administers Medi-Cal. “If it weren’t for Medi-Cal, so many people would either be dead or would be severely compromised.”\u003c/p>\n\u003cp>In a new series, California Healthline will shed light on Medi-Cal’s successes and failures through the experiences of its enrollees. They include Stephanie Lammers, who can’t get her troubling abdominal symptoms checked at a clinic 50 miles from her small Calaveras County town because the transportation Medi-Cal is supposed to provide isn’t trustworthy; Carolina Morga Tapia, a Fresno woman who credits Medi-Cal with helping her have five healthy children; and Lucas Moreno Ramirez, a Los Angeles County man with stage 4 lung cancer who had to fight to keep his treatment going.\u003c/p>\n\u003cp>Medi-Cal is at a critical juncture as it attempts to serve the needs of a diverse patient population with a dizzying array of medical needs — from childhood vaccinations and cancer screenings to state-of-the-art care for rare genetic disorders. \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/statistics/Documents/FastFacts-March2022.pdf\">Roughly half of enrollees are Hispanic (PDF)\u003c/a>, and, next year, \u003ca href=\"https://californiahealthline.org/news/article/covered-california-bill-undocumented-immigrant-health-insurance/\">California will become the first state to expand eligibility to all immigrants who qualify, regardless of their legal status\u003c/a>.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Medi-Cal is also undertaking several new initiatives that aim to save taxpayer money and improve quality. State \u003ca href=\"https://khn.org/news/article/californias-reboot-of-troubled-medi-cal-puts-pressure-on-health-plans/\">officials are demanding that the 23 health insurers that serve most Medi-Cal patients provide better care\u003c/a> — or face significant penalties, including potential expulsion from the program.\u003c/p>\n\u003cp>The state is also \u003ca href=\"https://khn.org/news/article/california-medicaid-makeover-newsom-california-medi-cal-homeless-public-funds/\">adding innovative social services\u003c/a> that fall outside the traditional realm of medicine, including helping some enrollees pay for rent and buy groceries.\u003c/p>\n\u003cp>“People are watching California,” said Cindy Mann, who served as federal Medicaid director under former President Barack Obama. “What the state is doing is ambitious and very aggressive. It makes a significant mark on health care and health policy, not just because of the size and breadth of its program, but by being very comprehensive.”\u003c/p>\n\u003cp>But only a sliver of enrollees will get the new social services, even as \u003ca href=\"https://khn.org/news/article/california-governor-newsom-pricey-medicaid-reforms-leave-most-patients-behind/\">many patients struggle to obtain basic care\u003c/a> or get in to see their doctors. In reality, the type of care you get in Medi-Cal depends on where you live and which insurer provides your benefits.\u003c/p>\n\u003cp>That means the program is working for some, but failing for many others.\u003c/p>\n\u003cp>If you are in Medi-Cal, \u003ca href=\"https://californiahealthline.org/faces-of-medi-cal-submissions/\">we would like to hear from you\u003c/a>, whether you live in a big city or a rural region, regardless of your age, race or ethnicity, and whatever your medical, dental or mental health condition. Have you had difficulty seeing the right doctor for what ails you, even to the point of putting your life at risk? Or did Medi-Cal provide good care, perhaps sparing you serious harm or disability? Either way, \u003ca href=\"https://californiahealthline.org/faces-of-medi-cal-submissions/\">please consider sharing your experience with us\u003c/a>.\u003c/p>\n\u003cp>Here are snapshots of patients who have used the program at a critical time in their lives.\u003c/p>\n\u003ch2>'I just don't go to the doctor anymore'\u003c/h2>\n\u003cp>When Stephanie Lammers leans over to put on her shoes, it feels as if she’s squishing something inside her abdomen, she said.\u003c/p>\n\u003cp>Lammers, 53, has been suffering from frequent bouts of nausea, pain and bloating for six months.\u003c/p>\n\u003cp>Her gastroenterologist wants to perform diagnostic procedures, including a colonoscopy and, if anything shows up, a biopsy. But Lammers, who lives in a motel with her boyfriend and teenage daughter in the Gold Rush town of San Andreas, doesn’t have a working car and can’t readily get to the clinic — which is 50 miles away.\u003c/p>\n\u003cfigure id=\"attachment_11942519\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942519 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-800x548.jpg\" alt=\"A middle-aged white woman with a long-sleeved shirt with horizontal blue-and-white stripes, with one shoulder pulled down to reveal a tattoo of an eye, looks at the camera as she leans against a door jamb. To her left, a white husky dog looks out from a window.\" width=\"800\" height=\"548\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-800x548.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-1020x699.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-160x110.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-1536x1052.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-2048x1402.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-1920x1315.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Stephanie Lammers says the ride service provided by her Medi-Cal health plan is so bad that she stopped trying to use it about a year ago, after it left her in the lurch multiple times. 'I just don't go to the doctor anymore,' she says. \u003ccite>(Rich Pedroncelli/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For Lammers, like many Medi-Cal enrollees who live in rural areas, lack of transportation is a major impediment to obtaining care. The problem is particularly acute for patients who need to see specialists.\u003c/p>\n\u003cp>Lammers’ dermatologist and eye doctor are over an hour away from San Andreas, the county seat of Calaveras County, about 125 miles northeast of San Francisco. She isn’t seeing a neurologist, despite a series of mini-strokes and stress-related seizures. And she hasn’t been to a podiatrist in two years, even though her toes are twisted over one another and hang down, causing her to trip. She’s often in excruciating pain when she walks.\u003c/p>\n\u003cp>Medi-Cal is supposed to provide \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/Pages/Transportation.aspx\">free transportation to enrollees\u003c/a> who can’t otherwise get to their appointments.\u003c/p>\n\u003cp>But Lammers — whose health plan is California Health and Wellness, owned by Centene, \u003ca href=\"https://khn.org/news/article/centene-political-donations-medicaid-contracts-overbilling-allegations/\">the nation’s largest commercial Medicaid insurer\u003c/a> — stopped using its ride service nearly a year ago, after she missed dozens of appointments because drivers just didn’t show up, she said. She was getting threatening letters from doctors’ offices over the no-shows.\u003c/p>\n\u003cp>Once, she had to hitchhike more than 30 miles home from a counseling appointment. On other occasions, Lammers said, she did not receive the reimbursement she was owed for arranging her own rides.\u003c/p>\n\u003cp>“I just don’t go to the doctor anymore,” Lammers said. “If I go to the doctor, my boyfriend has to take the day off work, and if he takes the day off work, we have no money.”\u003c/p>\n\u003cp>During the last three months of 2022, Lammers canceled five appointments she had scheduled for the diagnostic abdominal procedures because her boyfriend had to work each time and couldn’t take her. She finally stopped rescheduling.\u003c/p>\n\u003cp>California Health and Wellness contracts with ModivCare, a Denver-based medical transportation company that is no stranger to \u003ca href=\"https://khn.org/news/article/medicaid-transportation-nonemergency-benefit-patients-stranded/\">patient complaints and lawsuits\u003c/a>.\u003c/p>\n\u003cp>Before she gave up on the ride service, Lammers said, she would call California Health and Wellness to try to resolve the issue, only to be told that ModivCare was a separate company. “I’m like, ‘If you guys hired them and put them in charge of transportation, who oversees their screwups?,’” she said.\u003c/p>\n\u003cfigure id=\"attachment_11942520\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942520 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-800x614.jpg\" alt=\"A white woman, standing in a crowded room of unmade beds, dishes potatoes onto a plate of biscuits and gravy from a hot plate on a cabinet next to a fridge. \" width=\"800\" height=\"614\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-800x614.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-1020x783.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-160x123.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-1536x1180.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-2048x1573.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-1920x1475.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Stephanie Lammers has serious abdominal symptoms, and her gastroenterologist wants to run diagnostic tests, but she had to cancel five appointments in the last three months of 2022 because she didn't have transportation. \u003ccite>(Rich Pedroncelli/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Courtney Schwyzer, a member of a legal aid team representing Lammers on various Medi-Cal matters, said the failure of medical ride services is a systemic problem. In late February, Schwyzer and her fellow attorneys filed a petition in court that she hopes will force the state Department of Health Care Services to address the problem.\u003c/p>\n\u003cp>California Health and Wellness spokesperson Darrel Ng said the company monitors the quality of its contractors, but a shortage of transportation providers in rural areas “has created unique challenges.”\u003c/p>\n\u003cp>ModivCare provides more than 4 million rides for Medi-Cal recipients annually, and more than 99% are without complaint, said Melody Lai, a company spokesperson.\u003c/p>\n\u003cp>Lammers, who is unemployed and trying to start a custom craft business called Stuff by Steph, said doctors have warned her that if she doesn’t reduce her stress level, it could shorten her life. But arranging medical care is the most stressful thing in her life right now, so she doesn’t try anymore.\u003c/p>\n\u003cp>“In order to keep from dying, I have to not go to the doctor,” she said.\u003c/p>\n\u003ch2>'It's a blessing'\u003c/h2>\n\u003cp>Medi-Cal helped save the life of Carolina Morga Tapia, a 30-year-old full-time mother of five who lives with her family amid almond groves in an agricultural enclave of Fresno.\u003c/p>\n\u003cp>Nine years ago, a bacterial infection triggered premature labor during the 25th week of her second pregnancy, and Morga Tapia almost died. She spiked a fever, bled profusely and needed immediate transfusions and emergency surgery. After several days in critical care, she fully recovered.\u003c/p>\n\u003cfigure id=\"attachment_11942521\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942521 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-800x534.jpg\" alt=\"A Latina woman with a blue cardigan and a black shirt looks at the camera, arms akimbo, standing in a leafless orchard.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-1536x1025.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-2048x1367.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-1920x1281.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Carolina Morga Tapia stands amid almond trees outside her home in Fresno. She, her husband and their five children are enrolled in Medi-Cal, and she says she is very happy with the care it has provided, including emergency surgery that saved her life after she fell gravely ill during her second pregnancy. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But the doctors could not stop the premature birth, and her baby came out weighing just 1 pound. She and her husband, David Nuñez, named her Milagros Guadalupe, and she died four days later, on Sept. 13, 2013.\u003c/p>\n\u003cp>In each of her subsequent pregnancies, Medi-Cal paid for Morga Tapia to get shots of synthetic progesterone, intended to prevent another preterm birth. Those shots — one a week for about 20 weeks — can cost an average of \u003ca href=\"https://www.npr.org/sections/health-shots/2020/01/24/798731110/drug-to-prevent-premature-birth-divides-doctors-insurers-and-fda-experts\">more than $10,000 per pregnancy\u003c/a>.\u003c/p>\n\u003cp>Morga Tapia and Nuñez, a construction worker, signed up for Medi-Cal when she was pregnant with her first child more than a decade ago. They’ve been on the same Anthem Blue Cross Medi-Cal plan ever since.\u003c/p>\n\u003cp>The plan paid for prenatal care through all six of Morga Tapia’s pregnancies, and it has provided all the medical and dental care the family needs, she said.\u003c/p>\n\u003cp>“Without Medi-Cal, we would have to be paying for all of our children,” said Morga Tapia. “It saves a lot of money, and it’s a blessing to have that extra help.”\u003c/p>\n\u003cp>Her children, four girls and a boy, range in age from 1 to 10. They all go to the same children’s clinic and see the same pediatrician.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The kids, all in good health, get routine checkups, vaccinations and other preventive care, Morga Tapia said. She gets appointment reminders via text and cards in the mail notifying her when it’s time for the kids’ vaccinations and wellness checks, as well as her Pap smears, she said.\u003c/p>\n\u003cp>Her family’s experience contrasts sharply with the state’s assessment of their health plan, according to a \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/reports/Documents/Enhancing-Quality-for-Medi-Cal-Members.pdf\">report on quality of care in Medi-Cal issued late last year (PDF)\u003c/a>. The report, which evaluated Medi-Cal health plans on pediatric care, women’s health and chronic disease management, put Anthem Blue Cross in the lowest tier, and below par on multiple measures in numerous counties, including Fresno.\u003c/p>\n\u003cp>Another state report, released in late January, detailed how quickly insurers provide appointments for their patients, and put \u003ca href=\"https://www.dmhc.ca.gov/Portals/0/Docs/OPM/MY2021TAR.pdf\">Anthem Blue Cross’ Medi-Cal plan near the bottom of the heap (PDF)\u003c/a>.\u003c/p>\n\u003cp>Anthem Blue Cross spokesperson Michael Bowman said in a statement that the period covered in the reports coincide with the COVID-19 pandemic, “when our safety net providers dealt with significant challenges with workforce and appointment availability.”\u003c/p>\n\u003cp>Morga Tapia doesn’t give the insurer low marks. “It’s different for everybody. I have a good, healthy family, and what Medi-Cal covers is really fortunate for us,” she said.\u003c/p>\n\u003ch2>'I don't want to die yet'\u003c/h2>\n\u003cp>In late 2021, doctors gave Lucas Moreno Ramirez a few months to live.\u003c/p>\n\u003cp>Struggling with diabetes and late-stage lung cancer, Moreno Ramirez suffered debilitating pain as he hacked and labored for breath. His doctors recommended that he stop treatment and start hospice care.\u003c/p>\n\u003cp>He felt as if they were giving up on him.\u003c/p>\n\u003cp>“They said they’re going to give me opioids for my pain and help me have a comfortable death,” said Moreno Ramirez, 68, who lives in Norwalk, in Los Angeles County. “I told them I don’t believe in that. I don’t want to die yet.”\u003c/p>\n\u003cfigure id=\"attachment_11942525\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942525 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-800x534.jpg\" alt=\"A middle-aged Latino man, with a bushy gray mustache and thick gray hair combed back from his forehead, sits at a long table along a wall, on the other side of which a gauzy white curtain blows inward. He rests his right arm on the table, holding a blue-and-white mug. He looks at the camera, and is surrounded by cabinets with CDs, a massive water bottle, salt-and-pepper shakers, a clock on the wall and a nearby wind chime, and other homey detritus.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-1536x1025.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-2048x1367.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-1920x1281.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Lucas Moreno Ramirez, a former landscaper and factory worker, has been diagnosed with both diabetes and lung cancer. Working alongside a care manager through his Medi-Cal managed-care plan, he has fought for better care and treatment for both conditions. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A former landscaper and factory worker, Moreno Ramirez learned he had to be his own advocate, fighting for the care he believed he deserved from Medi-Cal.\u003c/p>\n\u003cp>He said his Christian faith gave him strength, and over the next few months, he pushed the program and his doctors to keep battling his cancer, using a different treatment with fewer side effects than chemotherapy.\u003c/p>\n\u003cp>“I believe in prayer,” he said. “But I believe in science and medication, too.”\u003c/p>\n\u003cp>Moreno Ramirez is one of the \u003ca href=\"https://www.chcf.org/publication/in-alignment-calaims-plan-coordinate-care-dual-enrollees-medicare-medi-cal/\">roughly 1.6 million Californians enrolled in both Medicare, which covers people who are 65 and older or have disabilities, and Medi-Cal\u003c/a>, which \u003ca href=\"https://www.kff.org/medicare/issue-brief/a-profile-of-medicare-medicaid-enrollees-dual-eligibles/?utm_campaign=KFF-2023-Medicaid&utm_medium=email&_hsmi=243959452&_hsenc=p2ANqtz--_YdJIpoiPQ6BsTqKV7XWKRpOoR_sJTFFsZI7MrJWw-BvXTcEh0PRgAq42XpbIvOpISMXOG8GW_lDUH-w2IgL2Syf6YA&utm_content=243959452&utm_source=hs_email\">kicks in to cover the costs and benefits that Medicare doesn’t\u003c/a>.\u003c/p>\n\u003cp>He also relies on his Medi-Cal insurer to help him navigate the Byzantine system. L.A. Care, the largest Medi-Cal plan with nearly 2.6 million members, connected him with a care manager who worked with him to identify \u003ca href=\"https://www.cancer.gov/publications/dictionaries/cancer-terms/def/tagrisso\">a different treatment called Tagrisso\u003c/a> and advocated for him to get it.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Even with the new medication, Moreno Ramirez’s coughing fits returned last year, and his symptoms grew so painful he suspected the cancer was growing. He asked to see his pulmonologist but was told the first appointment would be in June 2023. So he switched doctors and scored an appointment nearly six months sooner.\u003c/p>\n\u003cp>“My old doctor didn’t help me. I didn’t trust him,” Moreno Ramirez said. “He was always too busy for me. I told my doctors, ‘Give me a chance.’”\u003c/p>\n\u003cp>Having taken his care into his own hands, he says he’s not in pain, his cough has subsided and he feels hopeful for the future. “Now I feel good,” he said.\u003c/p>\n\u003cp>He has also sought more attention for his diabetes and received a continuous glucose monitor to measure his blood sugar. It’s better controlled now than it has been in decades, he said.\u003c/p>\n\u003cp>“You have to stand up for yourself and advocate,” said Joann Pacelo, the care manager who helped Moreno Ramirez change doctors, get quicker referrals to specialists and get approved for in-home nursing visits.\u003c/p>\n\u003cp>“A lot of times, it’s difficult with Medi-Cal because the doctors are busy and the reimbursements are so low, but no one should be denied the care they deserve.”\u003c/p>\n\u003cp>\u003cem>California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>A year has passed since a massive statewide effort called \u003ca href=\"https://www.dhcs.ca.gov/calaim\">CalAIM\u003c/a> began rolling out. Among several significant changes CalAIM promised: an overhaul of the availability of mental health care for young people insured by Medi-Cal, the public insurance program for lower-income Californians.\u003c/p>\n\u003cp>Advocates for youth mental health say they remain enthusiastic about CalAIM’s potential, using words like “game-changing” and “transformational.”\u003c/p>\n\u003cp>But they also say the new framework is being born at a tricky time. Three years into the pandemic, provider burnout and escalating patient need have combined to create a severe \u003ca href=\"https://calmatters.org/health/2022/09/california-shortage-mental-health-workers/\">mental health workforce shortage\u003c/a>. Meanwhile, community-based organizations that provide many of the mental health services outlined under CalAIM say they feel left out of the loop in important conversations about coming payment reforms.[pullquote size=\"medium\" align=\"right\" citation=\"Adrienne Shilton, director of public policy, California Alliance of Child and Family Services\"]‘Where are the people who are going to be delivering these services?’[/pullquote]\u003c/p>\n\u003cp>Gov. Gavin \u003ca href=\"https://ebudget.ca.gov/2023-24/pdf/BudgetSummary/HealthandHumanServices.pdf\">Newsom’s budget proposal (PDF)\u003c/a> — which would delay certain behavioral health investments to combat a \u003ca href=\"https://calmatters.org/california-budget/2023/01/california-budget-newsom-deficit/\">projected $22 billion deficit\u003c/a> — also risks hampering progress for CalAIM.\u003c/p>\n\u003cp>“Our members are really panicked right now,” said Adrienne Shilton, director of public policy for the nonprofit California Alliance of Child and Family Services. In September 2022, hers was one of a dozen organizations that signed \u003ca href=\"https://www.documentcloud.org/documents/23587669-final-dhcs-letter-on-rates-9-12-2022-2\">a letter to the state Department of Health Care Services\u003c/a> expressing concerns about a lack of transparency around the new rate structure.\u003c/p>\n\u003cp>“Providers must have the ability to plan and prepare alongside their county partners,” it said. Shilton’s organization also co-authored \u003ca href=\"https://calmatters.org/wp-content/uploads/2022/06/CA-Alliance-and-CBHDA-Feedback-on-BHCIP-Funding-Delays.pdf\">a letter Wednesday to legislators (PDF)\u003c/a>, decrying the proposed budget delays.\u003c/p>\n\u003cp>Shilton told CalMatters earlier that other issues CalAIM is meant to address, including alleviating burdensome documentation requirements, have yet to change the on-the-ground reality for many providers.[aside postID=\"news_11926757,news_11934623\" label=\"Related Posts\"]\u003ca href=\"https://www.dhcs.ca.gov/calaim\">CalAIM\u003c/a> is about much more than mental health. The initiative, short for California Advancing and Innovating Medi-Cal, is a five-year plan that began rolling out a year ago. It aims to provide children and adults insured by Medi-Cal with better access to a range of health and mental health services. It also strives to use a \u003ca href=\"https://calmatters.org/health/2022/02/california-medi-cal-reform/\">“whole person care”\u003c/a> approach to addressing social issues that affect health, including housing and food insecurity.\u003c/p>\n\u003cp>It also redesigns the payment system to more seamlessly integrate the county mental health plans and managed care organizations that pay for those services.\u003c/p>\n\u003cp>The relevance and urgency of addressing children’s mental health is especially clear: Racism. School closures. Online bullying. Climate disaster. A pandemic pocked with grief, loss and fear.\u003c/p>\n\u003cp>All of these factors have aggravated a youth mental health crisis that’s been raging for more than a decade. Incidence of \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2019-125.pdf\">self-harm for young people, which increased dramatically (PDF)\u003c/a> even before the pandemic, has \u003ca href=\"https://calmatters.org/health/2021/09/children-suicide-residential-treatment-crisis-california/\">spiked further\u003c/a> in the past few years.\u003c/p>\n\u003cp>CalAIM has not yet significantly shifted the on-the-ground reality for many of these young people, experts say, but a number of important policy changes are officially underway:\u003c/p>\n\u003cul>\n\u003cli>About 40% of the state’s children and youth are insured by Medi-Cal. They no longer need a formal diagnosis to access specialty mental health services.\u003c/li>\n\u003cli>The state has simplified behavioral health documentation requirements.\u003c/li>\n\u003cli>A “No Wrong Door Policy” should make it easier for children and adults to receive behavioral health care no matter where they enter the system, replacing what can feel like a bureaucratic maze that varies by county.\u003c/li>\n\u003cli>An “enhanced care management” benefit provides services and case management to members of priority populations, including those who are unhoused, experiencing early psychosis or involved with the child welfare or criminal justice systems.\u003c/li>\n\u003c/ul>\n\u003cp>Other efforts, including changing the way mental health services are paid for, also are rolling out this year.\u003c/p>\n\u003cp>Newsom’s administration, which early on made behavioral health a signature issue, is simultaneously unveiling several other ambitious initiatives, all of which require additional staffing and funding: a statewide program to set up new court systems to address the needs of people with severe mental illness, known as \u003ca href=\"https://calmatters.org/housing/2022/09/california-lawmakers-approved-care-court-what-comes-next/\">CARE Court\u003c/a>; expanded crisis response services through state funding \u003ca href=\"https://calmatters.org/health/2022/07/california-mental-health-crisis-hotline/\">for a 988 hotline\u003c/a>; and a \u003ca href=\"https://calmatters.org/health/2022/03/california-children-mental-health-crisis/\">major initiative to improve mental health care for children and youth\u003c/a>, parts of which will be\u003ca href=\"https://www.chhs.ca.gov/wp-content/uploads/2022/10/CYBHI-101-Deck-September-2022.pdf\"> affected by the proposed budget delays (PDF)\u003c/a>.\u003c/p>\n\u003cp>Despite belt-tightening in other areas of the governor’s proposed January budget, CalAIM continues to be funded. Newsom’s proposal would dedicate more than $10 billion to CalAIM implementation, including \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Pages/CalBH-CBC.aspx\">$6.1 billion over five years\u003c/a> to improve local treatment services and pay for short-term stays in treatment facilities for people with serious mental and behavioral health illnesses.\u003c/p>\n\u003cp>“We’re committed. We’re not touching that,” he said in a press conference earlier this month.\u003c/p>\n\u003cp>The budget proposal does, however, delay more than $1.1 billion in other behavioral health investments over the next two years, including money intended to increase treatment capacity for adults and kids in crisis, and money for workforce development. These \u003ca href=\"https://www.infrastructure.buildingcalhhs.com/wp-content/uploads/2022/05/BHCIP-and-CCE-Infrastructure-Funds-Status-Legislative-Update-April-2022-Update.pdf\">investments were intended in part to shore up CalAIM’s goals (PDF)\u003c/a>, according to state documents.\u003c/p>\n\u003cp>“We’re concerned about the delays,” Shilton said. “This is funding outside of CalAIM but … the system is so stressed. Having this additional investment from the state was really beneficial.”\u003c/p>\n\u003cp>The governor’s office did not respond to questions about the proposed funding delays. He will revise his budget proposal in May, based on actual state revenue, and hammer out a final funding deal with legislators in June.\u003c/p>\n\u003cp>While CalAIM is an important step toward meeting the mental health needs of vulnerable young people, experts say staffing shortages, especially, are complicating the picture. As a result, some say, it’s not yet clear how and when official policy changes will translate into better mental health treatment for individuals. The proposed budget would delay nearly $400 million for health care workforce training, including some social work and behavioral health pipeline programs.\u003c/p>\n\u003cp>“Where are the people who are going to be delivering these services?” Shilton said.\u003c/p>\n\u003cp>Michelle Cabrera, executive director of the County Behavioral Health Directors Association of California, calls CalAIM “an uber-ambitious reform agenda that’s sitting on top of a system that’s really been through the storm.”\u003c/p>\n\u003cp>Counties are being asked to implement “ambitious, sweeping new reforms on top of the worst workforce crisis we’ve ever seen,” she said.\u003c/p>\n\u003cp>In an emailed response to CalMatters, the Department of Health Care Services said the Newsom administration is committed to “collaborating closely” with counties, health plans and others to plan, implement and monitor the various “unprecedented and intersecting initiatives.”\u003c/p>\n\u003cp>Still, community-based organizations that contract with counties and managed care organizations to provide mental health services say they are worried about the payment they will receive for their services and how that could affect their ability to recruit and retain necessary staff.\u003c/p>\n\u003cp>Jodi Kurata, chief executive officer of the Association of Community Human Service Agencies, which represents nonprofit organizations in Los Angeles, said the groups she works with are too overwhelmed dealing with workforce shortages to focus on the administrative transformation underway.\u003c/p>\n\u003cp>“The system right now is just so depleted,” she said.\u003c/p>\n\u003cp>She said she worries that inadequate rates could lead to a further exodus of nonprofit mental health care providers from the Medi-Cal system, a concern others have echoed.\u003c/p>\n\u003cp>The state says a preliminary draft of revised payment rates has been shared with counties. The Department of Health Care Services said it has committed to publishing a fee schedule in the first few months of this year.\u003c/p>\n\u003cp>Cabrera, of the County Behavioral Health Directors Association, said CalAIM’s new payment structure marks an important shift in that the state will now allow counties to pay providers without being capped, and will remove many burdensome documentation requirements. She said counties are just now seeing the new rates, and that the administration’s “aggressive” timeline will likely lead to a “bumpy ride this year” before ultimately resulting in a positive change.\u003c/p>\n\u003ch2>When care depends on your county\u003c/h2>\n\u003cp>Other longstanding funding problems remain unaddressed. This past fall, Young Minds Advocacy, a children’s mental health advocacy organization, published a report showing that \u003ca href=\"https://static1.squarespace.com/static/5e8cda3fbb668903f24a24ca/t/638787ce2c4a6b17b39c295f/1669826513743/30NOV2022_YMA_REPORT.pdf\">longstanding variability in the way the state funds county specialty mental health services has translated into disparities (PDF)\u003c/a> in the kinds of intensive care offered to young Medi-Cal enrollees.\u003c/p>\n\u003cp>For decades, said Patrick Gardner, an attorney who founded the advocacy organization, the state has underfunded certain counties, “and their performance has suffered accordingly, sometimes pretty dramatically.”\u003c/p>\n\u003cp>In his report, Gardner found that counties with significantly lower-than-average state funding generally provided young people with less intensive services than counties with significantly higher-than-average state funding. According to his report, in 2019–20, poorly funded San Joaquin and Madera counties provided just 16% and 17% of the estimated need for care, while the better-funded Santa Clara and Butte counties provided 86%.\u003c/p>\n\u003cp>While CalAIM is moving “in the right direction,” Gardner said, it fails to address this fundamental issue. (Cabrera contends that the analysis fails to capture the services that counties provide without billing Medi-Cal.)\u003c/p>\n\u003cp>Despite these concerns, many mental health care advocates say they are witnessing important changes to the way care is delivered under CalAIM.\u003c/p>\n\u003cp>“We are seeing shifts happening already,” said Leticia Galyean, CEO and president of Seneca Family of Agencies. She said her organization — which serves youth and families in 14 counties — is especially seeing “an immediate benefit” in terms of faster access to specialty mental health care for foster youth, unhoused youth and those involved in the juvenile justice system.\u003c/p>\n\u003cp>Brian Blalock, senior staff attorney at the Youth Law Center, which advocates for youth in the child welfare and juvenile justice systems, called CalAIM “the most important thing California has done in a long time.”\u003c/p>\n\u003cp>“There’s just tremendous opportunity there,” he said.\u003c/p>\n\u003cp>Now, he added, “we as a state can go in either direction — either we realize that promise, or we let this pass us by.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A year has passed since a massive statewide effort called \u003ca href=\"https://www.dhcs.ca.gov/calaim\">CalAIM\u003c/a> began rolling out. Among several significant changes CalAIM promised: an overhaul of the availability of mental health care for young people insured by Medi-Cal, the public insurance program for lower-income Californians.\u003c/p>\n\u003cp>Advocates for youth mental health say they remain enthusiastic about CalAIM’s potential, using words like “game-changing” and “transformational.”\u003c/p>\n\u003cp>But they also say the new framework is being born at a tricky time. Three years into the pandemic, provider burnout and escalating patient need have combined to create a severe \u003ca href=\"https://calmatters.org/health/2022/09/california-shortage-mental-health-workers/\">mental health workforce shortage\u003c/a>. Meanwhile, community-based organizations that provide many of the mental health services outlined under CalAIM say they feel left out of the loop in important conversations about coming payment reforms.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Gov. Gavin \u003ca href=\"https://ebudget.ca.gov/2023-24/pdf/BudgetSummary/HealthandHumanServices.pdf\">Newsom’s budget proposal (PDF)\u003c/a> — which would delay certain behavioral health investments to combat a \u003ca href=\"https://calmatters.org/california-budget/2023/01/california-budget-newsom-deficit/\">projected $22 billion deficit\u003c/a> — also risks hampering progress for CalAIM.\u003c/p>\n\u003cp>“Our members are really panicked right now,” said Adrienne Shilton, director of public policy for the nonprofit California Alliance of Child and Family Services. In September 2022, hers was one of a dozen organizations that signed \u003ca href=\"https://www.documentcloud.org/documents/23587669-final-dhcs-letter-on-rates-9-12-2022-2\">a letter to the state Department of Health Care Services\u003c/a> expressing concerns about a lack of transparency around the new rate structure.\u003c/p>\n\u003cp>“Providers must have the ability to plan and prepare alongside their county partners,” it said. Shilton’s organization also co-authored \u003ca href=\"https://calmatters.org/wp-content/uploads/2022/06/CA-Alliance-and-CBHDA-Feedback-on-BHCIP-Funding-Delays.pdf\">a letter Wednesday to legislators (PDF)\u003c/a>, decrying the proposed budget delays.\u003c/p>\n\u003cp>Shilton told CalMatters earlier that other issues CalAIM is meant to address, including alleviating burdensome documentation requirements, have yet to change the on-the-ground reality for many providers.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003ca href=\"https://www.dhcs.ca.gov/calaim\">CalAIM\u003c/a> is about much more than mental health. The initiative, short for California Advancing and Innovating Medi-Cal, is a five-year plan that began rolling out a year ago. It aims to provide children and adults insured by Medi-Cal with better access to a range of health and mental health services. It also strives to use a \u003ca href=\"https://calmatters.org/health/2022/02/california-medi-cal-reform/\">“whole person care”\u003c/a> approach to addressing social issues that affect health, including housing and food insecurity.\u003c/p>\n\u003cp>It also redesigns the payment system to more seamlessly integrate the county mental health plans and managed care organizations that pay for those services.\u003c/p>\n\u003cp>The relevance and urgency of addressing children’s mental health is especially clear: Racism. School closures. Online bullying. Climate disaster. A pandemic pocked with grief, loss and fear.\u003c/p>\n\u003cp>All of these factors have aggravated a youth mental health crisis that’s been raging for more than a decade. Incidence of \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2019-125.pdf\">self-harm for young people, which increased dramatically (PDF)\u003c/a> even before the pandemic, has \u003ca href=\"https://calmatters.org/health/2021/09/children-suicide-residential-treatment-crisis-california/\">spiked further\u003c/a> in the past few years.\u003c/p>\n\u003cp>CalAIM has not yet significantly shifted the on-the-ground reality for many of these young people, experts say, but a number of important policy changes are officially underway:\u003c/p>\n\u003cul>\n\u003cli>About 40% of the state’s children and youth are insured by Medi-Cal. They no longer need a formal diagnosis to access specialty mental health services.\u003c/li>\n\u003cli>The state has simplified behavioral health documentation requirements.\u003c/li>\n\u003cli>A “No Wrong Door Policy” should make it easier for children and adults to receive behavioral health care no matter where they enter the system, replacing what can feel like a bureaucratic maze that varies by county.\u003c/li>\n\u003cli>An “enhanced care management” benefit provides services and case management to members of priority populations, including those who are unhoused, experiencing early psychosis or involved with the child welfare or criminal justice systems.\u003c/li>\n\u003c/ul>\n\u003cp>Other efforts, including changing the way mental health services are paid for, also are rolling out this year.\u003c/p>\n\u003cp>Newsom’s administration, which early on made behavioral health a signature issue, is simultaneously unveiling several other ambitious initiatives, all of which require additional staffing and funding: a statewide program to set up new court systems to address the needs of people with severe mental illness, known as \u003ca href=\"https://calmatters.org/housing/2022/09/california-lawmakers-approved-care-court-what-comes-next/\">CARE Court\u003c/a>; expanded crisis response services through state funding \u003ca href=\"https://calmatters.org/health/2022/07/california-mental-health-crisis-hotline/\">for a 988 hotline\u003c/a>; and a \u003ca href=\"https://calmatters.org/health/2022/03/california-children-mental-health-crisis/\">major initiative to improve mental health care for children and youth\u003c/a>, parts of which will be\u003ca href=\"https://www.chhs.ca.gov/wp-content/uploads/2022/10/CYBHI-101-Deck-September-2022.pdf\"> affected by the proposed budget delays (PDF)\u003c/a>.\u003c/p>\n\u003cp>Despite belt-tightening in other areas of the governor’s proposed January budget, CalAIM continues to be funded. Newsom’s proposal would dedicate more than $10 billion to CalAIM implementation, including \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Pages/CalBH-CBC.aspx\">$6.1 billion over five years\u003c/a> to improve local treatment services and pay for short-term stays in treatment facilities for people with serious mental and behavioral health illnesses.\u003c/p>\n\u003cp>“We’re committed. We’re not touching that,” he said in a press conference earlier this month.\u003c/p>\n\u003cp>The budget proposal does, however, delay more than $1.1 billion in other behavioral health investments over the next two years, including money intended to increase treatment capacity for adults and kids in crisis, and money for workforce development. These \u003ca href=\"https://www.infrastructure.buildingcalhhs.com/wp-content/uploads/2022/05/BHCIP-and-CCE-Infrastructure-Funds-Status-Legislative-Update-April-2022-Update.pdf\">investments were intended in part to shore up CalAIM’s goals (PDF)\u003c/a>, according to state documents.\u003c/p>\n\u003cp>“We’re concerned about the delays,” Shilton said. “This is funding outside of CalAIM but … the system is so stressed. Having this additional investment from the state was really beneficial.”\u003c/p>\n\u003cp>The governor’s office did not respond to questions about the proposed funding delays. He will revise his budget proposal in May, based on actual state revenue, and hammer out a final funding deal with legislators in June.\u003c/p>\n\u003cp>While CalAIM is an important step toward meeting the mental health needs of vulnerable young people, experts say staffing shortages, especially, are complicating the picture. As a result, some say, it’s not yet clear how and when official policy changes will translate into better mental health treatment for individuals. The proposed budget would delay nearly $400 million for health care workforce training, including some social work and behavioral health pipeline programs.\u003c/p>\n\u003cp>“Where are the people who are going to be delivering these services?” Shilton said.\u003c/p>\n\u003cp>Michelle Cabrera, executive director of the County Behavioral Health Directors Association of California, calls CalAIM “an uber-ambitious reform agenda that’s sitting on top of a system that’s really been through the storm.”\u003c/p>\n\u003cp>Counties are being asked to implement “ambitious, sweeping new reforms on top of the worst workforce crisis we’ve ever seen,” she said.\u003c/p>\n\u003cp>In an emailed response to CalMatters, the Department of Health Care Services said the Newsom administration is committed to “collaborating closely” with counties, health plans and others to plan, implement and monitor the various “unprecedented and intersecting initiatives.”\u003c/p>\n\u003cp>Still, community-based organizations that contract with counties and managed care organizations to provide mental health services say they are worried about the payment they will receive for their services and how that could affect their ability to recruit and retain necessary staff.\u003c/p>\n\u003cp>Jodi Kurata, chief executive officer of the Association of Community Human Service Agencies, which represents nonprofit organizations in Los Angeles, said the groups she works with are too overwhelmed dealing with workforce shortages to focus on the administrative transformation underway.\u003c/p>\n\u003cp>“The system right now is just so depleted,” she said.\u003c/p>\n\u003cp>She said she worries that inadequate rates could lead to a further exodus of nonprofit mental health care providers from the Medi-Cal system, a concern others have echoed.\u003c/p>\n\u003cp>The state says a preliminary draft of revised payment rates has been shared with counties. The Department of Health Care Services said it has committed to publishing a fee schedule in the first few months of this year.\u003c/p>\n\u003cp>Cabrera, of the County Behavioral Health Directors Association, said CalAIM’s new payment structure marks an important shift in that the state will now allow counties to pay providers without being capped, and will remove many burdensome documentation requirements. She said counties are just now seeing the new rates, and that the administration’s “aggressive” timeline will likely lead to a “bumpy ride this year” before ultimately resulting in a positive change.\u003c/p>\n\u003ch2>When care depends on your county\u003c/h2>\n\u003cp>Other longstanding funding problems remain unaddressed. This past fall, Young Minds Advocacy, a children’s mental health advocacy organization, published a report showing that \u003ca href=\"https://static1.squarespace.com/static/5e8cda3fbb668903f24a24ca/t/638787ce2c4a6b17b39c295f/1669826513743/30NOV2022_YMA_REPORT.pdf\">longstanding variability in the way the state funds county specialty mental health services has translated into disparities (PDF)\u003c/a> in the kinds of intensive care offered to young Medi-Cal enrollees.\u003c/p>\n\u003cp>For decades, said Patrick Gardner, an attorney who founded the advocacy organization, the state has underfunded certain counties, “and their performance has suffered accordingly, sometimes pretty dramatically.”\u003c/p>\n\u003cp>In his report, Gardner found that counties with significantly lower-than-average state funding generally provided young people with less intensive services than counties with significantly higher-than-average state funding. According to his report, in 2019–20, poorly funded San Joaquin and Madera counties provided just 16% and 17% of the estimated need for care, while the better-funded Santa Clara and Butte counties provided 86%.\u003c/p>\n\u003cp>While CalAIM is moving “in the right direction,” Gardner said, it fails to address this fundamental issue. (Cabrera contends that the analysis fails to capture the services that counties provide without billing Medi-Cal.)\u003c/p>\n\u003cp>Despite these concerns, many mental health care advocates say they are witnessing important changes to the way care is delivered under CalAIM.\u003c/p>\n\u003cp>“We are seeing shifts happening already,” said Leticia Galyean, CEO and president of Seneca Family of Agencies. She said her organization — which serves youth and families in 14 counties — is especially seeing “an immediate benefit” in terms of faster access to specialty mental health care for foster youth, unhoused youth and those involved in the juvenile justice system.\u003c/p>\n\u003cp>Brian Blalock, senior staff attorney at the Youth Law Center, which advocates for youth in the child welfare and juvenile justice systems, called CalAIM “the most important thing California has done in a long time.”\u003c/p>\n\u003cp>“There’s just tremendous opportunity there,” he said.\u003c/p>\n\u003cp>Now, he added, “we as a state can go in either direction — either we realize that promise, or we let this pass us by.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Federal regulators have agreed to continue to hold off on patient discharges and transfers out of Laguna Honda Hospital and Rehabilitation Center until at least May 19, 2023, San Francisco officials confirmed on Wednesday.\u003c/p>\n\u003cp>The reprieve comes just one day ahead of when the pause on patient transfers was set to expire.\u003c/p>\n\u003cp>“The transfers and discharge of residents has been arduous as many have complex healthcare needs, and Laguna Honda and City leadership have strongly advocated against the involuntary transfers,” a statement released Wednesday from Laguna Honda officials reads. “The vast majority of residents and their families are fighting to remain at Laguna Honda and this continued reprieve of involuntary transfers provides stability, continuity of care, and short-term relief.”\u003c/p>\n\u003cp>City leaders, residents and their loved ones celebrated the decision.\u003c/p>\n\u003cp>“Laguna Honda is a critical part of San Francisco’s ability to care for our most vulnerable residents and is essential to the future of our city,” said Mayor London Breed, whose grandmother lived the final years of her life at Laguna Honda. “We appreciate that CMS has agreed to continue this pause of transfers from Laguna Honda while we work collaboratively towards recertification,” she said, referring to the regulatory body, the Centers for Medicare and Medicaid Services.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Joe Urban, whose mother-in-law was a resident at Laguna Honda, said CMS “did the right thing.”\u003c/p>\n\u003cp>“Restarting the discharges would have killed a lot of San Franciscans,” Urban said. “There’s no need to do it if Laguna Honda is making progress towards recertification.”\u003c/p>\n\u003cp>But relief may be temporary. The hospital is still working to regain certification with CMS to participate in government-subsidized health care plans like Medicare and Medi-Cal, which cover the majority of patients at Laguna Honda.\u003c/p>\n\u003cp>“I’m worried that May will be here before you know it and we will go through this again,” said Tony Chicotel, staff attorney with California Advocates for Nursing Home Reform. “With each extension, [another extension] become increasingly unlikely, and at some point I think it will stop happening.”\u003c/p>\n\u003cp>[aside label='Related Coverage' tag='laguna-honda-hospital']In April 2022, CMS decertified Laguna Honda after a series of inspections found the hospital out of compliance with safety measures for a skilled nursing facility. The hospital was then required to create and implement a closure plan, which included transferring or discharging all of its residents by September 2022.\u003c/p>\n\u003cp>The hospital, city leaders and senior advocates pushed hard against the transfers, citing how it can be physically and emotionally traumatic for older people and people with disabilities to be uprooted.\u003c/p>\n\u003cp>Laguna Honda transferred 41 residents to other skilled nursing facilities and discharged an additional 16 residents. Of those, 12 people died — eight of them within weeks, and four within months, of leaving Laguna Honda.\u003c/p>\n\u003cp>After reports came in that some residents had died after being transferred, San Francisco sued the federal government for failing to provide adequate time to repeal the original citations.\u003c/p>\n\u003cp>The city and CMS came to an agreement in July 2022 to pause transfers until Feb. 2, 2023.\u003c/p>\n\u003cp>The hospital maintains that it is working to prepare for recertification in the meantime.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“This is the humane and compassionate thing to do for the residents of Laguna Honda, their families and staff,” said San Francisco City Attorney David Chiu. “We certainly hope we don’t cut things as close next time. I know that the staff at Laguna Honda will work and do everything they can to address the issues and get us to that recertification. Our hope is we aren’t in this place again.”\u003c/p>\n\n",
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"excerpt": "San Francisco officials had raised alarm bells about having to resume relocating the hospital's more than 550 remaining patients, many of whom are elderly and lower-income, to other facilities as early as Friday.\r\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Federal regulators have agreed to continue to hold off on patient discharges and transfers out of Laguna Honda Hospital and Rehabilitation Center until at least May 19, 2023, San Francisco officials confirmed on Wednesday.\u003c/p>\n\u003cp>The reprieve comes just one day ahead of when the pause on patient transfers was set to expire.\u003c/p>\n\u003cp>“The transfers and discharge of residents has been arduous as many have complex healthcare needs, and Laguna Honda and City leadership have strongly advocated against the involuntary transfers,” a statement released Wednesday from Laguna Honda officials reads. “The vast majority of residents and their families are fighting to remain at Laguna Honda and this continued reprieve of involuntary transfers provides stability, continuity of care, and short-term relief.”\u003c/p>\n\u003cp>City leaders, residents and their loved ones celebrated the decision.\u003c/p>\n\u003cp>“Laguna Honda is a critical part of San Francisco’s ability to care for our most vulnerable residents and is essential to the future of our city,” said Mayor London Breed, whose grandmother lived the final years of her life at Laguna Honda. “We appreciate that CMS has agreed to continue this pause of transfers from Laguna Honda while we work collaboratively towards recertification,” she said, referring to the regulatory body, the Centers for Medicare and Medicaid Services.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Joe Urban, whose mother-in-law was a resident at Laguna Honda, said CMS “did the right thing.”\u003c/p>\n\u003cp>“Restarting the discharges would have killed a lot of San Franciscans,” Urban said. “There’s no need to do it if Laguna Honda is making progress towards recertification.”\u003c/p>\n\u003cp>But relief may be temporary. The hospital is still working to regain certification with CMS to participate in government-subsidized health care plans like Medicare and Medi-Cal, which cover the majority of patients at Laguna Honda.\u003c/p>\n\u003cp>“I’m worried that May will be here before you know it and we will go through this again,” said Tony Chicotel, staff attorney with California Advocates for Nursing Home Reform. “With each extension, [another extension] become increasingly unlikely, and at some point I think it will stop happening.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>In April 2022, CMS decertified Laguna Honda after a series of inspections found the hospital out of compliance with safety measures for a skilled nursing facility. The hospital was then required to create and implement a closure plan, which included transferring or discharging all of its residents by September 2022.\u003c/p>\n\u003cp>The hospital, city leaders and senior advocates pushed hard against the transfers, citing how it can be physically and emotionally traumatic for older people and people with disabilities to be uprooted.\u003c/p>\n\u003cp>Laguna Honda transferred 41 residents to other skilled nursing facilities and discharged an additional 16 residents. Of those, 12 people died — eight of them within weeks, and four within months, of leaving Laguna Honda.\u003c/p>\n\u003cp>After reports came in that some residents had died after being transferred, San Francisco sued the federal government for failing to provide adequate time to repeal the original citations.\u003c/p>\n\u003cp>The city and CMS came to an agreement in July 2022 to pause transfers until Feb. 2, 2023.\u003c/p>\n\u003cp>The hospital maintains that it is working to prepare for recertification in the meantime.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“This is the humane and compassionate thing to do for the residents of Laguna Honda, their families and staff,” said San Francisco City Attorney David Chiu. “We certainly hope we don’t cut things as close next time. I know that the staff at Laguna Honda will work and do everything they can to address the issues and get us to that recertification. Our hope is we aren’t in this place again.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "'Down to the Wire Again': SF Officials Blast Feds for Silence on Laguna Honda Patient-Transfer Decision, Just Days Before Deadline",
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"headTitle": "‘Down to the Wire Again’: SF Officials Blast Feds for Silence on Laguna Honda Patient-Transfer Decision, Just Days Before Deadline | KQED",
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"content": "\u003cp>\u003cstrong>Update, 6 p.m. Tuesday: \u003c/strong>Federal officials have yet to say whether they will allow San Francisco to continue postponing the transfer of hundreds of Laguna Honda Hospital patients to other skilled nursing facilities, frustrated city leaders said Tuesday.[pullquote align=\"right\" size=\"medium\" citation=\"San Francisco Supervisor Myrna Melgar\"]‘It is entirely possible that on Friday, Feb. 3, hundreds of San Franciscans residing at Laguna Honda will face the trauma of possible relocation again from being discharged.’[/pullquote]\u003c/p>\n\u003cp>The clock is ticking. If the Biden administration rejects the city’s requests to continue halting transfers, the hospital could be required to resume relocating its more than 550 remaining patients, many of whom are elderly and lower-income, to other skilled nursing facilities as early as Friday.\u003c/p>\n\u003cp>“It is entirely possible that on Friday, Feb. 3, hundreds of San Franciscans residing at Laguna Honda will face the trauma of possible relocation again from being discharged,” San Francisco Supervisor Myrna Melgar, whose district includes the hospital, said at Tuesday’s Board of Supervisors hearing. “The rigid bureaucracy of the U.S. government has put us into this position.”\u003c/p>\n\u003cp>Hospital officials have said they have no plans to resume transferring patients unless compelled to do so. Twelve of the 57 patients who were initially transferred from the hospital last summer — some of whom had dementia and limited physical and cognitive ability — died within weeks or months of being relocated.\u003c/p>\n\u003cp>“Laguna Honda strongly advocated against these transfers. We warned CMS (the Center for Medicare and Medicaid Services) that the four-month deadline to transfer nearly 700 residents to other facilities was entirely insufficient given the complex nature of our resident population and the lack of available beds at SNFs (skilled nursing facilities) anywhere in the region or the state,” hospital officials said in a public statement earlier this month in response to regulatory citations it received following the deaths of the transferred patients.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Roland Pickens, Laguna Honda’s interim CEO, said he is hopeful the current pause on patient transfers will be extended, allowing the hospital to continue working to address deficiencies cited by state and federal regulators.\u003c/p>\n\u003cp>At Tuesday’s hearing, other San Francisco leaders blasted federal officials for so far failing to respond to the city’s extension request, just days before the hospital could be required to resume patient transfers.\u003c/p>\n\u003cp>“This is a powerful and unaccountable bureaucracy,” Supervisor Rafael Mandelman said. “They [CMS] have done significant harm. They have created a ton of stress and anxiety for hundreds more people.”\u003c/p>\n\u003cp>\u003cstrong>Original story, 6 a.m. Tuesday: \u003c/strong>San Francisco officials are expected to find out this week whether federal regulators will allow the city to continue postponing the transfer of patients out of Laguna Honda Hospital.\u003c/p>\n\u003cp>An extension would allow patients and their families to breathe a temporary sigh of relief, just days before the recently decertified hospital could be required to resume relocating its more than 550 remaining charges.\u003c/p>\n\u003cp>\u003ca href=\"https://www.kqed.org/news/11920121/sf-officials-outraged-over-laguna-honda-patient-deaths-following-federally-mandated-transfers\">Regulators paused their initial transfer requirement\u003c/a> in July 2022, after reports that some of the 57 patients who had initially been moved from the hospital had died. In total, 12 former patients are confirmed to have died, nearly all of whom had been transferred last year to other skilled nursing facilities.\u003c/p>\n\u003cp>San Francisco City Attorney David Chiu is now requesting that the pause on transfers extend until at least May 30, 2023, and the status of the relocation plan is scheduled to be addressed at a Board of Supervisors hearing on Tuesday afternoon.\u003c/p>\n\u003cp>“There is a moral and ethical imperative to not continue the transfers,” said Joseph Urban, a health care consultant whose mother-in-law, Betty Campbell, was a resident at Laguna Honda. “We’re down to the wire again.”\u003c/p>\n\u003cp>Citing Campbell’s frail state, Urban and his spouse turned down the hospital’s offer last summer to relocate her. The 86-year-old died recently at the hospital.\u003c/p>\n\u003cp>Opened in 1866, Laguna Honda is one of the oldest and largest public skilled nursing facilities in the country, treating a wide range of medical conditions including dementia, stroke, mental illness and HIV.\u003c/p>\n\u003cp>Although the hospital is still licensed, it was decertified last year by the federal Centers for Medicare and Medicaid Services (CMS) for a series of safety violations. That means it is no longer in good standing with government-provided health care options like Medicare and Medi-Cal, which fund medical costs for the vast majority of its patients.\u003c/p>\n\u003cp>After Laguna Honda lost certification, CMS required the hospital to create and implement a closure plan, including the transfer of all of its nearly 700 patients, many of them elderly and frail.\u003c/p>\n\u003cp>[aside label=\"related coverage\" tag=\"laguna-honda-hospital\"]At the same time, the hospital has been working with consultants to prepare for recertification.\u003c/p>\n\u003cp>“The focus of this meeting needs to be primarily on how the Board of Supervisors can be a force for protecting the most vulnerable: those who are now residents at Laguna Honda and those of us could need a bed there at any time,” Teresa Palmer, a former Laguna Honda physician and geriatrician, wrote in a letter to the board ahead of its Tuesday hearing. “Administration at Laguna Honda and consultants obviously need more time to ‘turn the ship around.’ In order to prevent death and harm to current and future residents, this time needs to be made available by CMS.”\u003c/p>\n\u003cp>Last month, the California Department of Public Health fined Laguna Honda $36,000 for providing inadequate care to the patients who died after their transfers. Nearly all of those patients, who ranged in age from 63 to 100, were considered severely disabled, including some who were on feeding tubes, living with dementia or nonverbal, the agency’s citations show.\u003c/p>\n\u003cp>The citations also noted that the patients who died were identified as “not discharge ready” because they were frail or otherwise not in a condition to be relocated.\u003c/p>\n\u003cp>The \u003ca href=\"https://abc7news.com/amp/laguna-honda-hospital-san-francisco-funding-mayor-london-breed-press-conference-healthcare-in-sf/11747735/\">current regulatory crisis facing Laguna Honda\u003c/a> began last spring, when federal regulators decertified the hospital after conducting a series of safety inspections triggered by two nonfatal drug overdoses the previous year.\u003c/p>\n\u003cp>Because San Francisco lacks an adequate supply of skilled nursing options, especially for people who rely on government health care plans like Medicare, most of those 57 patients were transferred out of the county. Two of the patients were sent to homeless shelters after discharge.\u003c/p>\n\u003cp>In August, city leaders responded to the relocation requirement and subsequent deaths by \u003ca href=\"https://www.kqed.org/news/11921717/san-francisco-sues-feds-over-forced-closure-of-laguna-honda-hospital/\">suing the federal government\u003c/a>, arguing that CMS had imposed an arbitrary and unrealistic closure deadline that didn’t give the city enough time to appeal the original infractions.\u003c/p>\n\u003cp>Several months later, however, the city agreed to drop the lawsuit in exchange for federal regulators temporarily halting the transfers and continuing to pay the $18 million in monthly Medicare and Medi-Cal costs for the remaining residents through November 2023.\u003c/p>\n\u003cp>Patricia McGinnis, executive director of California Advocates for Nursing Home Reform, called out the hurried transfers as a form of abuse and criticized state and federal regulators for pressuring the hospital to carry out the closure plan, despite the severe risk it posed to many patients.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“We call on CMS to stop the Laguna Honda closure before more residents are killed, and the Legislature to investigate CDPH and hold its leaders accountable,” she said.\u003c/p>\n\n",
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"excerpt": "Federal regulators, who decertified the public skilled nursing facility last year due to a series of safety violations, could order the city to resume transferring its hundreds of remaining patients as early as Friday. As of Tuesday, however, city officials had received no word of that decision.",
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"title": "'Down to the Wire Again': SF Officials Blast Feds for Silence on Laguna Honda Patient-Transfer Decision, Just Days Before Deadline | KQED",
"description": "Federal regulators, who decertified the public skilled nursing facility last year due to a series of safety violations, could order the city to resume transferring its hundreds of remaining patients as early as Friday. As of Tuesday, however, city officials had received no word of that decision.",
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"headline": "'Down to the Wire Again': SF Officials Blast Feds for Silence on Laguna Honda Patient-Transfer Decision, Just Days Before Deadline",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update, 6 p.m. Tuesday: \u003c/strong>Federal officials have yet to say whether they will allow San Francisco to continue postponing the transfer of hundreds of Laguna Honda Hospital patients to other skilled nursing facilities, frustrated city leaders said Tuesday.\u003c/p>\u003c/div>",
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"content": "‘It is entirely possible that on Friday, Feb. 3, hundreds of San Franciscans residing at Laguna Honda will face the trauma of possible relocation again from being discharged.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The clock is ticking. If the Biden administration rejects the city’s requests to continue halting transfers, the hospital could be required to resume relocating its more than 550 remaining patients, many of whom are elderly and lower-income, to other skilled nursing facilities as early as Friday.\u003c/p>\n\u003cp>“It is entirely possible that on Friday, Feb. 3, hundreds of San Franciscans residing at Laguna Honda will face the trauma of possible relocation again from being discharged,” San Francisco Supervisor Myrna Melgar, whose district includes the hospital, said at Tuesday’s Board of Supervisors hearing. “The rigid bureaucracy of the U.S. government has put us into this position.”\u003c/p>\n\u003cp>Hospital officials have said they have no plans to resume transferring patients unless compelled to do so. Twelve of the 57 patients who were initially transferred from the hospital last summer — some of whom had dementia and limited physical and cognitive ability — died within weeks or months of being relocated.\u003c/p>\n\u003cp>“Laguna Honda strongly advocated against these transfers. We warned CMS (the Center for Medicare and Medicaid Services) that the four-month deadline to transfer nearly 700 residents to other facilities was entirely insufficient given the complex nature of our resident population and the lack of available beds at SNFs (skilled nursing facilities) anywhere in the region or the state,” hospital officials said in a public statement earlier this month in response to regulatory citations it received following the deaths of the transferred patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Roland Pickens, Laguna Honda’s interim CEO, said he is hopeful the current pause on patient transfers will be extended, allowing the hospital to continue working to address deficiencies cited by state and federal regulators.\u003c/p>\n\u003cp>At Tuesday’s hearing, other San Francisco leaders blasted federal officials for so far failing to respond to the city’s extension request, just days before the hospital could be required to resume patient transfers.\u003c/p>\n\u003cp>“This is a powerful and unaccountable bureaucracy,” Supervisor Rafael Mandelman said. “They [CMS] have done significant harm. They have created a ton of stress and anxiety for hundreds more people.”\u003c/p>\n\u003cp>\u003cstrong>Original story, 6 a.m. Tuesday: \u003c/strong>San Francisco officials are expected to find out this week whether federal regulators will allow the city to continue postponing the transfer of patients out of Laguna Honda Hospital.\u003c/p>\n\u003cp>An extension would allow patients and their families to breathe a temporary sigh of relief, just days before the recently decertified hospital could be required to resume relocating its more than 550 remaining charges.\u003c/p>\n\u003cp>\u003ca href=\"https://www.kqed.org/news/11920121/sf-officials-outraged-over-laguna-honda-patient-deaths-following-federally-mandated-transfers\">Regulators paused their initial transfer requirement\u003c/a> in July 2022, after reports that some of the 57 patients who had initially been moved from the hospital had died. In total, 12 former patients are confirmed to have died, nearly all of whom had been transferred last year to other skilled nursing facilities.\u003c/p>\n\u003cp>San Francisco City Attorney David Chiu is now requesting that the pause on transfers extend until at least May 30, 2023, and the status of the relocation plan is scheduled to be addressed at a Board of Supervisors hearing on Tuesday afternoon.\u003c/p>\n\u003cp>“There is a moral and ethical imperative to not continue the transfers,” said Joseph Urban, a health care consultant whose mother-in-law, Betty Campbell, was a resident at Laguna Honda. “We’re down to the wire again.”\u003c/p>\n\u003cp>Citing Campbell’s frail state, Urban and his spouse turned down the hospital’s offer last summer to relocate her. The 86-year-old died recently at the hospital.\u003c/p>\n\u003cp>Opened in 1866, Laguna Honda is one of the oldest and largest public skilled nursing facilities in the country, treating a wide range of medical conditions including dementia, stroke, mental illness and HIV.\u003c/p>\n\u003cp>Although the hospital is still licensed, it was decertified last year by the federal Centers for Medicare and Medicaid Services (CMS) for a series of safety violations. That means it is no longer in good standing with government-provided health care options like Medicare and Medi-Cal, which fund medical costs for the vast majority of its patients.\u003c/p>\n\u003cp>After Laguna Honda lost certification, CMS required the hospital to create and implement a closure plan, including the transfer of all of its nearly 700 patients, many of them elderly and frail.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>At the same time, the hospital has been working with consultants to prepare for recertification.\u003c/p>\n\u003cp>“The focus of this meeting needs to be primarily on how the Board of Supervisors can be a force for protecting the most vulnerable: those who are now residents at Laguna Honda and those of us could need a bed there at any time,” Teresa Palmer, a former Laguna Honda physician and geriatrician, wrote in a letter to the board ahead of its Tuesday hearing. “Administration at Laguna Honda and consultants obviously need more time to ‘turn the ship around.’ In order to prevent death and harm to current and future residents, this time needs to be made available by CMS.”\u003c/p>\n\u003cp>Last month, the California Department of Public Health fined Laguna Honda $36,000 for providing inadequate care to the patients who died after their transfers. Nearly all of those patients, who ranged in age from 63 to 100, were considered severely disabled, including some who were on feeding tubes, living with dementia or nonverbal, the agency’s citations show.\u003c/p>\n\u003cp>The citations also noted that the patients who died were identified as “not discharge ready” because they were frail or otherwise not in a condition to be relocated.\u003c/p>\n\u003cp>The \u003ca href=\"https://abc7news.com/amp/laguna-honda-hospital-san-francisco-funding-mayor-london-breed-press-conference-healthcare-in-sf/11747735/\">current regulatory crisis facing Laguna Honda\u003c/a> began last spring, when federal regulators decertified the hospital after conducting a series of safety inspections triggered by two nonfatal drug overdoses the previous year.\u003c/p>\n\u003cp>Because San Francisco lacks an adequate supply of skilled nursing options, especially for people who rely on government health care plans like Medicare, most of those 57 patients were transferred out of the county. Two of the patients were sent to homeless shelters after discharge.\u003c/p>\n\u003cp>In August, city leaders responded to the relocation requirement and subsequent deaths by \u003ca href=\"https://www.kqed.org/news/11921717/san-francisco-sues-feds-over-forced-closure-of-laguna-honda-hospital/\">suing the federal government\u003c/a>, arguing that CMS had imposed an arbitrary and unrealistic closure deadline that didn’t give the city enough time to appeal the original infractions.\u003c/p>\n\u003cp>Several months later, however, the city agreed to drop the lawsuit in exchange for federal regulators temporarily halting the transfers and continuing to pay the $18 million in monthly Medicare and Medi-Cal costs for the remaining residents through November 2023.\u003c/p>\n\u003cp>Patricia McGinnis, executive director of California Advocates for Nursing Home Reform, called out the hurried transfers as a form of abuse and criticized state and federal regulators for pressuring the hospital to carry out the closure plan, despite the severe risk it posed to many patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We call on CMS to stop the Laguna Honda closure before more residents are killed, and the Legislature to investigate CDPH and hold its leaders accountable,” she said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "New California Law Targets Inequity in Cancer Care. Some Say It Doesn't Go Far Enough",
"title": "New California Law Targets Inequity in Cancer Care. Some Say It Doesn't Go Far Enough",
"headTitle": "CALmatters | KQED News",
"content": "\u003cp>Cancer is the second-leading cause of death in California, behind only heart disease. This year alone, the state will tally an estimated \u003ca href=\"https://cancerstatisticscenter.cancer.org/#!/state/California\">189,000 new cancer cases\u003c/a> and close to 61,000 deaths.\u003c/p>\n\u003cp>Yet while patients often need specialists, treatments and the chance to participate in clinical trials, that access is not equitable throughout the state. It typically depends on where patients live, and sometimes on their health insurance.\u003c/p>\n\u003cp>Cancer patients with lower incomes — and especially those in rural places — \u003ca href=\"https://www.cancer.gov/news-events/cancer-currents-blog/2020/persistent-poverty-increased-cancer-death-risk#:~:text=A%20new%20study%20by%20NCI,than%20people%20in%20other%20counties.\">tend to fare worse\u003c/a>. \u003ca href=\"https://escholarship.org/content/qt8xc078vj/qt8xc078vj_noSplash_451b26b4f066a1cfb27ba71f52096a73.pdf?t=nxk0lm\">Studies have shown (PDF)\u003c/a> that patients with Medi-Cal, the health insurance program for residents with lower incomes, are less likely to get the recommended treatment and have lower cancer survival rates compared to people with private insurance.\u003c/p>\n\u003cp>This disparity is at the crux of a California bill recently signed into law by Gov. Gavin Newsom that supporters say will make it at least a little easier for Medi-Cal patients to access cancer subspecialists, treatments and clinical trials.[pullquote size=\"medium\" align=\"right\" citation=\"Linda Nguy, policy advocate, Western Center on Law and Poverty\"]'Actually requiring plans [to contract with cancer centers] — that would have brought some meat to the table. From our understanding, plans already make efforts to contract with as many providers as possible, but it comes down to a reimbursement issue.'[/pullquote]\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220SB987\">The new law\u003c/a>, which goes into effect in January, requires Medi-Cal insurance plans to “make a good faith effort” to contract with \u003ca href=\"https://www.cancer.gov/research/infrastructure/cancer-centers\">cancer centers recognized by the National Cancer Institute\u003c/a> — which often have access to the latest treatments — or other qualifying cancer centers.\u003c/p>\n\u003cp>Authored by Democratic \u003ca href=\"https://calmatters.org/legislator-tracker/anthony-portantino-1961/\">Sen. Anthony Portantino\u003c/a> of Glendale, it was originally drafted to mandate that Medi-Cal plans add at least one of these cancer centers to their provider networks, but negotiations resulted in a scaled-back version, only requiring health plans to \u003cem>try\u003c/em> to add a cancer center.\u003c/p>\n\u003cp>The law also requires Medi-Cal plans to notify enrollees with complex cancers about their right to request a referral to any of these centers, even if it’s out of their plan’s network. Whether a patient can be treated at one of these centers, however, depends on whether the plan and the out-of-network provider can hash out a payment deal. This referral notification, supporters say, is critical: Patients can’t ask for something they don’t know is an option.\u003c/p>\n\u003cp>Supporters say that even if limited, this law will be an important step toward helping cancer patients with lower incomes get specialized care.\u003c/p>\n\u003cp>“I think making incremental change has the ability to save lives and that’s what we’re trying to do here,” Portantino said.\u003c/p>\n\u003cp>Too often patients from underserved communities arrive at these specialized cancer centers very late after their diagnoses, said Dr. Joseph Alvarnas, hematologist-oncologist and vice president of government affairs at \u003ca href=\"https://www.cityofhope.org/\">City of Hope\u003c/a>, one of eight California cancer centers with a National Cancer Institute designation, and a sponsor of the law.\u003c/p>\n\u003cp>“The conversation begins with, ‘If I could only have gotten here sooner,’ or ‘My family and I fought tooth-and-nail to get here,’” he said.\u003c/p>\n\u003cp>Alvarnas said that, historically, City of Hope used to see more Medi-Cal patients, but that changed as the state has largely moved its Medi-Cal program from a fee-for-service model (in which patients could see any provider who accepted Medi-Cal and the state paid providers for each service rendered) to managed care (considered a more cost-effective model, in which the state pays health insurance companies a fixed amount per enrollee).\u003c/p>\n\u003cp>“In managed care, part of the way that model works is it includes narrower clinician networks and more limited hospital choices,” Alvarnas said. “If you have high blood pressure or you’ve got a condition that can be cared for by many types of doctors, that’s an OK model.\u003c/p>\n\u003cp>“But when it comes to cancer care, your network of clinicians may not have an expert in leukemia or relapsed myeloma.”\u003c/p>\n\u003cp>Hospitals sometimes must send some of their sickest patients to cancer centers like City of Hope — as was the case for Patrick Nandy of Whittier. In 2008, during his senior year of college, he was diagnosed with acute lymphoblastic leukemia, a cancer of the blood and bone marrow that can progress very quickly. Nandy said that when oncologists at St. Jude Medical Center could no longer treat him, he was transferred to City of Hope, where he participated in a chemotherapy clinical trial and a cord blood stem cell transplant.\u003c/p>\n\u003cp>“I think about how lucky I am,” Nandy said. “Doctors said two more weeks and I probably would have been gone.”\u003c/p>\n\u003cp>These are the types of therapies that should be available to all patients with complex or aggressive cancers, but that’s not always the case, Alvarnas said.\u003c/p>\n\u003cp>A \u003ca href=\"https://escholarship.org/content/qt8xc078vj/qt8xc078vj_noSplash_451b26b4f066a1cfb27ba71f52096a73.pdf?t=nxk0lm\">2015 analysis by the University of California, Davis (PDF)\u003c/a> found worse outcomes for cancer patients with Medi-Cal compared to people with other types of insurance. Among some of the findings: Thirty-nine percent of breast cancer patients on Medi-Cal were diagnosed at an early stage compared to 61% of those who were privately insured.\u003c/p>\n\u003cp>The study also found Medi-Cal patients diagnosed with early stage lung cancer had a 48% five-year survival rate, lower than the 65% five-year survival rate for those with private insurance. Medi-Cal patients also were less likely to receive the necessary therapies or treatments for several cancer types.\u003c/p>\n\u003cp>The law will apply to people with rare or complex cancers, including advanced stage brain cancer, lung cancer, colorectal cancer, leukemia and lymphoma, among others, Alvarnas said. The sought- after treatment and research centers include City of Hope, University of California comprehensive cancer centers, the Stanford Cancer Institute, as well as a number of Kaiser Permanente sites and the Cedars-Sinai Cancer Institute.\u003c/p>\n\u003cp>While the law as passed had no registered opposition, it was watered down during negotiations involving providers, health plans and the California Department of Health Care Services, which oversees the Medi-Cal program.\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org/wp-content/uploads/2022/06/SB-987-Portantino-Author-OPPOSE-4.12.22.pdf\">Health insurance plans initially opposed Portantino’s bill (PDF)\u003c/a> because requiring plans to contract with centers, they warned, comes with new administrative hurdles that could disrupt or delay patient care.[pullquote size=\"medium\" align=\"right\" citation=\"Dr. Joseph Alvarnas, vice president of government affairs, City of Hope\"]'The state has worked very hard over the last decade to improve health care coverage. The issue, though, is there's a gulf between coverage and real access, because there is also a focus by the state to make sure that health care costs are somewhat controlled.'[/pullquote]\u003c/p>\n\u003cp>Linda Nguy, an advocate with the Western Center on Law and Poverty, said her organization withdrew its support after the bill was narrowed. “Actually requiring plans [to contract with cancer centers] — that would have brought some meat to the table,” Nguy said. “From our understanding, plans already make efforts to contract with as many providers as possible, but it comes down to a reimbursement issue.”\u003c/p>\n\u003cp>Medi-Cal, which covers about a third of Californians, pays providers \u003ca href=\"https://www.urban.org/sites/default/files/publication/88836/2001180-medicaid-physician-fees-after-the-aca-primary-care-fee-bump_0.pdf\">a lower rate than other insurance types (PDF)\u003c/a>. While lower reimbursement rates make the program \u003ca href=\"https://www.cbpp.org/research/health/frequently-asked-questions-about-medicaid\">more cost-efficient\u003c/a>, \u003ca href=\"https://www.healthaffairs.org/do/10.1377/forefront.20190401.678690/full/\">low payments can deter providers\u003c/a> from participating in Medi-Cal.\u003c/p>\n\u003cp>The debate over cancer care equity shows the complexities of achieving true access even in a state that has expanded insurance coverage to more people. California is scheduled to become the first state in the country to offer Medi-Cal coverage to all income-eligible people regardless of immigration status. Last week, Gov. Gavin Newsom’s office announced that \u003ca href=\"https://www.gov.ca.gov/2022/10/19/medi-cal-expansion-provided-286000-undocumented-californians-with-comprehensive-health-care/#:~:text=SACRAMENTO%20%E2%80%93%20Today%2C%20Governor%20Gavin%20Newsom,years%20of%20age%20and%20older%2C\">286,000 undocumented people age 50 and older started to receive comprehensive coverage in May\u003c/a>. In 2024, California will open the Medi-Cal program to approximately 700,000 more people ages 26 to 49.\u003c/p>\n\u003cp>“The state has worked very hard over the last decade to improve health care coverage,” Alvarnas said. “The issue, though, is there’s a gulf between coverage and real access, because there is also a focus by the state to make sure that health care costs are somewhat controlled.”\u003c/p>\n\u003cp>While the bill fell short of what supporters initially aimed for, the work to make cancer care more easily accessible will continue, said Autumn Ogden-Smith, director of state legislation for the American Cancer Society Cancer Action Network, another sponsor of the bill. For instance, how to more easily get a patient into one of these cancer centers if they don’t live nearby is a priority, she said.\u003c/p>\n\u003cp>“If you pull up a map, you’ll see these centers tend to cover certain areas — San Diego, Los Angeles, San Francisco, Davis-Sacramento,” Ogden-Smith said. “We’re going to have to focus on how we get the people in Northern California and in the middle of the state” to cancer centers, she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Patients with lower incomes who need specialized cancer treatment often struggle to get it. Advocates say a new law is a small step toward improving services for them.",
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"description": "Patients with lower incomes who need specialized cancer treatment often struggle to get it. Advocates say a new law is a small step toward improving services for them.",
"title": "New California Law Targets Inequity in Cancer Care. Some Say It Doesn't Go Far Enough | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Cancer is the second-leading cause of death in California, behind only heart disease. This year alone, the state will tally an estimated \u003ca href=\"https://cancerstatisticscenter.cancer.org/#!/state/California\">189,000 new cancer cases\u003c/a> and close to 61,000 deaths.\u003c/p>\n\u003cp>Yet while patients often need specialists, treatments and the chance to participate in clinical trials, that access is not equitable throughout the state. It typically depends on where patients live, and sometimes on their health insurance.\u003c/p>\n\u003cp>Cancer patients with lower incomes — and especially those in rural places — \u003ca href=\"https://www.cancer.gov/news-events/cancer-currents-blog/2020/persistent-poverty-increased-cancer-death-risk#:~:text=A%20new%20study%20by%20NCI,than%20people%20in%20other%20counties.\">tend to fare worse\u003c/a>. \u003ca href=\"https://escholarship.org/content/qt8xc078vj/qt8xc078vj_noSplash_451b26b4f066a1cfb27ba71f52096a73.pdf?t=nxk0lm\">Studies have shown (PDF)\u003c/a> that patients with Medi-Cal, the health insurance program for residents with lower incomes, are less likely to get the recommended treatment and have lower cancer survival rates compared to people with private insurance.\u003c/p>\n\u003cp>This disparity is at the crux of a California bill recently signed into law by Gov. Gavin Newsom that supporters say will make it at least a little easier for Medi-Cal patients to access cancer subspecialists, treatments and clinical trials.\u003c/p>\u003c/div>",
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"content": "'Actually requiring plans [to contract with cancer centers] — that would have brought some meat to the table. From our understanding, plans already make efforts to contract with as many providers as possible, but it comes down to a reimbursement issue.'",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220SB987\">The new law\u003c/a>, which goes into effect in January, requires Medi-Cal insurance plans to “make a good faith effort” to contract with \u003ca href=\"https://www.cancer.gov/research/infrastructure/cancer-centers\">cancer centers recognized by the National Cancer Institute\u003c/a> — which often have access to the latest treatments — or other qualifying cancer centers.\u003c/p>\n\u003cp>Authored by Democratic \u003ca href=\"https://calmatters.org/legislator-tracker/anthony-portantino-1961/\">Sen. Anthony Portantino\u003c/a> of Glendale, it was originally drafted to mandate that Medi-Cal plans add at least one of these cancer centers to their provider networks, but negotiations resulted in a scaled-back version, only requiring health plans to \u003cem>try\u003c/em> to add a cancer center.\u003c/p>\n\u003cp>The law also requires Medi-Cal plans to notify enrollees with complex cancers about their right to request a referral to any of these centers, even if it’s out of their plan’s network. Whether a patient can be treated at one of these centers, however, depends on whether the plan and the out-of-network provider can hash out a payment deal. This referral notification, supporters say, is critical: Patients can’t ask for something they don’t know is an option.\u003c/p>\n\u003cp>Supporters say that even if limited, this law will be an important step toward helping cancer patients with lower incomes get specialized care.\u003c/p>\n\u003cp>“I think making incremental change has the ability to save lives and that’s what we’re trying to do here,” Portantino said.\u003c/p>\n\u003cp>Too often patients from underserved communities arrive at these specialized cancer centers very late after their diagnoses, said Dr. Joseph Alvarnas, hematologist-oncologist and vice president of government affairs at \u003ca href=\"https://www.cityofhope.org/\">City of Hope\u003c/a>, one of eight California cancer centers with a National Cancer Institute designation, and a sponsor of the law.\u003c/p>\n\u003cp>“The conversation begins with, ‘If I could only have gotten here sooner,’ or ‘My family and I fought tooth-and-nail to get here,’” he said.\u003c/p>\n\u003cp>Alvarnas said that, historically, City of Hope used to see more Medi-Cal patients, but that changed as the state has largely moved its Medi-Cal program from a fee-for-service model (in which patients could see any provider who accepted Medi-Cal and the state paid providers for each service rendered) to managed care (considered a more cost-effective model, in which the state pays health insurance companies a fixed amount per enrollee).\u003c/p>\n\u003cp>“In managed care, part of the way that model works is it includes narrower clinician networks and more limited hospital choices,” Alvarnas said. “If you have high blood pressure or you’ve got a condition that can be cared for by many types of doctors, that’s an OK model.\u003c/p>\n\u003cp>“But when it comes to cancer care, your network of clinicians may not have an expert in leukemia or relapsed myeloma.”\u003c/p>\n\u003cp>Hospitals sometimes must send some of their sickest patients to cancer centers like City of Hope — as was the case for Patrick Nandy of Whittier. In 2008, during his senior year of college, he was diagnosed with acute lymphoblastic leukemia, a cancer of the blood and bone marrow that can progress very quickly. Nandy said that when oncologists at St. Jude Medical Center could no longer treat him, he was transferred to City of Hope, where he participated in a chemotherapy clinical trial and a cord blood stem cell transplant.\u003c/p>\n\u003cp>“I think about how lucky I am,” Nandy said. “Doctors said two more weeks and I probably would have been gone.”\u003c/p>\n\u003cp>These are the types of therapies that should be available to all patients with complex or aggressive cancers, but that’s not always the case, Alvarnas said.\u003c/p>\n\u003cp>A \u003ca href=\"https://escholarship.org/content/qt8xc078vj/qt8xc078vj_noSplash_451b26b4f066a1cfb27ba71f52096a73.pdf?t=nxk0lm\">2015 analysis by the University of California, Davis (PDF)\u003c/a> found worse outcomes for cancer patients with Medi-Cal compared to people with other types of insurance. Among some of the findings: Thirty-nine percent of breast cancer patients on Medi-Cal were diagnosed at an early stage compared to 61% of those who were privately insured.\u003c/p>\n\u003cp>The study also found Medi-Cal patients diagnosed with early stage lung cancer had a 48% five-year survival rate, lower than the 65% five-year survival rate for those with private insurance. Medi-Cal patients also were less likely to receive the necessary therapies or treatments for several cancer types.\u003c/p>\n\u003cp>The law will apply to people with rare or complex cancers, including advanced stage brain cancer, lung cancer, colorectal cancer, leukemia and lymphoma, among others, Alvarnas said. The sought- after treatment and research centers include City of Hope, University of California comprehensive cancer centers, the Stanford Cancer Institute, as well as a number of Kaiser Permanente sites and the Cedars-Sinai Cancer Institute.\u003c/p>\n\u003cp>While the law as passed had no registered opposition, it was watered down during negotiations involving providers, health plans and the California Department of Health Care Services, which oversees the Medi-Cal program.\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org/wp-content/uploads/2022/06/SB-987-Portantino-Author-OPPOSE-4.12.22.pdf\">Health insurance plans initially opposed Portantino’s bill (PDF)\u003c/a> because requiring plans to contract with centers, they warned, comes with new administrative hurdles that could disrupt or delay patient care.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Linda Nguy, an advocate with the Western Center on Law and Poverty, said her organization withdrew its support after the bill was narrowed. “Actually requiring plans [to contract with cancer centers] — that would have brought some meat to the table,” Nguy said. “From our understanding, plans already make efforts to contract with as many providers as possible, but it comes down to a reimbursement issue.”\u003c/p>\n\u003cp>Medi-Cal, which covers about a third of Californians, pays providers \u003ca href=\"https://www.urban.org/sites/default/files/publication/88836/2001180-medicaid-physician-fees-after-the-aca-primary-care-fee-bump_0.pdf\">a lower rate than other insurance types (PDF)\u003c/a>. While lower reimbursement rates make the program \u003ca href=\"https://www.cbpp.org/research/health/frequently-asked-questions-about-medicaid\">more cost-efficient\u003c/a>, \u003ca href=\"https://www.healthaffairs.org/do/10.1377/forefront.20190401.678690/full/\">low payments can deter providers\u003c/a> from participating in Medi-Cal.\u003c/p>\n\u003cp>The debate over cancer care equity shows the complexities of achieving true access even in a state that has expanded insurance coverage to more people. California is scheduled to become the first state in the country to offer Medi-Cal coverage to all income-eligible people regardless of immigration status. Last week, Gov. Gavin Newsom’s office announced that \u003ca href=\"https://www.gov.ca.gov/2022/10/19/medi-cal-expansion-provided-286000-undocumented-californians-with-comprehensive-health-care/#:~:text=SACRAMENTO%20%E2%80%93%20Today%2C%20Governor%20Gavin%20Newsom,years%20of%20age%20and%20older%2C\">286,000 undocumented people age 50 and older started to receive comprehensive coverage in May\u003c/a>. In 2024, California will open the Medi-Cal program to approximately 700,000 more people ages 26 to 49.\u003c/p>\n\u003cp>“The state has worked very hard over the last decade to improve health care coverage,” Alvarnas said. “The issue, though, is there’s a gulf between coverage and real access, because there is also a focus by the state to make sure that health care costs are somewhat controlled.”\u003c/p>\n\u003cp>While the bill fell short of what supporters initially aimed for, the work to make cancer care more easily accessible will continue, said Autumn Ogden-Smith, director of state legislation for the American Cancer Society Cancer Action Network, another sponsor of the bill. For instance, how to more easily get a patient into one of these cancer centers if they don’t live nearby is a priority, she said.\u003c/p>\n\u003cp>“If you pull up a map, you’ll see these centers tend to cover certain areas — San Diego, Los Angeles, San Francisco, Davis-Sacramento,” Ogden-Smith said. “We’re going to have to focus on how we get the people in Northern California and in the middle of the state” to cancer centers, she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"slug": "medi-cal-shake-up-might-create-more-problems-than-solutions-for-low-income-californians",
"title": "Medi-Cal Shake-Up Might Create More Problems Than Solutions for Lower-Income Californians",
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"content": "\u003cp>Almost 2 million of California’s lowest-income and most medically fragile residents may have to switch health insurers as a result of a new strategy by the state to improve care in its Medicaid program, called Medi-Cal.\u003c/p>\n\u003cp>A first-ever statewide contracting competition to participate in Medi-Cal required commercial managed-care plans to rebid for their contracts and compete against others hoping to take those contracts away. The contracts will be revamped to require insurers to offer new benefits and meet stiffer benchmarks for care.\u003c/p>\n\u003cp>The long-planned reshuffle of insurers is likely to come with short-term pain. Four of the managed-care insurers, including Health Net and Blue Shield of California, stand to \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/MCP-County-Enrollment-Table.pdf\">lose Medi-Cal contracts\u003c/a> in a little over a year, according to the \u003ca href=\"https://www.dhcs.ca.gov/formsandpubs/publications/oc/Documents/2022/22-10-MCP-Selections-8-25-22.pdf\">preliminary results of the bidding\u003c/a>, announced in late August. If the results stand, some enrollees in rural Alpine and El Dorado counties, as well as in populous Los Angeles, San Diego, Sacramento and Kern counties, will have to change health plans — and possibly doctors.[aside label='Related Coverage' tag='medicaid']“I’m still shocked and I’m still reeling from it,” said John Sturm, \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/MCP-County-Enrollment-Table.pdf\">one of about 325,000 members of Community Health Group\u003c/a>, the largest Medi-Cal plan in San Diego County, which could lose its contract. “Which doctors can I keep? How long is it going to take me to switch plans? Are there contingency plans when, inevitably, folks slip through the cracks?”\u003c/p>\n\u003cp>Sturm, 54, who has three mental health conditions, largely because of childhood sexual abuse, said finding a psychologist and psychiatrist he could trust took a lot of time and effort. He pointed to \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-patients-struggle-to-fill-prescriptions-medi-cal-rx/\">the disruption caused by the rollout of Medi-Cal’s new prescription drug program\u003c/a> this year, despite assurances it would go smoothly.\u003c/p>\n\u003cp>“I have concerns, and I know other people in the community have concerns about what we’re being told versus what the reality is going to be,” Sturm said.\u003c/p>\n\u003cp>Arguably, the biggest loser in the bidding is Health Net, the largest commercial insurer in Medi-Cal, which stands to lose half its enrollees — including more than 1 million in Los Angeles County alone. St. Louis-based Centene Corp., which \u003ca href=\"https://www.latimes.com/california/story/2022-04-07/california-investigating-corporation-took-over-medicaid-drug-program\">California is investigating\u003c/a> over allegations it overcharged the state for prescription drugs, \u003ca href=\"https://www.prnewswire.com/news-releases/centene-completes-acquisition-of-health-net-300241037.html\">bought Health Net\u003c/a> in 2016, in part for its Medicaid business, of which LA is the crown jewel.\u003c/p>\n\u003cp>But the state’s health plan selections are not set in stone. The losing insurers are fiercely contesting the results in formal appeals that read like declarations of war on their competitors and on the state. Some of the losers essentially call their winning rivals liars.\u003c/p>\n\u003cp>The stakes are high, with contracts in play worth billions of dollars annually. Insurers that lose their appeals with the state Department of Health Care Services, which runs Medi-Cal, are likely to take their complaints to court. That could delay final decisions by months or years, causing a headache for the department, which wants coverage under the new contracts to start Jan. 1, 2024.\u003c/p>\n\u003cp>State officials hope to spend the rest of this year and all of 2023 ensuring that the chosen health plans are up to the task, which includes having enough participating providers to minimize disruptions in care.\u003c/p>\n\u003cp>“Member access and continuity are really our top priorities as part of this transition, and we have dedicated teams that will be working with the health plans on the transition planning and the continuity planning,” Michelle Baass, director of the department, told KHN.[pullquote size=\"medium\" align=\"right\" citation=\"John Sturm, Medi-Cal recipient\"]‘I have concerns, and I know other people in the community have concerns about what we’re being told versus what the reality is going to be.’[/pullquote]Baass also noted that enrollees have continuity-of-care rights. “For example, if a member is currently under the care of a doctor during the prior 12 months, the member has the right to continue seeing that doctor for up to 12 months, if certain conditions are met,” she said.\u003c/p>\n\u003cp>The competitive bidding process is an effort by the department to address persistent complaints that \u003ca href=\"https://californiahealthline.org/news/article/californias-reboot-of-troubled-medi-cal-puts-pressure-on-health-plans/\">it has not effectively monitored subpar health plans\u003c/a>.\u003c/p>\n\u003cp>Eight commercial insurers bid for Medi-Cal business in 21 counties. They were required to submit voluminous documents detailing every aspect of their operations, including past performance; the scope of their provider networks; and their capacity to meet the terms of the new, stricter contracts.\u003c/p>\n\u003cp>The new contracts contain numerous provisions intended to bolster quality, health care equity and transparency — and to boost accountability of the subcontractors to whom \u003ca href=\"https://californiahealthline.org/news/article/layers-of-subcontracted-services-confuse-and-frustrate-medi-cal-patients/\">health plans often outsource patient care\u003c/a>. For example, the plans and their subcontractors will be required to reach or exceed \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCP-RFP-Issue-Brief.pdf\">the 50th percentile\u003c/a> among Medicaid plans nationally on a host of pediatric and maternal care measures — or face financial penalties.\u003c/p>\n\u003cp>They will also be on the hook for providing nonmedical social services that address socioeconomic factors, such as homelessness and food insecurity, in an ambitious $8.7 billion, \u003ca href=\"https://khn.org/news/article/california-medicaid-makeover-newsom-california-medi-cal-homeless-public-funds/\">five-year Medi-Cal initiative known as CalAIM\u003c/a>, that is already underway.\u003c/p>\n\u003cp>Local, publicly governed Medi-Cal plans, which cover about 70% of the \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/statistics/Documents/FastFacts-March2022.pdf\">12.4 million Medi-Cal members who are in managed care\u003c/a>, did not participate in the bidding, though their performance has not always been top-notch. Kaiser Permanente, which this year negotiated a controversial deal with the state for an \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-contract-kaiser-permanente-key-details-missing/\">exclusive Medi-Cal contract\u003c/a> in 32 counties, was also exempt from the bidding. (KHN is not affiliated with Kaiser Permanente.)\u003c/p>\n\u003cp>But all Medi-Cal health insurers, including KP and the local plans, will have to commit to the same goals and requirements.\u003c/p>\n\u003cp>In addition to Health Net, both Blue Shield of California and Community Health Group — which have contracts with Medi-Cal only in San Diego County — are also big losers, as is Aetna, which lost bids in 10 counties.\u003c/p>\n\u003cp>Blue Shield, which lost in all 13 counties where it submitted bids, filed a fiercely worded appeal that accuses its rivals Anthem Blue Cross, Molina and Health Net of failing to disclose hundreds of millions of dollars in penalties against them. It accused those three plans of poor performance “and even mendacity” and said they filled their bids with “puffery,” which the state “bought, hook, line and sinker,” without “an iota of independent analysis.”\u003c/p>\n\u003cfigure id=\"attachment_11926773\" class=\"wp-caption alignnone\" style=\"max-width: 724px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11926773\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/09/GettyImages-1279766844.jpg\" alt=\"A hand in the foreground holds a card as someone reaches out to hold it from across a table.\" width=\"724\" height=\"483\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/09/GettyImages-1279766844.jpg 724w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/09/GettyImages-1279766844-160x107.jpg 160w\" sizes=\"(max-width: 724px) 100vw, 724px\">\u003cfigcaption class=\"wp-caption-text\">The competitive bidding process is an effort by the state Department of Health Care Services to address persistent complaints that it has not effectively monitored subpar health plans. \u003ccite>(Willie B. Thomas/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Health Net’s appeal slammed Molina, which beat it out in LA, Sacramento, Riverside and San Bernardino counties. Molina’s bid, Health Net said, “contains false, inaccurate and misleading information.” The whole bidding process, it said, was “highly flawed,” resulting in “erroneous contract awards that jeopardize the stability of Medi-Cal.”\u003c/p>\n\u003cp>In particular, Health Net said, the Department of Health Care Services “improperly reopened the procurement” after the deadline, which allowed Molina to make “comprehensive changes” that raised its score.\u003c/p>\n\u003cp>The protesting health plans are requesting that they be awarded contracts or that the bidding process start over from scratch.\u003c/p>\n\u003cp>Joseph Garcia, chief operating officer for Community Health Group, said, “It would be easiest for all concerned if they just added us. They don’t have to remove anybody.”\u003c/p>\n\u003cp>Community Health Group has garnered an outpouring of support from hospital executives, physician groups, community clinics and the heads of multiple publicly governed Medi-Cal plans, \u003ca href=\"https://californiahealthline.org/wp-content/uploads/sites/3/2022/09/Medi-Cal-Reprocurement-Letter-of-Support-for-CHG-1.pdf\">who sent a letter to Baass\u003c/a> saying they were “shocked, concerned, and very disappointed” by the state’s decision. They called Community Health Group “our strongest partner of 40 years,” for whom “equity is not a buzzword or a new priority,” noting that more than 85% of its staff is bilingual and multicultural.\u003c/p>\n\u003cp>Community Health Group noted in its appeal that it had lost by less than a point to Health Net, which won a San Diego contract — “a minuscule difference that in itself resulted from deeply flawed scoring.”\u003c/p>\n\u003cp>Garcia said that if Community Health Group loses its appeal, it will “absolutely” sue in state court. A hearing officer appointed by Baass to consider the appeals has set deadlines to receive written responses and rebuttals by October 7.\u003c/p>\n\u003cp>There is ample precedent for protracted legal battles in bidding for Medicaid contracts. In Louisiana, Centene and Aetna \u003ca href=\"https://www.thecentersquare.com/louisiana/rejected-bidders-for-louisiana-medicaid-contracts-file-protests-alleging-bias/article_2fe6ecec-c44c-11e9-833d-331f84e9c8f0.html\">protested the results of a 2019 rebidding process\u003c/a>, which led the state to nullify its awards and restart the bidding. The \u003ca href=\"https://ldh.la.gov/news/ldh-mco-contracts\">new results\u003c/a> were announced this year, with Centene and Aetna among the winners. In Kentucky, the state court of appeals \u003ca href=\"https://www.courier-journal.com/story/news/local/2022/09/15/kentucky-medicaid-contracts-upheld-by-court-anthem-is-out-as-mco/69494863007/\">issued a ruling\u003c/a> this month in a contested Medicaid procurement that had been held two years earlier.\u003c/p>\n\u003cp>Another factor could delay the new contract: California is juggling several massive Medi-Cal changes at the same time. Among them are the implementation of CalAIM and the \u003ca href=\"https://lao.ca.gov/Publications/Report/4423\">anticipated enrollment of nearly 700,000 unauthorized immigrants age 26-49\u003c/a> by January 2024, on top of nearly a quarter-million unauthorized immigrants age 50 and older who \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-older-unauthorized-immigrants/\">became eligible this year\u003c/a>. And then there’s the recalculation of enrollees’ eligibility, which will take place whenever the federal COVID-19-related public health emergency ends. That could push \u003ca href=\"https://www.dhcs.ca.gov/Documents/PHE-UOP/Medi-Cal-COVID-19-PHE-Unwinding-Plan.pdf\">2 million to 3 million\u003c/a> Californians out of Medi-Cal.\u003c/p>\n\u003cp>“Just hearing you list all those things gave me a minor panic attack,” said Abigail Coursolle, a senior attorney at the National Health Law Program. “They are making a lot of work for themselves in a short amount of time.”\u003c/p>\n\u003cp>But, Coursolle added, the state has “a very positive vision for improving access and improving the quality of services that people in Medi-Cal receive, and that’s very important.”\u003c/p>\n\u003cp>\u003cem>California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Almost 2 million of California's lowest-income and most medically fragile residents may have to switch health insurers as a result of a new strategy by the state to improve care in its Medicaid program.",
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"title": "Medi-Cal Shake-Up Might Create More Problems Than Solutions for Lower-Income Californians | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Almost 2 million of California’s lowest-income and most medically fragile residents may have to switch health insurers as a result of a new strategy by the state to improve care in its Medicaid program, called Medi-Cal.\u003c/p>\n\u003cp>A first-ever statewide contracting competition to participate in Medi-Cal required commercial managed-care plans to rebid for their contracts and compete against others hoping to take those contracts away. The contracts will be revamped to require insurers to offer new benefits and meet stiffer benchmarks for care.\u003c/p>\n\u003cp>The long-planned reshuffle of insurers is likely to come with short-term pain. Four of the managed-care insurers, including Health Net and Blue Shield of California, stand to \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/MCP-County-Enrollment-Table.pdf\">lose Medi-Cal contracts\u003c/a> in a little over a year, according to the \u003ca href=\"https://www.dhcs.ca.gov/formsandpubs/publications/oc/Documents/2022/22-10-MCP-Selections-8-25-22.pdf\">preliminary results of the bidding\u003c/a>, announced in late August. If the results stand, some enrollees in rural Alpine and El Dorado counties, as well as in populous Los Angeles, San Diego, Sacramento and Kern counties, will have to change health plans — and possibly doctors.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“I’m still shocked and I’m still reeling from it,” said John Sturm, \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/MCP-County-Enrollment-Table.pdf\">one of about 325,000 members of Community Health Group\u003c/a>, the largest Medi-Cal plan in San Diego County, which could lose its contract. “Which doctors can I keep? How long is it going to take me to switch plans? Are there contingency plans when, inevitably, folks slip through the cracks?”\u003c/p>\n\u003cp>Sturm, 54, who has three mental health conditions, largely because of childhood sexual abuse, said finding a psychologist and psychiatrist he could trust took a lot of time and effort. He pointed to \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-patients-struggle-to-fill-prescriptions-medi-cal-rx/\">the disruption caused by the rollout of Medi-Cal’s new prescription drug program\u003c/a> this year, despite assurances it would go smoothly.\u003c/p>\n\u003cp>“I have concerns, and I know other people in the community have concerns about what we’re being told versus what the reality is going to be,” Sturm said.\u003c/p>\n\u003cp>Arguably, the biggest loser in the bidding is Health Net, the largest commercial insurer in Medi-Cal, which stands to lose half its enrollees — including more than 1 million in Los Angeles County alone. St. Louis-based Centene Corp., which \u003ca href=\"https://www.latimes.com/california/story/2022-04-07/california-investigating-corporation-took-over-medicaid-drug-program\">California is investigating\u003c/a> over allegations it overcharged the state for prescription drugs, \u003ca href=\"https://www.prnewswire.com/news-releases/centene-completes-acquisition-of-health-net-300241037.html\">bought Health Net\u003c/a> in 2016, in part for its Medicaid business, of which LA is the crown jewel.\u003c/p>\n\u003cp>But the state’s health plan selections are not set in stone. The losing insurers are fiercely contesting the results in formal appeals that read like declarations of war on their competitors and on the state. Some of the losers essentially call their winning rivals liars.\u003c/p>\n\u003cp>The stakes are high, with contracts in play worth billions of dollars annually. Insurers that lose their appeals with the state Department of Health Care Services, which runs Medi-Cal, are likely to take their complaints to court. That could delay final decisions by months or years, causing a headache for the department, which wants coverage under the new contracts to start Jan. 1, 2024.\u003c/p>\n\u003cp>State officials hope to spend the rest of this year and all of 2023 ensuring that the chosen health plans are up to the task, which includes having enough participating providers to minimize disruptions in care.\u003c/p>\n\u003cp>“Member access and continuity are really our top priorities as part of this transition, and we have dedicated teams that will be working with the health plans on the transition planning and the continuity planning,” Michelle Baass, director of the department, told KHN.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Baass also noted that enrollees have continuity-of-care rights. “For example, if a member is currently under the care of a doctor during the prior 12 months, the member has the right to continue seeing that doctor for up to 12 months, if certain conditions are met,” she said.\u003c/p>\n\u003cp>The competitive bidding process is an effort by the department to address persistent complaints that \u003ca href=\"https://californiahealthline.org/news/article/californias-reboot-of-troubled-medi-cal-puts-pressure-on-health-plans/\">it has not effectively monitored subpar health plans\u003c/a>.\u003c/p>\n\u003cp>Eight commercial insurers bid for Medi-Cal business in 21 counties. They were required to submit voluminous documents detailing every aspect of their operations, including past performance; the scope of their provider networks; and their capacity to meet the terms of the new, stricter contracts.\u003c/p>\n\u003cp>The new contracts contain numerous provisions intended to bolster quality, health care equity and transparency — and to boost accountability of the subcontractors to whom \u003ca href=\"https://californiahealthline.org/news/article/layers-of-subcontracted-services-confuse-and-frustrate-medi-cal-patients/\">health plans often outsource patient care\u003c/a>. For example, the plans and their subcontractors will be required to reach or exceed \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCP-RFP-Issue-Brief.pdf\">the 50th percentile\u003c/a> among Medicaid plans nationally on a host of pediatric and maternal care measures — or face financial penalties.\u003c/p>\n\u003cp>They will also be on the hook for providing nonmedical social services that address socioeconomic factors, such as homelessness and food insecurity, in an ambitious $8.7 billion, \u003ca href=\"https://khn.org/news/article/california-medicaid-makeover-newsom-california-medi-cal-homeless-public-funds/\">five-year Medi-Cal initiative known as CalAIM\u003c/a>, that is already underway.\u003c/p>\n\u003cp>Local, publicly governed Medi-Cal plans, which cover about 70% of the \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/statistics/Documents/FastFacts-March2022.pdf\">12.4 million Medi-Cal members who are in managed care\u003c/a>, did not participate in the bidding, though their performance has not always been top-notch. Kaiser Permanente, which this year negotiated a controversial deal with the state for an \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-contract-kaiser-permanente-key-details-missing/\">exclusive Medi-Cal contract\u003c/a> in 32 counties, was also exempt from the bidding. (KHN is not affiliated with Kaiser Permanente.)\u003c/p>\n\u003cp>But all Medi-Cal health insurers, including KP and the local plans, will have to commit to the same goals and requirements.\u003c/p>\n\u003cp>In addition to Health Net, both Blue Shield of California and Community Health Group — which have contracts with Medi-Cal only in San Diego County — are also big losers, as is Aetna, which lost bids in 10 counties.\u003c/p>\n\u003cp>Blue Shield, which lost in all 13 counties where it submitted bids, filed a fiercely worded appeal that accuses its rivals Anthem Blue Cross, Molina and Health Net of failing to disclose hundreds of millions of dollars in penalties against them. It accused those three plans of poor performance “and even mendacity” and said they filled their bids with “puffery,” which the state “bought, hook, line and sinker,” without “an iota of independent analysis.”\u003c/p>\n\u003cfigure id=\"attachment_11926773\" class=\"wp-caption alignnone\" style=\"max-width: 724px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11926773\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/09/GettyImages-1279766844.jpg\" alt=\"A hand in the foreground holds a card as someone reaches out to hold it from across a table.\" width=\"724\" height=\"483\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/09/GettyImages-1279766844.jpg 724w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/09/GettyImages-1279766844-160x107.jpg 160w\" sizes=\"(max-width: 724px) 100vw, 724px\">\u003cfigcaption class=\"wp-caption-text\">The competitive bidding process is an effort by the state Department of Health Care Services to address persistent complaints that it has not effectively monitored subpar health plans. \u003ccite>(Willie B. Thomas/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Health Net’s appeal slammed Molina, which beat it out in LA, Sacramento, Riverside and San Bernardino counties. Molina’s bid, Health Net said, “contains false, inaccurate and misleading information.” The whole bidding process, it said, was “highly flawed,” resulting in “erroneous contract awards that jeopardize the stability of Medi-Cal.”\u003c/p>\n\u003cp>In particular, Health Net said, the Department of Health Care Services “improperly reopened the procurement” after the deadline, which allowed Molina to make “comprehensive changes” that raised its score.\u003c/p>\n\u003cp>The protesting health plans are requesting that they be awarded contracts or that the bidding process start over from scratch.\u003c/p>\n\u003cp>Joseph Garcia, chief operating officer for Community Health Group, said, “It would be easiest for all concerned if they just added us. They don’t have to remove anybody.”\u003c/p>\n\u003cp>Community Health Group has garnered an outpouring of support from hospital executives, physician groups, community clinics and the heads of multiple publicly governed Medi-Cal plans, \u003ca href=\"https://californiahealthline.org/wp-content/uploads/sites/3/2022/09/Medi-Cal-Reprocurement-Letter-of-Support-for-CHG-1.pdf\">who sent a letter to Baass\u003c/a> saying they were “shocked, concerned, and very disappointed” by the state’s decision. They called Community Health Group “our strongest partner of 40 years,” for whom “equity is not a buzzword or a new priority,” noting that more than 85% of its staff is bilingual and multicultural.\u003c/p>\n\u003cp>Community Health Group noted in its appeal that it had lost by less than a point to Health Net, which won a San Diego contract — “a minuscule difference that in itself resulted from deeply flawed scoring.”\u003c/p>\n\u003cp>Garcia said that if Community Health Group loses its appeal, it will “absolutely” sue in state court. A hearing officer appointed by Baass to consider the appeals has set deadlines to receive written responses and rebuttals by October 7.\u003c/p>\n\u003cp>There is ample precedent for protracted legal battles in bidding for Medicaid contracts. In Louisiana, Centene and Aetna \u003ca href=\"https://www.thecentersquare.com/louisiana/rejected-bidders-for-louisiana-medicaid-contracts-file-protests-alleging-bias/article_2fe6ecec-c44c-11e9-833d-331f84e9c8f0.html\">protested the results of a 2019 rebidding process\u003c/a>, which led the state to nullify its awards and restart the bidding. The \u003ca href=\"https://ldh.la.gov/news/ldh-mco-contracts\">new results\u003c/a> were announced this year, with Centene and Aetna among the winners. In Kentucky, the state court of appeals \u003ca href=\"https://www.courier-journal.com/story/news/local/2022/09/15/kentucky-medicaid-contracts-upheld-by-court-anthem-is-out-as-mco/69494863007/\">issued a ruling\u003c/a> this month in a contested Medicaid procurement that had been held two years earlier.\u003c/p>\n\u003cp>Another factor could delay the new contract: California is juggling several massive Medi-Cal changes at the same time. Among them are the implementation of CalAIM and the \u003ca href=\"https://lao.ca.gov/Publications/Report/4423\">anticipated enrollment of nearly 700,000 unauthorized immigrants age 26-49\u003c/a> by January 2024, on top of nearly a quarter-million unauthorized immigrants age 50 and older who \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-older-unauthorized-immigrants/\">became eligible this year\u003c/a>. And then there’s the recalculation of enrollees’ eligibility, which will take place whenever the federal COVID-19-related public health emergency ends. That could push \u003ca href=\"https://www.dhcs.ca.gov/Documents/PHE-UOP/Medi-Cal-COVID-19-PHE-Unwinding-Plan.pdf\">2 million to 3 million\u003c/a> Californians out of Medi-Cal.\u003c/p>\n\u003cp>“Just hearing you list all those things gave me a minor panic attack,” said Abigail Coursolle, a senior attorney at the National Health Law Program. “They are making a lot of work for themselves in a short amount of time.”\u003c/p>\n\u003cp>But, Coursolle added, the state has “a very positive vision for improving access and improving the quality of services that people in Medi-Cal receive, and that’s very important.”\u003c/p>\n\u003cp>\u003cem>California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>About 40,000 undocumented adults with low incomes won't lose their government-funded health insurance over the next year under a new policy announced Monday by Gov. Gavin Newsom's administration.\u003c/p>\n\u003cp>California already pays for the health care expenses of lower-income adults age 25 and younger, regardless of their immigration status. A new law scheduled to take effect in January 2024 would extend those benefits to cover all adults who, but for their immigration status, would qualify for the state's Medicaid program.\u003c/p>\n\u003cp>[aside label=\"Related Stories\" postID=\"news_11914800,news_11882852,news_11879266\"]But between now and when that new law takes effect in 2024, about 40,000 young adults who already have Medicaid in California are expected to lose their benefits because they are older than 25. Monday, the state Department of Health Care Services announced it would continue to cover those young adults through the end of 2023 to make sure they won't lose their benefits.\u003c/p>\n\u003cp>“Providing continuous coverage means that tens of thousands of young Californians won’t face a disruption in care, keeping them covered and healthier as a result,” said Jose Torres Casillas, policy and legislative advocate for Health Access California, a consumer health care advocacy group. “California is again leading the way in making our health care system work better for all communities, regardless of income, age or immigration status.”\u003c/p>\n\u003cp>Nationwide, about 22.1 million people, or about 7% of the population, were undocumented in 2020, according to the Kaiser Family Foundation, a health care nonprofit. They are not eligible for most federal public benefit programs, even though many have jobs and pay taxes.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Some states, including California, have used their own money to cover the health care expenses of this group. Eighteen states provide prenatal care to people regardless of their immigration status, while five states and the District of Columbia cover all children from lower-income families regardless of their immigration status. California and Illinois recently made older adult immigrants eligible for their Medicaid programs.\u003c/p>\n\u003cp>California was the first state to pay for the health care expenses of some undocumented adults when, in 2019, state lawmakers voted to make people 25 and younger eligible for Medicaid regardless of their immigration status.\u003c/p>\n\u003cp>That policy took effect in 2020, right when the COVID-19 pandemic started. The federal government issued a public health emergency, meaning no one could lose their Medicaid benefits. That's why lots of young immigrants in California have been able to stay on Medicaid, even though they are now older than 25 and are technically no longer eligible.\u003c/p>\n\u003cp>The federal public health emergency is expected to end soon. When it does, all of those young adults who are now older than 25 would lose their benefits once they came up for renewal. Instead, the Newsom administration said it would delay those renewals until the end of 2023, giving them time for the new law to take effect.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Protecting these young adults — who currently have Medi-Cal — from losing coverage, only to become eligible again shortly thereafter, will prevent needless gaps in health care services and medication that people need,\" said Connie Choi, policy director at the California Immigrant Policy Center.\u003c/p>\n\n",
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"radiolab": {
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"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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"reveal": {
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"info": "Created by The Center for Investigative Reporting and PRX, Reveal is public radios first one-hour weekly radio show and podcast dedicated to investigative reporting. Credible, fact based and without a partisan agenda, Reveal combines the power and artistry of driveway moment storytelling with data-rich reporting on critically important issues. The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.",
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"officialWebsiteLink": "https://www.revealnews.org/episodes/",
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},
"rightnowish": {
"id": "rightnowish",
"title": "Rightnowish",
"tagline": "Art is where you find it",
"info": "Rightnowish digs into life in the Bay Area right now… ish. Journalist Pendarvis Harshaw takes us to galleries painted on the sides of liquor stores in West Oakland. We'll dance in warehouses in the Bayview, make smoothies with kids in South Berkeley, and listen to classical music in a 1984 Cutlass Supreme in Richmond. Every week, Pen talks to movers and shakers about how the Bay Area shapes what they create, and how they shape the place we call home.",
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"science-friday": {
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