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"content": "\u003cp>Almost 2 million of California’s lowest-income and most medically fragile residents may have to switch health insurers as a result of a new strategy by the state to improve care in its Medicaid program, called Medi-Cal.\u003c/p>\n\u003cp>A first-ever statewide contracting competition to participate in Medi-Cal required commercial managed-care plans to rebid for their contracts and compete against others hoping to take those contracts away. The contracts will be revamped to require insurers to offer new benefits and meet stiffer benchmarks for care.\u003c/p>\n\u003cp>The long-planned reshuffle of insurers is likely to come with short-term pain. Four of the managed-care insurers, including Health Net and Blue Shield of California, stand to \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/MCP-County-Enrollment-Table.pdf\">lose Medi-Cal contracts\u003c/a> in a little over a year, according to the \u003ca href=\"https://www.dhcs.ca.gov/formsandpubs/publications/oc/Documents/2022/22-10-MCP-Selections-8-25-22.pdf\">preliminary results of the bidding\u003c/a>, announced in late August. If the results stand, some enrollees in rural Alpine and El Dorado counties, as well as in populous Los Angeles, San Diego, Sacramento and Kern counties, will have to change health plans — and possibly doctors.[aside label='Related Coverage' tag='medicaid']“I’m still shocked and I’m still reeling from it,” said John Sturm, \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/MCP-County-Enrollment-Table.pdf\">one of about 325,000 members of Community Health Group\u003c/a>, the largest Medi-Cal plan in San Diego County, which could lose its contract. “Which doctors can I keep? How long is it going to take me to switch plans? Are there contingency plans when, inevitably, folks slip through the cracks?”\u003c/p>\n\u003cp>Sturm, 54, who has three mental health conditions, largely because of childhood sexual abuse, said finding a psychologist and psychiatrist he could trust took a lot of time and effort. He pointed to \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-patients-struggle-to-fill-prescriptions-medi-cal-rx/\">the disruption caused by the rollout of Medi-Cal’s new prescription drug program\u003c/a> this year, despite assurances it would go smoothly.\u003c/p>\n\u003cp>“I have concerns, and I know other people in the community have concerns about what we’re being told versus what the reality is going to be,” Sturm said.\u003c/p>\n\u003cp>Arguably, the biggest loser in the bidding is Health Net, the largest commercial insurer in Medi-Cal, which stands to lose half its enrollees — including more than 1 million in Los Angeles County alone. St. Louis-based Centene Corp., which \u003ca href=\"https://www.latimes.com/california/story/2022-04-07/california-investigating-corporation-took-over-medicaid-drug-program\">California is investigating\u003c/a> over allegations it overcharged the state for prescription drugs, \u003ca href=\"https://www.prnewswire.com/news-releases/centene-completes-acquisition-of-health-net-300241037.html\">bought Health Net\u003c/a> in 2016, in part for its Medicaid business, of which LA is the crown jewel.\u003c/p>\n\u003cp>But the state’s health plan selections are not set in stone. The losing insurers are fiercely contesting the results in formal appeals that read like declarations of war on their competitors and on the state. Some of the losers essentially call their winning rivals liars.\u003c/p>\n\u003cp>The stakes are high, with contracts in play worth billions of dollars annually. Insurers that lose their appeals with the state Department of Health Care Services, which runs Medi-Cal, are likely to take their complaints to court. That could delay final decisions by months or years, causing a headache for the department, which wants coverage under the new contracts to start Jan. 1, 2024.\u003c/p>\n\u003cp>State officials hope to spend the rest of this year and all of 2023 ensuring that the chosen health plans are up to the task, which includes having enough participating providers to minimize disruptions in care.\u003c/p>\n\u003cp>“Member access and continuity are really our top priorities as part of this transition, and we have dedicated teams that will be working with the health plans on the transition planning and the continuity planning,” Michelle Baass, director of the department, told KHN.[pullquote size=\"medium\" align=\"right\" citation=\"John Sturm, Medi-Cal recipient\"]‘I have concerns, and I know other people in the community have concerns about what we’re being told versus what the reality is going to be.’[/pullquote]Baass also noted that enrollees have continuity-of-care rights. “For example, if a member is currently under the care of a doctor during the prior 12 months, the member has the right to continue seeing that doctor for up to 12 months, if certain conditions are met,” she said.\u003c/p>\n\u003cp>The competitive bidding process is an effort by the department to address persistent complaints that \u003ca href=\"https://californiahealthline.org/news/article/californias-reboot-of-troubled-medi-cal-puts-pressure-on-health-plans/\">it has not effectively monitored subpar health plans\u003c/a>.\u003c/p>\n\u003cp>Eight commercial insurers bid for Medi-Cal business in 21 counties. They were required to submit voluminous documents detailing every aspect of their operations, including past performance; the scope of their provider networks; and their capacity to meet the terms of the new, stricter contracts.\u003c/p>\n\u003cp>The new contracts contain numerous provisions intended to bolster quality, health care equity and transparency — and to boost accountability of the subcontractors to whom \u003ca href=\"https://californiahealthline.org/news/article/layers-of-subcontracted-services-confuse-and-frustrate-medi-cal-patients/\">health plans often outsource patient care\u003c/a>. For example, the plans and their subcontractors will be required to reach or exceed \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCP-RFP-Issue-Brief.pdf\">the 50th percentile\u003c/a> among Medicaid plans nationally on a host of pediatric and maternal care measures — or face financial penalties.\u003c/p>\n\u003cp>They will also be on the hook for providing nonmedical social services that address socioeconomic factors, such as homelessness and food insecurity, in an ambitious $8.7 billion, \u003ca href=\"https://khn.org/news/article/california-medicaid-makeover-newsom-california-medi-cal-homeless-public-funds/\">five-year Medi-Cal initiative known as CalAIM\u003c/a>, that is already underway.\u003c/p>\n\u003cp>Local, publicly governed Medi-Cal plans, which cover about 70% of the \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/statistics/Documents/FastFacts-March2022.pdf\">12.4 million Medi-Cal members who are in managed care\u003c/a>, did not participate in the bidding, though their performance has not always been top-notch. Kaiser Permanente, which this year negotiated a controversial deal with the state for an \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-contract-kaiser-permanente-key-details-missing/\">exclusive Medi-Cal contract\u003c/a> in 32 counties, was also exempt from the bidding. (KHN is not affiliated with Kaiser Permanente.)\u003c/p>\n\u003cp>But all Medi-Cal health insurers, including KP and the local plans, will have to commit to the same goals and requirements.\u003c/p>\n\u003cp>In addition to Health Net, both Blue Shield of California and Community Health Group — which have contracts with Medi-Cal only in San Diego County — are also big losers, as is Aetna, which lost bids in 10 counties.\u003c/p>\n\u003cp>Blue Shield, which lost in all 13 counties where it submitted bids, filed a fiercely worded appeal that accuses its rivals Anthem Blue Cross, Molina and Health Net of failing to disclose hundreds of millions of dollars in penalties against them. It accused those three plans of poor performance “and even mendacity” and said they filled their bids with “puffery,” which the state “bought, hook, line and sinker,” without “an iota of independent analysis.”\u003c/p>\n\u003cfigure id=\"attachment_11926773\" class=\"wp-caption alignnone\" style=\"max-width: 724px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11926773\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/09/GettyImages-1279766844.jpg\" alt=\"A hand in the foreground holds a card as someone reaches out to hold it from across a table.\" width=\"724\" height=\"483\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/09/GettyImages-1279766844.jpg 724w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/09/GettyImages-1279766844-160x107.jpg 160w\" sizes=\"(max-width: 724px) 100vw, 724px\">\u003cfigcaption class=\"wp-caption-text\">The competitive bidding process is an effort by the state Department of Health Care Services to address persistent complaints that it has not effectively monitored subpar health plans. \u003ccite>(Willie B. Thomas/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Health Net’s appeal slammed Molina, which beat it out in LA, Sacramento, Riverside and San Bernardino counties. Molina’s bid, Health Net said, “contains false, inaccurate and misleading information.” The whole bidding process, it said, was “highly flawed,” resulting in “erroneous contract awards that jeopardize the stability of Medi-Cal.”\u003c/p>\n\u003cp>In particular, Health Net said, the Department of Health Care Services “improperly reopened the procurement” after the deadline, which allowed Molina to make “comprehensive changes” that raised its score.\u003c/p>\n\u003cp>The protesting health plans are requesting that they be awarded contracts or that the bidding process start over from scratch.\u003c/p>\n\u003cp>Joseph Garcia, chief operating officer for Community Health Group, said, “It would be easiest for all concerned if they just added us. They don’t have to remove anybody.”\u003c/p>\n\u003cp>Community Health Group has garnered an outpouring of support from hospital executives, physician groups, community clinics and the heads of multiple publicly governed Medi-Cal plans, \u003ca href=\"https://californiahealthline.org/wp-content/uploads/sites/3/2022/09/Medi-Cal-Reprocurement-Letter-of-Support-for-CHG-1.pdf\">who sent a letter to Baass\u003c/a> saying they were “shocked, concerned, and very disappointed” by the state’s decision. They called Community Health Group “our strongest partner of 40 years,” for whom “equity is not a buzzword or a new priority,” noting that more than 85% of its staff is bilingual and multicultural.\u003c/p>\n\u003cp>Community Health Group noted in its appeal that it had lost by less than a point to Health Net, which won a San Diego contract — “a minuscule difference that in itself resulted from deeply flawed scoring.”\u003c/p>\n\u003cp>Garcia said that if Community Health Group loses its appeal, it will “absolutely” sue in state court. A hearing officer appointed by Baass to consider the appeals has set deadlines to receive written responses and rebuttals by October 7.\u003c/p>\n\u003cp>There is ample precedent for protracted legal battles in bidding for Medicaid contracts. In Louisiana, Centene and Aetna \u003ca href=\"https://www.thecentersquare.com/louisiana/rejected-bidders-for-louisiana-medicaid-contracts-file-protests-alleging-bias/article_2fe6ecec-c44c-11e9-833d-331f84e9c8f0.html\">protested the results of a 2019 rebidding process\u003c/a>, which led the state to nullify its awards and restart the bidding. The \u003ca href=\"https://ldh.la.gov/news/ldh-mco-contracts\">new results\u003c/a> were announced this year, with Centene and Aetna among the winners. In Kentucky, the state court of appeals \u003ca href=\"https://www.courier-journal.com/story/news/local/2022/09/15/kentucky-medicaid-contracts-upheld-by-court-anthem-is-out-as-mco/69494863007/\">issued a ruling\u003c/a> this month in a contested Medicaid procurement that had been held two years earlier.\u003c/p>\n\u003cp>Another factor could delay the new contract: California is juggling several massive Medi-Cal changes at the same time. Among them are the implementation of CalAIM and the \u003ca href=\"https://lao.ca.gov/Publications/Report/4423\">anticipated enrollment of nearly 700,000 unauthorized immigrants age 26-49\u003c/a> by January 2024, on top of nearly a quarter-million unauthorized immigrants age 50 and older who \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-older-unauthorized-immigrants/\">became eligible this year\u003c/a>. And then there’s the recalculation of enrollees’ eligibility, which will take place whenever the federal COVID-19-related public health emergency ends. That could push \u003ca href=\"https://www.dhcs.ca.gov/Documents/PHE-UOP/Medi-Cal-COVID-19-PHE-Unwinding-Plan.pdf\">2 million to 3 million\u003c/a> Californians out of Medi-Cal.\u003c/p>\n\u003cp>“Just hearing you list all those things gave me a minor panic attack,” said Abigail Coursolle, a senior attorney at the National Health Law Program. “They are making a lot of work for themselves in a short amount of time.”\u003c/p>\n\u003cp>But, Coursolle added, the state has “a very positive vision for improving access and improving the quality of services that people in Medi-Cal receive, and that’s very important.”\u003c/p>\n\u003cp>\u003cem>California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Almost 2 million of California’s lowest-income and most medically fragile residents may have to switch health insurers as a result of a new strategy by the state to improve care in its Medicaid program, called Medi-Cal.\u003c/p>\n\u003cp>A first-ever statewide contracting competition to participate in Medi-Cal required commercial managed-care plans to rebid for their contracts and compete against others hoping to take those contracts away. The contracts will be revamped to require insurers to offer new benefits and meet stiffer benchmarks for care.\u003c/p>\n\u003cp>The long-planned reshuffle of insurers is likely to come with short-term pain. Four of the managed-care insurers, including Health Net and Blue Shield of California, stand to \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/MCP-County-Enrollment-Table.pdf\">lose Medi-Cal contracts\u003c/a> in a little over a year, according to the \u003ca href=\"https://www.dhcs.ca.gov/formsandpubs/publications/oc/Documents/2022/22-10-MCP-Selections-8-25-22.pdf\">preliminary results of the bidding\u003c/a>, announced in late August. If the results stand, some enrollees in rural Alpine and El Dorado counties, as well as in populous Los Angeles, San Diego, Sacramento and Kern counties, will have to change health plans — and possibly doctors.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“I’m still shocked and I’m still reeling from it,” said John Sturm, \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/MCP-County-Enrollment-Table.pdf\">one of about 325,000 members of Community Health Group\u003c/a>, the largest Medi-Cal plan in San Diego County, which could lose its contract. “Which doctors can I keep? How long is it going to take me to switch plans? Are there contingency plans when, inevitably, folks slip through the cracks?”\u003c/p>\n\u003cp>Sturm, 54, who has three mental health conditions, largely because of childhood sexual abuse, said finding a psychologist and psychiatrist he could trust took a lot of time and effort. He pointed to \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-patients-struggle-to-fill-prescriptions-medi-cal-rx/\">the disruption caused by the rollout of Medi-Cal’s new prescription drug program\u003c/a> this year, despite assurances it would go smoothly.\u003c/p>\n\u003cp>“I have concerns, and I know other people in the community have concerns about what we’re being told versus what the reality is going to be,” Sturm said.\u003c/p>\n\u003cp>Arguably, the biggest loser in the bidding is Health Net, the largest commercial insurer in Medi-Cal, which stands to lose half its enrollees — including more than 1 million in Los Angeles County alone. St. Louis-based Centene Corp., which \u003ca href=\"https://www.latimes.com/california/story/2022-04-07/california-investigating-corporation-took-over-medicaid-drug-program\">California is investigating\u003c/a> over allegations it overcharged the state for prescription drugs, \u003ca href=\"https://www.prnewswire.com/news-releases/centene-completes-acquisition-of-health-net-300241037.html\">bought Health Net\u003c/a> in 2016, in part for its Medicaid business, of which LA is the crown jewel.\u003c/p>\n\u003cp>But the state’s health plan selections are not set in stone. The losing insurers are fiercely contesting the results in formal appeals that read like declarations of war on their competitors and on the state. Some of the losers essentially call their winning rivals liars.\u003c/p>\n\u003cp>The stakes are high, with contracts in play worth billions of dollars annually. Insurers that lose their appeals with the state Department of Health Care Services, which runs Medi-Cal, are likely to take their complaints to court. That could delay final decisions by months or years, causing a headache for the department, which wants coverage under the new contracts to start Jan. 1, 2024.\u003c/p>\n\u003cp>State officials hope to spend the rest of this year and all of 2023 ensuring that the chosen health plans are up to the task, which includes having enough participating providers to minimize disruptions in care.\u003c/p>\n\u003cp>“Member access and continuity are really our top priorities as part of this transition, and we have dedicated teams that will be working with the health plans on the transition planning and the continuity planning,” Michelle Baass, director of the department, told KHN.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Baass also noted that enrollees have continuity-of-care rights. “For example, if a member is currently under the care of a doctor during the prior 12 months, the member has the right to continue seeing that doctor for up to 12 months, if certain conditions are met,” she said.\u003c/p>\n\u003cp>The competitive bidding process is an effort by the department to address persistent complaints that \u003ca href=\"https://californiahealthline.org/news/article/californias-reboot-of-troubled-medi-cal-puts-pressure-on-health-plans/\">it has not effectively monitored subpar health plans\u003c/a>.\u003c/p>\n\u003cp>Eight commercial insurers bid for Medi-Cal business in 21 counties. They were required to submit voluminous documents detailing every aspect of their operations, including past performance; the scope of their provider networks; and their capacity to meet the terms of the new, stricter contracts.\u003c/p>\n\u003cp>The new contracts contain numerous provisions intended to bolster quality, health care equity and transparency — and to boost accountability of the subcontractors to whom \u003ca href=\"https://californiahealthline.org/news/article/layers-of-subcontracted-services-confuse-and-frustrate-medi-cal-patients/\">health plans often outsource patient care\u003c/a>. For example, the plans and their subcontractors will be required to reach or exceed \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCP-RFP-Issue-Brief.pdf\">the 50th percentile\u003c/a> among Medicaid plans nationally on a host of pediatric and maternal care measures — or face financial penalties.\u003c/p>\n\u003cp>They will also be on the hook for providing nonmedical social services that address socioeconomic factors, such as homelessness and food insecurity, in an ambitious $8.7 billion, \u003ca href=\"https://khn.org/news/article/california-medicaid-makeover-newsom-california-medi-cal-homeless-public-funds/\">five-year Medi-Cal initiative known as CalAIM\u003c/a>, that is already underway.\u003c/p>\n\u003cp>Local, publicly governed Medi-Cal plans, which cover about 70% of the \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/statistics/Documents/FastFacts-March2022.pdf\">12.4 million Medi-Cal members who are in managed care\u003c/a>, did not participate in the bidding, though their performance has not always been top-notch. Kaiser Permanente, which this year negotiated a controversial deal with the state for an \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-contract-kaiser-permanente-key-details-missing/\">exclusive Medi-Cal contract\u003c/a> in 32 counties, was also exempt from the bidding. (KHN is not affiliated with Kaiser Permanente.)\u003c/p>\n\u003cp>But all Medi-Cal health insurers, including KP and the local plans, will have to commit to the same goals and requirements.\u003c/p>\n\u003cp>In addition to Health Net, both Blue Shield of California and Community Health Group — which have contracts with Medi-Cal only in San Diego County — are also big losers, as is Aetna, which lost bids in 10 counties.\u003c/p>\n\u003cp>Blue Shield, which lost in all 13 counties where it submitted bids, filed a fiercely worded appeal that accuses its rivals Anthem Blue Cross, Molina and Health Net of failing to disclose hundreds of millions of dollars in penalties against them. It accused those three plans of poor performance “and even mendacity” and said they filled their bids with “puffery,” which the state “bought, hook, line and sinker,” without “an iota of independent analysis.”\u003c/p>\n\u003cfigure id=\"attachment_11926773\" class=\"wp-caption alignnone\" style=\"max-width: 724px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11926773\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/09/GettyImages-1279766844.jpg\" alt=\"A hand in the foreground holds a card as someone reaches out to hold it from across a table.\" width=\"724\" height=\"483\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/09/GettyImages-1279766844.jpg 724w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/09/GettyImages-1279766844-160x107.jpg 160w\" sizes=\"(max-width: 724px) 100vw, 724px\">\u003cfigcaption class=\"wp-caption-text\">The competitive bidding process is an effort by the state Department of Health Care Services to address persistent complaints that it has not effectively monitored subpar health plans. \u003ccite>(Willie B. Thomas/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Health Net’s appeal slammed Molina, which beat it out in LA, Sacramento, Riverside and San Bernardino counties. Molina’s bid, Health Net said, “contains false, inaccurate and misleading information.” The whole bidding process, it said, was “highly flawed,” resulting in “erroneous contract awards that jeopardize the stability of Medi-Cal.”\u003c/p>\n\u003cp>In particular, Health Net said, the Department of Health Care Services “improperly reopened the procurement” after the deadline, which allowed Molina to make “comprehensive changes” that raised its score.\u003c/p>\n\u003cp>The protesting health plans are requesting that they be awarded contracts or that the bidding process start over from scratch.\u003c/p>\n\u003cp>Joseph Garcia, chief operating officer for Community Health Group, said, “It would be easiest for all concerned if they just added us. They don’t have to remove anybody.”\u003c/p>\n\u003cp>Community Health Group has garnered an outpouring of support from hospital executives, physician groups, community clinics and the heads of multiple publicly governed Medi-Cal plans, \u003ca href=\"https://californiahealthline.org/wp-content/uploads/sites/3/2022/09/Medi-Cal-Reprocurement-Letter-of-Support-for-CHG-1.pdf\">who sent a letter to Baass\u003c/a> saying they were “shocked, concerned, and very disappointed” by the state’s decision. They called Community Health Group “our strongest partner of 40 years,” for whom “equity is not a buzzword or a new priority,” noting that more than 85% of its staff is bilingual and multicultural.\u003c/p>\n\u003cp>Community Health Group noted in its appeal that it had lost by less than a point to Health Net, which won a San Diego contract — “a minuscule difference that in itself resulted from deeply flawed scoring.”\u003c/p>\n\u003cp>Garcia said that if Community Health Group loses its appeal, it will “absolutely” sue in state court. A hearing officer appointed by Baass to consider the appeals has set deadlines to receive written responses and rebuttals by October 7.\u003c/p>\n\u003cp>There is ample precedent for protracted legal battles in bidding for Medicaid contracts. In Louisiana, Centene and Aetna \u003ca href=\"https://www.thecentersquare.com/louisiana/rejected-bidders-for-louisiana-medicaid-contracts-file-protests-alleging-bias/article_2fe6ecec-c44c-11e9-833d-331f84e9c8f0.html\">protested the results of a 2019 rebidding process\u003c/a>, which led the state to nullify its awards and restart the bidding. The \u003ca href=\"https://ldh.la.gov/news/ldh-mco-contracts\">new results\u003c/a> were announced this year, with Centene and Aetna among the winners. In Kentucky, the state court of appeals \u003ca href=\"https://www.courier-journal.com/story/news/local/2022/09/15/kentucky-medicaid-contracts-upheld-by-court-anthem-is-out-as-mco/69494863007/\">issued a ruling\u003c/a> this month in a contested Medicaid procurement that had been held two years earlier.\u003c/p>\n\u003cp>Another factor could delay the new contract: California is juggling several massive Medi-Cal changes at the same time. Among them are the implementation of CalAIM and the \u003ca href=\"https://lao.ca.gov/Publications/Report/4423\">anticipated enrollment of nearly 700,000 unauthorized immigrants age 26-49\u003c/a> by January 2024, on top of nearly a quarter-million unauthorized immigrants age 50 and older who \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-older-unauthorized-immigrants/\">became eligible this year\u003c/a>. And then there’s the recalculation of enrollees’ eligibility, which will take place whenever the federal COVID-19-related public health emergency ends. That could push \u003ca href=\"https://www.dhcs.ca.gov/Documents/PHE-UOP/Medi-Cal-COVID-19-PHE-Unwinding-Plan.pdf\">2 million to 3 million\u003c/a> Californians out of Medi-Cal.\u003c/p>\n\u003cp>“Just hearing you list all those things gave me a minor panic attack,” said Abigail Coursolle, a senior attorney at the National Health Law Program. “They are making a lot of work for themselves in a short amount of time.”\u003c/p>\n\u003cp>But, Coursolle added, the state has “a very positive vision for improving access and improving the quality of services that people in Medi-Cal receive, and that’s very important.”\u003c/p>\n\u003cp>\u003cem>California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>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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"content": "\u003cdiv class=\"post-body\">\u003cp>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>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\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\u003c/div>\u003c/p>",
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"title": "Mental Health Advocates Seek State Funding to Help Kids Age 5 and Under in California",
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"content": "\u003cp>While California has committed billions of dollars to support the mental health of K-12 students, little has been dedicated specifically to children 5 and younger.\u003c/p>\n\u003cp>Advocates say this needs to be addressed, and are asking Gov. Gavin Newsom to set aside $250 million in the state budget to support the mental health of infants, toddlers, preschoolers and their parents and caregivers.\u003c/p>\n\u003cp>Kids under 5 account for almost a quarter of all Medi-Cal recipients under 21 but do not receive a proportionate share of health and mental health care compared to older youth, according to Children Now, an advocacy organization focused on the health and welfare of California’s children. At least 43% of those children under 5 have experienced at least one adverse childhood experience. These experiences — including violence, abuse or neglect — have been connected to chronic illnesses later in life, and to death.\u003c/p>\n\u003cp>[aside postID=mindshift_59313 label='Children's Anxiety Screening']\u003c/p>\n\u003cp>“They are very cute and adorable so people don’t see any needs besides feeding and clothing them at this age,” said Lishaun Francis, director of behavioral health for Children Now. “Because they can’t speak about their needs, they can’t say, ‘This is making me sad,’ or, ‘This is not a healthy attachment relationship.’ They can’t express themselves so we take for granted what they need.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Children Now, along with more than 400 organizations, sent a letter to Newsom asking for $250 million over four years to fund organizations that provide mental health support for mainly lower-income infants and toddlers and their families. Advocates say providing support services early helps prevent children from experiencing adverse events, and if they have gone through trauma already it can help them heal and process.\u003c/p>\n\u003cp>The money also would support training for child care providers and other caregivers to ensure they have the skills to help prevent traumatic experiences. Those skills include providing a nurturing relationship with children and helping a child cope with trauma.\u003c/p>\n\u003cp>These needs have increased during the pandemic as children have experienced isolation, family stress over finances and housing, and possibly the death of a parent or loved one to COVID-19.[pullquote size=\"medium\" align=\"right\" citation=\"Lishaun Francis, director of behavioral health, Children Now\"]‘We are essentially asking the state not to forget about very little kids, infants and toddlers.’[/pullquote]Because infants and toddlers can’t express their feelings the way an older child might, there is a perception that they don’t register stressful or traumatic events the way older children might.\u003c/p>\n\u003cp>But young children do experience anxiety, stress, sadness and other emotions related to trauma and they rely on their caregivers to help them make sense of it all, said Dr. Chelsea Lee, a specialist in infant and early childhood mental health at the UC Davis CAARE Center, a mental health clinic serving children who have experienced trauma and abuse.\u003c/p>\n\u003cp>If those experiences are not addressed or prevented early on, a child’s future may be marked by angry outbursts, bad grades and the inability to have a relationship or keep a job, experts said.\u003c/p>\n\u003cp>“The first five years are crucial for setting the foundation for functioning across the life span up to teenage years, adolescence, adulthood and everything,” Lee said. “Early caregiving experiences and nurturing relationships are very important for little kiddos.”\u003c/p>\n\u003cp>Last year, California launched the $4.4 billion Children and Youth Behavioral Health Initiative to redesign behavioral support for kids. But the initiative doesn’t directly address the needs of children younger than kindergarten age.\u003c/p>\n\u003cp>“We are essentially asking the state not to forget about very little kids, infants and toddlers” with the current funding request, Francis said.\u003c/p>\n\u003cp>Putting resources into early intervention is vital for the health and safety of future populations, said Kelly Morehouse-Smith, director of family well-being for the Child Care Resource Center, which operates a home-based family support program in Los Angeles. If there is no intervention or support, issues like aggressive behavior or isolation show up in school and often affect learning, she said.[pullquote size=\"medium\" align=\"right\" citation=\"Kelly Morehouse-Smith, director of family well-being, Child Care Resource Center\"]‘Trauma doesn’t just stay in 0 to 5. It manifests throughout someone’s lifetime.’[/pullquote]“Trauma doesn’t just stay in 0 to 5. It manifests throughout someone’s lifetime,” Morehouse-Smith said. “If you don’t address it at all, then the child hasn’t processed the trauma, doesn’t learn coping skills, and what we see are behaviors that impact the school setting, social settings and family relationships.”\u003c/p>\n\u003cp>That is why Elizabeth Lomeli, a para-educator for the Child Care Resource Center who does home visits with families, worries about her own daughter. When her 8-year-old daughter Gisselle was around 4, she witnessed a lot of infighting among her extended family. Lomeli could not find resources for her daughter until she started school. It took three years for Gisselle to begin therapy.\u003c/p>\n\u003cp>“It impacted her as she was growing — she was very insecure about her being able to do things and was worried about other people,” Lomeli said. “If she had received these services when she was young, she would have had that confidence and received that independence.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Infants and toddlers are unique in how they show stress and trauma, and because they are so young, the outreach takes a two-generational approach, Francis said. Parents and caregivers are part of the formula for ensuring young children are healthy, safe and nurtured, she said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>While California has committed billions of dollars to support the mental health of K-12 students, little has been dedicated specifically to children 5 and younger.\u003c/p>\n\u003cp>Advocates say this needs to be addressed, and are asking Gov. Gavin Newsom to set aside $250 million in the state budget to support the mental health of infants, toddlers, preschoolers and their parents and caregivers.\u003c/p>\n\u003cp>Kids under 5 account for almost a quarter of all Medi-Cal recipients under 21 but do not receive a proportionate share of health and mental health care compared to older youth, according to Children Now, an advocacy organization focused on the health and welfare of California’s children. At least 43% of those children under 5 have experienced at least one adverse childhood experience. These experiences — including violence, abuse or neglect — have been connected to chronic illnesses later in life, and to death.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“They are very cute and adorable so people don’t see any needs besides feeding and clothing them at this age,” said Lishaun Francis, director of behavioral health for Children Now. “Because they can’t speak about their needs, they can’t say, ‘This is making me sad,’ or, ‘This is not a healthy attachment relationship.’ They can’t express themselves so we take for granted what they need.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Children Now, along with more than 400 organizations, sent a letter to Newsom asking for $250 million over four years to fund organizations that provide mental health support for mainly lower-income infants and toddlers and their families. Advocates say providing support services early helps prevent children from experiencing adverse events, and if they have gone through trauma already it can help them heal and process.\u003c/p>\n\u003cp>The money also would support training for child care providers and other caregivers to ensure they have the skills to help prevent traumatic experiences. Those skills include providing a nurturing relationship with children and helping a child cope with trauma.\u003c/p>\n\u003cp>These needs have increased during the pandemic as children have experienced isolation, family stress over finances and housing, and possibly the death of a parent or loved one to COVID-19.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Because infants and toddlers can’t express their feelings the way an older child might, there is a perception that they don’t register stressful or traumatic events the way older children might.\u003c/p>\n\u003cp>But young children do experience anxiety, stress, sadness and other emotions related to trauma and they rely on their caregivers to help them make sense of it all, said Dr. Chelsea Lee, a specialist in infant and early childhood mental health at the UC Davis CAARE Center, a mental health clinic serving children who have experienced trauma and abuse.\u003c/p>\n\u003cp>If those experiences are not addressed or prevented early on, a child’s future may be marked by angry outbursts, bad grades and the inability to have a relationship or keep a job, experts said.\u003c/p>\n\u003cp>“The first five years are crucial for setting the foundation for functioning across the life span up to teenage years, adolescence, adulthood and everything,” Lee said. “Early caregiving experiences and nurturing relationships are very important for little kiddos.”\u003c/p>\n\u003cp>Last year, California launched the $4.4 billion Children and Youth Behavioral Health Initiative to redesign behavioral support for kids. But the initiative doesn’t directly address the needs of children younger than kindergarten age.\u003c/p>\n\u003cp>“We are essentially asking the state not to forget about very little kids, infants and toddlers” with the current funding request, Francis said.\u003c/p>\n\u003cp>Putting resources into early intervention is vital for the health and safety of future populations, said Kelly Morehouse-Smith, director of family well-being for the Child Care Resource Center, which operates a home-based family support program in Los Angeles. If there is no intervention or support, issues like aggressive behavior or isolation show up in school and often affect learning, she said.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“Trauma doesn’t just stay in 0 to 5. It manifests throughout someone’s lifetime,” Morehouse-Smith said. “If you don’t address it at all, then the child hasn’t processed the trauma, doesn’t learn coping skills, and what we see are behaviors that impact the school setting, social settings and family relationships.”\u003c/p>\n\u003cp>That is why Elizabeth Lomeli, a para-educator for the Child Care Resource Center who does home visits with families, worries about her own daughter. When her 8-year-old daughter Gisselle was around 4, she witnessed a lot of infighting among her extended family. Lomeli could not find resources for her daughter until she started school. It took three years for Gisselle to begin therapy.\u003c/p>\n\u003cp>“It impacted her as she was growing — she was very insecure about her being able to do things and was worried about other people,” Lomeli said. “If she had received these services when she was young, she would have had that confidence and received that independence.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Infants and toddlers are unique in how they show stress and trauma, and because they are so young, the outreach takes a two-generational approach, Francis said. Parents and caregivers are part of the formula for ensuring young children are healthy, safe and nurtured, she said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Many working undocumented immigrants won’t qualify for state health insurance even if they don’t earn a living wage. That leaves them with few viable options for coverage.\u003c/p>\n\u003cp>Lucia Marroquin knows what it’s like to wait out pain in hopes that it will go away on its own. She is suffering from kidney stones and may need surgery. But because she lacks health coverage, her first question when she falls ill is always, “How much will that cost me?”\u003c/p>\n\u003cp>So when California officials announced plans to extend Medi-Cal coverage to more undocumented adults, the Fresno County resident was hopeful that she would finally qualify for health insurance.\u003c/p>\n\u003cp>But her farmworker husband’s annual income of $35,000 puts the couple over the limit to qualify for Medi-Cal, which is reserved for residents with lower incomes. So even under Gov. Gavin Newsom’s planned expansion, she’ll likely be left with no health insurance.[pullquote size=\"medium\" align=\"right\" citation=\"Arturo Vargas Bustamante, professor, UCLA Fielding School of Public Health\"]‘This is a great achievement and it is absolutely amazing, but there will still be some who will remain uninsured.’[/pullquote]\u003c/p>\n\u003cp>Experts say allowing people to sign up for comprehensive Medi-Cal coverage regardless of their immigration status is the single biggest step California can take to insure as many people as possible in the current system. Newsom called his latest planned expansion “\u003ca href=\"https://twitter.com/GavinNewsom/status/1480618598762647553?s=20&t=6kiFbKIbAMdNs3tpMmRspw\">universal access to coverage\u003c/a>.”\u003c/p>\n\u003cp>But the expansion would still leave several hundred thousand undocumented immigrants like Marroquin uninsured. They are unable to qualify because they have jobs where they earn above Medi-Cal’s annual income thresholds for most adults: $17,609 for single people, $23,792 for a couple and $36,156 for a family of four.\u003c/p>\n\u003cp>That leaves many immigrants with low incomes with few viable options for health coverage. While most Californians who earn over the Medi-Cal limit can get subsidized coverage through \u003ca href=\"https://www.coveredca.com/learning-center/information-for-immigrants/\">Covered California, undocumented people are not allowed\u003c/a> to buy insurance through the marketplace under the federal Affordable Care Act.\u003c/p>\n\u003cp>On May 1, about \u003ca href=\"https://www.gov.ca.gov/2021/07/27/governor-newsom-signs-into-law-first-in-the-nation-expansion-of-medi-cal-to-undocumented-californians-age-50-and-over-bold-initiatives-to-advance-more-equitable-and-prevention-focused-health-care/\">235,000 undocumented people\u003c/a> age 50 and older will gain new access to Medi-Cal under a law signed last summer. A second proposal, unveiled in Newsom’s January budget, would include another 700,000 undocumented adults in the 26-to-49 age group, starting as early as 2024, if approved in this year’s final budget. Children and young adults are already eligible.\u003c/p>\n\u003cp>“This is a great achievement and it is absolutely amazing, but there will still be some who will remain uninsured,” said Arturo Vargas Bustamante, health policy professor at the UCLA Fielding School of Public Health. “It’s not universal health care, but the situation for many immigrants in California will be much better.”\u003c/p>\n\u003cp>In 2023, after Medi-Cal expands to cover undocumented immigrants 50 and older, about \u003ca href=\"https://www.itup.org/wp-content/uploads/2021/12/Final.-ITUP-Snapshot-2021.pdf#page=3\">3.2 million people will remain uninsured in California\u003c/a>, according to researchers at the UC Berkeley Labor Center and the UCLA Center for Health Policy Research. Of those, 1.16 million will be unauthorized immigrants.[aside postID=\"news_11901253,news_11901347,news_11902149\" label=\"Related Posts\"]Even if Newsom’s next step is approved — covering undocumented adults 26 to 49 years old as early as 2024 — that would still leave roughly 450,000 undocumented people under 65 with no health coverage (the difference between 1.16 million people and the 700,000 who would gain access).\u003c/p>\n\u003ch2>‘Doesn’t have to be free. Just a fair price’\u003c/h2>\n\u003cp>The governor’s latest proposal would help Virginia Moscoso, a 29-year-old mother of two in Yolo County who is undocumented. She is enrolled in restricted-scope Medi-Cal, which is limited to emergencies and pregnancies, but hopes she would obtain full benefits if the proposal is approved in the final budget.\u003c/p>\n\u003cp>Full-scope benefits allow people coverage for routine, preventive care, long-term care and \u003ca href=\"https://www.cdss.ca.gov/in-home-supportive-services\">in-home supportive services\u003c/a>.\u003c/p>\n\u003cp>Moscoso is especially interested in dental care. A few months back, she had a toothache that she alleviated with home remedies, but she is overdue for a checkup.\u003c/p>\n\u003cfigure id=\"attachment_11906905\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/03/Screen-Shot-2022-03-01-at-11.37.59-AM.png\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11906905\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/03/Screen-Shot-2022-03-01-at-11.37.59-AM-800x532.png\" alt=\"A woman wearing a pink shirt rests her arms on a fence outside.\" width=\"800\" height=\"532\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/03/Screen-Shot-2022-03-01-at-11.37.59-AM-800x532.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/03/Screen-Shot-2022-03-01-at-11.37.59-AM-1020x678.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/03/Screen-Shot-2022-03-01-at-11.37.59-AM-160x106.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/03/Screen-Shot-2022-03-01-at-11.37.59-AM-1536x1021.png 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/03/Screen-Shot-2022-03-01-at-11.37.59-AM.png 1552w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Virginia Moscoso, who lives in the Yolo County town of Dunnigan, will qualify for full-scope Medi-Cal if Gov. Gavin Newsom’s budget is approved, expanding it to undocumented immigrants age 26 through 49. But the expansion would still leave hundreds of thousands of undocumented immigrants who earn over the income threshold with no insurance. \u003ccite>(Miguel Gutierrez Jr./CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In the past, Moscoso has worked seasonal jobs in farm fields, but her family of four mostly relies on her husband’s earnings of about $35,000, which means they would likely qualify — just barely — for Medi-Cal under Newsom’s expansion. Her children are already enrolled in Medi-Cal, and that’s a huge help, she said.\u003c/p>\n\u003cp>She’s grateful that apart from her pregnancies, she hasn’t needed to use her emergency Medi-Cal. But if she qualified for primary care, it would make a lot more sense than waiting until she’s ill in the hospital.\u003c/p>\n\u003cp>“For me it would be a great blessing,” Moscoso said. “Because when you go to the doctor, it’s never just the one visit — you need tests and medication, and it adds up.”\u003c/p>\n\u003cp>Many people without health insurance seek care at community clinics where services may be offered on a sliding fee scale, so what they pay is based on their income.\u003c/p>\n\u003cp>That’s how Marroquin, 55, usually gets care. Each visit to the clinic costs her about $40. A recent ultrasound for her kidney stones cost her $200.\u003c/p>\n\u003cp>Marroquin has applied for emergency Medi-Cal in the past but was denied because her husband’s income of $35,000 was too high.\u003c/p>\n\u003cp>“It’s very difficult to be without coverage,” Marroquin said. “It doesn’t have to be free, just at a fair price. As my husband says, we can get car insurance, why can’t we buy health insurance?”\u003c/p>\n\u003cp>For most adult enrollees, the limit to qualify for Medi-Cal is \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/Pages/DoYouQualifyForMedi-Cal.aspx\">138% of the federal poverty level\u003c/a>. Eligibility takes into account income and household size. (Certain groups like pregnant women qualify at slightly higher incomes.)\u003c/p>\n\u003cp>People like Marroquin with wages near that threshold are considered to be among the working poor: They \u003ca href=\"https://livingwage.mit.edu/states/06\">are not earning a living wage in California\u003c/a>. Most Californians in that situation can buy subsidized plans from Covered California. But undocumented immigrants cannot, and while they can purchase coverage directly from insurance companies, it is often unaffordable. For instance, premiums for a couple in their 50s could cost more than $1,000 a month, said \u003ca href=\"https://www.quotevalley.com/contact.aspx\">Alex Hernandez\u003c/a>, a health insurance agent in Merced.\u003c/p>\n\u003cp>“I think some people, especially if they have an illness, see the value of having insurance despite the cost. But it’s tough,” Hernandez said. Facing such high premiums, he said, “most people are going to say forget it.”\u003c/p>\n\u003cp>In 2016, California applied for a waiver from the federal government to allow undocumented people to buy from Covered California. But the state \u003ca href=\"https://khn.org/news/california-withdraws-bid-to-allow-undocumented-immigrants-to-buy-unsubsidized-obamacare-plans/\">withdrew the application\u003c/a> at the request of the Legislature when former President Donald Trump took office.\u003c/p>\n\u003cp>Insurance Commissioner Ricardo Lara, who spearheaded legislation for the waiver application when he was a state senator, said the request was rescinded because of concern that the Trump administration would use immigrants’ information against them.\u003c/p>\n\u003cp>The waiver application has not been resubmitted by the state, but it’s still an option, Lara said.\u003c/p>\n\u003cp>Even if a waiver were approved, undocumented residents would still have to purchase insurance without federal subsidies. The state could, in theory, provide some financial assistance, health advocates say.\u003c/p>\n\u003cp>Lara said Newsom made Medi-Cal expansion for undocumented immigrants a priority in this year’s budget, which shows just how much attitudes around the issue have changed.\u003c/p>\n\u003cp>“Back in the day this was an issue that people thought would cost you the election or cost you grief. It’s a tremendous shift in attitude toward the undocumented community,” Lara said.\u003c/p>\n\u003cp>But to truly get to universal coverage, California will need to continue innovative approaches and drill down on affordability, Lara said. He authored a \u003ca href=\"https://khn.org/news/single-payer-health-care-bill-introduced-in-california-senate/\">single-payer bill in 2017\u003c/a> and thinks that type of system is inevitable, but will take time. In the meantime, he said the state should keep expanding coverage where it can.\u003c/p>\n\u003cp>Last month, the Legislature’s latest version of \u003ca href=\"https://calmatters.org/politics/2022/02/california-single-payer-legislature/?utm_source=CalMatters+Newsletters&utm_campaign=da289b23b6-WHATMATTERS&utm_medium=email&utm_term=0_faa7be558d-da289b23b6-150460103&mc_cid=da289b23b6&mc_eid=099a508f5c\">a bill that would have created a state-funded single-payer system\u003c/a> died on the Assembly floor. \u003ca href=\"https://a27.asmdc.org/press-releases/20220131-assemblymember-ash-kalra-author-ab-1400-ca-guaranteed-health-care-all-act\">It didn’t have enough votes\u003c/a>, according to its author, Assemblymember Ash Kalra of San Jose.\u003c/p>\n\u003cp>Lack of access because of immigration status is just one piece of the remaining uninsured. Many other Californians forgo coverage despite being eligible, likely because of the cost. According to the UC Berkeley and UCLA study, 2 million uninsured people qualify for Medi-Cal, employer coverage or Covered California.\u003c/p>\n\u003cp>“The most common reason that people eligible for employer coverage remain uninsured is that they can’t afford the premium contributions,” said Laurel Lucia, director of the Health Care Program at UC Berkeley’s Labor Center.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://e.infogram.com/af381a4c-1356-4991-a3b4-b2ca7a12f01a?src=embed\" title=\"uninsured 2023- UC estimates\" width=\"950\" height=\"800\" scrolling=\"no\" frameborder=\"0\" style=\"border:none;\" allowfullscreen=\"allowfullscreen\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>People eligible for Medi-Cal may go without it for a number of reasons. A report from the California Health Care Foundation found that \u003ca href=\"https://www.chcf.org/publication/medi-cal-maze-why-many-eligible-californians-dont-enroll/\">people may be deterred from applying\u003c/a> because of misinformation about or a negative perception of the Medi-Cal program. Some who tried applying reported having a hard time navigating the enrollment process.\u003c/p>\n\u003cp>Similarly, people eligible for Covered California may go without it because they either don’t know they are eligible for financial aid or may still not be able to afford it even with the help.\u003c/p>\n\u003cp>Covered California officials last month announced that because of a \u003ca href=\"https://calmatters.org/health/2021/04/health-insurance-subsidies/\">temporary boost in federal subsidies\u003c/a>, two-thirds of enrollees in its most recent sign-up period were eligible to \u003ca href=\"https://www.coveredca.com/pdfs/news/01-25-22-CoveredCA-1.8-Million.pdf\">get coverage for $10 or less a month\u003c/a>. This year’s enrollment period closed with a record 1.8 million Californians signed up for health insurance through the marketplace.\u003c/p>\n\u003cp>To further aid with affordability, the chairs of the Legislature’s health committees recently introduced \u003ca href=\"https://health-access.org/press_release/2022/02/health-access-ca-health-committee-chairs-introduce-bills-to-increase-affordability-in-coveredca/\">bills that aim to reduce deductibles and copays\u003c/a> for people enrolled through Covered California.\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>\u003c/p>\n\u003cp>Experts say allowing people to sign up for comprehensive Medi-Cal coverage regardless of their immigration status is the single biggest step California can take to insure as many people as possible in the current system. Newsom called his latest planned expansion “\u003ca href=\"https://twitter.com/GavinNewsom/status/1480618598762647553?s=20&t=6kiFbKIbAMdNs3tpMmRspw\">universal access to coverage\u003c/a>.”\u003c/p>\n\u003cp>But the expansion would still leave several hundred thousand undocumented immigrants like Marroquin uninsured. They are unable to qualify because they have jobs where they earn above Medi-Cal’s annual income thresholds for most adults: $17,609 for single people, $23,792 for a couple and $36,156 for a family of four.\u003c/p>\n\u003cp>That leaves many immigrants with low incomes with few viable options for health coverage. While most Californians who earn over the Medi-Cal limit can get subsidized coverage through \u003ca href=\"https://www.coveredca.com/learning-center/information-for-immigrants/\">Covered California, undocumented people are not allowed\u003c/a> to buy insurance through the marketplace under the federal Affordable Care Act.\u003c/p>\n\u003cp>On May 1, about \u003ca href=\"https://www.gov.ca.gov/2021/07/27/governor-newsom-signs-into-law-first-in-the-nation-expansion-of-medi-cal-to-undocumented-californians-age-50-and-over-bold-initiatives-to-advance-more-equitable-and-prevention-focused-health-care/\">235,000 undocumented people\u003c/a> age 50 and older will gain new access to Medi-Cal under a law signed last summer. A second proposal, unveiled in Newsom’s January budget, would include another 700,000 undocumented adults in the 26-to-49 age group, starting as early as 2024, if approved in this year’s final budget. Children and young adults are already eligible.\u003c/p>\n\u003cp>“This is a great achievement and it is absolutely amazing, but there will still be some who will remain uninsured,” said Arturo Vargas Bustamante, health policy professor at the UCLA Fielding School of Public Health. “It’s not universal health care, but the situation for many immigrants in California will be much better.”\u003c/p>\n\u003cp>In 2023, after Medi-Cal expands to cover undocumented immigrants 50 and older, about \u003ca href=\"https://www.itup.org/wp-content/uploads/2021/12/Final.-ITUP-Snapshot-2021.pdf#page=3\">3.2 million people will remain uninsured in California\u003c/a>, according to researchers at the UC Berkeley Labor Center and the UCLA Center for Health Policy Research. Of those, 1.16 million will be unauthorized immigrants.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Even if Newsom’s next step is approved — covering undocumented adults 26 to 49 years old as early as 2024 — that would still leave roughly 450,000 undocumented people under 65 with no health coverage (the difference between 1.16 million people and the 700,000 who would gain access).\u003c/p>\n\u003ch2>‘Doesn’t have to be free. Just a fair price’\u003c/h2>\n\u003cp>The governor’s latest proposal would help Virginia Moscoso, a 29-year-old mother of two in Yolo County who is undocumented. She is enrolled in restricted-scope Medi-Cal, which is limited to emergencies and pregnancies, but hopes she would obtain full benefits if the proposal is approved in the final budget.\u003c/p>\n\u003cp>Full-scope benefits allow people coverage for routine, preventive care, long-term care and \u003ca href=\"https://www.cdss.ca.gov/in-home-supportive-services\">in-home supportive services\u003c/a>.\u003c/p>\n\u003cp>Moscoso is especially interested in dental care. A few months back, she had a toothache that she alleviated with home remedies, but she is overdue for a checkup.\u003c/p>\n\u003cfigure id=\"attachment_11906905\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/03/Screen-Shot-2022-03-01-at-11.37.59-AM.png\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11906905\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/03/Screen-Shot-2022-03-01-at-11.37.59-AM-800x532.png\" alt=\"A woman wearing a pink shirt rests her arms on a fence outside.\" width=\"800\" height=\"532\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/03/Screen-Shot-2022-03-01-at-11.37.59-AM-800x532.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/03/Screen-Shot-2022-03-01-at-11.37.59-AM-1020x678.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/03/Screen-Shot-2022-03-01-at-11.37.59-AM-160x106.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/03/Screen-Shot-2022-03-01-at-11.37.59-AM-1536x1021.png 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/03/Screen-Shot-2022-03-01-at-11.37.59-AM.png 1552w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Virginia Moscoso, who lives in the Yolo County town of Dunnigan, will qualify for full-scope Medi-Cal if Gov. Gavin Newsom’s budget is approved, expanding it to undocumented immigrants age 26 through 49. But the expansion would still leave hundreds of thousands of undocumented immigrants who earn over the income threshold with no insurance. \u003ccite>(Miguel Gutierrez Jr./CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In the past, Moscoso has worked seasonal jobs in farm fields, but her family of four mostly relies on her husband’s earnings of about $35,000, which means they would likely qualify — just barely — for Medi-Cal under Newsom’s expansion. Her children are already enrolled in Medi-Cal, and that’s a huge help, she said.\u003c/p>\n\u003cp>She’s grateful that apart from her pregnancies, she hasn’t needed to use her emergency Medi-Cal. But if she qualified for primary care, it would make a lot more sense than waiting until she’s ill in the hospital.\u003c/p>\n\u003cp>“For me it would be a great blessing,” Moscoso said. “Because when you go to the doctor, it’s never just the one visit — you need tests and medication, and it adds up.”\u003c/p>\n\u003cp>Many people without health insurance seek care at community clinics where services may be offered on a sliding fee scale, so what they pay is based on their income.\u003c/p>\n\u003cp>That’s how Marroquin, 55, usually gets care. Each visit to the clinic costs her about $40. A recent ultrasound for her kidney stones cost her $200.\u003c/p>\n\u003cp>Marroquin has applied for emergency Medi-Cal in the past but was denied because her husband’s income of $35,000 was too high.\u003c/p>\n\u003cp>“It’s very difficult to be without coverage,” Marroquin said. “It doesn’t have to be free, just at a fair price. As my husband says, we can get car insurance, why can’t we buy health insurance?”\u003c/p>\n\u003cp>For most adult enrollees, the limit to qualify for Medi-Cal is \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/Pages/DoYouQualifyForMedi-Cal.aspx\">138% of the federal poverty level\u003c/a>. Eligibility takes into account income and household size. (Certain groups like pregnant women qualify at slightly higher incomes.)\u003c/p>\n\u003cp>People like Marroquin with wages near that threshold are considered to be among the working poor: They \u003ca href=\"https://livingwage.mit.edu/states/06\">are not earning a living wage in California\u003c/a>. Most Californians in that situation can buy subsidized plans from Covered California. But undocumented immigrants cannot, and while they can purchase coverage directly from insurance companies, it is often unaffordable. For instance, premiums for a couple in their 50s could cost more than $1,000 a month, said \u003ca href=\"https://www.quotevalley.com/contact.aspx\">Alex Hernandez\u003c/a>, a health insurance agent in Merced.\u003c/p>\n\u003cp>“I think some people, especially if they have an illness, see the value of having insurance despite the cost. But it’s tough,” Hernandez said. Facing such high premiums, he said, “most people are going to say forget it.”\u003c/p>\n\u003cp>In 2016, California applied for a waiver from the federal government to allow undocumented people to buy from Covered California. But the state \u003ca href=\"https://khn.org/news/california-withdraws-bid-to-allow-undocumented-immigrants-to-buy-unsubsidized-obamacare-plans/\">withdrew the application\u003c/a> at the request of the Legislature when former President Donald Trump took office.\u003c/p>\n\u003cp>Insurance Commissioner Ricardo Lara, who spearheaded legislation for the waiver application when he was a state senator, said the request was rescinded because of concern that the Trump administration would use immigrants’ information against them.\u003c/p>\n\u003cp>The waiver application has not been resubmitted by the state, but it’s still an option, Lara said.\u003c/p>\n\u003cp>Even if a waiver were approved, undocumented residents would still have to purchase insurance without federal subsidies. The state could, in theory, provide some financial assistance, health advocates say.\u003c/p>\n\u003cp>Lara said Newsom made Medi-Cal expansion for undocumented immigrants a priority in this year’s budget, which shows just how much attitudes around the issue have changed.\u003c/p>\n\u003cp>“Back in the day this was an issue that people thought would cost you the election or cost you grief. It’s a tremendous shift in attitude toward the undocumented community,” Lara said.\u003c/p>\n\u003cp>But to truly get to universal coverage, California will need to continue innovative approaches and drill down on affordability, Lara said. He authored a \u003ca href=\"https://khn.org/news/single-payer-health-care-bill-introduced-in-california-senate/\">single-payer bill in 2017\u003c/a> and thinks that type of system is inevitable, but will take time. In the meantime, he said the state should keep expanding coverage where it can.\u003c/p>\n\u003cp>Last month, the Legislature’s latest version of \u003ca href=\"https://calmatters.org/politics/2022/02/california-single-payer-legislature/?utm_source=CalMatters+Newsletters&utm_campaign=da289b23b6-WHATMATTERS&utm_medium=email&utm_term=0_faa7be558d-da289b23b6-150460103&mc_cid=da289b23b6&mc_eid=099a508f5c\">a bill that would have created a state-funded single-payer system\u003c/a> died on the Assembly floor. \u003ca href=\"https://a27.asmdc.org/press-releases/20220131-assemblymember-ash-kalra-author-ab-1400-ca-guaranteed-health-care-all-act\">It didn’t have enough votes\u003c/a>, according to its author, Assemblymember Ash Kalra of San Jose.\u003c/p>\n\u003cp>Lack of access because of immigration status is just one piece of the remaining uninsured. Many other Californians forgo coverage despite being eligible, likely because of the cost. According to the UC Berkeley and UCLA study, 2 million uninsured people qualify for Medi-Cal, employer coverage or Covered California.\u003c/p>\n\u003cp>“The most common reason that people eligible for employer coverage remain uninsured is that they can’t afford the premium contributions,” said Laurel Lucia, director of the Health Care Program at UC Berkeley’s Labor Center.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://e.infogram.com/af381a4c-1356-4991-a3b4-b2ca7a12f01a?src=embed\" title=\"uninsured 2023- UC estimates\" width=\"950\" height=\"800\" scrolling=\"no\" frameborder=\"0\" style=\"border:none;\" allowfullscreen=\"allowfullscreen\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>People eligible for Medi-Cal may go without it for a number of reasons. A report from the California Health Care Foundation found that \u003ca href=\"https://www.chcf.org/publication/medi-cal-maze-why-many-eligible-californians-dont-enroll/\">people may be deterred from applying\u003c/a> because of misinformation about or a negative perception of the Medi-Cal program. Some who tried applying reported having a hard time navigating the enrollment process.\u003c/p>\n\u003cp>Similarly, people eligible for Covered California may go without it because they either don’t know they are eligible for financial aid or may still not be able to afford it even with the help.\u003c/p>\n\u003cp>Covered California officials last month announced that because of a \u003ca href=\"https://calmatters.org/health/2021/04/health-insurance-subsidies/\">temporary boost in federal subsidies\u003c/a>, two-thirds of enrollees in its most recent sign-up period were eligible to \u003ca href=\"https://www.coveredca.com/pdfs/news/01-25-22-CoveredCA-1.8-Million.pdf\">get coverage for $10 or less a month\u003c/a>. This year’s enrollment period closed with a record 1.8 million Californians signed up for health insurance through the marketplace.\u003c/p>\n\u003cp>To further aid with affordability, the chairs of the Legislature’s health committees recently introduced \u003ca href=\"https://health-access.org/press_release/2022/02/health-access-ca-health-committee-chairs-introduce-bills-to-increase-affordability-in-coveredca/\">bills that aim to reduce deductibles and copays\u003c/a> for people enrolled through Covered California.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "California Reformed Medi-Cal to Include 'Whole Person Care' — Is It Working?",
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"headTitle": "California Reformed Medi-Cal to Include ‘Whole Person Care’ — Is It Working? | KQED",
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"content": "\u003cp>At 66, Edward El has a new lease on life — literally. In two weeks, he’ll move into his own apartment in Berkeley after spending the better part of the past 16 years unhoused.\u003c/p>\n\u003cp>Years ago, a back injury and pinched nerves in his legs made standing and walking painful, and he was laid off from his construction job. He ended up in “shelter after shelter after shelter.”\u003c/p>\n\u003cp>But nine months ago, El moved into one of 12 Project Roomkey shelters in Alameda County designed to reduce COVID-19 among the unhoused population. He was connected with a housing navigator, a counselor and medical staff. They helped El apply for affordable housing and rental assistance vouchers, and coordinated with landlords who would give unhoused renters a chance.\u003c/p>\n\u003cfigure id=\"attachment_11905186\" class=\"wp-caption alignnone\" style=\"max-width: 1536px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11905186\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-14-CM.jpg\" alt=\"A man, wearing a hoodie, beanie and a face mask, sits on a chair in an indoor space. He looks to the side, a bit away from the camera.\" width=\"1536\" height=\"1025\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/02/020922-CALAIM-MHN-14-CM.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/02/020922-CALAIM-MHN-14-CM-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/02/020922-CALAIM-MHN-14-CM-1020x681.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/02/020922-CALAIM-MHN-14-CM-160x107.jpg 160w\" sizes=\"auto, (max-width: 1536px) 100vw, 1536px\">\u003cfigcaption class=\"wp-caption-text\">As Edward El prepares to move to a permanent home, he has enrolled in Medi-Cal. He said he couldn’t have navigated the array of complex systems if it weren’t for his new case management team. ‘I’m happy. They knew about programs that I didn’t know about that allowed me to get a place,’ he said. \u003ccite>(Martin do Nascimento/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Now El will pay a fraction of the cost to live in an area where one-bedroom apartments often exceed $3,000 per month.\u003c/p>\n\u003cp>The team also made sure that El was enrolled in Medi-Cal and had transportation to his doctor’s appointments. He said he couldn’t have navigated the array of complex systems if it weren’t for his new case management team. “I’m happy. They knew about programs that I didn’t know about that allowed me to get a place,” he said.\u003c/p>\n\u003cp>Intensive case management like this is an example of the ambitious, sweeping changes California made to Medi-Cal beginning in January under an initiative it’s calling CalAIM, or California Advancing and Innovating Medi-Cal.\u003c/p>\n\u003cp>Medi-Cal \u003ca href=\"https://www.chcf.org/publication/2021-edition-medi-cal-facts-figures/\">offers medical insurance to lower-income Californians\u003c/a>, serving as a lifeline for nearly half the state’s children, 1 in 5 adults and 2 million seniors and people with disabilities. But the program is inefficient: More than half of Medi-Cal’s \u003ca href=\"https://calmatters.org/health/coronavirus/2021/07/medi-cal-covid-vaccinations/\">roughly $133 billion annual budget is spent on just 5% of the program’s highest-needs individuals\u003c/a> — people with multiple complex health problems compounded by homelessness, poverty, substance abuse, mental illness or incarceration, \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/CalAIM-ECM-a11y.pdf\">according the Department of Health Care Services\u003c/a>.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Edward El, CalAIM beneficiary\"]‘I’m happy. They knew about programs that I didn’t know about that allowed me to get a place.’[/pullquote]Over the next five years, CalAIM will seek to address the upstream drivers of deteriorating health — things like food insecurity and housing instability — in an effort to reduce costly emergency department visits, hospitalizations and nursing home stays. The program redesign is based on “whole person care” principles, which help people avoid situations that worsen their physical and mental health.\u003c/p>\n\u003cp>“This was designed at the county level to identify very high-risk populations — oftentimes people who were coming to the emergency room five to 10 times a month.” said Erica Murray, president and CEO of the California Association of Public Hospitals and Health Systems.\u003c/p>\n\u003cp>In his January budget, \u003ca href=\"https://www.ebudget.ca.gov/2022-23/pdf/GovernorsBudget/4000.pdf\">Gov. Gavin Newsom proposed $8 billion over five years to implement the program\u003c/a>, about 6% of Medi-Cal’s total budget. Included are temporary payments to managed care plans to offer enhanced case management and other services.\u003c/p>\n\u003cp>These so-called social determinants of health have not been historically covered by health insurance like Medi-Cal. Yet they have an outsized impact on people who often struggle with economic instability, poor nutrition, discrimination, violence and disproportionate exposure to polluted air and water.\u003c/p>\n\u003cp>“One of my patients calls it social deterrents to health,” said Alameda County Medical Director Dr. Kathleen Clanon.\u003c/p>\n\u003cp>No other state has mounted such a comprehensive program that wraps in so many elements. The scale is unprecedented, too: Medi-Cal provides health insurance for more than 13 million people.\u003c/p>\n\u003cp>[aside postID=\"news_11887815\" hero=\"https://ww2.kqed.org/app/uploads/sites/10/2021/09/GettyImages-1233456190-1020x680.jpg\"]“This is a big deal. Not only is California taking the lead but also setting a precedent for potentially other states to follow it,” said Anthony Wright, executive director of Health Access California, a consumer advocate group.\u003c/p>\n\u003cp>Pilot programs in 25 counties helped get CalAIM off the ground. Roughly \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/wholepersoncare-report-jan2020.pdf\">108,000 Medi-Cal patients were enrolled in county pilots\u003c/a> and \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/First-Interim-Evaluation-CA-HHP-Report-sep2020.pdf\">15,000 in managed care pilots during a two-year period\u003c/a>, according to an early analysis by UCLA researchers. As a result of the success, federal officials granted a waiver allowing CalAIM to move forward for the next five years.\u003c/p>\n\u003cp>In Placer County, David Norris, 67, was one of the patients who benefited from the experimental programs.\u003c/p>\n\u003cp>Norris ended up in a homeless shelter after his mother, for whom he was a long-term caregiver, died. He earns $900 a month in Social Security and retirement, but it’s not enough for rent and living expenses. In April, an infected foot wound spread to the bone and cost Norris his left leg. Another infection resulted in more trips to the ER and subsequent surgeries. Several months later, a fight at the shelter ended in a shove, a fall and a broken right leg.\u003c/p>\n\u003cp>His caseworker, Todd Perbetsky, helped him enroll in Medi-Cal, find a nursing home where he could recuperate and apply for a housing voucher. He’s now helping Norris find permanent housing after leaving the nursing home.\u003c/p>\n\u003cp>“These are definitely people that are falling through the cracks,” Perbetsky said. “They may not meet the criteria of some programs. They may need linkage to services. They can have tons of barriers to even getting their CalFresh turned on or other benefits they qualify for.”\u003c/p>\n\u003cp>Norris called Perbetsky a “hell of a godsend. If you don’t know the ins and outs, you just get spit out. You get absolutely no help at all. That’s where Todd … helps me and people like me navigate the waters and get all squared away.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003ch2>\u003cstrong>Creating a one-stop shop\u003c/strong>\u003c/h2>\n\u003cp>Wraparound services aren’t new, but they haven’t always been easy to access, nor have they been directly connected to medical care. Walk through the wrong door and you might not get any help at all.\u003c/p>\n\u003cp>An unhoused patient who suffers from addiction and mental health issues and has diabetes would have to approach three different county departments and a doctor to get all their needs addressed, and even then they’re likely to get lost in the system.\u003c/p>\n\u003cp>“It’s a little bit like if you needed to get ingredients for a meal and instead of just going to the supermarket, you had to go to different stores to get your proteins and your fruits and your grains and your vegetables. And at those stores, you had to pay with different cards and navigate different rules about what you could buy,” said Melora Simon, a senior strategist at the California Health Care Foundation.\u003c/p>\n\u003cp>[aside postID=\"news_11894981\" hero=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/NPR-fentanyl-1-1020x766.jpg\"]This fragmentation frequently causes barriers to health care and is one of the primary reasons the Department of Health Care Services is focused on reforming Medi-Cal under CalAIM.\u003c/p>\n\u003cp>One such barrier is making sure patients don’t get lost between systems that don’t traditionally talk to one another.\u003c/p>\n\u003cp>Clanon, who also works as a physician in Alameda County, said a few years ago a pregnant, HIV-positive patient needed to begin HIV treatment but had left the usual encampment she stayed in and couldn’t be found. A nurse spent more than an hour calling local emergency departments, homeless shelters and case managers to see whether anyone had seen the patient, with no luck.\u003c/p>\n\u003cp>Had the system been integrated, Clanon’s patient would have been flagged as needing critical medical care any time she entered a homeless shelter, emergency department, substance abuse center or mental health facility.\u003c/p>\n\u003cp>“CalAIM is trying to fix the problem of disparate systems of care both among and between different counties and among and between different parts of the health care system,” said Diana Douglas, a health policy expert with Health Access California.\u003c/p>\n\u003ch2>\u003cstrong>Accountability and missing pieces\u003c/strong>\u003c/h2>\n\u003cp>Since 2016, California has dedicated more than $3 billion in state and federal funds to experiment with doing just that.\u003c/p>\n\u003cp>Four years after launch, the pilots demonstrated “substantial evidence” of improved follow-up after hospitalization for mental illness, increased participation in substance abuse treatment and decreased use of emergency services, among other metrics, \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/First-Interim-Evaluation-CA-HHP-Report-sep2020.pdf\">according to the UCLA analysis\u003c/a>.\u003c/p>\n\u003cp>In Contra Costa County, more than 12,000 patients were enrolled in the pilot annually, and the county health department hired more than 100 public health nurses, mental health specialists, community health workers, homeless service specialists, substance abuse specialists and social workers to provide coordinated case management.\u003c/p>\n\u003cp>“Most of them were types of positions that existed in the county before, but they were very siloed,” said Emily Parmenter, the pilot’s program manager at Contra Costa County Health Services. “So we brought them all together in these multidisciplinary teams where they had a wealth of experience … and were able to provide case consultations across divisions.”\u003c/p>\n\u003cp>Medi-Cal patients who enrolled in the Contra Costa pilot experienced medical emergencies less frequently than nonenrolled patients.\u003c/p>\n\u003cp>“We found that after being involved in the program for a year, our hospital admission rates decreased by 25% … and our [emergency department] rates were 14% lower compared to the control group,” Parmenter said.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Emily Parmenter, Contra Costa Health Services\"]‘We found that after being involved in the program for a year, our hospital admission rates decreased by 25%.’[/pullquote]UCLA researcher Nadereh Pourat, who conducted the pilot evaluation, said her team has just begun to analyze the impact on specific health conditions, such as blood pressure and congestive heart failure, as well as cost-effectiveness.\u003c/p>\n\u003cp>Despite their promise — or perhaps because of it — advocates say the transition from pilot programs to CalAIM will need to be watched carefully.\u003c/p>\n\u003cp>Responsibility has now shifted from county health departments to health care plans, which don’t always meet quality benchmarks. And health care plans in the 33 counties that did not have pilots are starting from scratch.\u003c/p>\n\u003cp>“There are serious concerns about Medi-Cal [health care] plans on the ground being able to implement some of the work necessary for CalAIM to really be effective and live up to its potential,” health policy expert Douglas said.\u003c/p>\n\u003cp>“In some cases, plans struggle to deliver quality care across what we think of as very basic measures: childhood immunizations, are people getting mammograms on time, just very basic preventive care and chronic disease management,” she said.\u003c/p>\n\u003cfigure id=\"attachment_11905185\" class=\"wp-caption alignnone\" style=\"max-width: 1024px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11905185\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-10-CM_11.jpg\" alt=\"Two people sit at a table, handling paperwork. One person has their backed to the camera, the other one sits across from them.\" width=\"1024\" height=\"682\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/02/020922-CALAIM-MHN-10-CM_11.jpg 1024w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/02/020922-CALAIM-MHN-10-CM_11-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/02/020922-CALAIM-MHN-10-CM_11-1020x679.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/02/020922-CALAIM-MHN-10-CM_11-160x107.jpg 160w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\">\u003cfigcaption class=\"wp-caption-text\">Alameda County intake specialist Annie Wyley meets with a Medi-Cal patient in the repurposed dining room at the Radisson Hotel in Oakland. \u003ccite>(Martin do Nascimento/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Accountability is especially important for improving equity among communities of color, advocates say.\u003c/p>\n\u003cp>“Communities of color are disproportionately impacted by these same factors: lack of housing, lack of income, lack of food security,” said Cary Sanders, senior policy director for the California Pan-Ethnic Health Network.\u003c/p>\n\u003cp>Health plans need to provide services that are “linguistically and culturally appropriate,” Sanders said.\u003c/p>\n\u003cp>One critical piece of the pilot programs that was left out of CalAIM is legal aid. In counties that funded legal aid during the pilot programs, lawyers and paralegals were stationed in medical clinics to assist patients who needed help with benefit denials, eviction notices, immigration issues or domestic abuse cases.\u003c/p>\n\u003cp>Frequently patients and even their doctors don’t realize that their issue could use the help of a lawyer, said Daniel Nesbit, managing attorney for medical legal partnerships with California Rural Legal Assistance. Nesbit said that during the pilot program in Monterey County his team helped 700 clients with more than 1,000 cases.\u003c/p>\n\u003cp>“A really good example is someone struggling with some sort of medical condition, and it’s making it hard for them to go to work every day and do their job to the full extent,” Nesbit said. “They might not know, for example, that they have a possible right to a reasonable accommodation under the Americans with Disabilities Act.”\u003c/p>\n\u003cp>Alameda and Contra Costa counties, which contracted with Bay Area Legal Aid to participate in the pilot, hired five additional attorneys dedicated to assisting Medi-Cal patients. The partnership helped reach people who ordinarily wouldn’t be able to access legal aid because their disability prevented them from attending an appointment or they didn’t have a phone number or an address. Case managers were able to link people to the attorneys, accounting for 300 referrals a year.\u003c/p>\n\u003cp>But when the pilot ended in December and state funding dried up, attorneys were reassigned and are no longer able to focus on Medi-Cal patients.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Diana Douglas, Health Access California\"]‘There are serious concerns about Medi-Cal [health care] … being able to implement some of the work necessary for CalAIM to really be effective.’[/pullquote]“I’m still getting emails and phone calls from the case managers I worked with who I think are now kind of scrambling to figure out how to help,” said Abby Khodayari, an attorney who worked in Contra Costa County’s program. “Case managers are hoping to get help analyzing eviction notices and figuring out the validity of them. It’s hard not having dedicated time to be able to spend working on those issues.”\u003c/p>\n\u003cp>While legal services aren’t explicitly named as one of 14 preapproved services under CalAIM, the Department of Health Care Services said health care plans could integrate them as part of supportive housing services, which are covered.\u003c/p>\n\u003cp>But attorneys say it’s unlikely to happen unless plans get specific guarantees that CalAIM will cover the cost. They hope that subsequent phases of CalAIM will include legal aid.\u003c/p>\n\u003cp>“There hasn’t been a health plan here in LA who’s come forward and said we want to offer these legal services,” said Gerson Sorto, a managing attorney with Neighborhood Legal Services of Los Angeles County.\u003c/p>\n\u003cp>Los Angeles County has continued funding their partnership through the summer, but there’s no permanent money in sight. “As of today, there is no funding secured or confirmed beyond June 30,” Sorto said.\u003c/p>\n\u003ch2>\u003cstrong>Life under ‘whole person care’\u003c/strong>\u003c/h2>\n\u003cp>Back at the Radisson Hotel in Oakland, the shelter where El is waiting patiently to move into his new apartment, he watches a home renovation show on the television. He likes to see how the hosts redesign the interior and gets ideas for his own future home.\u003c/p>\n\u003cp>Before losing his job, El lived in an apartment near Lake Merritt but hasn’t had a place to call his own in years. After he enrolled in Alameda County’s pilot program, things started turning around for him.\u003c/p>\n\u003cp>“These people really respect you and help if you ask for it,” El said.\u003c/p>\n\u003cp>Part of the program is connecting Medi-Cal patients to peers with similar backgrounds.\u003c/p>\n\u003cp>[aside label='More Housing Coverage' tag='housing']“You can’t tell them ‘do this and do that.’ You walk alongside someone and support whatever they’ve got going on,” said Michael Webb, a CalAIM peer support navigator who experienced addiction and homelessness. “Most importantly,” he said, “[is] someone to listen. I might not have any answer at all but there’s power in listening.”\u003c/p>\n\u003cp>Down the hall from El’s room, shelter monitors are delivering lunch to residents who can’t make it to the dining room. Lunch is a chicken sandwich, banana, salad and a soda, but those with dietary restrictions or certain medical conditions like diabetes get tailored meals.\u003c/p>\n\u003cp>As part of the CalAIM program, caretakers perform wellness checks on shelter residents with disabilities, helping them clean, bathe and use the restroom.\u003c/p>\n\u003cp>In the lobby, an intake worker asks a new guest about his seizure disorder and works to link him to his CalAIM team of health care providers, case workers and housing navigators. As the program grows, millions more Californians may benefit. On this day alone, the Oakland team expects to sign up eight new people.\u003cbr>\n[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "California's first-of-its-kind Medi-Cal reform aims to help lower-income patients navigate problems like homelessness, poverty and substance abuse that can harm health.",
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"title": "California Reformed Medi-Cal to Include 'Whole Person Care' — Is It Working? | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>At 66, Edward El has a new lease on life — literally. In two weeks, he’ll move into his own apartment in Berkeley after spending the better part of the past 16 years unhoused.\u003c/p>\n\u003cp>Years ago, a back injury and pinched nerves in his legs made standing and walking painful, and he was laid off from his construction job. He ended up in “shelter after shelter after shelter.”\u003c/p>\n\u003cp>But nine months ago, El moved into one of 12 Project Roomkey shelters in Alameda County designed to reduce COVID-19 among the unhoused population. He was connected with a housing navigator, a counselor and medical staff. They helped El apply for affordable housing and rental assistance vouchers, and coordinated with landlords who would give unhoused renters a chance.\u003c/p>\n\u003cfigure id=\"attachment_11905186\" class=\"wp-caption alignnone\" style=\"max-width: 1536px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11905186\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-14-CM.jpg\" alt=\"A man, wearing a hoodie, beanie and a face mask, sits on a chair in an indoor space. He looks to the side, a bit away from the camera.\" width=\"1536\" height=\"1025\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/02/020922-CALAIM-MHN-14-CM.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/02/020922-CALAIM-MHN-14-CM-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/02/020922-CALAIM-MHN-14-CM-1020x681.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/02/020922-CALAIM-MHN-14-CM-160x107.jpg 160w\" sizes=\"auto, (max-width: 1536px) 100vw, 1536px\">\u003cfigcaption class=\"wp-caption-text\">As Edward El prepares to move to a permanent home, he has enrolled in Medi-Cal. He said he couldn’t have navigated the array of complex systems if it weren’t for his new case management team. ‘I’m happy. They knew about programs that I didn’t know about that allowed me to get a place,’ he said. \u003ccite>(Martin do Nascimento/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Now El will pay a fraction of the cost to live in an area where one-bedroom apartments often exceed $3,000 per month.\u003c/p>\n\u003cp>The team also made sure that El was enrolled in Medi-Cal and had transportation to his doctor’s appointments. He said he couldn’t have navigated the array of complex systems if it weren’t for his new case management team. “I’m happy. They knew about programs that I didn’t know about that allowed me to get a place,” he said.\u003c/p>\n\u003cp>Intensive case management like this is an example of the ambitious, sweeping changes California made to Medi-Cal beginning in January under an initiative it’s calling CalAIM, or California Advancing and Innovating Medi-Cal.\u003c/p>\n\u003cp>Medi-Cal \u003ca href=\"https://www.chcf.org/publication/2021-edition-medi-cal-facts-figures/\">offers medical insurance to lower-income Californians\u003c/a>, serving as a lifeline for nearly half the state’s children, 1 in 5 adults and 2 million seniors and people with disabilities. But the program is inefficient: More than half of Medi-Cal’s \u003ca href=\"https://calmatters.org/health/coronavirus/2021/07/medi-cal-covid-vaccinations/\">roughly $133 billion annual budget is spent on just 5% of the program’s highest-needs individuals\u003c/a> — people with multiple complex health problems compounded by homelessness, poverty, substance abuse, mental illness or incarceration, \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/CalAIM-ECM-a11y.pdf\">according the Department of Health Care Services\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Over the next five years, CalAIM will seek to address the upstream drivers of deteriorating health — things like food insecurity and housing instability — in an effort to reduce costly emergency department visits, hospitalizations and nursing home stays. The program redesign is based on “whole person care” principles, which help people avoid situations that worsen their physical and mental health.\u003c/p>\n\u003cp>“This was designed at the county level to identify very high-risk populations — oftentimes people who were coming to the emergency room five to 10 times a month.” said Erica Murray, president and CEO of the California Association of Public Hospitals and Health Systems.\u003c/p>\n\u003cp>In his January budget, \u003ca href=\"https://www.ebudget.ca.gov/2022-23/pdf/GovernorsBudget/4000.pdf\">Gov. Gavin Newsom proposed $8 billion over five years to implement the program\u003c/a>, about 6% of Medi-Cal’s total budget. Included are temporary payments to managed care plans to offer enhanced case management and other services.\u003c/p>\n\u003cp>These so-called social determinants of health have not been historically covered by health insurance like Medi-Cal. Yet they have an outsized impact on people who often struggle with economic instability, poor nutrition, discrimination, violence and disproportionate exposure to polluted air and water.\u003c/p>\n\u003cp>“One of my patients calls it social deterrents to health,” said Alameda County Medical Director Dr. Kathleen Clanon.\u003c/p>\n\u003cp>No other state has mounted such a comprehensive program that wraps in so many elements. The scale is unprecedented, too: Medi-Cal provides health insurance for more than 13 million people.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“This is a big deal. Not only is California taking the lead but also setting a precedent for potentially other states to follow it,” said Anthony Wright, executive director of Health Access California, a consumer advocate group.\u003c/p>\n\u003cp>Pilot programs in 25 counties helped get CalAIM off the ground. Roughly \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/wholepersoncare-report-jan2020.pdf\">108,000 Medi-Cal patients were enrolled in county pilots\u003c/a> and \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/First-Interim-Evaluation-CA-HHP-Report-sep2020.pdf\">15,000 in managed care pilots during a two-year period\u003c/a>, according to an early analysis by UCLA researchers. As a result of the success, federal officials granted a waiver allowing CalAIM to move forward for the next five years.\u003c/p>\n\u003cp>In Placer County, David Norris, 67, was one of the patients who benefited from the experimental programs.\u003c/p>\n\u003cp>Norris ended up in a homeless shelter after his mother, for whom he was a long-term caregiver, died. He earns $900 a month in Social Security and retirement, but it’s not enough for rent and living expenses. In April, an infected foot wound spread to the bone and cost Norris his left leg. Another infection resulted in more trips to the ER and subsequent surgeries. Several months later, a fight at the shelter ended in a shove, a fall and a broken right leg.\u003c/p>\n\u003cp>His caseworker, Todd Perbetsky, helped him enroll in Medi-Cal, find a nursing home where he could recuperate and apply for a housing voucher. He’s now helping Norris find permanent housing after leaving the nursing home.\u003c/p>\n\u003cp>“These are definitely people that are falling through the cracks,” Perbetsky said. “They may not meet the criteria of some programs. They may need linkage to services. They can have tons of barriers to even getting their CalFresh turned on or other benefits they qualify for.”\u003c/p>\n\u003cp>Norris called Perbetsky a “hell of a godsend. If you don’t know the ins and outs, you just get spit out. You get absolutely no help at all. That’s where Todd … helps me and people like me navigate the waters and get all squared away.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003ch2>\u003cstrong>Creating a one-stop shop\u003c/strong>\u003c/h2>\n\u003cp>Wraparound services aren’t new, but they haven’t always been easy to access, nor have they been directly connected to medical care. Walk through the wrong door and you might not get any help at all.\u003c/p>\n\u003cp>An unhoused patient who suffers from addiction and mental health issues and has diabetes would have to approach three different county departments and a doctor to get all their needs addressed, and even then they’re likely to get lost in the system.\u003c/p>\n\u003cp>“It’s a little bit like if you needed to get ingredients for a meal and instead of just going to the supermarket, you had to go to different stores to get your proteins and your fruits and your grains and your vegetables. And at those stores, you had to pay with different cards and navigate different rules about what you could buy,” said Melora Simon, a senior strategist at the California Health Care Foundation.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>This fragmentation frequently causes barriers to health care and is one of the primary reasons the Department of Health Care Services is focused on reforming Medi-Cal under CalAIM.\u003c/p>\n\u003cp>One such barrier is making sure patients don’t get lost between systems that don’t traditionally talk to one another.\u003c/p>\n\u003cp>Clanon, who also works as a physician in Alameda County, said a few years ago a pregnant, HIV-positive patient needed to begin HIV treatment but had left the usual encampment she stayed in and couldn’t be found. A nurse spent more than an hour calling local emergency departments, homeless shelters and case managers to see whether anyone had seen the patient, with no luck.\u003c/p>\n\u003cp>Had the system been integrated, Clanon’s patient would have been flagged as needing critical medical care any time she entered a homeless shelter, emergency department, substance abuse center or mental health facility.\u003c/p>\n\u003cp>“CalAIM is trying to fix the problem of disparate systems of care both among and between different counties and among and between different parts of the health care system,” said Diana Douglas, a health policy expert with Health Access California.\u003c/p>\n\u003ch2>\u003cstrong>Accountability and missing pieces\u003c/strong>\u003c/h2>\n\u003cp>Since 2016, California has dedicated more than $3 billion in state and federal funds to experiment with doing just that.\u003c/p>\n\u003cp>Four years after launch, the pilots demonstrated “substantial evidence” of improved follow-up after hospitalization for mental illness, increased participation in substance abuse treatment and decreased use of emergency services, among other metrics, \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/First-Interim-Evaluation-CA-HHP-Report-sep2020.pdf\">according to the UCLA analysis\u003c/a>.\u003c/p>\n\u003cp>In Contra Costa County, more than 12,000 patients were enrolled in the pilot annually, and the county health department hired more than 100 public health nurses, mental health specialists, community health workers, homeless service specialists, substance abuse specialists and social workers to provide coordinated case management.\u003c/p>\n\u003cp>“Most of them were types of positions that existed in the county before, but they were very siloed,” said Emily Parmenter, the pilot’s program manager at Contra Costa County Health Services. “So we brought them all together in these multidisciplinary teams where they had a wealth of experience … and were able to provide case consultations across divisions.”\u003c/p>\n\u003cp>Medi-Cal patients who enrolled in the Contra Costa pilot experienced medical emergencies less frequently than nonenrolled patients.\u003c/p>\n\u003cp>“We found that after being involved in the program for a year, our hospital admission rates decreased by 25% … and our [emergency department] rates were 14% lower compared to the control group,” Parmenter said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>UCLA researcher Nadereh Pourat, who conducted the pilot evaluation, said her team has just begun to analyze the impact on specific health conditions, such as blood pressure and congestive heart failure, as well as cost-effectiveness.\u003c/p>\n\u003cp>Despite their promise — or perhaps because of it — advocates say the transition from pilot programs to CalAIM will need to be watched carefully.\u003c/p>\n\u003cp>Responsibility has now shifted from county health departments to health care plans, which don’t always meet quality benchmarks. And health care plans in the 33 counties that did not have pilots are starting from scratch.\u003c/p>\n\u003cp>“There are serious concerns about Medi-Cal [health care] plans on the ground being able to implement some of the work necessary for CalAIM to really be effective and live up to its potential,” health policy expert Douglas said.\u003c/p>\n\u003cp>“In some cases, plans struggle to deliver quality care across what we think of as very basic measures: childhood immunizations, are people getting mammograms on time, just very basic preventive care and chronic disease management,” she said.\u003c/p>\n\u003cfigure id=\"attachment_11905185\" class=\"wp-caption alignnone\" style=\"max-width: 1024px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11905185\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-10-CM_11.jpg\" alt=\"Two people sit at a table, handling paperwork. One person has their backed to the camera, the other one sits across from them.\" width=\"1024\" height=\"682\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/02/020922-CALAIM-MHN-10-CM_11.jpg 1024w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/02/020922-CALAIM-MHN-10-CM_11-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/02/020922-CALAIM-MHN-10-CM_11-1020x679.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/02/020922-CALAIM-MHN-10-CM_11-160x107.jpg 160w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\">\u003cfigcaption class=\"wp-caption-text\">Alameda County intake specialist Annie Wyley meets with a Medi-Cal patient in the repurposed dining room at the Radisson Hotel in Oakland. \u003ccite>(Martin do Nascimento/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Accountability is especially important for improving equity among communities of color, advocates say.\u003c/p>\n\u003cp>“Communities of color are disproportionately impacted by these same factors: lack of housing, lack of income, lack of food security,” said Cary Sanders, senior policy director for the California Pan-Ethnic Health Network.\u003c/p>\n\u003cp>Health plans need to provide services that are “linguistically and culturally appropriate,” Sanders said.\u003c/p>\n\u003cp>One critical piece of the pilot programs that was left out of CalAIM is legal aid. In counties that funded legal aid during the pilot programs, lawyers and paralegals were stationed in medical clinics to assist patients who needed help with benefit denials, eviction notices, immigration issues or domestic abuse cases.\u003c/p>\n\u003cp>Frequently patients and even their doctors don’t realize that their issue could use the help of a lawyer, said Daniel Nesbit, managing attorney for medical legal partnerships with California Rural Legal Assistance. Nesbit said that during the pilot program in Monterey County his team helped 700 clients with more than 1,000 cases.\u003c/p>\n\u003cp>“A really good example is someone struggling with some sort of medical condition, and it’s making it hard for them to go to work every day and do their job to the full extent,” Nesbit said. “They might not know, for example, that they have a possible right to a reasonable accommodation under the Americans with Disabilities Act.”\u003c/p>\n\u003cp>Alameda and Contra Costa counties, which contracted with Bay Area Legal Aid to participate in the pilot, hired five additional attorneys dedicated to assisting Medi-Cal patients. The partnership helped reach people who ordinarily wouldn’t be able to access legal aid because their disability prevented them from attending an appointment or they didn’t have a phone number or an address. Case managers were able to link people to the attorneys, accounting for 300 referrals a year.\u003c/p>\n\u003cp>But when the pilot ended in December and state funding dried up, attorneys were reassigned and are no longer able to focus on Medi-Cal patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“I’m still getting emails and phone calls from the case managers I worked with who I think are now kind of scrambling to figure out how to help,” said Abby Khodayari, an attorney who worked in Contra Costa County’s program. “Case managers are hoping to get help analyzing eviction notices and figuring out the validity of them. It’s hard not having dedicated time to be able to spend working on those issues.”\u003c/p>\n\u003cp>While legal services aren’t explicitly named as one of 14 preapproved services under CalAIM, the Department of Health Care Services said health care plans could integrate them as part of supportive housing services, which are covered.\u003c/p>\n\u003cp>But attorneys say it’s unlikely to happen unless plans get specific guarantees that CalAIM will cover the cost. They hope that subsequent phases of CalAIM will include legal aid.\u003c/p>\n\u003cp>“There hasn’t been a health plan here in LA who’s come forward and said we want to offer these legal services,” said Gerson Sorto, a managing attorney with Neighborhood Legal Services of Los Angeles County.\u003c/p>\n\u003cp>Los Angeles County has continued funding their partnership through the summer, but there’s no permanent money in sight. “As of today, there is no funding secured or confirmed beyond June 30,” Sorto said.\u003c/p>\n\u003ch2>\u003cstrong>Life under ‘whole person care’\u003c/strong>\u003c/h2>\n\u003cp>Back at the Radisson Hotel in Oakland, the shelter where El is waiting patiently to move into his new apartment, he watches a home renovation show on the television. He likes to see how the hosts redesign the interior and gets ideas for his own future home.\u003c/p>\n\u003cp>Before losing his job, El lived in an apartment near Lake Merritt but hasn’t had a place to call his own in years. After he enrolled in Alameda County’s pilot program, things started turning around for him.\u003c/p>\n\u003cp>“These people really respect you and help if you ask for it,” El said.\u003c/p>\n\u003cp>Part of the program is connecting Medi-Cal patients to peers with similar backgrounds.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“You can’t tell them ‘do this and do that.’ You walk alongside someone and support whatever they’ve got going on,” said Michael Webb, a CalAIM peer support navigator who experienced addiction and homelessness. “Most importantly,” he said, “[is] someone to listen. I might not have any answer at all but there’s power in listening.”\u003c/p>\n\u003cp>Down the hall from El’s room, shelter monitors are delivering lunch to residents who can’t make it to the dining room. Lunch is a chicken sandwich, banana, salad and a soda, but those with dietary restrictions or certain medical conditions like diabetes get tailored meals.\u003c/p>\n\u003cp>As part of the CalAIM program, caretakers perform wellness checks on shelter residents with disabilities, helping them clean, bathe and use the restroom.\u003c/p>\n\u003cp>In the lobby, an intake worker asks a new guest about his seizure disorder and works to link him to his CalAIM team of health care providers, case workers and housing navigators. As the program grows, millions more Californians may benefit. On this day alone, the Oakland team expects to sign up eight new people.\u003cbr>\n\u003c/p>\u003c/div>",
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"content": "\u003cp>\u003cem>Editor’s note: KHN is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cp>Gov. Gavin Newsom’s administration has negotiated a secret deal to give Kaiser Permanente a special Medicaid contract that would allow the health care behemoth to expand its reach in California and largely continue selecting the enrollees it wants, which other health care plans say leaves them with a disproportionate share of the program’s sickest and costliest patients.\u003c/p>\n\u003cp>The deal, hammered out behind closed doors between Kaiser Permanente and senior officials in Newsom’s office, could complicate a long-planned and expensive transformation of Medi-Cal, the state’s Medicaid program, which covers roughly 14 million lower-income Californians.\u003c/p>\n\u003cp>It has infuriated executives of other managed-care insurance plans in Medi-Cal, who say they stand to lose hundreds of thousands of patients and millions of dollars a year. The deal allows KP to limit enrollment primarily to its previous enrollees, except in the case of kids in foster care and people who are eligible for both Medicare and Medi-Cal.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Jarrod McNaughton, CEO, Inland Empire Health Plan\"]‘[This deal] has caused a massive amount of frenzy.’[/pullquote]\u003c/p>\n\u003cp>“It has caused a massive amount of frenzy,” said Jarrod McNaughton, CEO of the Inland Empire Health Plan, which covers about 1.5 million Medi-Cal enrollees in Riverside and San Bernardino counties. “All of us are doing our best to implement the most transformational Medi-Cal initiative in state history, and to put all this together without a public process is very disconcerting.”\u003c/p>\n\u003cp>Linnea Koopmans, CEO of the Local Health Plans of California, echoed McNaughton’s concerns.\u003c/p>\n\u003cp>Insurance plans got wind of the backroom talks when broad outlines of the deal were leaked days before the state briefed their executives Thursday.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Dr. Bechara Choucair, Kaiser Permanente’s chief health officer, argued \u003ca href=\"https://khn.org/wp-content/uploads/sites/2/2022/02/Kaiser-Permanente-response-to-KHN-inquiry.pdf\">in a prepared written response\u003c/a> on behalf of KP that because it operates both as a health insurer and a health care provider, KP should be treated differently from other commercial health care plans that participate in Medi-Cal. Doing business directly with the state will eliminate complexity and improve the quality of care for the Medi-Cal patients it serves, he said.\u003c/p>\n\u003cp>“We are not seeking to turn a profit off Medi-Cal enrollment,” Choucair said. “Kaiser Permanente participates in Medi-Cal because it is part of our mission to improve the health of the communities we serve. We participate in Medi-Cal despite incurring losses every year.”\u003c/p>\n\u003cp>His statement cited nearly $1.8 billion in losses in the program in 2020 and said KP had donated $402 million to help care for uninsured people that year.\u003c/p>\n\u003cp>Kaiser Permanente, the state’s largest managed-care organization, is one of Newsom’s most generous supporters and close political allies.\u003c/p>\n\u003cp>The new, five-year contract, confirmed to KHN by administration officials and expected to be announced publicly Friday, will take effect in 2024 pending approval from the Legislature — and will make KP the only insurer with a statewide Medi-Cal contract. It allows KP to solidify its position before California’s other commercial Medi-Cal plans participate in a \u003ca href=\"https://californiahealthline.org/news/article/californias-reboot-of-troubled-medi-cal-puts-pressure-on-health-plans/\">statewide bidding process\u003c/a> — and after those plans have spent many months and considerable resources developing their bidding strategies.\u003c/p>\n\u003cp>[aside postID=news_11902149 hero='https://ww2.kqed.org/app/uploads/sites/10/2022/01/RS53217_034_Richmond_LifelongCOVIDClinic_01192022-qut-1020x680.jpg']Other health care plans fear the contract could also muddle a massive and expensive initiative called \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-makeover-calaim-homeless-whole-body-care/\">CalAIM\u003c/a> that seeks to provide social services to the state’s most vulnerable patients, including home-delivered meals, housing aid for unhoused people, and \u003ca href=\"https://californiahealthline.org/news/article/mattresses-and-mold-removal-medi-cal-to-offer-unconventional-treatments-to-asthma-patients/\">mold removal\u003c/a> from homes. Under its new contract, KP must provide some of those services. But some executives at other health care plans say KP will not have to enroll a large number of sick patients who need such services because of how it limits enrollment.\u003c/p>\n\u003cp>Critics of the deal noted Newsom’s close relationship with KP, which has given nearly $100 million in charitable funding and grant money to boost Newsom’s efforts against homelessness, COVID response and wildfire relief since 2019, according to state records and KP news releases. The health care giant was also one of two hospital systems awarded a no-bid contract from the state to run a \u003ca href=\"https://about.kaiserpermanente.org/our-story/news/announcements/innovative-partnership-creates-los-angeles-surge-hospital\">field hospital in Los Angeles\u003c/a> during the early days of the COVID pandemic, and it got \u003ca href=\"https://khn.org/news/article/blue-shield-spent-years-cultivating-a-relationship-with-newsom-it-got-the-state-vaccine-contract/\">a special agreement\u003c/a> from the Newsom administration to help vaccinate Californians last year.\u003c/p>\n\u003cp>Jim DeBoo, Newsom’s executive secretary, \u003ca href=\"https://cal-access.sos.ca.gov/Lobbying/Firms/Detail.aspx?id=1364764&session=2019\">used to lobby for KP\u003c/a> before joining the administration. Toby Douglas, a former director of the state Department of Health Care Services, which runs Medi-Cal, is now Kaiser Permanente’s vice president for national Medicaid.\u003c/p>\n\u003cp>https://twitter.com/Paul_Erskine/status/1218294697593933825?s=20&t=VHrby3saI4V4EOHIQJNoWg\u003c/p>\n\u003cp>Still, many critics agree that Kaiser Permanente is a linchpin of the state’s health care system, with its strong focus on preventive care and high marks for quality of care. Many of the public insurance plans upset by the deal subcontract with KP for patient care and acknowledge that their overall quality scores will likely decline when KP goes its own way.\u003c/p>\n\u003cp>Michelle Baass, director of the state Department of Health Care Services, said Medi-Cal had risked losing KP’s “high quality” and “clinical expertise” altogether had it been required to accept all enrollees, as the other health plans must. But she said KP will have to comply with all other conditions that other plans must meet, including tightened requirements on access, quality, consumer satisfaction and health equity.\u003c/p>\n\u003cp>The state will also have greater oversight over patient care, she said.\u003c/p>\n\u003cp>“This proposal is a way to help ensure Kaiser treats more low-income patients, and that more low-income patients have access to Kaiser’s high-quality services,” Baass said.\u003c/p>\n\u003cp>Though Kaiser Permanente has 9 million enrollees, close to a quarter of all Californians, only about 900,000 of them are Medi-Cal members.\u003c/p>\n\u003cp>Under the current system, 12 of the 24 other managed care insurance plans that participate in Medi-Cal subcontract with KP to care for a subset of their patients, keeping a small slice of the Medi-Cal dollars earmarked for those patients. Under the new contract, KP can take those patients away and keep all the money.\u003c/p>\n\u003cp>In its subcontracts, and in counties where it enrolls patients directly, KP accepts only people who are recent Kaiser Permanente members and, in some cases, their family members. It is the only health plan that can limit its Medi-Cal enrollment in this way.\u003c/p>\n\u003cp>The new contract allows KP to continue this practice, but it also requires Kaiser Permanente to take on more children in foster care and complex, expensive patients who are eligible for both Medi-Cal and Medicare. It allows KP to expand its geographic reach in Medi-Cal to do so.\u003c/p>\n\u003cp>Baass said the state expects KP’s Medi-Cal enrollment to increase 25% over the life of the contract.\u003c/p>\n\u003cp>KP defended the practice of limiting enrollment primarily to its previous members, arguing that it provides “continuity of care when members transition into and out of Medi-Cal.”\u003c/p>\n\u003cp>[aside label='More Health Coverage' tag='health']The state has long pushed for a larger KP footprint in Medi-Cal, citing its high quality ratings, its strong integrated network, and its huge role on the broader health care landscape.\u003c/p>\n\u003cp>“Kaiser Permanente historically has not played a very big role in Medi-Cal, and the state has long recognized that we would benefit from having them more engaged because they get better health outcomes and focus on prevention,” said Daniel Zingale, a former Newsom administration official and health insurance regulator who now advises a lobbying firm that has Kaiser Permanente as a client.\u003c/p>\n\u003cp>But by accepting primarily people who have been KP members in the recent past, the health care system has been able to limit its share of high-need, expensive patients, say rival health plan executives and former state health officials.\u003c/p>\n\u003cp>The executives fear the deal could saddle them with even more of these patients in the future, including unhoused people and those with mental illnesses — and make it harder to provide adequate care for them. Many of those patients will join Medi-Cal for the first time under the CalAIM initiative, and KP will not be required to accept many of them.\u003c/p>\n\u003cp>“Awarding a no-bid Medi-Cal contract to a statewide commercial plan with a track record of ‘cherry picking’ members and offering only limited behavioral health and community support benefits not only conflicts with the intent and goals of CalAIM but undermines publicly organized health care,” according to an internal document prepared by the Inland Empire Health Plan.\u003c/p>\n\u003cp>The plan said it stands to lose the roughly 144,000 Medi-Cal members it delegates to KP and about $10 million in annual revenue. LA Care, the nation’s largest Medicaid health plan, with 2.4 million enrollees in Los Angeles County, will lose its 244,000 KP members, based on data shared by the plan.\u003c/p>\n\u003cp>The state had been scheduled on Wednesday to release final details and instructions for the commercial plans that are submitting bids for new contracts starting in 2024. But it delayed the release a week to make the KP deal public beforehand.\u003c/p>\n\u003cp>Baass said the state agreed to exempt KP from the bidding process because the standardized contract expected to result from it would have required the insurer to accept all enrollees, which Kaiser Permanente does not have the capacity to do.\u003c/p>\n\u003cp>“It’s not surprising to me that the state will go to extraordinary means to make sure that Kaiser is in the mix, given it has been in the vanguard of our health care delivery system,” Zingale said.\u003c/p>\n\u003cp>Having a direct statewide Medi-Cal contract will greatly reduce the administrative workload for KP, which will now deal with only one agency on reporting and oversight, rather than the 12 public plans it currently subcontracts with.\u003c/p>\n\u003cp>And the new contract will give it an even closer relationship with Newsom and state health officials.\u003c/p>\n\u003cp>In 2020, \u003ca href=\"https://about.kaiserpermanente.org/community-health/news/25m-pledge-to-california-governors-housing-fund\">KP gave $25 million to one of Newsom’s key initiatives\u003c/a>, a state homelessness fund to move people off the streets and into hotel rooms, according to a KHN analysis of charitable payments filed with the California \u003ca href=\"https://www.fppc.ca.gov/transparency/behested-payments.html\">Fair Political Practices Commission\u003c/a>. The same year, it donated $9.75 million to a state COVID relief fund.\u003c/p>\n\u003cp>In summer 2020, when local and state public health departments struggled to contain COVID spread, the health care giant pledged \u003ca href=\"https://about.kaiserpermanente.org/community-health/news/kaiser-permanente-commits-63m-to-support-contact-tracing-in-california\">$63 million in grant funding to help contract-tracing efforts\u003c/a>.\u003c/p>\n\u003cp>KP’s influence extends beyond its massive charitable giving. Its CEO, Greg Adams, landed an appointment on the governor’s economic recovery task force early in the pandemic, and Newsom has showcased KP hospitals at vaccine media events throughout the state.\u003c/p>\n\u003cp>https://twitter.com/KPSCALnews/status/1338603794062438400?s=20&t=4dpVkiilzowe4ESRlCyPOg\u003c/p>\n\u003cp>“In California and across the U.S., the campaign contributions and the organizing, the lobbying, all of that stuff is important,” said Andrew Kelly, an assistant professor of health policy at California State University, East Bay. “But there’s a different type of power that comes from your ability to have this privileged position within public programs.”\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"https://khn.org/\">KHN\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003cem>KHN is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Editor’s note: KHN is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cp>Gov. Gavin Newsom’s administration has negotiated a secret deal to give Kaiser Permanente a special Medicaid contract that would allow the health care behemoth to expand its reach in California and largely continue selecting the enrollees it wants, which other health care plans say leaves them with a disproportionate share of the program’s sickest and costliest patients.\u003c/p>\n\u003cp>The deal, hammered out behind closed doors between Kaiser Permanente and senior officials in Newsom’s office, could complicate a long-planned and expensive transformation of Medi-Cal, the state’s Medicaid program, which covers roughly 14 million lower-income Californians.\u003c/p>\n\u003cp>It has infuriated executives of other managed-care insurance plans in Medi-Cal, who say they stand to lose hundreds of thousands of patients and millions of dollars a year. The deal allows KP to limit enrollment primarily to its previous enrollees, except in the case of kids in foster care and people who are eligible for both Medicare and Medi-Cal.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It has caused a massive amount of frenzy,” said Jarrod McNaughton, CEO of the Inland Empire Health Plan, which covers about 1.5 million Medi-Cal enrollees in Riverside and San Bernardino counties. “All of us are doing our best to implement the most transformational Medi-Cal initiative in state history, and to put all this together without a public process is very disconcerting.”\u003c/p>\n\u003cp>Linnea Koopmans, CEO of the Local Health Plans of California, echoed McNaughton’s concerns.\u003c/p>\n\u003cp>Insurance plans got wind of the backroom talks when broad outlines of the deal were leaked days before the state briefed their executives Thursday.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Dr. Bechara Choucair, Kaiser Permanente’s chief health officer, argued \u003ca href=\"https://khn.org/wp-content/uploads/sites/2/2022/02/Kaiser-Permanente-response-to-KHN-inquiry.pdf\">in a prepared written response\u003c/a> on behalf of KP that because it operates both as a health insurer and a health care provider, KP should be treated differently from other commercial health care plans that participate in Medi-Cal. Doing business directly with the state will eliminate complexity and improve the quality of care for the Medi-Cal patients it serves, he said.\u003c/p>\n\u003cp>“We are not seeking to turn a profit off Medi-Cal enrollment,” Choucair said. “Kaiser Permanente participates in Medi-Cal because it is part of our mission to improve the health of the communities we serve. We participate in Medi-Cal despite incurring losses every year.”\u003c/p>\n\u003cp>His statement cited nearly $1.8 billion in losses in the program in 2020 and said KP had donated $402 million to help care for uninsured people that year.\u003c/p>\n\u003cp>Kaiser Permanente, the state’s largest managed-care organization, is one of Newsom’s most generous supporters and close political allies.\u003c/p>\n\u003cp>The new, five-year contract, confirmed to KHN by administration officials and expected to be announced publicly Friday, will take effect in 2024 pending approval from the Legislature — and will make KP the only insurer with a statewide Medi-Cal contract. It allows KP to solidify its position before California’s other commercial Medi-Cal plans participate in a \u003ca href=\"https://californiahealthline.org/news/article/californias-reboot-of-troubled-medi-cal-puts-pressure-on-health-plans/\">statewide bidding process\u003c/a> — and after those plans have spent many months and considerable resources developing their bidding strategies.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Other health care plans fear the contract could also muddle a massive and expensive initiative called \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-makeover-calaim-homeless-whole-body-care/\">CalAIM\u003c/a> that seeks to provide social services to the state’s most vulnerable patients, including home-delivered meals, housing aid for unhoused people, and \u003ca href=\"https://californiahealthline.org/news/article/mattresses-and-mold-removal-medi-cal-to-offer-unconventional-treatments-to-asthma-patients/\">mold removal\u003c/a> from homes. Under its new contract, KP must provide some of those services. But some executives at other health care plans say KP will not have to enroll a large number of sick patients who need such services because of how it limits enrollment.\u003c/p>\n\u003cp>Critics of the deal noted Newsom’s close relationship with KP, which has given nearly $100 million in charitable funding and grant money to boost Newsom’s efforts against homelessness, COVID response and wildfire relief since 2019, according to state records and KP news releases. The health care giant was also one of two hospital systems awarded a no-bid contract from the state to run a \u003ca href=\"https://about.kaiserpermanente.org/our-story/news/announcements/innovative-partnership-creates-los-angeles-surge-hospital\">field hospital in Los Angeles\u003c/a> during the early days of the COVID pandemic, and it got \u003ca href=\"https://khn.org/news/article/blue-shield-spent-years-cultivating-a-relationship-with-newsom-it-got-the-state-vaccine-contract/\">a special agreement\u003c/a> from the Newsom administration to help vaccinate Californians last year.\u003c/p>\n\u003cp>Jim DeBoo, Newsom’s executive secretary, \u003ca href=\"https://cal-access.sos.ca.gov/Lobbying/Firms/Detail.aspx?id=1364764&session=2019\">used to lobby for KP\u003c/a> before joining the administration. Toby Douglas, a former director of the state Department of Health Care Services, which runs Medi-Cal, is now Kaiser Permanente’s vice president for national Medicaid.\u003c/p>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>Still, many critics agree that Kaiser Permanente is a linchpin of the state’s health care system, with its strong focus on preventive care and high marks for quality of care. Many of the public insurance plans upset by the deal subcontract with KP for patient care and acknowledge that their overall quality scores will likely decline when KP goes its own way.\u003c/p>\n\u003cp>Michelle Baass, director of the state Department of Health Care Services, said Medi-Cal had risked losing KP’s “high quality” and “clinical expertise” altogether had it been required to accept all enrollees, as the other health plans must. But she said KP will have to comply with all other conditions that other plans must meet, including tightened requirements on access, quality, consumer satisfaction and health equity.\u003c/p>\n\u003cp>The state will also have greater oversight over patient care, she said.\u003c/p>\n\u003cp>“This proposal is a way to help ensure Kaiser treats more low-income patients, and that more low-income patients have access to Kaiser’s high-quality services,” Baass said.\u003c/p>\n\u003cp>Though Kaiser Permanente has 9 million enrollees, close to a quarter of all Californians, only about 900,000 of them are Medi-Cal members.\u003c/p>\n\u003cp>Under the current system, 12 of the 24 other managed care insurance plans that participate in Medi-Cal subcontract with KP to care for a subset of their patients, keeping a small slice of the Medi-Cal dollars earmarked for those patients. Under the new contract, KP can take those patients away and keep all the money.\u003c/p>\n\u003cp>In its subcontracts, and in counties where it enrolls patients directly, KP accepts only people who are recent Kaiser Permanente members and, in some cases, their family members. It is the only health plan that can limit its Medi-Cal enrollment in this way.\u003c/p>\n\u003cp>The new contract allows KP to continue this practice, but it also requires Kaiser Permanente to take on more children in foster care and complex, expensive patients who are eligible for both Medi-Cal and Medicare. It allows KP to expand its geographic reach in Medi-Cal to do so.\u003c/p>\n\u003cp>Baass said the state expects KP’s Medi-Cal enrollment to increase 25% over the life of the contract.\u003c/p>\n\u003cp>KP defended the practice of limiting enrollment primarily to its previous members, arguing that it provides “continuity of care when members transition into and out of Medi-Cal.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The state has long pushed for a larger KP footprint in Medi-Cal, citing its high quality ratings, its strong integrated network, and its huge role on the broader health care landscape.\u003c/p>\n\u003cp>“Kaiser Permanente historically has not played a very big role in Medi-Cal, and the state has long recognized that we would benefit from having them more engaged because they get better health outcomes and focus on prevention,” said Daniel Zingale, a former Newsom administration official and health insurance regulator who now advises a lobbying firm that has Kaiser Permanente as a client.\u003c/p>\n\u003cp>But by accepting primarily people who have been KP members in the recent past, the health care system has been able to limit its share of high-need, expensive patients, say rival health plan executives and former state health officials.\u003c/p>\n\u003cp>The executives fear the deal could saddle them with even more of these patients in the future, including unhoused people and those with mental illnesses — and make it harder to provide adequate care for them. Many of those patients will join Medi-Cal for the first time under the CalAIM initiative, and KP will not be required to accept many of them.\u003c/p>\n\u003cp>“Awarding a no-bid Medi-Cal contract to a statewide commercial plan with a track record of ‘cherry picking’ members and offering only limited behavioral health and community support benefits not only conflicts with the intent and goals of CalAIM but undermines publicly organized health care,” according to an internal document prepared by the Inland Empire Health Plan.\u003c/p>\n\u003cp>The plan said it stands to lose the roughly 144,000 Medi-Cal members it delegates to KP and about $10 million in annual revenue. LA Care, the nation’s largest Medicaid health plan, with 2.4 million enrollees in Los Angeles County, will lose its 244,000 KP members, based on data shared by the plan.\u003c/p>\n\u003cp>The state had been scheduled on Wednesday to release final details and instructions for the commercial plans that are submitting bids for new contracts starting in 2024. But it delayed the release a week to make the KP deal public beforehand.\u003c/p>\n\u003cp>Baass said the state agreed to exempt KP from the bidding process because the standardized contract expected to result from it would have required the insurer to accept all enrollees, which Kaiser Permanente does not have the capacity to do.\u003c/p>\n\u003cp>“It’s not surprising to me that the state will go to extraordinary means to make sure that Kaiser is in the mix, given it has been in the vanguard of our health care delivery system,” Zingale said.\u003c/p>\n\u003cp>Having a direct statewide Medi-Cal contract will greatly reduce the administrative workload for KP, which will now deal with only one agency on reporting and oversight, rather than the 12 public plans it currently subcontracts with.\u003c/p>\n\u003cp>And the new contract will give it an even closer relationship with Newsom and state health officials.\u003c/p>\n\u003cp>In 2020, \u003ca href=\"https://about.kaiserpermanente.org/community-health/news/25m-pledge-to-california-governors-housing-fund\">KP gave $25 million to one of Newsom’s key initiatives\u003c/a>, a state homelessness fund to move people off the streets and into hotel rooms, according to a KHN analysis of charitable payments filed with the California \u003ca href=\"https://www.fppc.ca.gov/transparency/behested-payments.html\">Fair Political Practices Commission\u003c/a>. The same year, it donated $9.75 million to a state COVID relief fund.\u003c/p>\n\u003cp>In summer 2020, when local and state public health departments struggled to contain COVID spread, the health care giant pledged \u003ca href=\"https://about.kaiserpermanente.org/community-health/news/kaiser-permanente-commits-63m-to-support-contact-tracing-in-california\">$63 million in grant funding to help contract-tracing efforts\u003c/a>.\u003c/p>\n\u003cp>KP’s influence extends beyond its massive charitable giving. Its CEO, Greg Adams, landed an appointment on the governor’s economic recovery task force early in the pandemic, and Newsom has showcased KP hospitals at vaccine media events throughout the state.\u003c/p>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>“In California and across the U.S., the campaign contributions and the organizing, the lobbying, all of that stuff is important,” said Andrew Kelly, an assistant professor of health policy at California State University, East Bay. “But there’s a different type of power that comes from your ability to have this privileged position within public programs.”\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"https://khn.org/\">KHN\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003cem>KHN is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "With Little Chance of Success, Single-Payer Health Care Bill Withdrawn Ahead of Vote in State Legislature",
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"content": "\u003cp>California Democrats decided not to advance a bill that would make the government pay for everybody’s health care in the nation’s most populous state. Assemblymember Ash Kalra announced that he would withdraw AB 1400, California Guaranteed Health Care for All Act (CalCare), from a vote today after it became clear there would not be enough votes for it to pass.\u003c/p>\n\u003cp>“Despite heavy opposition and substantial misinformation from those that stand to profit from our current healthcare system, we were able to ignite a realistic and achievable path toward single-payer and bring AB 1400 to the floor of the Assembly,” said Kalra in a news release. “Although the bill did not pass the Assembly by today’s deadline, this is only a pause for the single-payer movement; our coalition, including the mighty California Nurses Association, will continue the fight for accessible, affordable, and equitable healthcare for all Californians.”\u003c/p>\n\u003cp>The bill would have created the nation’s only statewide universal health care system and set its rules — but it would not have paid for it. There’s another bill that would do that. It has a different deadline and does not have to pass on Monday.[pullquote size=\"medium\" align=\"right\" citation=\"Assemblymember Ash Kalra, D-San Jose\"]‘Although the bill did not pass the Assembly by today’s deadline, this is only a pause for the single-payer movement; our coalition, including the mighty California Nurses Association, will continue the fight for accessible, affordable, and equitable healthcare for all Californians.’[/pullquote]There were still many unanswered questions about financing, quality and how doctors would make decisions. Monday’s debate would likely have been dominated by concerns about cost. The latest estimate says it would cost taxpayers at least $356.5 billion per year to pay for the health care of nearly 40 million residents. California’s total operating budget — which pays for public schools, courts, roads and bridges and other important services — is roughly $262 billion this year.\u003c/p>\n\u003cp>In light of the news that the Assembly failed to vote on the bill, the California Nurses Association released a statement condemning the decision.\u003c/p>\n\u003cp>“Today, elected leaders in California had the opportunity to put patients first and set an example for the whole country by passing AB 1400, the California Guaranteed Health Care for All Act, in the State Assembly. Instead, Assembly Member Ash Kalra, the main author of the bill, chose not to hold a vote on this bill at all, providing cover for those who would have been forced to go on the record about where they stand on guaranteed health care for all people in California. Nurses condemn this failure by elected representatives to put patients above profits, especially during the worst surge of COVID-19 yet, at a time when it’s more clear than ever before that health care must be a right, not just a privilege for those who can afford it.”\u003c/p>\n\u003cp>Assembly Republican Leader Marie Waldron lauded Democrats who stood up to their base and joined Republicans to put an end to the bill she referred to as a “foolhardy plan.”\u003c/p>\n\u003cp>“Better late than never,” said Waldron in a news release. “The fact that a proposal for a government takeover of our state’s entire health care system even made it this far shows just how out of touch the Democratic party is from the needs of everyday Californians. Even though this plan is dead for now, every Democrat who supported it will have to answer for their effort to end Medicare, kick 20 million Californians off their existing plans, require the largest tax increase in state history and put bureaucrats in charge of health care.”\u003c/p>\n\u003cp>Other coalitions opposed to the bill expressed concern that its passage would have done more harm than good.\u003c/p>\n\u003cp>“Californians are already facing higher inflation and taxes while struggling with the many difficulties/hardships that the pandemic has caused,” said Ned Wigglesworth, a spokesperson for the Protect California Health Care coalition, in a news statement. “They should have the right to choose the coverage they want, and deserve a stable health care system they can always rely on. AB 1400 would have eliminated both Medicare for seniors and private coverage for everyone, with no guarantee that patients could keep their doctor. The bill would have irreparably damaged the health care that millions of Californians rely on every day — all in the middle of a pandemic. Today’s vote in the Assembly was a vote to protect their constituents from higher taxes and chaos in our health care system.”\u003c/p>\n\u003cp>Earlier this month, Democrats filed a proposed amendment to the state Constitution that would impose hefty new taxes on businesses and individuals to pay for the system. The taxes would generate roughly $163 billion per year, and the amendment would give lawmakers the power to raise those taxes to keep up with costs. Supporters hoped both proposals — the bill to create the system and the bill to pay for it — would move forward together this year.\u003c/p>\n\u003cp>But Monday’s deadline was only on the bill that would create the system.\u003c/p>\n\u003cp>Supporters say Californians and their employers are already paying exorbitant amounts for health care through high deductibles, co-pays and monthly insurance premiums. The bill would have eliminated all of those and replace them with taxes.\u003c/p>\n\u003cp>“Sure, there is sticker shock. But there should be sticker shock for how much we are paying now,” said Stephanie Roberson, director of government relations for the California Nurses Association.\u003c/p>\n\u003cp>“What are we getting? People are still uninsured. People are still underinsured. People are going into medical debt. People have to reach tens of thousands of dollars of deductibles. We’ll eliminate that under this program,” she said.\u003c/p>\n\u003cp>Right now, lots of people pay for California’s health care system, including patients, insurance companies and employers. The bill before the Legislature would change that to a single payer — the government. If enacted, it would unravel the private health insurance market. Private health insurance would still be allowed, but only for services not covered by the government.\u003c/p>\n\u003cp>Progressives have long dreamed of a single-payer health system in the U.S., believing it would control costs and save lives. But it’s never happened. Vermont enacted the nation’s first single-payer health care system in 2011, but later abandoned it because of the cost. Proposals in Congress have gone nowhere.[aside postID=\"news_11902591,news_11901347,news_11902585\" label=\"Related Posts\"]In California, voters overwhelmingly rejected a single-payer system in a 1994 ballot initiative. State lawmakers tried again in the 2000s, twice passing single-payer legislation only to have both bills vetoed by then-Gov. Arnold Schwarzenegger, a Republican. Another attempt in 2017 passed the Senate but died in the Assembly.\u003c/p>\n\u003cp>This year’s vote wouldn’t have been easy, even in famously liberal California. While this bill had the support of some Democratic leaders and powerful labor unions, it had intense opposition from business groups that are pressuring more moderate Democrats not to vote for it.\u003c/p>\n\u003cp>The bill needed 41 votes to survive on Monday. Democrats have 56 of the 80 seats in the Assembly. But they are missing three of their more liberal members, who have recently resigned to take other jobs, leaving little room for defections. The current idea for financing includes new taxes, and legislators will need to get voter approval for that.\u003c/p>\n\u003cp>Supporters did not get a boost from Newsom, who they thought would be an important ally. Newsom campaigned for a universal health care system during his 2018 run for governor. But since taking office, Newsom has focused mostly on expanding access to insurance coverage.\u003c/p>\n\u003cp>Newsom has said he still supports a single-payer system. A commission he established to study the idea is due to release its report later this year. But Newsom remained silent on this latest proposal ahead of Monday’s deadline.\u003c/p>\n\u003cp>“What we need right now is support from the governor on this bill,” Roberson said before the bill was withdrawn. “We welcome him to make good on his campaign promise.”\u003c/p>\n\u003cp>\u003cem>KQED’s April Dembosky contributed to this story.\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California Democrats decided not to advance a bill that would make the government pay for everybody’s health care in the nation’s most populous state. Assemblymember Ash Kalra announced that he would withdraw AB 1400, California Guaranteed Health Care for All Act (CalCare), from a vote today after it became clear there would not be enough votes for it to pass.\u003c/p>\n\u003cp>“Despite heavy opposition and substantial misinformation from those that stand to profit from our current healthcare system, we were able to ignite a realistic and achievable path toward single-payer and bring AB 1400 to the floor of the Assembly,” said Kalra in a news release. “Although the bill did not pass the Assembly by today’s deadline, this is only a pause for the single-payer movement; our coalition, including the mighty California Nurses Association, will continue the fight for accessible, affordable, and equitable healthcare for all Californians.”\u003c/p>\n\u003cp>The bill would have created the nation’s only statewide universal health care system and set its rules — but it would not have paid for it. There’s another bill that would do that. It has a different deadline and does not have to pass on Monday.\u003c/p>\u003c/div>",
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"content": "‘Although the bill did not pass the Assembly by today’s deadline, this is only a pause for the single-payer movement; our coalition, including the mighty California Nurses Association, will continue the fight for accessible, affordable, and equitable healthcare for all Californians.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>There were still many unanswered questions about financing, quality and how doctors would make decisions. Monday’s debate would likely have been dominated by concerns about cost. The latest estimate says it would cost taxpayers at least $356.5 billion per year to pay for the health care of nearly 40 million residents. California’s total operating budget — which pays for public schools, courts, roads and bridges and other important services — is roughly $262 billion this year.\u003c/p>\n\u003cp>In light of the news that the Assembly failed to vote on the bill, the California Nurses Association released a statement condemning the decision.\u003c/p>\n\u003cp>“Today, elected leaders in California had the opportunity to put patients first and set an example for the whole country by passing AB 1400, the California Guaranteed Health Care for All Act, in the State Assembly. Instead, Assembly Member Ash Kalra, the main author of the bill, chose not to hold a vote on this bill at all, providing cover for those who would have been forced to go on the record about where they stand on guaranteed health care for all people in California. Nurses condemn this failure by elected representatives to put patients above profits, especially during the worst surge of COVID-19 yet, at a time when it’s more clear than ever before that health care must be a right, not just a privilege for those who can afford it.”\u003c/p>\n\u003cp>Assembly Republican Leader Marie Waldron lauded Democrats who stood up to their base and joined Republicans to put an end to the bill she referred to as a “foolhardy plan.”\u003c/p>\n\u003cp>“Better late than never,” said Waldron in a news release. “The fact that a proposal for a government takeover of our state’s entire health care system even made it this far shows just how out of touch the Democratic party is from the needs of everyday Californians. Even though this plan is dead for now, every Democrat who supported it will have to answer for their effort to end Medicare, kick 20 million Californians off their existing plans, require the largest tax increase in state history and put bureaucrats in charge of health care.”\u003c/p>\n\u003cp>Other coalitions opposed to the bill expressed concern that its passage would have done more harm than good.\u003c/p>\n\u003cp>“Californians are already facing higher inflation and taxes while struggling with the many difficulties/hardships that the pandemic has caused,” said Ned Wigglesworth, a spokesperson for the Protect California Health Care coalition, in a news statement. “They should have the right to choose the coverage they want, and deserve a stable health care system they can always rely on. AB 1400 would have eliminated both Medicare for seniors and private coverage for everyone, with no guarantee that patients could keep their doctor. The bill would have irreparably damaged the health care that millions of Californians rely on every day — all in the middle of a pandemic. Today’s vote in the Assembly was a vote to protect their constituents from higher taxes and chaos in our health care system.”\u003c/p>\n\u003cp>Earlier this month, Democrats filed a proposed amendment to the state Constitution that would impose hefty new taxes on businesses and individuals to pay for the system. The taxes would generate roughly $163 billion per year, and the amendment would give lawmakers the power to raise those taxes to keep up with costs. Supporters hoped both proposals — the bill to create the system and the bill to pay for it — would move forward together this year.\u003c/p>\n\u003cp>But Monday’s deadline was only on the bill that would create the system.\u003c/p>\n\u003cp>Supporters say Californians and their employers are already paying exorbitant amounts for health care through high deductibles, co-pays and monthly insurance premiums. The bill would have eliminated all of those and replace them with taxes.\u003c/p>\n\u003cp>“Sure, there is sticker shock. But there should be sticker shock for how much we are paying now,” said Stephanie Roberson, director of government relations for the California Nurses Association.\u003c/p>\n\u003cp>“What are we getting? People are still uninsured. People are still underinsured. People are going into medical debt. People have to reach tens of thousands of dollars of deductibles. We’ll eliminate that under this program,” she said.\u003c/p>\n\u003cp>Right now, lots of people pay for California’s health care system, including patients, insurance companies and employers. The bill before the Legislature would change that to a single payer — the government. If enacted, it would unravel the private health insurance market. Private health insurance would still be allowed, but only for services not covered by the government.\u003c/p>\n\u003cp>Progressives have long dreamed of a single-payer health system in the U.S., believing it would control costs and save lives. But it’s never happened. Vermont enacted the nation’s first single-payer health care system in 2011, but later abandoned it because of the cost. Proposals in Congress have gone nowhere.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>In California, voters overwhelmingly rejected a single-payer system in a 1994 ballot initiative. State lawmakers tried again in the 2000s, twice passing single-payer legislation only to have both bills vetoed by then-Gov. Arnold Schwarzenegger, a Republican. Another attempt in 2017 passed the Senate but died in the Assembly.\u003c/p>\n\u003cp>This year’s vote wouldn’t have been easy, even in famously liberal California. While this bill had the support of some Democratic leaders and powerful labor unions, it had intense opposition from business groups that are pressuring more moderate Democrats not to vote for it.\u003c/p>\n\u003cp>The bill needed 41 votes to survive on Monday. Democrats have 56 of the 80 seats in the Assembly. But they are missing three of their more liberal members, who have recently resigned to take other jobs, leaving little room for defections. The current idea for financing includes new taxes, and legislators will need to get voter approval for that.\u003c/p>\n\u003cp>Supporters did not get a boost from Newsom, who they thought would be an important ally. Newsom campaigned for a universal health care system during his 2018 run for governor. But since taking office, Newsom has focused mostly on expanding access to insurance coverage.\u003c/p>\n\u003cp>Newsom has said he still supports a single-payer system. A commission he established to study the idea is due to release its report later this year. But Newsom remained silent on this latest proposal ahead of Monday’s deadline.\u003c/p>\n\u003cp>“What we need right now is support from the governor on this bill,” Roberson said before the bill was withdrawn. “We welcome him to make good on his campaign promise.”\u003c/p>\n\u003cp>\u003cem>KQED’s April Dembosky contributed to this story.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"slug": "community-covid-clinics-fill-crucial-need-in-underserved-communities-but-are-strapped-for-resources",
"title": "Community COVID Clinics Fill Crucial Need in Underserved Communities — But Are Strapped for Resources",
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"content": "\u003cp>Alejandra Felix, a house cleaner and grandmother from Richmond, had a cough and a sore throat. So she did the responsible thing in COVID times and called in sick.\u003c/p>\n\u003cp>Her symptoms were mild, but she wanted to get tested for COVID before she went back to work, so as not to spread the virus. She works for herself, and wants to keep her clients’ trust.\u003c/p>\n\u003cp>“First I need to know that I’ve taken all the precautions. I need to be sure it’s only a flu,” she says.\u003c/p>\n\u003cp>Felix had spent all morning driving around to pharmacies in Richmond and surrounding cities, looking for rapid antigen tests. There were none to be found.\u003c/p>\n\u003cp>The COVID testing site at her neighborhood clinic, LifeLong Medical Care, was fully booked. She called and called but waited so long on hold that she got discouraged and hung up. For Felix, a week with no work means losing up to $800 in income.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“That’s a lot because I need it to pay the bills,” she says with a nervous laugh. “I feel desperate because I have to cancel all my work this week. If they give me an appointment it’ll be tomorrow or the next day, so I have to cancel everything.”\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Renna Khuner-Haber, program manager, LifeLong Medical Care\"]‘Demand is through the roof. We don’t have staffing … [and] it’s so hard to prioritize. Everyone is coming because they were exposed, symptomatic, or needing to return to work or school. Everybody is top priority.’[/pullquote]Across the country, the spread of omicron has people scrambling to get tested for COVID. The lines are long, appointments get scooped up fast, and rapid antigen tests are hard to find. This problem is hitting essential workers — often people of color — particularly hard. Unlike many office workers, they can’t work from home, and their companies haven’t stockpiled tests. The result is lost wages, or risking infecting co-workers or family members.\u003c/p>\n\u003cp>Renna Khuner-Haber, who coordinates LifeLong Medical’s testing sites in the East Bay, including the Richmond facility, says the people who most need convenient home tests can’t get them. The disparity is glaring, especially in the Bay Area, where tech companies send boxes of rapid antigen tests to workers who have the option to work from home in a surge.\u003c/p>\n\u003cp>“Rapid tests — they’re not cheap. If you have a family of 10 people and everyone needs a rapid test and they’re each $10, that’s $100 right there. To test everyone twice, that adds up,” she says.\u003c/p>\n\u003cfigure id=\"attachment_11902203\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11902203\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/01/RS53220_037_Richmond_LifelongCOVIDClinic_01192022-qut.jpg\" alt=\"masked woman facing camera gestures with hands while masked woman with pink hair facing away from camera listens\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53220_037_Richmond_LifelongCOVIDClinic_01192022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53220_037_Richmond_LifelongCOVIDClinic_01192022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53220_037_Richmond_LifelongCOVIDClinic_01192022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53220_037_Richmond_LifelongCOVIDClinic_01192022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53220_037_Richmond_LifelongCOVIDClinic_01192022-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Program manager Renna Khuner-Haber (center) speaks with medical assistant Jenna Tran at a COVID-19 vaccination clinic outside LifeLong Medical Care’s health center in San Pablo on Jan. 19, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>Community testing sites try to fill the gaps\u003c/h3>\n\u003cp>One solution that’s filling in the gaps is small neighborhood clinics like LifeLong Medical’s three testing sites in Richmond, San Pablo and East Oakland, which specifically serve lower-income communities, including Medi-Cal patients, Spanish-speaking immigrants, and essential workers who risk COVID exposure at their jobs.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"José Castro, LifeLong Medical patient\"]‘I need to have a negative test to be confident that I don’t transmit it to anyone at the job site. Also, my oldest son needs a test to go back to school.’[/pullquote]Since the beginning of the year, the demand for testing at the Richmond clinic has ballooned.\u003c/p>\n\u003cp>LifeLong’s COVID hotline also is getting about 1,000 COVID calls daily, up from about 250 in the fall.\u003c/p>\n\u003cp>José Castro was one of those callers. His whole family had the sniffles, so he brought his wife and three children, ages 3, 5, and 14, to get tested. He works as a house painter and spent the previous day driving all the way to San Francisco, trying to find a test.\u003c/p>\n\u003cp>“I waited about an hour or 90 minutes on the phone [with LifeLong] and finally got through to get an appointment. I need to have a negative test to be confident that I’m not positive so I don’t transmit it to anyone at the job site,” he says in Spanish. “Also, my oldest son needs a test to go back to school.”\u003c/p>\n\u003cp>Another LifeLong patient, Victoria Martin, works as a dental hygienist and was worried about being exposed after someone tested positive at work. She was frustrated to have caught a cold — hopefully not COVID — even after she canceled holiday plans.\u003c/p>\n\u003cp>“It’s very scary. I came here yesterday and made an appointment for today,” she says. “You try to stay safe by staying in a close circle and not going out, and then someone in your bubble gets it and what can you do?”\u003c/p>\n\u003ch3>Reaching underserved communities, but struggling to scale up\u003c/h3>\n\u003cp>LifeLong’s Richmond site can test only 60 people daily and can’t scale up. Compare that to a county site a 15-minute drive away in Berkeley run by a private lab, which can do up to 1,000 tests per day.\u003c/p>\n\u003cp>During the surge, these smaller clinics have been swamped, struggling to keep up with demand. Yet public health officials say the small scale is by design — a feature, not a flaw.\u003c/p>\n\u003cfigure id=\"attachment_11902211\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11902211\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/01/RS53202_018_Richmond_LifelongCOVIDClinic_01192022-qut.jpg\" alt=\"nurse clothed in full PPE administers COVID test through a car window while just the mouth and nose of a vehicle occupant are visible\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53202_018_Richmond_LifelongCOVIDClinic_01192022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53202_018_Richmond_LifelongCOVIDClinic_01192022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53202_018_Richmond_LifelongCOVIDClinic_01192022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53202_018_Richmond_LifelongCOVIDClinic_01192022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53202_018_Richmond_LifelongCOVIDClinic_01192022-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Luciana Suelzle tests a family for COVID-19 at LifeLong Medical Care’s William Jenkins Health Center in Richmond on Jan. 19, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“It’s not always about quantity. But if we’re reaching those who have no other way to access testing resources, then we’re achieving our goal,” says Dr. Jocelyn Freeman Garrick, who leads COVID testing for Alameda County’s public health department.\u003c/p>\n\u003cp>With demand up 400% at county testing locations, Freeman Garrick says these smaller sites do what larger ones can’t: serve marginalized neighborhoods.\u003c/p>\n\u003cp>“We found at those smaller sites, their percent positivity rate was much higher than the general population. So the number [of tests] may be small, but that’s a pivotal role,” in serving people whose jobs and living situations put them at risk, Freeman Garrick says.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Dr. Carina Marquez, co-founder, Unidos en Salud\"]‘These sites are for communities who don’t have health care and where people might not trust other sites.’[/pullquote]Another group in San Francisco’s Mission district, called \u003ca href=\"https://unitedinhealth.org/\">Unidos en Salud\u003c/a>, also provides COVID testing and vaccinations to undocumented people, essential workers, recent immigrants and the uninsured, through a partnership with UCSF and the Latino Task Force.\u003c/p>\n\u003cp>“These sites are for communities who don’t have health care and where people might not trust other sites,” says Dr. Carina Marquez, who founded the partnership. Still, she adds: “Size does matter when you’re in a surge.”\u003c/p>\n\u003cp>At Unidos’s Mission testing site, the number of daily tests rose from about 200 in early December to about 980 in early January as omicron hit and people spilled over from private and county-run sites in better-resourced parts of the city.\u003c/p>\n\u003cp>Her organization has decided not to require appointments, even though it’s a challenge to manage the line that stretches around the block.\u003c/p>\n\u003cfigure id=\"attachment_11902230\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11902230\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/01/RS46108_016_KQED_SanFrancisco_COVIDTesting_11302020-qut.jpg\" alt=\"nurse in full PPE prepares to swab man wearing a mask facing away from camera, outside in sunlight\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS46108_016_KQED_SanFrancisco_COVIDTesting_11302020-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS46108_016_KQED_SanFrancisco_COVIDTesting_11302020-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS46108_016_KQED_SanFrancisco_COVIDTesting_11302020-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS46108_016_KQED_SanFrancisco_COVIDTesting_11302020-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS46108_016_KQED_SanFrancisco_COVIDTesting_11302020-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Health care worker Olga Duran tests a patient for COVID-19 at an Unidos En Salud testing site on 24th and Mission streets in San Francisco on Nov. 30, 2020. Unidos en Salud (United in Health) is a collaboration between UCSF and the Latino Task Force to help working class, immigrant families through COVID-19. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At LifeLong, after a lull in demand since late summer, it’s been hard to meet the community’s testing needs.\u003c/p>\n\u003cp>“We’re in a moment in the surge where demand is through the roof. We don’t have staffing and we were never built to do that,” Khuner-Haber says. “It’s so hard to prioritize. Everyone is coming because they were exposed, symptomatic or needing to return to work or school. Everybody is top priority.”\u003c/p>\n\u003cp>With some of her employees calling in sick, Khuner-Haber has struggled to stay fully staffed and hire culturally competent, Spanish-speaking staff, who are essential to building trust with patients.\u003c/p>\n\u003ch3>Strapped for resources\u003c/h3>\n\u003cp>Andie Martinez Patterson, a vice president with the California Primary Care Association, says mission-minded health clinics need more resources so they can hire more staff.\u003c/p>\n\u003cp>“The point for health centers is that we are open-door access for anybody and in particular for vulnerable and underserved, disenfranchised populations,” she says. “It is the moral imperative in the mission of why community health centers exist.”\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Andie Martinez Patterson, vice president, California Primary Care Association\"]‘We are not reimbursed anywhere close to what we’re reimbursed for in the typical primary care setting. So in effect … you lose money immediately to achieve the moral imperative.’[/pullquote]Martinez Patterson says neighborhood clinics have stepped into testing and vaccination as part of their role as primary care providers.\u003c/p>\n\u003cp>But because these clinics primarily serve recipients of Medi-Cal — California’s Medicaid program — they’re not reimbursed at the same rates as other testing centers, many of which negotiated large contracts with county health departments.\u003c/p>\n\u003cp>“We are not reimbursed anywhere close to what we’re reimbursed for in the typical primary care setting. So you, in effect, take staff, you lose money immediately to achieve the moral imperative,” she says. If Medi-Cal reimbursed more, she says, clinics could hire more staff and serve more people.\u003c/p>\n\u003cp>The state provides tests and vaccines to these sites, but she argues that the current payment structure in a fee-for-service environment means clinics lose money when providing life-saving vaccines and COVID tests.\u003c/p>\n\u003cp>COVID is a chance to restart the policy conversation about how health centers get paid, so they can be part of the response to public health disasters in the future, Martinez Patterson says.\u003c/p>\n\u003cp>[aside label='COVID Resources' tag='coronavirus-resources-and-explainers']\u003c/p>\n\u003ch3>Easy testing access and follow-up care are critical\u003c/h3>\n\u003cp>There’s a big need for easy access to testing in the neighborhoods served by community clinics because the mostly lower-income Latino immigrant families who live there are more likely to live in multigenerational households, where one sick family member could expose more vulnerable ones.\u003c/p>\n\u003cp>That was Alejandra Felix’s situation. There are seven people living in her home, including her daughter, and a grandson who’s too young to get vaccinated.\u003c/p>\n\u003cp>“There’s a baby in my house. That’s why I’m worried. I wear gloves and a mask in my own home, because I want to protect the baby,” she says. When she got sick, she stopped cooking for her family and sent her husband to sleep on the living room couch.\u003c/p>\n\u003cp>Says Marquez from Unidos en Salud, “Easy walk-up access to testing is critical. You want a situation where you can bring the whole family down and get tested. … Testing should be low-barrier, easy to access, with no online registration, where people can wait in line and get results quickly. Then they need to get linked to care.”\u003c/p>\n\u003cfigure id=\"attachment_11902233\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11902233\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/01/RS53191_004_Richmond_LifelongCOVIDClinic_01192022-qut.jpg\" alt=\"masked woman stands looking down at another masked nurse seated at a portable table, under tents at an outdoor COVID vaccination clinic\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53191_004_Richmond_LifelongCOVIDClinic_01192022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53191_004_Richmond_LifelongCOVIDClinic_01192022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53191_004_Richmond_LifelongCOVIDClinic_01192022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53191_004_Richmond_LifelongCOVIDClinic_01192022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53191_004_Richmond_LifelongCOVIDClinic_01192022-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Griselda Ramirez-Escamilla (center right), who runs LifeLong Medical’s urgent care center, speaks with medical assistant Jenna Tran in Richmond on Jan. 19, 2022. Ramirez-Escamilla says this surge is taking an emotional toll on her small staff. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Unidos also provides follow-up care to people who test positive, offering financial assistance, food, cleaning supplies and more medical care when appropriate.\u003c/p>\n\u003cp>“Sometimes people need guidance on how to isolate in crowded households, when they can go back to work and what to do on Day Five. Vulnerable workers and families want to prevent transmission, but a positive test has so many implications for them,” says Marquez.\u003c/p>\n\u003cp>[aside postID=news_11860883 hero='https://ww2.kqed.org/app/uploads/sites/10/2021/02/SanJose_COVIDTesting-1038x576.jpg']To improve testing access, Marquez sees potential in the \u003ca href=\"https://www.kqed.org/news/11860883/trusted-leaders-are-fighting-covid-19-vaccine-fears-in-black-and-latino-communities\">promotora model\u003c/a>, where community members are trained to conduct rapid antigen tests and counsel people, then can be called in to help deal with surges.\u003c/p>\n\u003cp>Primary care providers, schools and clinics also can be proactive in distributing at-home tests to their patients.\u003c/p>\n\u003cp>Meanwhile, staff at small community clinics are just trying to keep up with the surge. At LifeLong Medical, Griselda Ramirez-Escamilla, who runs the clinic’s urgent care center, says this surge is taking an emotional toll on her small staff.\u003c/p>\n\u003cp>“We get tired and we just got to step aside, take a breath. There are times where we cry a little,” she says, tearing up. “It’s hard! And we show up every morning. We have times where we do break down, but it’s just the nature of it. We have to lift our spirits and keep moving.”\u003c/p>\n\u003cp>Gaby Perez, a 24-year-old Richmond resident, knows how COVID can endanger multigenerational households — she lives with her 6-year-old son and her parents.\u003c/p>\n\u003cp>“Once somebody tests positive, it’s like there’s no way of getting away from it, unless you go to another home, but everyone you know has older relatives or little kids there, too,” she says. “You got to use the same bathroom, same bedroom, same kitchen. There’s not really a way around it.”\u003c/p>\n\u003cp>After her father got COVID last summer, Perez says she was inspired to switch careers to serve her community. She’s now a medical assistant at LifeLong Medical, with plans to become a nurse.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Clinics like LifeLong Medical in Richmond provide crucial services to lower-income communities, including immigrants and essential workers who risk COVID exposure at work. But they're overwhelmed, and reimbursed at a far lower rate than other providers.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Alejandra Felix, a house cleaner and grandmother from Richmond, had a cough and a sore throat. So she did the responsible thing in COVID times and called in sick.\u003c/p>\n\u003cp>Her symptoms were mild, but she wanted to get tested for COVID before she went back to work, so as not to spread the virus. She works for herself, and wants to keep her clients’ trust.\u003c/p>\n\u003cp>“First I need to know that I’ve taken all the precautions. I need to be sure it’s only a flu,” she says.\u003c/p>\n\u003cp>Felix had spent all morning driving around to pharmacies in Richmond and surrounding cities, looking for rapid antigen tests. There were none to be found.\u003c/p>\n\u003cp>The COVID testing site at her neighborhood clinic, LifeLong Medical Care, was fully booked. She called and called but waited so long on hold that she got discouraged and hung up. For Felix, a week with no work means losing up to $800 in income.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“That’s a lot because I need it to pay the bills,” she says with a nervous laugh. “I feel desperate because I have to cancel all my work this week. If they give me an appointment it’ll be tomorrow or the next day, so I have to cancel everything.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘Demand is through the roof. We don’t have staffing … [and] it’s so hard to prioritize. Everyone is coming because they were exposed, symptomatic, or needing to return to work or school. Everybody is top priority.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Across the country, the spread of omicron has people scrambling to get tested for COVID. The lines are long, appointments get scooped up fast, and rapid antigen tests are hard to find. This problem is hitting essential workers — often people of color — particularly hard. Unlike many office workers, they can’t work from home, and their companies haven’t stockpiled tests. The result is lost wages, or risking infecting co-workers or family members.\u003c/p>\n\u003cp>Renna Khuner-Haber, who coordinates LifeLong Medical’s testing sites in the East Bay, including the Richmond facility, says the people who most need convenient home tests can’t get them. The disparity is glaring, especially in the Bay Area, where tech companies send boxes of rapid antigen tests to workers who have the option to work from home in a surge.\u003c/p>\n\u003cp>“Rapid tests — they’re not cheap. If you have a family of 10 people and everyone needs a rapid test and they’re each $10, that’s $100 right there. To test everyone twice, that adds up,” she says.\u003c/p>\n\u003cfigure id=\"attachment_11902203\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11902203\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/01/RS53220_037_Richmond_LifelongCOVIDClinic_01192022-qut.jpg\" alt=\"masked woman facing camera gestures with hands while masked woman with pink hair facing away from camera listens\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53220_037_Richmond_LifelongCOVIDClinic_01192022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53220_037_Richmond_LifelongCOVIDClinic_01192022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53220_037_Richmond_LifelongCOVIDClinic_01192022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53220_037_Richmond_LifelongCOVIDClinic_01192022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53220_037_Richmond_LifelongCOVIDClinic_01192022-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Program manager Renna Khuner-Haber (center) speaks with medical assistant Jenna Tran at a COVID-19 vaccination clinic outside LifeLong Medical Care’s health center in San Pablo on Jan. 19, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>Community testing sites try to fill the gaps\u003c/h3>\n\u003cp>One solution that’s filling in the gaps is small neighborhood clinics like LifeLong Medical’s three testing sites in Richmond, San Pablo and East Oakland, which specifically serve lower-income communities, including Medi-Cal patients, Spanish-speaking immigrants, and essential workers who risk COVID exposure at their jobs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘I need to have a negative test to be confident that I don’t transmit it to anyone at the job site. Also, my oldest son needs a test to go back to school.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Since the beginning of the year, the demand for testing at the Richmond clinic has ballooned.\u003c/p>\n\u003cp>LifeLong’s COVID hotline also is getting about 1,000 COVID calls daily, up from about 250 in the fall.\u003c/p>\n\u003cp>José Castro was one of those callers. His whole family had the sniffles, so he brought his wife and three children, ages 3, 5, and 14, to get tested. He works as a house painter and spent the previous day driving all the way to San Francisco, trying to find a test.\u003c/p>\n\u003cp>“I waited about an hour or 90 minutes on the phone [with LifeLong] and finally got through to get an appointment. I need to have a negative test to be confident that I’m not positive so I don’t transmit it to anyone at the job site,” he says in Spanish. “Also, my oldest son needs a test to go back to school.”\u003c/p>\n\u003cp>Another LifeLong patient, Victoria Martin, works as a dental hygienist and was worried about being exposed after someone tested positive at work. She was frustrated to have caught a cold — hopefully not COVID — even after she canceled holiday plans.\u003c/p>\n\u003cp>“It’s very scary. I came here yesterday and made an appointment for today,” she says. “You try to stay safe by staying in a close circle and not going out, and then someone in your bubble gets it and what can you do?”\u003c/p>\n\u003ch3>Reaching underserved communities, but struggling to scale up\u003c/h3>\n\u003cp>LifeLong’s Richmond site can test only 60 people daily and can’t scale up. Compare that to a county site a 15-minute drive away in Berkeley run by a private lab, which can do up to 1,000 tests per day.\u003c/p>\n\u003cp>During the surge, these smaller clinics have been swamped, struggling to keep up with demand. Yet public health officials say the small scale is by design — a feature, not a flaw.\u003c/p>\n\u003cfigure id=\"attachment_11902211\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11902211\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/01/RS53202_018_Richmond_LifelongCOVIDClinic_01192022-qut.jpg\" alt=\"nurse clothed in full PPE administers COVID test through a car window while just the mouth and nose of a vehicle occupant are visible\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53202_018_Richmond_LifelongCOVIDClinic_01192022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53202_018_Richmond_LifelongCOVIDClinic_01192022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53202_018_Richmond_LifelongCOVIDClinic_01192022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53202_018_Richmond_LifelongCOVIDClinic_01192022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53202_018_Richmond_LifelongCOVIDClinic_01192022-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Luciana Suelzle tests a family for COVID-19 at LifeLong Medical Care’s William Jenkins Health Center in Richmond on Jan. 19, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“It’s not always about quantity. But if we’re reaching those who have no other way to access testing resources, then we’re achieving our goal,” says Dr. Jocelyn Freeman Garrick, who leads COVID testing for Alameda County’s public health department.\u003c/p>\n\u003cp>With demand up 400% at county testing locations, Freeman Garrick says these smaller sites do what larger ones can’t: serve marginalized neighborhoods.\u003c/p>\n\u003cp>“We found at those smaller sites, their percent positivity rate was much higher than the general population. So the number [of tests] may be small, but that’s a pivotal role,” in serving people whose jobs and living situations put them at risk, Freeman Garrick says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Another group in San Francisco’s Mission district, called \u003ca href=\"https://unitedinhealth.org/\">Unidos en Salud\u003c/a>, also provides COVID testing and vaccinations to undocumented people, essential workers, recent immigrants and the uninsured, through a partnership with UCSF and the Latino Task Force.\u003c/p>\n\u003cp>“These sites are for communities who don’t have health care and where people might not trust other sites,” says Dr. Carina Marquez, who founded the partnership. Still, she adds: “Size does matter when you’re in a surge.”\u003c/p>\n\u003cp>At Unidos’s Mission testing site, the number of daily tests rose from about 200 in early December to about 980 in early January as omicron hit and people spilled over from private and county-run sites in better-resourced parts of the city.\u003c/p>\n\u003cp>Her organization has decided not to require appointments, even though it’s a challenge to manage the line that stretches around the block.\u003c/p>\n\u003cfigure id=\"attachment_11902230\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11902230\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/01/RS46108_016_KQED_SanFrancisco_COVIDTesting_11302020-qut.jpg\" alt=\"nurse in full PPE prepares to swab man wearing a mask facing away from camera, outside in sunlight\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS46108_016_KQED_SanFrancisco_COVIDTesting_11302020-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS46108_016_KQED_SanFrancisco_COVIDTesting_11302020-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS46108_016_KQED_SanFrancisco_COVIDTesting_11302020-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS46108_016_KQED_SanFrancisco_COVIDTesting_11302020-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS46108_016_KQED_SanFrancisco_COVIDTesting_11302020-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Health care worker Olga Duran tests a patient for COVID-19 at an Unidos En Salud testing site on 24th and Mission streets in San Francisco on Nov. 30, 2020. Unidos en Salud (United in Health) is a collaboration between UCSF and the Latino Task Force to help working class, immigrant families through COVID-19. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At LifeLong, after a lull in demand since late summer, it’s been hard to meet the community’s testing needs.\u003c/p>\n\u003cp>“We’re in a moment in the surge where demand is through the roof. We don’t have staffing and we were never built to do that,” Khuner-Haber says. “It’s so hard to prioritize. Everyone is coming because they were exposed, symptomatic or needing to return to work or school. Everybody is top priority.”\u003c/p>\n\u003cp>With some of her employees calling in sick, Khuner-Haber has struggled to stay fully staffed and hire culturally competent, Spanish-speaking staff, who are essential to building trust with patients.\u003c/p>\n\u003ch3>Strapped for resources\u003c/h3>\n\u003cp>Andie Martinez Patterson, a vice president with the California Primary Care Association, says mission-minded health clinics need more resources so they can hire more staff.\u003c/p>\n\u003cp>“The point for health centers is that we are open-door access for anybody and in particular for vulnerable and underserved, disenfranchised populations,” she says. “It is the moral imperative in the mission of why community health centers exist.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘We are not reimbursed anywhere close to what we’re reimbursed for in the typical primary care setting. So in effect … you lose money immediately to achieve the moral imperative.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Martinez Patterson says neighborhood clinics have stepped into testing and vaccination as part of their role as primary care providers.\u003c/p>\n\u003cp>But because these clinics primarily serve recipients of Medi-Cal — California’s Medicaid program — they’re not reimbursed at the same rates as other testing centers, many of which negotiated large contracts with county health departments.\u003c/p>\n\u003cp>“We are not reimbursed anywhere close to what we’re reimbursed for in the typical primary care setting. So you, in effect, take staff, you lose money immediately to achieve the moral imperative,” she says. If Medi-Cal reimbursed more, she says, clinics could hire more staff and serve more people.\u003c/p>\n\u003cp>The state provides tests and vaccines to these sites, but she argues that the current payment structure in a fee-for-service environment means clinics lose money when providing life-saving vaccines and COVID tests.\u003c/p>\n\u003cp>COVID is a chance to restart the policy conversation about how health centers get paid, so they can be part of the response to public health disasters in the future, Martinez Patterson says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003ch3>Easy testing access and follow-up care are critical\u003c/h3>\n\u003cp>There’s a big need for easy access to testing in the neighborhoods served by community clinics because the mostly lower-income Latino immigrant families who live there are more likely to live in multigenerational households, where one sick family member could expose more vulnerable ones.\u003c/p>\n\u003cp>That was Alejandra Felix’s situation. There are seven people living in her home, including her daughter, and a grandson who’s too young to get vaccinated.\u003c/p>\n\u003cp>“There’s a baby in my house. That’s why I’m worried. I wear gloves and a mask in my own home, because I want to protect the baby,” she says. When she got sick, she stopped cooking for her family and sent her husband to sleep on the living room couch.\u003c/p>\n\u003cp>Says Marquez from Unidos en Salud, “Easy walk-up access to testing is critical. You want a situation where you can bring the whole family down and get tested. … Testing should be low-barrier, easy to access, with no online registration, where people can wait in line and get results quickly. Then they need to get linked to care.”\u003c/p>\n\u003cfigure id=\"attachment_11902233\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11902233\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/01/RS53191_004_Richmond_LifelongCOVIDClinic_01192022-qut.jpg\" alt=\"masked woman stands looking down at another masked nurse seated at a portable table, under tents at an outdoor COVID vaccination clinic\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53191_004_Richmond_LifelongCOVIDClinic_01192022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53191_004_Richmond_LifelongCOVIDClinic_01192022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53191_004_Richmond_LifelongCOVIDClinic_01192022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53191_004_Richmond_LifelongCOVIDClinic_01192022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/01/RS53191_004_Richmond_LifelongCOVIDClinic_01192022-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Griselda Ramirez-Escamilla (center right), who runs LifeLong Medical’s urgent care center, speaks with medical assistant Jenna Tran in Richmond on Jan. 19, 2022. Ramirez-Escamilla says this surge is taking an emotional toll on her small staff. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Unidos also provides follow-up care to people who test positive, offering financial assistance, food, cleaning supplies and more medical care when appropriate.\u003c/p>\n\u003cp>“Sometimes people need guidance on how to isolate in crowded households, when they can go back to work and what to do on Day Five. Vulnerable workers and families want to prevent transmission, but a positive test has so many implications for them,” says Marquez.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>To improve testing access, Marquez sees potential in the \u003ca href=\"https://www.kqed.org/news/11860883/trusted-leaders-are-fighting-covid-19-vaccine-fears-in-black-and-latino-communities\">promotora model\u003c/a>, where community members are trained to conduct rapid antigen tests and counsel people, then can be called in to help deal with surges.\u003c/p>\n\u003cp>Primary care providers, schools and clinics also can be proactive in distributing at-home tests to their patients.\u003c/p>\n\u003cp>Meanwhile, staff at small community clinics are just trying to keep up with the surge. At LifeLong Medical, Griselda Ramirez-Escamilla, who runs the clinic’s urgent care center, says this surge is taking an emotional toll on her small staff.\u003c/p>\n\u003cp>“We get tired and we just got to step aside, take a breath. There are times where we cry a little,” she says, tearing up. “It’s hard! And we show up every morning. We have times where we do break down, but it’s just the nature of it. We have to lift our spirits and keep moving.”\u003c/p>\n\u003cp>Gaby Perez, a 24-year-old Richmond resident, knows how COVID can endanger multigenerational households — she lives with her 6-year-old son and her parents.\u003c/p>\n\u003cp>“Once somebody tests positive, it’s like there’s no way of getting away from it, unless you go to another home, but everyone you know has older relatives or little kids there, too,” she says. “You got to use the same bathroom, same bedroom, same kitchen. There’s not really a way around it.”\u003c/p>\n\u003cp>After her father got COVID last summer, Perez says she was inspired to switch careers to serve her community. She’s now a medical assistant at LifeLong Medical, with plans to become a nurse.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>\u003cem>Updated 2 p.m. Wednesday\u003c/em>\u003c/p>\n\u003cp>California Democrats on Tuesday took their first step toward abolishing the private health insurance market in the nation’s most populous state and replacing it with a government-run plan that they promised would never deny anyone the care they need.\u003c/p>\n\u003cp>But the proposal that cleared a legislative committee in the state Assembly is still a long way from becoming law. Assembly Bill 1400, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220AB1400\">which would create a universal health care system called CalCare\u003c/a>, faces strong opposition from powerful business interests who say it would cost too much. And even if it does become law, voters would have to approve a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220ACA11\">major income tax increase\u003c/a> to pay for it — a vote that might not happen until 2024.\u003c/p>\n\u003cp>Still, Democrats hailed Tuesday’s vote for jump-starting one of their long-stalled policy goals and signaling they won’t back away from a fight even during an election year. In an hours-long hearing, some lawmakers and advocates assailed a health care industry they say has benefited corporate interests at the expense of consumers.\u003c/p>\n\u003cp>Ady Barkan, a 38-year-old father of two, was diagnosed with ALS six years ago and now is mostly paralyzed. He testified at Tuesday’s hearing with the help of a computerized voice that spoke as he typed using technology that followed the movement of his eyes. Barkan said he has battled his private insurance carrier to get treatment he needed, including suing them to get a ventilator that keeps him alive.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Even good health insurance, which I have, does not cover the cost of the care I need to survive,” he said.\u003c/p>\n\u003cp>The bill that advanced on Tuesday would create the universal health care system — CalCare — and set its rules. It cleared the Assembly Health Committee on an 11-3 vote. Republicans voted no, arguing the bill would cost too much and pay doctors and nurses less, potentially worsening a shortage of health care workers.\u003c/p>\n\u003cp>Assemblymember Ash Kalra, a Democrat from San Jos\u003cspan style=\"font-weight: 400\">é\u003c/span> and the author of the CalCare proposal, said Tuesday it could be 2024 before the tax increase proposal to pay for CalCare made it to the ballot.\u003c/p>\n\u003cp>An \u003ca href=\"https://calmatters.org/newsletters/whatmatters/2022/01/health-care-taxes-california/\">analysis from CalMatters\u003c/a> breaks down the proposed tax increase:\u003c/p>\n\u003cul>\n\u003cli>A 2.3% excise tax on businesses after their first $2 million in income\u003c/li>\n\u003cli>A 1.25% payroll tax on employers with 50-plus workers\u003c/li>\n\u003cli>An additional 1% payroll tax on wages for resident employees earning more than $49,900\u003c/li>\n\u003cli>A progressive income tax starting at 0.5% for Californians earning more than $149,500, up to 2.5% for people making about $2.5 million annually (with rates being adjusted for inflation)\u003c/li>\n\u003c/ul>\n\u003cp>The California Taxpayers Association, which opposes the plan, estimates it would raise taxes by about $163 billion per year.\u003c/p>\n\u003cp>“If government-run health care becomes law, millions of Californians will flee the state — either to avoid the $163 billion per year in new taxes or to escape the lengthy waits for care that will become the norm,” Assembly Republican Leader Marie Waldron said.\u003c/p>\n\u003cp>Even some Democrats who voted for the bill had sharp criticism for the proposal. Assemblymember Autumn Burke, a Democrat from Inglewood, said advancing the bill without a funding source made a mockery of the process.\u003c/p>\n\u003cp>“This bill has been sold to my community that it is going to change things now and that it is free. And neither one of those things are true,” she said.\u003c/p>\n\u003cp>Business groups, led by the California Chamber of Commerce, said the government-run health care system would be so expensive that the tax increase still wouldn’t be enough to pay for everything. In 2018, California’s total health care expenditures totaled $399.2 billion, accounting for 13.2% of the state’s gross domestic product, according to an analysis by the Healthy California for All Commission.\u003c/p>\n\u003cp>“Completely abolishing the current system in face of an unrelenting pandemic by annually taxing Californians hundreds of billions of dollars is not the solution,” said Preston Young, a policy advocate for the California Chamber of Commerce.\u003c/p>\n\u003cp>Kalra, the San Jos\u003cspan style=\"font-weight: 400\">é\u003c/span> Democrat and author of the proposal, said he knew opponents would focus on how much the plan would cost. But he said that argument distracts from the fact that Californians are already paying “the highest health tax in the world.”\u003c/p>\n\u003cp>“You may refer to it as premiums, deductibles, co-pays, denial of care,” Kalra said, saying none of those costs would exist under a universal health care system. “It’s clear as day they are being fleeced, and far too many understandably feel helpless about it.”\u003c/p>\n\u003cp>California’s health care system is paid for by multiple entities: patients, insurance companies, employers and government. But a universal health care system would be paid for by a single entity — the government, or the “single payer.”\u003c/p>\n\u003cp>A single-payer system has been a staple of California progressive political rhetoric for decades. But it’s not been easy to accomplish in a state where most people pay for private health insurance through their jobs. In 1994, voters overwhelmingly rejected a ballot initiative that would have created a universal health care system. Another attempt passed the state Senate in 2017, but it never got a vote in the state Assembly.\u003c/p>\n\u003cp>Questions about how to pay for a single-payer system have doomed previous plans. In 2011, Vermont enacted the nation’s first universal health care system in the country. But state officials abandoned it three years later because they said they couldn’t afford to pay for it.\u003c/p>\n\u003cp>[aside postID=news_11901253 hero='https://ww2.kqed.org/app/uploads/sites/10/2021/09/021_SanFrancisco_NewsomRecallEvent_09142021-1020x680.jpg']Gov. Gavin Newsom \u003ca href=\"https://calmatters.org/politics/2021/02/newsom-single-payer-health-care-dilemma/\">promised to do it when he ran for governor in 2018\u003c/a>, and voters elected him in a landslide. But in his first three years in office, Newsom has focused more on making sure everyone in California has health insurance. He has expanded Medi-Cal, the state’s health care program for lower-income Californians, to cover people 26 years old and younger and 50 years old and older, regardless of their immigration status. On Monday, \u003ca href=\"https://www.kqed.org/news/11901253/flush-with-cash-governor-newsom-wants-to-invest-in-pandemic-response-universal-health-access-fighting-inequality\">Newsom proposed extending Medi-Cal again, this time to all eligible Californians\u003c/a>, regardless of immigration status, older than 26 and younger than 50, at a potential cost of $2.7 billion per year.\u003c/p>\n\u003cp>Also on Monday, Newsom reiterated his support for a universal health care system, but declined to say whether he supported the plan in the Legislature \u003ca href=\"https://calmatters.org/newsletters/whatmatters/2022/01/california-health-insurance-newsom/\">because he said he had not read it\u003c/a>. Asked if he had “given up” on a universal health care system in California, Newsom pointed to a commission he founded that is examining such a system and how much it would cost.\u003c/p>\n\u003cp>He also said he’s working with President Joe Biden’s administration on the “flexibility” required for California to implement such a system.\u003c/p>\n\u003cp>“When you’re governor, you’ve got to be in the ‘how’ business,” Newsom said. “I believe in a single-payer financing model. The ‘how’ at the state level is the question that needs to be answered thoughtfully.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story includes reporting from Adam Beam of The Associated Press.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Updated 2 p.m. Wednesday\u003c/em>\u003c/p>\n\u003cp>California Democrats on Tuesday took their first step toward abolishing the private health insurance market in the nation’s most populous state and replacing it with a government-run plan that they promised would never deny anyone the care they need.\u003c/p>\n\u003cp>But the proposal that cleared a legislative committee in the state Assembly is still a long way from becoming law. Assembly Bill 1400, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220AB1400\">which would create a universal health care system called CalCare\u003c/a>, faces strong opposition from powerful business interests who say it would cost too much. And even if it does become law, voters would have to approve a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220ACA11\">major income tax increase\u003c/a> to pay for it — a vote that might not happen until 2024.\u003c/p>\n\u003cp>Still, Democrats hailed Tuesday’s vote for jump-starting one of their long-stalled policy goals and signaling they won’t back away from a fight even during an election year. In an hours-long hearing, some lawmakers and advocates assailed a health care industry they say has benefited corporate interests at the expense of consumers.\u003c/p>\n\u003cp>Ady Barkan, a 38-year-old father of two, was diagnosed with ALS six years ago and now is mostly paralyzed. He testified at Tuesday’s hearing with the help of a computerized voice that spoke as he typed using technology that followed the movement of his eyes. Barkan said he has battled his private insurance carrier to get treatment he needed, including suing them to get a ventilator that keeps him alive.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Even good health insurance, which I have, does not cover the cost of the care I need to survive,” he said.\u003c/p>\n\u003cp>The bill that advanced on Tuesday would create the universal health care system — CalCare — and set its rules. It cleared the Assembly Health Committee on an 11-3 vote. Republicans voted no, arguing the bill would cost too much and pay doctors and nurses less, potentially worsening a shortage of health care workers.\u003c/p>\n\u003cp>Assemblymember Ash Kalra, a Democrat from San Jos\u003cspan style=\"font-weight: 400\">é\u003c/span> and the author of the CalCare proposal, said Tuesday it could be 2024 before the tax increase proposal to pay for CalCare made it to the ballot.\u003c/p>\n\u003cp>An \u003ca href=\"https://calmatters.org/newsletters/whatmatters/2022/01/health-care-taxes-california/\">analysis from CalMatters\u003c/a> breaks down the proposed tax increase:\u003c/p>\n\u003cul>\n\u003cli>A 2.3% excise tax on businesses after their first $2 million in income\u003c/li>\n\u003cli>A 1.25% payroll tax on employers with 50-plus workers\u003c/li>\n\u003cli>An additional 1% payroll tax on wages for resident employees earning more than $49,900\u003c/li>\n\u003cli>A progressive income tax starting at 0.5% for Californians earning more than $149,500, up to 2.5% for people making about $2.5 million annually (with rates being adjusted for inflation)\u003c/li>\n\u003c/ul>\n\u003cp>The California Taxpayers Association, which opposes the plan, estimates it would raise taxes by about $163 billion per year.\u003c/p>\n\u003cp>“If government-run health care becomes law, millions of Californians will flee the state — either to avoid the $163 billion per year in new taxes or to escape the lengthy waits for care that will become the norm,” Assembly Republican Leader Marie Waldron said.\u003c/p>\n\u003cp>Even some Democrats who voted for the bill had sharp criticism for the proposal. Assemblymember Autumn Burke, a Democrat from Inglewood, said advancing the bill without a funding source made a mockery of the process.\u003c/p>\n\u003cp>“This bill has been sold to my community that it is going to change things now and that it is free. And neither one of those things are true,” she said.\u003c/p>\n\u003cp>Business groups, led by the California Chamber of Commerce, said the government-run health care system would be so expensive that the tax increase still wouldn’t be enough to pay for everything. In 2018, California’s total health care expenditures totaled $399.2 billion, accounting for 13.2% of the state’s gross domestic product, according to an analysis by the Healthy California for All Commission.\u003c/p>\n\u003cp>“Completely abolishing the current system in face of an unrelenting pandemic by annually taxing Californians hundreds of billions of dollars is not the solution,” said Preston Young, a policy advocate for the California Chamber of Commerce.\u003c/p>\n\u003cp>Kalra, the San Jos\u003cspan style=\"font-weight: 400\">é\u003c/span> Democrat and author of the proposal, said he knew opponents would focus on how much the plan would cost. But he said that argument distracts from the fact that Californians are already paying “the highest health tax in the world.”\u003c/p>\n\u003cp>“You may refer to it as premiums, deductibles, co-pays, denial of care,” Kalra said, saying none of those costs would exist under a universal health care system. “It’s clear as day they are being fleeced, and far too many understandably feel helpless about it.”\u003c/p>\n\u003cp>California’s health care system is paid for by multiple entities: patients, insurance companies, employers and government. But a universal health care system would be paid for by a single entity — the government, or the “single payer.”\u003c/p>\n\u003cp>A single-payer system has been a staple of California progressive political rhetoric for decades. But it’s not been easy to accomplish in a state where most people pay for private health insurance through their jobs. In 1994, voters overwhelmingly rejected a ballot initiative that would have created a universal health care system. Another attempt passed the state Senate in 2017, but it never got a vote in the state Assembly.\u003c/p>\n\u003cp>Questions about how to pay for a single-payer system have doomed previous plans. In 2011, Vermont enacted the nation’s first universal health care system in the country. But state officials abandoned it three years later because they said they couldn’t afford to pay for it.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Gov. Gavin Newsom \u003ca href=\"https://calmatters.org/politics/2021/02/newsom-single-payer-health-care-dilemma/\">promised to do it when he ran for governor in 2018\u003c/a>, and voters elected him in a landslide. But in his first three years in office, Newsom has focused more on making sure everyone in California has health insurance. He has expanded Medi-Cal, the state’s health care program for lower-income Californians, to cover people 26 years old and younger and 50 years old and older, regardless of their immigration status. On Monday, \u003ca href=\"https://www.kqed.org/news/11901253/flush-with-cash-governor-newsom-wants-to-invest-in-pandemic-response-universal-health-access-fighting-inequality\">Newsom proposed extending Medi-Cal again, this time to all eligible Californians\u003c/a>, regardless of immigration status, older than 26 and younger than 50, at a potential cost of $2.7 billion per year.\u003c/p>\n\u003cp>Also on Monday, Newsom reiterated his support for a universal health care system, but declined to say whether he supported the plan in the Legislature \u003ca href=\"https://calmatters.org/newsletters/whatmatters/2022/01/california-health-insurance-newsom/\">because he said he had not read it\u003c/a>. Asked if he had “given up” on a universal health care system in California, Newsom pointed to a commission he founded that is examining such a system and how much it would cost.\u003c/p>\n\u003cp>He also said he’s working with President Joe Biden’s administration on the “flexibility” required for California to implement such a system.\u003c/p>\n\u003cp>“When you’re governor, you’ve got to be in the ‘how’ business,” Newsom said. “I believe in a single-payer financing model. The ‘how’ at the state level is the question that needs to be answered thoughtfully.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"slug": "new-momnibus-bill-wants-to-help-more-black-moms-survive-childbirth",
"title": "New California Law Aims to Help More Black and Indigenous People Survive Childbirth",
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"content": "\u003cp>\u003cem>Updated Oct. 4, 2021, 2:30 p.m.\u003c/em>\u003c/p>\n\u003cp>Gov. Gavin Newsom signed a bill into law on Monday that aims to improve the survival rates of Black and Indigenous people and their babies during childbirth in California.\u003c/p>\n\u003cp>Black people were six times more likely to die within a year of pregnancy than white women from 2014 to 2016 and had a higher rate of death than Black women nationally from 2014 to 2017.\u003c/p>\n\u003cp>In California, Black and Native American babies die at a rate \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220SB65\">more than double the state average\u003c/a>. Black birthing people die at more than three times the state average.\u003c/p>\n\u003cp>Senate Bill 65, also known as the California Momnibus Act, will collect more details about pregnancy-related deaths, diversify the experts looking at that data and require them to recommend ways to reduce racial and socioeconomic gaps. It also would expand access to doulas and midwives, whose presence can drive better care.\u003c/p>\n\u003cp>“Every individual deserves to have a healthy pregnancy and birth, and this bill will help make this a reality for more California families,” Newsom said in a press release. “It is unacceptable that the maternal and infant mortality rate among Black and Indigenous communities remains significantly higher than the state average.”\u003c/p>\n\u003cp>SB 65, co-authored by Democratic state Sen. Nancy Skinner, D-Berkeley, formalizes a committee that is tasked with investigating every death of a birthing person and allows for voluntary interviews of family members to better understand what happened. It also looks into pregnancy-related deaths among members of the LGBTQ+ community.\u003c/p>\n\u003cp>“Gov. Newsom’s signing SB 65, the California Momnibus Act, represents a significant victory for Black maternal and infant health. Despite our medical advances, more U.S. babies and mothers die during birth than in all other high-income countries, and these preventable deaths are disproportionately higher for Black families,” said Skinner, who is also vice chair of the Legislative Women’s Caucus. “With the enactment of SB 65, California will help close racial disparities in maternal and infant deaths and save lives.”\u003c/p>\n\u003cp>The bill also increases Medi-Cal coverage to a full year postpartum. Previously, birthing people in lower-income families were kicked off Medi-Cal, California’s version of the federal Medicaid program, two months after giving birth.\u003c/p>\n\u003cp>“This bill affirms here in California these kinds of disparities in our maternal and infant outcomes will no longer be tolerated,” said state Assemblymember Dr. Akilah Weber, D-San Diego, another co-author of SB 65.\u003c/p>\n\u003cp>\u003cem>See the signing below:\u003c/em>\u003c/p>\n\u003cp>https://youtu.be/mTDSMNyUNrQ\u003c/p>\n\u003cp>\u003cstrong>Original post: Sept. 27, 2021\u003c/strong>\u003c/p>\n\u003cp>California has among the lowest death rates nationally among pregnant and birthing people, but the numbers for Black people in those populations tell a different story.\u003c/p>\n\u003cp>They were six times more likely to die within a year of pregnancy than white women from 2014 to 2016 and had a higher rate of death than Black women nationally from 2014 to 2017, the most recent time frame for which data is available.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Jen Flory, Western Center on Law and Poverty\"]‘It is going to take a serious investment and resources, whether that means providing every Black mother a doula or really investigating what’s happening when Black mothers die.’[/pullquote]A bill before Gov. Gavin Newsom aims to change that. Nicknamed the “Momnibus” bill, it would collect more details about pregnancy-related deaths, diversify the experts looking at that data and require them to recommend ways to reduce racial gaps. It also would expand access to doulas and midwives, whose presence can drive better care.\u003c/p>\n\u003cp>“If you really want to address the issue, it is going to take a serious investment and resources, whether that means providing every Black mother a doula or really investigating what’s happening when Black mothers die,” said Jen Flory, policy advocate for the Western Center on Law and Poverty, which supports the bill.\u003c/p>\n\u003cp>Newsom backed past efforts to improve care for Black pregnant people by requiring implicit bias training for health care workers involved in perinatal care, and he’s made support for women and new birthing people a priority for his administration. But his Department of Finance opposes the bill because the $6.7 million price tag for expanded data collection wasn’t included in the state budget. Newsom hasn’t said whether he’ll sign it.\u003c/p>\n\u003cp>Among wealthy nations, the United States ranks poorly in death rates of birthing people, and California’s effort is part of a national push to improve outcomes. Back in 2020, Democratic legislators on Capitol Hill introduced the Black Maternal Health Momnibus Act, which received the support of then-Senator Kamala Harris. But the bill never got a vote.\u003c/p>\n\u003cp>During his campaign, President Joe Biden lauded California’s efforts to reduce deaths, and in April he recognized Black Maternal Health Week.\u003cbr>\n[ad fullwidth]\u003cbr>\nThere are two ways to track deaths: The mortality rate for birthing people, used globally, counts deaths during pregnancy and within 42 days of giving birth. The pregnancy-related mortality rate, used in California and some other states, tracks deaths within a year of giving birth. The Centers for Disease Control and Prevention looks at both, though data lags and isn’t available to compare across states for the latter measure.\u003c/p>\n\u003cp>Earlier this month, the California Department of Public Health released a report tracking California’s outcomes from 2008 to 2016. Deaths of birthing people within a year of pregnancy hit a low in 2012, with fewer than 10 per 100,000 live births. It ticked up to about 14 deaths in 2016, slightly behind the national rate of almost 17 deaths. Using the mortality rate of birthing people, California ranked only behind Illinois for lowest death rates in 2019.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Kimberly D. Gregory, Cedars-Sinai Medical Center\"]‘There is a disparity between Black and white women and it’s not getting better.’[/pullquote]But the rate for Black birthing people was far higher. From 2014 to 2016 in California, about 56 Black birthing people died per 100,000 live births, compared to 13 Asian, 11 Latina and fewer than 10 white birthing people. Nationally, Black birthing people died at a rate of nearly 42 per 100,000 live births from 2014 to 2017. California’s Black birthing people died at six times the rate of white birthing people, up from three times the rate in 2008.\u003c/p>\n\u003cp>“The reality is there is a disparity between Black and white women and it’s not getting better,” said Kimberly D. Gregory, director of maternal fetal medicine at Cedars-Sinai Medical Center in Los Angeles and a former member of California’s pregnancy surveillance committee.\u003c/p>\n\u003cp>The committee plans to release data on pregnancy-related deaths through 2020 by next year. It relies on grant funding.\u003c/p>\n\u003cp>SB 65, authored by Democratic state Sen. Nancy Skinner, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220SB65\">aims to write the committee into state law\u003c/a> and strengthen its data collection and duties. It would require the committee to have 13 members, including doctors, midwives, doulas and community advocates and would include a tribal representative. According to the bill’s text, California’s Native American infant mortality rate is 11.7 deaths per 1,000 live births, which is far above the state’s average of 4.2 deaths per 1,000 live births.\u003c/p>\n\u003cp>Most of the committee’s current members are doctors.\u003c/p>\n\u003cp>The committee would investigate every death of a birthing person and allow for voluntary interviews of family members to better understand what happened. The committee would have to publish its findings and recommendations every three years. It would also look into pregnancy-related deaths among members of the LGBTQ+ community.\u003c/p>\n\u003cp>“We can make better decisions about prevention, intervention, systems changes, not only at the hospital level but at the community level,” said Mashariki Kudumu, director of maternal and infant health initiatives for the \u003ca href=\"https://www.marchofdimes.org/news/march-of-dimes-greater-los-angeles-division-board.aspx\">March of Dimes, Greater Los Angeles\u003c/a>, which is a co-sponsor of the bill. “What comes with diverse and different perspectives are better changes to systems that improve care.”\u003c/p>\n\u003cp>Kudumu is also trained as a doula. Newsom in his state budget made doulas a covered benefit under Medi-Cal, the state’s health insurance program for lower-income people, following states including New York and Illinois. Doulas are trained to assist and advocate for birthing people in pregnancy and during and after birth. Research shows their presence reduces pregnancy complications and low birthweight in babies.\u003c/p>\n\u003cp>[aside label ='Related Coverage' tag='health-equity']The benefit takes effect next year, and the bill before Newsom would establish a group to study its use. The proposal also expands training for midwives.\u003c/p>\n\u003cp>Kudumu said she’s helped birthing people stick to their birthing plans in the face of pressure from doctors and provided them with nursing and lactation support.\u003c/p>\n\u003cp>She knows the value from personal experience. When Kudumu delivered her son prematurely, she felt disrespected by the doctor because she’s a Black woman who was on Medi-Cal at the time while she was in graduate school.\u003c/p>\n\u003cp>Kudumu had to fight to ensure her son got breastmilk instead of formula while he was in the newborn intensive care unit. She remembers the doctor’s attitude changing when another doula at the hospital came up to greet her.\u003c/p>\n\u003cp>“We want to make sure that this resource, that evidence shows improves health outcomes, is more accessible to people,” she said.\u003c/p>\n\u003cp>\u003cem>Original reporting for this post was from Kathleen Ronayne of the The Associated Press. KQED’s April Dembosky contributed reporting to the updates.\u003c/em>\u003cbr>\n[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Updated Oct. 4, 2021, 2:30 p.m.\u003c/em>\u003c/p>\n\u003cp>Gov. Gavin Newsom signed a bill into law on Monday that aims to improve the survival rates of Black and Indigenous people and their babies during childbirth in California.\u003c/p>\n\u003cp>Black people were six times more likely to die within a year of pregnancy than white women from 2014 to 2016 and had a higher rate of death than Black women nationally from 2014 to 2017.\u003c/p>\n\u003cp>In California, Black and Native American babies die at a rate \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220SB65\">more than double the state average\u003c/a>. Black birthing people die at more than three times the state average.\u003c/p>\n\u003cp>Senate Bill 65, also known as the California Momnibus Act, will collect more details about pregnancy-related deaths, diversify the experts looking at that data and require them to recommend ways to reduce racial and socioeconomic gaps. It also would expand access to doulas and midwives, whose presence can drive better care.\u003c/p>\n\u003cp>“Every individual deserves to have a healthy pregnancy and birth, and this bill will help make this a reality for more California families,” Newsom said in a press release. “It is unacceptable that the maternal and infant mortality rate among Black and Indigenous communities remains significantly higher than the state average.”\u003c/p>\n\u003cp>SB 65, co-authored by Democratic state Sen. Nancy Skinner, D-Berkeley, formalizes a committee that is tasked with investigating every death of a birthing person and allows for voluntary interviews of family members to better understand what happened. It also looks into pregnancy-related deaths among members of the LGBTQ+ community.\u003c/p>\n\u003cp>“Gov. Newsom’s signing SB 65, the California Momnibus Act, represents a significant victory for Black maternal and infant health. Despite our medical advances, more U.S. babies and mothers die during birth than in all other high-income countries, and these preventable deaths are disproportionately higher for Black families,” said Skinner, who is also vice chair of the Legislative Women’s Caucus. “With the enactment of SB 65, California will help close racial disparities in maternal and infant deaths and save lives.”\u003c/p>\n\u003cp>The bill also increases Medi-Cal coverage to a full year postpartum. Previously, birthing people in lower-income families were kicked off Medi-Cal, California’s version of the federal Medicaid program, two months after giving birth.\u003c/p>\n\u003cp>“This bill affirms here in California these kinds of disparities in our maternal and infant outcomes will no longer be tolerated,” said state Assemblymember Dr. Akilah Weber, D-San Diego, another co-author of SB 65.\u003c/p>\n\u003cp>\u003cem>See the signing below:\u003c/em>\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/mTDSMNyUNrQ'\n title='//www.youtube.com/embed/mTDSMNyUNrQ'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>\u003cstrong>Original post: Sept. 27, 2021\u003c/strong>\u003c/p>\n\u003cp>California has among the lowest death rates nationally among pregnant and birthing people, but the numbers for Black people in those populations tell a different story.\u003c/p>\n\u003cp>They were six times more likely to die within a year of pregnancy than white women from 2014 to 2016 and had a higher rate of death than Black women nationally from 2014 to 2017, the most recent time frame for which data is available.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>A bill before Gov. Gavin Newsom aims to change that. Nicknamed the “Momnibus” bill, it would collect more details about pregnancy-related deaths, diversify the experts looking at that data and require them to recommend ways to reduce racial gaps. It also would expand access to doulas and midwives, whose presence can drive better care.\u003c/p>\n\u003cp>“If you really want to address the issue, it is going to take a serious investment and resources, whether that means providing every Black mother a doula or really investigating what’s happening when Black mothers die,” said Jen Flory, policy advocate for the Western Center on Law and Poverty, which supports the bill.\u003c/p>\n\u003cp>Newsom backed past efforts to improve care for Black pregnant people by requiring implicit bias training for health care workers involved in perinatal care, and he’s made support for women and new birthing people a priority for his administration. But his Department of Finance opposes the bill because the $6.7 million price tag for expanded data collection wasn’t included in the state budget. Newsom hasn’t said whether he’ll sign it.\u003c/p>\n\u003cp>Among wealthy nations, the United States ranks poorly in death rates of birthing people, and California’s effort is part of a national push to improve outcomes. Back in 2020, Democratic legislators on Capitol Hill introduced the Black Maternal Health Momnibus Act, which received the support of then-Senator Kamala Harris. But the bill never got a vote.\u003c/p>\n\u003cp>During his campaign, President Joe Biden lauded California’s efforts to reduce deaths, and in April he recognized Black Maternal Health Week.\u003cbr>\n\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cbr>\nThere are two ways to track deaths: The mortality rate for birthing people, used globally, counts deaths during pregnancy and within 42 days of giving birth. The pregnancy-related mortality rate, used in California and some other states, tracks deaths within a year of giving birth. The Centers for Disease Control and Prevention looks at both, though data lags and isn’t available to compare across states for the latter measure.\u003c/p>\n\u003cp>Earlier this month, the California Department of Public Health released a report tracking California’s outcomes from 2008 to 2016. Deaths of birthing people within a year of pregnancy hit a low in 2012, with fewer than 10 per 100,000 live births. It ticked up to about 14 deaths in 2016, slightly behind the national rate of almost 17 deaths. Using the mortality rate of birthing people, California ranked only behind Illinois for lowest death rates in 2019.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>But the rate for Black birthing people was far higher. From 2014 to 2016 in California, about 56 Black birthing people died per 100,000 live births, compared to 13 Asian, 11 Latina and fewer than 10 white birthing people. Nationally, Black birthing people died at a rate of nearly 42 per 100,000 live births from 2014 to 2017. California’s Black birthing people died at six times the rate of white birthing people, up from three times the rate in 2008.\u003c/p>\n\u003cp>“The reality is there is a disparity between Black and white women and it’s not getting better,” said Kimberly D. Gregory, director of maternal fetal medicine at Cedars-Sinai Medical Center in Los Angeles and a former member of California’s pregnancy surveillance committee.\u003c/p>\n\u003cp>The committee plans to release data on pregnancy-related deaths through 2020 by next year. It relies on grant funding.\u003c/p>\n\u003cp>SB 65, authored by Democratic state Sen. Nancy Skinner, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220SB65\">aims to write the committee into state law\u003c/a> and strengthen its data collection and duties. It would require the committee to have 13 members, including doctors, midwives, doulas and community advocates and would include a tribal representative. According to the bill’s text, California’s Native American infant mortality rate is 11.7 deaths per 1,000 live births, which is far above the state’s average of 4.2 deaths per 1,000 live births.\u003c/p>\n\u003cp>Most of the committee’s current members are doctors.\u003c/p>\n\u003cp>The committee would investigate every death of a birthing person and allow for voluntary interviews of family members to better understand what happened. The committee would have to publish its findings and recommendations every three years. It would also look into pregnancy-related deaths among members of the LGBTQ+ community.\u003c/p>\n\u003cp>“We can make better decisions about prevention, intervention, systems changes, not only at the hospital level but at the community level,” said Mashariki Kudumu, director of maternal and infant health initiatives for the \u003ca href=\"https://www.marchofdimes.org/news/march-of-dimes-greater-los-angeles-division-board.aspx\">March of Dimes, Greater Los Angeles\u003c/a>, which is a co-sponsor of the bill. “What comes with diverse and different perspectives are better changes to systems that improve care.”\u003c/p>\n\u003cp>Kudumu is also trained as a doula. Newsom in his state budget made doulas a covered benefit under Medi-Cal, the state’s health insurance program for lower-income people, following states including New York and Illinois. Doulas are trained to assist and advocate for birthing people in pregnancy and during and after birth. Research shows their presence reduces pregnancy complications and low birthweight in babies.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The benefit takes effect next year, and the bill before Newsom would establish a group to study its use. The proposal also expands training for midwives.\u003c/p>\n\u003cp>Kudumu said she’s helped birthing people stick to their birthing plans in the face of pressure from doctors and provided them with nursing and lactation support.\u003c/p>\n\u003cp>She knows the value from personal experience. When Kudumu delivered her son prematurely, she felt disrespected by the doctor because she’s a Black woman who was on Medi-Cal at the time while she was in graduate school.\u003c/p>\n\u003cp>Kudumu had to fight to ensure her son got breastmilk instead of formula while he was in the newborn intensive care unit. She remembers the doctor’s attitude changing when another doula at the hospital came up to greet her.\u003c/p>\n\u003cp>“We want to make sure that this resource, that evidence shows improves health outcomes, is more accessible to people,” she said.\u003c/p>\n\u003cp>\u003cem>Original reporting for this post was from Kathleen Ronayne of the The Associated Press. KQED’s April Dembosky contributed reporting to the updates.\u003c/em>\u003cbr>\n\u003c/p>\u003c/div>",
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"content": "\u003cp>Living unmedicated with schizophrenia and bipolar disorder, Eugenia Hunter has a hard time recalling how long she’s been staying in the tent she calls home at the bustling intersection of San Pablo Avenue and Martin Luther King Jr. Way in Oakland’s Uptown neighborhood. Craft coffee shops and weed dispensaries are plentiful here, and one-bedroom apartments push $3,000 per month.\u003c/p>\n\u003cp>“At least the rats aren’t all over me in here,” the 59-year-old Oakland native said on a bright August afternoon, stretching her arm to grab the zipper to her front door.\u003c/p>\n\u003cp>It was hot inside and the stench of wildfire smoke hung in the air. Still, after sleeping on a nearby bench for the better part of a year, she felt safer here, Hunter explained as she rolled a joint she’d use to ease the pain from also living with what she said is untreated pancreatic cancer.\u003c/p>\n\u003cfigure id=\"attachment_11887857\" class=\"wp-caption alignnone\" style=\"max-width: 1350px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11887857 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/09/Hunter03.jpg\" alt=\"Woman with no hair sits in door of a tent on a bedframe, looking tired.\" width=\"1350\" height=\"900\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter03.jpg 1350w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter03-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter03-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter03-160x107.jpg 160w\" sizes=\"auto, (max-width: 1350px) 100vw, 1350px\">\u003cfigcaption class=\"wp-caption-text\">Eugenia Hunter lives in Oakland’s Uptown neighborhood surrounded by upscale apartments and hip eateries. She can’t find a place she can afford on the $930 per month she receives in federal disability payments. \u003ccite>(Angela Hart/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hunter has been hospitalized repeatedly, including once last summer after she overdosed on alcohol and lay unconscious on a sidewalk until someone stopped to help. But she is reluctant to see a doctor or use Medi-Cal, California’s health insurance program for low-income and disabled people, largely because it would force her to leave her tent.\u003c/p>\n\u003cp>“My stuff keeps on getting taken when I’m not around and, besides, I’m waiting until I got a place to live to start taking my medication again,” Hunter said, tearing up. “I can’t get anything right out here.”\u003c/p>\n\u003cp>Hunter’s long and complex list of ailments, combined with her mistrust of the health care system, make her an incredibly difficult and expensive patient to treat. But she is exactly the kind of person California intends to prioritize under an ambitious experiment to move Medi-Cal beyond traditional doctor visits and hospital stays into the realm of social services.\u003c/p>\n\u003cfigure id=\"attachment_11887890\" class=\"wp-caption alignnone\" style=\"max-width: 1350px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11887890 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/09/Hunter06.jpg\" alt=\"A row of tents alongside a cement sidewalk in an urban park surrounded by buildings.\" width=\"1350\" height=\"900\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter06.jpg 1350w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter06-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter06-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter06-160x107.jpg 160w\" sizes=\"auto, (max-width: 1350px) 100vw, 1350px\">\u003cfigcaption class=\"wp-caption-text\">Staying in a tent in Oakland’s Uptown neighborhood has been a safer experience for Eugenia Hunter than sleeping on a nearby bench, which was her living situation for most of the year. However, she is reluctant to see a doctor or use Medi-Cal, largely because it would force her to leave her tent. When she has left her tent in the past, her belongings have been stolen. \u003ccite>(Angela Hart/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Under the program, vulnerable patients like Hunter will be assigned a personal care manager to coordinate their health care treatments and daily needs, like paying bills and buying groceries. And they will receive \u003ca href=\"https://californiahealthline.org/wp-content/uploads/sites/3/2021/09/CalAIM-Nontraditional-Services-2022.pdf\">services that aren’t typically covered by health insurance plans\u003c/a>, such as getting security deposits paid, receiving deliveries of fruits and vegetables, and having toxic mold removed from homes to reduce asthma flare-ups.\u003c/p>\n\u003cp>Over the next five years, California is plowing nearly $6 billion in state and federal money into the plan, which will target just a sliver of the 14 million low-income Californians enrolled in Medi-Cal: unhoused individuals or those at risk of losing their homes; heavy users of hospital emergency rooms; children and seniors with complicated physical and mental health conditions; and people in — or at risk of landing in — expensive institutions like jails, nursing homes or mental health crisis centers.\u003c/p>\n\u003cp>[pullquote size='large' align='right']Under the program, vulnerable patients like Hunter will be assigned a personal care manager to coordinate their health care treatments and daily needs, like paying bills and buying groceries.[/pullquote]\u003c/p>\n\u003cp>Gov. Gavin Newsom is trumpeting the first-in-the-nation initiative as the centerpiece of his ambitious health care agenda — and vows it will help fix the mental health and addiction crisis on the streets and get people into housing, all while saving taxpayer money. His top health care advisers have even \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCQMD/CalAIM-Role-in-Addressing-Homelessness-Fact-Sheet-%26-Letter-4-9-21.pdf\">cast it as an antidote to California’s worsening homelessness crisis\u003c/a>.\u003c/p>\n\u003cp>But the first-term Democrat, who faces a Sept. 14 recall election, is making a risky bet.\u003c/p>\n\u003cp>California does not have the evidence to prove this approach will work statewide, nor the workforce or infrastructure to make it happen on such a large scale.\u003c/p>\n\u003cp>[aside postID=\"news_11883165\" hero=\"https://ww2.kqed.org/app/uploads/sites/10/2021/07/041021_FacebookVaccine_AW_09-1020x680.jpeg\"]Critics also fear the program will do nothing to improve care for the millions of other Medi-Cal enrollees who won’t get help from this initiative. Medi-Cal has been slammed for failing to provide basic services, \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2018-111.pdf\">including vaccinations for kids\u003c/a>, \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2018-122.pdf\">timely appointments for rural residents\u003c/a> and \u003ca href=\"https://californiahealthline.org/wp-content/uploads/sites/3/2021/09/Newsom_begins_mental_health_care_crackdown_with_county_sanctions.pdf\">adequate mental health treatment\u003c/a> for Californians in crisis.\u003c/p>\n\u003cp>Yet the managed-care insurance companies responsible for most enrollees’ health will nonetheless be given massive new power as they implement this experiment. The insurers will decide which services to offer and which high-needs patients to target, likely creating disparities across regions and further contributing to an unequal system of care in California.\u003c/p>\n\u003cp>“This will leave a lot of people behind,” said Linda Nguy, a policy advocate at the Western Center on Law & Poverty.\u003c/p>\n\u003cp>“We haven’t seen health plans excel in even providing basic preventative services to healthy people,” she said. “I mean, do your basic job first. How can they be expected to successfully take on these additional responsibilities for people with very high health needs?”\u003c/p>\n\u003cp>This revolution in Medi-Cal’s scope and mission is taking place alongside a parallel initiative to hold insurance companies more accountable for providing quality health care.\u003c/p>\n\u003cp>[pullquote size='large' align='right']If California’s experiment succeeds, other states will likely follow … but if the richest state in the country can’t pull off better health outcomes and cost savings, the movement to put health insurers into the business of social work will falter.[/pullquote]\u003c/p>\n\u003cp>State health officials are forcing Medi-Cal managed-care plans to reapply and meet stricter standards if they want to continue doing business in the program. Together, these initiatives will fundamentally reinvent the biggest Medicaid program in the country, which serves about one-third of the state population at a cost of $124 billion this fiscal year.\u003c/p>\n\u003cp>If California’s \u003ca href=\"https://www.dhcs.ca.gov/provgovpart/Documents/CalAIM-Proposal-03-23-2021.pdf\">experiment succeeds\u003c/a>, other states will likely follow, national Medicaid experts say. But if the richest state in the country can’t pull off better health outcomes and cost savings, the movement to put health insurers into the business of social work will falter.\u003cbr>\n[ad fullwidth]\u003c/p>\n\u003ch3>What it takes to provide ‘whole person care’\u003c/h3>\n\u003cp>When Newsom signed the “California Advancing and Innovating Medi-Cal” initiative into law in late July — “CalAIM” for short — he celebrated it as a “once-in-a-generation opportunity to completely transform the Medicaid system in California.” He declined an interview request.\u003c/p>\n\u003cp>[aside postID=\"news_11877000\" hero=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/RS49414_028_SanRafael_ProjectHomekey_05172021-qut-1020x680.jpg\"]Beginning next year, public and private managed health care plans will pick high-needs Medi-Cal enrollees to receive nontraditional services from among \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCQMD/MCP-ECM-and-ILOS-Contract-Template-Provisions.pdf\">14 broad categories, including housing and food benefits, addiction care and home repairs\u003c/a>.\u003c/p>\n\u003cp>The approach is known as “whole person care,” and insurers will be required to assign patients a personal care manager to help them navigate the system. Insurers will receive incentive payments to offer new services and boost provider networks and, over time, the program will expand to more people and services. For instance, members of Native American tribes will eventually be eligible to receive treatment for substance use disorder, and incarcerated people will be enrolled in Medi-Cal automatically upon release.\u003c/p>\n\u003cp>The insurers — currently 25 are participating — will focus most intensely on developing housing programs to combat the state’s \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCQMD/CalAIM-Role-in-Addressing-Homelessness-Fact-Sheet-%26-Letter-4-9-21.pdf\">worsening homelessness epidemic\u003c/a>. The state was home to at least 162,000 unhoused people in 2020, a 6.8% increase since Newsom took office in 2019.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Jacey Cooper, director of Medicaid for California\"]‘If you generally focus on [the most vulnerable], you will be able to yield better health outcomes for those individuals and, ultimately, cost savings.’[/pullquote]Jacey Cooper, the state’s Medicaid director, said \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCQMD/CalAIM-Role-in-Addressing-Homelessness-Fact-Sheet-%26-Letter-4-9-21.pdf\">all Medi-Cal members will eventually be eligible for housing services\u003c/a>. Initially, though, they will be available only to the costliest patients. State Medi-Cal expenditure data shows that 1% of Medi-Cal enrollees, many of the unhoused patients who frequently land in hospitals, account for a staggering 21% of overall spending. And 5% account for 44% of the budget.\u003c/p>\n\u003cp>“You really need to focus on your top 1% to 5% of utilizers — that’s your most vulnerable,” Cooper said. “If you generally focus on that group, you will be able to yield better health outcomes for those individuals and, ultimately, cost savings.”\u003c/p>\n\u003cp>State officials do not have a savings estimate for the program, nor a projection of how many people will be enrolled.\u003c/p>\n\u003cp>The plan, Cooper said, builds on more than \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/wholepersoncare-report-jan2020.pdf\">25 successful regional experiments underway since 2016\u003c/a>. From Los Angeles to rural Shasta, big and small counties have provided vulnerable Medi-Cal patients with different services based on their communities’ needs, from job placement services to providing a safe place for an unhoused person to get sober.\u003c/p>\n\u003cp>Cooper highlighted \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/wholepersoncare-report-jan2020.pdf\">interim data from the experiments\u003c/a> that showed patients hospitalized due to mental illness were more likely to receive follow-up care, obtain treatment for substance abuse, avoid hospitalizations and emergency department visits, and see improvements in chronic diseases like diabetes.\u003c/p>\n\u003cp>She argued that data — even though it is not comprehensive — is enough to prove the initiative will work on a statewide scale.\u003c/p>\n\u003cp>[aside postID=\"news_11870625\" hero=\"https://ww2.kqed.org/app/uploads/sites/10/2021/04/RS43040_011_KQED_SanFrancisco_TentEncampments_05052020-qut-1020x680.jpg\"]However, studies of similar programs elsewhere have yielded mixed results. New York provided housing services to high-cost Medicaid enrollees with chronic diseases and mental health and substance use disorders and found major reductions in hospital admissions and emergency department visits between 2012 and 2017, and saw a \u003ca href=\"https://www.health.ny.gov/health_care/medicaid/redesign/supportive_housing/evaluation.htm\">15% reduction in Medicaid spending.\u003c/a>\u003c/p>\n\u003cp>In Camden, New Jersey, \u003ca href=\"https://californiahealthline.org/news/despite-new-doubts-hotspotting-help-for-heavy-health-care-users-marches-on/\">an early test of the “whole person care” approach\u003c/a> provided expensive Medicaid patients with intensive care coordination, but not nontraditional services. A \u003ca href=\"https://www.nejm.org/doi/full/10.1056/NEJMsa1906848\">study concluded in 2020 that it hadn’t lowered hospital readmissions\u003c/a> — and thus didn’t save health care dollars.\u003c/p>\n\u003cp>“We found we just couldn’t help people with housing as quickly as they needed help,” said Kathleen Noonan, CEO of the Camden Coalition of Healthcare Providers. “Many of these clients have bad credit, they may have a record, and they’re still using. Those are huge challenges.”\u003c/p>\n\u003cp>California may find success where the coalition hadn’t because it will offer social services, she said, which the coalition has also started doing.\u003c/p>\n\u003cp>But it will take time. California will have five years to prove to the federal government it can save money and improve health care quality. Insurers will be required to track health outcomes and savings, and can boost services over time or drop programs that don’t work.\u003c/p>\n\u003cp>So far, the regional experiments have failed to serve low-income Black and Latino residents, according to the interim assessments conducted by Nadereh Pourat, director of the UCLA Center for Health Policy Research. She concluded that they have \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/wholepersoncare-report-jan2020.pdf\">primarily benefited white, English-speaking, middle-aged men\u003c/a>.\u003c/p>\n\u003cp>[aside postID=\"news_11877585\" hero=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/RS49286_002_LakeCounty_ProjectHomekey_05142021-qut-1020x680.jpg\"]Cooper said \u003ca href=\"https://www.dhcs.ca.gov/provgovpart/Documents/CalAIM-Proposal-03-23-2021.pdf\">the statewide initiative will tackle “systemic racism,” \u003c/a>initially as it targets \u003ca href=\"https://endhomelessness.org/resource/racial-inequalities-homelessness-numbers/\">unhoused individuals, who are disproportionately Black\u003c/a>.\u003c/p>\n\u003cp>Consider Eugenia Hunter, who is African American, and whose many untreated mental and physical illnesses, intertwined with her addictions, mean it will take a herculean effort — and cost — to get her off the street.\u003c/p>\n\u003cp>Hunter has gone without a stable housing situation for at least three years. Or maybe it’s five; her mental illness clouds her memory, and she erupts in anger when pressed for details. She eases her frustration sometimes with sleep, sometimes by smoking crystal meth.\u003c/p>\n\u003cp>A stack of unopened health insurance letters sat beside Hunter one evening in late August. Her eyes were glassy when she struggled to remember when she received a cancer diagnosis — if she ever did at all.\u003c/p>\n\u003ch3>Bringing stakeholders on board\u003c/h3>\n\u003cp>Health insurers will not be required to offer social services to patients like Hunter because federal law requires nontraditional Medicaid services to be optional. But California is enticing insurers with bigger payouts and higher state rankings.\u003c/p>\n\u003cp>“We are asking the plans and providers to stretch. We’re asking them to reform,” Cooper said.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Jacey Cooper, director of Medicaid for California\"]‘We are asking the plans and providers to stretch. We’re asking them to reform.’[/pullquote]The state is urging insurers to start with the roughly 130,500 Medi-Cal patients already enrolled in the local experiments. To prepare, they are cobbling together networks of nonprofits and social service organizations to provide food, housing and other services — much as they do with doctors and hospitals contracted to deliver medical care.\u003c/p>\n\u003cp>\u003ca href=\"https://californiahealthline.org/wp-content/uploads/sites/3/2021/09/CalAIM-Nontraditional-Services-2022.pdf\">Services will also vary by insurer and region.\u003c/a>\u003c/p>\n\u003cp>The Inland Empire Health Plan, for example, will offer some patients home repairs that reduce asthma triggers, such as mold removal and installing air filters. But Partnership HealthPlan of California will not offer those benefits in its wildfire-prone Northern California region because it doesn’t have an adequate network of organizations equipped to provide those services.\u003c/p>\n\u003cp>In interviews with nearly all of California’s Medi-Cal managed-care plans, executives said they support the dual goals of helping patients get healthier while saving money, but “it is a lot to take on,” said Richard Sanchez, CEO of CalOptima, which serves Orange County and will start modestly, primarily with housing services.\u003c/p>\n\u003cp>[pullquote size='large' align='right']Nearly all the health plans will offer housing services right away, focusing on three categories of aid: helping enrollees secure housing and rent subsidies; providing temporary rent and security deposit payments; and helping tenants stay housed.[/pullquote]\u003c/p>\n\u003cp>“The last thing I want to do is make promises that we can do all these things and not come through,” he said.\u003c/p>\n\u003cp>Nearly all the health plans will offer housing services right away, focusing on three categories of aid: helping enrollees secure housing and rent subsidies; providing temporary rent and security deposit payments; and helping tenants stay housed, like intervening with a landlord if a patient misses rent.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Dr. Robert Moore, chief medical officer of Partnership HealthPlan\"]‘It’s a great deal of money for a small number of members … we are building something extraordinarily ambitious quickly, without the infrastructure in place to make it successful.’[/pullquote]Partnership HealthPlan, which serves 616,000 Medi-Cal patients in 14 Northern California counties, will prioritize its most at-risk enrollees with housing services, food deliveries and a “homemaker” benefit to help them cook dinner, do laundry and pay bills.\u003c/p>\n\u003cp>“It’s a great deal of money for a small number of members and, frankly, there’s no guarantee it’s going to work,” said Dr. Robert Moore, the plan’s chief medical officer. “We are building something extraordinarily ambitious quickly, without the infrastructure in place to make it successful.”\u003c/p>\n\u003cp>Even if offering new services costs more money than it saves, it’s a worthwhile investment, said John Baackes, CEO of L.A. Care Health Plan, the largest Medi-Cal plan, which serves more than 2 million patients in Los Angeles County.\u003c/p>\n\u003cp>“When somebody has congestive heart failure, their diet should be structured around alleviating that chronic condition,” he said, explaining his plan to offer patients healthful food. “What are we going to do — let them eat ramen noodles for the rest of their lives?”\u003c/p>\n\u003cp>In Alameda County, two plans are available to serve Hunter. The Alameda Alliance for Health, a public insurer established by the county, and Anthem Blue Cross, a private insurance company, will expand housing services.\u003c/p>\n\u003cp>[aside label ='Related Coverage' tag='healthcare, health care']“People like Eugenia Hunter are exactly who we want to serve, and we’re prepared to go out and help her,” said Scott Coffin, CEO of the Alameda Alliance for Health, who is also on a local street medicine team.\u003c/p>\n\u003cp>But they’d have to find her first — chaos and homeless encampment sweeps force her to move her tent frequently. And then they’d have to win her trust.\u003c/p>\n\u003cp>In one moment, Hunter angrily described how health plans have tried to enroll her in services, but she declined, mistrustful of their motives. In the next moment, fighting back voices in her head, she said she desperately wants care.\u003c/p>\n\u003cp>“Someone is going to help me?” she asked. “All I want to do is pay my rent and succeed.”\u003c/p>\n\u003cp>\u003cem>Kaiser Health News is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at Kaiser Family Foundation, an endowed nonprofit providing information on health issues.\u003c/em>\u003cbr>\n[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"title": "'Whole Person Care': A Major Shift in Medi-Cal's Scope Targets Those Most in Need | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Living unmedicated with schizophrenia and bipolar disorder, Eugenia Hunter has a hard time recalling how long she’s been staying in the tent she calls home at the bustling intersection of San Pablo Avenue and Martin Luther King Jr. Way in Oakland’s Uptown neighborhood. Craft coffee shops and weed dispensaries are plentiful here, and one-bedroom apartments push $3,000 per month.\u003c/p>\n\u003cp>“At least the rats aren’t all over me in here,” the 59-year-old Oakland native said on a bright August afternoon, stretching her arm to grab the zipper to her front door.\u003c/p>\n\u003cp>It was hot inside and the stench of wildfire smoke hung in the air. Still, after sleeping on a nearby bench for the better part of a year, she felt safer here, Hunter explained as she rolled a joint she’d use to ease the pain from also living with what she said is untreated pancreatic cancer.\u003c/p>\n\u003cfigure id=\"attachment_11887857\" class=\"wp-caption alignnone\" style=\"max-width: 1350px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11887857 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/09/Hunter03.jpg\" alt=\"Woman with no hair sits in door of a tent on a bedframe, looking tired.\" width=\"1350\" height=\"900\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter03.jpg 1350w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter03-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter03-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter03-160x107.jpg 160w\" sizes=\"auto, (max-width: 1350px) 100vw, 1350px\">\u003cfigcaption class=\"wp-caption-text\">Eugenia Hunter lives in Oakland’s Uptown neighborhood surrounded by upscale apartments and hip eateries. She can’t find a place she can afford on the $930 per month she receives in federal disability payments. \u003ccite>(Angela Hart/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hunter has been hospitalized repeatedly, including once last summer after she overdosed on alcohol and lay unconscious on a sidewalk until someone stopped to help. But she is reluctant to see a doctor or use Medi-Cal, California’s health insurance program for low-income and disabled people, largely because it would force her to leave her tent.\u003c/p>\n\u003cp>“My stuff keeps on getting taken when I’m not around and, besides, I’m waiting until I got a place to live to start taking my medication again,” Hunter said, tearing up. “I can’t get anything right out here.”\u003c/p>\n\u003cp>Hunter’s long and complex list of ailments, combined with her mistrust of the health care system, make her an incredibly difficult and expensive patient to treat. But she is exactly the kind of person California intends to prioritize under an ambitious experiment to move Medi-Cal beyond traditional doctor visits and hospital stays into the realm of social services.\u003c/p>\n\u003cfigure id=\"attachment_11887890\" class=\"wp-caption alignnone\" style=\"max-width: 1350px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11887890 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/09/Hunter06.jpg\" alt=\"A row of tents alongside a cement sidewalk in an urban park surrounded by buildings.\" width=\"1350\" height=\"900\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter06.jpg 1350w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter06-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter06-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter06-160x107.jpg 160w\" sizes=\"auto, (max-width: 1350px) 100vw, 1350px\">\u003cfigcaption class=\"wp-caption-text\">Staying in a tent in Oakland’s Uptown neighborhood has been a safer experience for Eugenia Hunter than sleeping on a nearby bench, which was her living situation for most of the year. However, she is reluctant to see a doctor or use Medi-Cal, largely because it would force her to leave her tent. When she has left her tent in the past, her belongings have been stolen. \u003ccite>(Angela Hart/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Under the program, vulnerable patients like Hunter will be assigned a personal care manager to coordinate their health care treatments and daily needs, like paying bills and buying groceries. And they will receive \u003ca href=\"https://californiahealthline.org/wp-content/uploads/sites/3/2021/09/CalAIM-Nontraditional-Services-2022.pdf\">services that aren’t typically covered by health insurance plans\u003c/a>, such as getting security deposits paid, receiving deliveries of fruits and vegetables, and having toxic mold removed from homes to reduce asthma flare-ups.\u003c/p>\n\u003cp>Over the next five years, California is plowing nearly $6 billion in state and federal money into the plan, which will target just a sliver of the 14 million low-income Californians enrolled in Medi-Cal: unhoused individuals or those at risk of losing their homes; heavy users of hospital emergency rooms; children and seniors with complicated physical and mental health conditions; and people in — or at risk of landing in — expensive institutions like jails, nursing homes or mental health crisis centers.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Gov. Gavin Newsom is trumpeting the first-in-the-nation initiative as the centerpiece of his ambitious health care agenda — and vows it will help fix the mental health and addiction crisis on the streets and get people into housing, all while saving taxpayer money. His top health care advisers have even \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCQMD/CalAIM-Role-in-Addressing-Homelessness-Fact-Sheet-%26-Letter-4-9-21.pdf\">cast it as an antidote to California’s worsening homelessness crisis\u003c/a>.\u003c/p>\n\u003cp>But the first-term Democrat, who faces a Sept. 14 recall election, is making a risky bet.\u003c/p>\n\u003cp>California does not have the evidence to prove this approach will work statewide, nor the workforce or infrastructure to make it happen on such a large scale.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Critics also fear the program will do nothing to improve care for the millions of other Medi-Cal enrollees who won’t get help from this initiative. Medi-Cal has been slammed for failing to provide basic services, \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2018-111.pdf\">including vaccinations for kids\u003c/a>, \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2018-122.pdf\">timely appointments for rural residents\u003c/a> and \u003ca href=\"https://californiahealthline.org/wp-content/uploads/sites/3/2021/09/Newsom_begins_mental_health_care_crackdown_with_county_sanctions.pdf\">adequate mental health treatment\u003c/a> for Californians in crisis.\u003c/p>\n\u003cp>Yet the managed-care insurance companies responsible for most enrollees’ health will nonetheless be given massive new power as they implement this experiment. The insurers will decide which services to offer and which high-needs patients to target, likely creating disparities across regions and further contributing to an unequal system of care in California.\u003c/p>\n\u003cp>“This will leave a lot of people behind,” said Linda Nguy, a policy advocate at the Western Center on Law & Poverty.\u003c/p>\n\u003cp>“We haven’t seen health plans excel in even providing basic preventative services to healthy people,” she said. “I mean, do your basic job first. How can they be expected to successfully take on these additional responsibilities for people with very high health needs?”\u003c/p>\n\u003cp>This revolution in Medi-Cal’s scope and mission is taking place alongside a parallel initiative to hold insurance companies more accountable for providing quality health care.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "If California’s experiment succeeds, other states will likely follow … but if the richest state in the country can’t pull off better health outcomes and cost savings, the movement to put health insurers into the business of social work will falter.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>State health officials are forcing Medi-Cal managed-care plans to reapply and meet stricter standards if they want to continue doing business in the program. Together, these initiatives will fundamentally reinvent the biggest Medicaid program in the country, which serves about one-third of the state population at a cost of $124 billion this fiscal year.\u003c/p>\n\u003cp>If California’s \u003ca href=\"https://www.dhcs.ca.gov/provgovpart/Documents/CalAIM-Proposal-03-23-2021.pdf\">experiment succeeds\u003c/a>, other states will likely follow, national Medicaid experts say. But if the richest state in the country can’t pull off better health outcomes and cost savings, the movement to put health insurers into the business of social work will falter.\u003cbr>\n\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003ch3>What it takes to provide ‘whole person care’\u003c/h3>\n\u003cp>When Newsom signed the “California Advancing and Innovating Medi-Cal” initiative into law in late July — “CalAIM” for short — he celebrated it as a “once-in-a-generation opportunity to completely transform the Medicaid system in California.” He declined an interview request.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Beginning next year, public and private managed health care plans will pick high-needs Medi-Cal enrollees to receive nontraditional services from among \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCQMD/MCP-ECM-and-ILOS-Contract-Template-Provisions.pdf\">14 broad categories, including housing and food benefits, addiction care and home repairs\u003c/a>.\u003c/p>\n\u003cp>The approach is known as “whole person care,” and insurers will be required to assign patients a personal care manager to help them navigate the system. Insurers will receive incentive payments to offer new services and boost provider networks and, over time, the program will expand to more people and services. For instance, members of Native American tribes will eventually be eligible to receive treatment for substance use disorder, and incarcerated people will be enrolled in Medi-Cal automatically upon release.\u003c/p>\n\u003cp>The insurers — currently 25 are participating — will focus most intensely on developing housing programs to combat the state’s \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCQMD/CalAIM-Role-in-Addressing-Homelessness-Fact-Sheet-%26-Letter-4-9-21.pdf\">worsening homelessness epidemic\u003c/a>. The state was home to at least 162,000 unhoused people in 2020, a 6.8% increase since Newsom took office in 2019.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘If you generally focus on [the most vulnerable], you will be able to yield better health outcomes for those individuals and, ultimately, cost savings.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Jacey Cooper, the state’s Medicaid director, said \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCQMD/CalAIM-Role-in-Addressing-Homelessness-Fact-Sheet-%26-Letter-4-9-21.pdf\">all Medi-Cal members will eventually be eligible for housing services\u003c/a>. Initially, though, they will be available only to the costliest patients. State Medi-Cal expenditure data shows that 1% of Medi-Cal enrollees, many of the unhoused patients who frequently land in hospitals, account for a staggering 21% of overall spending. And 5% account for 44% of the budget.\u003c/p>\n\u003cp>“You really need to focus on your top 1% to 5% of utilizers — that’s your most vulnerable,” Cooper said. “If you generally focus on that group, you will be able to yield better health outcomes for those individuals and, ultimately, cost savings.”\u003c/p>\n\u003cp>State officials do not have a savings estimate for the program, nor a projection of how many people will be enrolled.\u003c/p>\n\u003cp>The plan, Cooper said, builds on more than \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/wholepersoncare-report-jan2020.pdf\">25 successful regional experiments underway since 2016\u003c/a>. From Los Angeles to rural Shasta, big and small counties have provided vulnerable Medi-Cal patients with different services based on their communities’ needs, from job placement services to providing a safe place for an unhoused person to get sober.\u003c/p>\n\u003cp>Cooper highlighted \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/wholepersoncare-report-jan2020.pdf\">interim data from the experiments\u003c/a> that showed patients hospitalized due to mental illness were more likely to receive follow-up care, obtain treatment for substance abuse, avoid hospitalizations and emergency department visits, and see improvements in chronic diseases like diabetes.\u003c/p>\n\u003cp>She argued that data — even though it is not comprehensive — is enough to prove the initiative will work on a statewide scale.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>However, studies of similar programs elsewhere have yielded mixed results. New York provided housing services to high-cost Medicaid enrollees with chronic diseases and mental health and substance use disorders and found major reductions in hospital admissions and emergency department visits between 2012 and 2017, and saw a \u003ca href=\"https://www.health.ny.gov/health_care/medicaid/redesign/supportive_housing/evaluation.htm\">15% reduction in Medicaid spending.\u003c/a>\u003c/p>\n\u003cp>In Camden, New Jersey, \u003ca href=\"https://californiahealthline.org/news/despite-new-doubts-hotspotting-help-for-heavy-health-care-users-marches-on/\">an early test of the “whole person care” approach\u003c/a> provided expensive Medicaid patients with intensive care coordination, but not nontraditional services. A \u003ca href=\"https://www.nejm.org/doi/full/10.1056/NEJMsa1906848\">study concluded in 2020 that it hadn’t lowered hospital readmissions\u003c/a> — and thus didn’t save health care dollars.\u003c/p>\n\u003cp>“We found we just couldn’t help people with housing as quickly as they needed help,” said Kathleen Noonan, CEO of the Camden Coalition of Healthcare Providers. “Many of these clients have bad credit, they may have a record, and they’re still using. Those are huge challenges.”\u003c/p>\n\u003cp>California may find success where the coalition hadn’t because it will offer social services, she said, which the coalition has also started doing.\u003c/p>\n\u003cp>But it will take time. California will have five years to prove to the federal government it can save money and improve health care quality. Insurers will be required to track health outcomes and savings, and can boost services over time or drop programs that don’t work.\u003c/p>\n\u003cp>So far, the regional experiments have failed to serve low-income Black and Latino residents, according to the interim assessments conducted by Nadereh Pourat, director of the UCLA Center for Health Policy Research. She concluded that they have \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/wholepersoncare-report-jan2020.pdf\">primarily benefited white, English-speaking, middle-aged men\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Cooper said \u003ca href=\"https://www.dhcs.ca.gov/provgovpart/Documents/CalAIM-Proposal-03-23-2021.pdf\">the statewide initiative will tackle “systemic racism,” \u003c/a>initially as it targets \u003ca href=\"https://endhomelessness.org/resource/racial-inequalities-homelessness-numbers/\">unhoused individuals, who are disproportionately Black\u003c/a>.\u003c/p>\n\u003cp>Consider Eugenia Hunter, who is African American, and whose many untreated mental and physical illnesses, intertwined with her addictions, mean it will take a herculean effort — and cost — to get her off the street.\u003c/p>\n\u003cp>Hunter has gone without a stable housing situation for at least three years. Or maybe it’s five; her mental illness clouds her memory, and she erupts in anger when pressed for details. She eases her frustration sometimes with sleep, sometimes by smoking crystal meth.\u003c/p>\n\u003cp>A stack of unopened health insurance letters sat beside Hunter one evening in late August. Her eyes were glassy when she struggled to remember when she received a cancer diagnosis — if she ever did at all.\u003c/p>\n\u003ch3>Bringing stakeholders on board\u003c/h3>\n\u003cp>Health insurers will not be required to offer social services to patients like Hunter because federal law requires nontraditional Medicaid services to be optional. But California is enticing insurers with bigger payouts and higher state rankings.\u003c/p>\n\u003cp>“We are asking the plans and providers to stretch. We’re asking them to reform,” Cooper said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The state is urging insurers to start with the roughly 130,500 Medi-Cal patients already enrolled in the local experiments. To prepare, they are cobbling together networks of nonprofits and social service organizations to provide food, housing and other services — much as they do with doctors and hospitals contracted to deliver medical care.\u003c/p>\n\u003cp>\u003ca href=\"https://californiahealthline.org/wp-content/uploads/sites/3/2021/09/CalAIM-Nontraditional-Services-2022.pdf\">Services will also vary by insurer and region.\u003c/a>\u003c/p>\n\u003cp>The Inland Empire Health Plan, for example, will offer some patients home repairs that reduce asthma triggers, such as mold removal and installing air filters. But Partnership HealthPlan of California will not offer those benefits in its wildfire-prone Northern California region because it doesn’t have an adequate network of organizations equipped to provide those services.\u003c/p>\n\u003cp>In interviews with nearly all of California’s Medi-Cal managed-care plans, executives said they support the dual goals of helping patients get healthier while saving money, but “it is a lot to take on,” said Richard Sanchez, CEO of CalOptima, which serves Orange County and will start modestly, primarily with housing services.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "Nearly all the health plans will offer housing services right away, focusing on three categories of aid: helping enrollees secure housing and rent subsidies; providing temporary rent and security deposit payments; and helping tenants stay housed.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The last thing I want to do is make promises that we can do all these things and not come through,” he said.\u003c/p>\n\u003cp>Nearly all the health plans will offer housing services right away, focusing on three categories of aid: helping enrollees secure housing and rent subsidies; providing temporary rent and security deposit payments; and helping tenants stay housed, like intervening with a landlord if a patient misses rent.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘It’s a great deal of money for a small number of members … we are building something extraordinarily ambitious quickly, without the infrastructure in place to make it successful.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Partnership HealthPlan, which serves 616,000 Medi-Cal patients in 14 Northern California counties, will prioritize its most at-risk enrollees with housing services, food deliveries and a “homemaker” benefit to help them cook dinner, do laundry and pay bills.\u003c/p>\n\u003cp>“It’s a great deal of money for a small number of members and, frankly, there’s no guarantee it’s going to work,” said Dr. Robert Moore, the plan’s chief medical officer. “We are building something extraordinarily ambitious quickly, without the infrastructure in place to make it successful.”\u003c/p>\n\u003cp>Even if offering new services costs more money than it saves, it’s a worthwhile investment, said John Baackes, CEO of L.A. Care Health Plan, the largest Medi-Cal plan, which serves more than 2 million patients in Los Angeles County.\u003c/p>\n\u003cp>“When somebody has congestive heart failure, their diet should be structured around alleviating that chronic condition,” he said, explaining his plan to offer patients healthful food. “What are we going to do — let them eat ramen noodles for the rest of their lives?”\u003c/p>\n\u003cp>In Alameda County, two plans are available to serve Hunter. The Alameda Alliance for Health, a public insurer established by the county, and Anthem Blue Cross, a private insurance company, will expand housing services.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“People like Eugenia Hunter are exactly who we want to serve, and we’re prepared to go out and help her,” said Scott Coffin, CEO of the Alameda Alliance for Health, who is also on a local street medicine team.\u003c/p>\n\u003cp>But they’d have to find her first — chaos and homeless encampment sweeps force her to move her tent frequently. And then they’d have to win her trust.\u003c/p>\n\u003cp>In one moment, Hunter angrily described how health plans have tried to enroll her in services, but she declined, mistrustful of their motives. In the next moment, fighting back voices in her head, she said she desperately wants care.\u003c/p>\n\u003cp>“Someone is going to help me?” she asked. “All I want to do is pay my rent and succeed.”\u003c/p>\n\u003cp>\u003cem>Kaiser Health News is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at Kaiser Family Foundation, an endowed nonprofit providing information on health issues.\u003c/em>\u003cbr>\n\u003c/p>\u003c/div>",
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"title": "COVID Vaccinations Lag for People on Medi-Cal",
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"content": "\u003cp>Low-income Californians enrolled in Medi-Cal have been vaccinated at far lower rates than the overall population in all 58 counties, \u003ca href=\"https://www.dhcs.ca.gov/Documents/COVID-19/COVID-19-Vaccine-Stats-07-08-21.pdf\">according to state data\u003c/a>.\u003c/p>\n\u003cp>The disparity reveals a strong economic divide between the vaccinated and unvaccinated throughout California.\u003c/p>\n\u003cp>About 45% of Medi-Cal enrollees eligible for the COVID-19 vaccine (those 12 and older) had received at least one dose as of July 18, compared to about 70% of all eligible Californians, state officials said Thursday.\u003c/p>\n\u003cp>Nearly 14 million Californians are enrolled in Medi-Cal, the state’s health care program for low-income people.\u003c/p>\n\u003cp>The gap in their vaccination rate leaves low-income people once again highly vulnerable to the virus, particularly the more contagious delta variant. And it poses a major obstacle to the state’s efforts to try to reach herd immunity.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Jacey Cooper, the state’s Medicaid director, called the vaccination disparity a “stark reminder of the inequities within our delivery system.”\u003c/p>\n\u003cp>\u003ca href=\"https://www.dhcs.ca.gov/Documents/COVID-19/COVID-19-Vaccine-Stats-07-08-21.pdf\">Medi-Cal vaccination rates \u003c/a>are under 50% in most counties, but the rates are especially low in rural far-northern counties. In Lassen, Shasta, Tehama, Trinity and Modoc counties, less than 30% of Medi-Cal enrollees are vaccinated. Those counties also have low overall vaccination rates for their entire population.\u003c/p>\n\u003cp>In Tulare County, which has one of the largest Medi-Cal populations in the state, 48% of the county’s residents have been vaccinated but only 33% of Medi-Cal enrollees have been. In Los Angeles County, 70% of its overall population is vaccinated, compared to only 49% of people on Medi-Cal.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://calmatters-map-covid-vaccine-medi-cal.netlify.app/#amp=1\" width=\"800\" height=\"1200\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>“It is problematic that this gap exists, but it is \u003ca href=\"https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-profile-of-the-unvaccinated/\">consistent with national trends \u003c/a>that show people with low incomes are less likely to be vaccinated,” said Laurel Lucia, director of the Health Care Program at UC Berkeley’s Labor Center.\u003c/p>\n\u003cp>State and county health officials and nonprofit groups have been struggling to reach people in low-income communities. They are trying mobile vaccination clinics, door-to-door canvassing and monetary incentives.\u003c/p>\n\u003cp>The state’s Department of Health Care Services said it’s doing several things to increase vaccination among Medi-Cal patients, including sharing data with health plans about which enrollees have yet to be vaccinated, encouraging more Medi-Cal providers to sign up to administer the vaccine and working with hospital associations to improve vaccine access in emergency rooms.\u003c/p>\n\u003cp>Experts said one major reason that many people on Medi-Cal may be unvaccinated is that it is harder for them to take time off work.\u003c/p>\n\u003cp>[pullquote size='medium' align='right' citation=\"Laurel Lucia, UC Berkeley's Labor Center\"]‘Low-income workers face significant practical challenges. They often have limited time because of multiple jobs, they may lack childcare, spend a lot of time commuting.’[/pullquote]\u003c/p>\n\u003cp>“Low-income workers face significant practical challenges. They often have limited time because of multiple jobs, they may lack childcare, spend a lot of time commuting. And they’re worried about missing work, not just for the appointment but also if they have symptoms from the vaccine,” Lucia said.\u003c/p>\n\u003cp>Amy Jester, a program director at the Humboldt Area Foundation, said it’s particularly a problem among seasonal employees like farmworkers.\u003c/p>\n\u003cp>For example, in Humboldt and surrounding counties, tourism and agriculture workers are in the middle of one of their busiest seasons. For many of them, taking time off during peak season means losing income.\u003c/p>\n\u003cp>Nationwide, adults whose employers either encouraged them to get vaccinated or provided them paid time off to recover from side effects were more likely to be immunized, according to a recent \u003ca href=\"https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-june-2021/#:~:text=Half%20of%20workers%20overall%20say,than%20%2440%2C000%20annually%20(41%25).\">Kaiser Family Foundation poll\u003c/a>.\u003c/p>\n\u003cp>In most California counties, only 25% to 35% of people on Medi-Cal are vaccinated. It’s more than half in only 11 counties, mostly in the Bay Area, but also Orange and Imperial counties.\u003c/p>\n\u003cp>[aside label=\"Related Stories\" tag=\"coronavirus-vaccine\"]\u003c/p>\n\u003cp>Alpine County shows the biggest gap — a difference of almost 53 percentage points between Medi-Cal recipients and the county’s total population. The rural county is home to about 1,100 people, so even a few unvaccinated people can make a big difference. Dr. Rick Johnson, the state’s public health officer, said Alpine is seeing high vaccine resistance at American Indian reservations; about 20% of the county’s population lives on a reservation.\u003c/p>\n\u003cp>In the Eastern Sierra’s Inyo County, the vaccination rate is almost twice as high among the general population than among people on Medi-Cal — 58% compared to 32%.\u003c/p>\n\u003cp>But the disparity is not just happening in rural, remote or less affluent counties. Marin County has the highest vaccination rate in California — 88% of all eligible residents. But only 61.5% of its Medi-Cal residents had received at least one shot by July 18. Roughly one out of every five Marin County residents is enrolled in Medi-Cal.\u003c/p>\n\u003cp>San Francisco has the highest percentage of vaccinated Medi-Cal enrollees with 65%, but that’s eclipsed by its overall vaccination rate of 84%.\u003c/p>\n\u003cp>“We believe we can do better, and must do better, to prevent further disparities in COVID infection and death among persons served by Medi-Cal,” a spokesperson for the state health care services agency told CalMatters in an email.\u003c/p>\n\u003cp>Last month, Ohio’s governor, noting a similar disparity in his state’s Medicaid population, challenged health plans \u003ca href=\"https://abc6onyourside.com/news/local/vaccine-incentive-doubles-ohio-medicaid-members-7-26-2021\">to get 900,000 more Medicaid members \u003c/a>vaccinated by Sept. 15. Now, every Medicaid enrollee in Ohio who gets a shot receives a $100 gift card.\u003c/p>\n\u003cp>Health care providers say they are not surprised that Medi-Cal enrollees have fallen behind on vaccination. State data that tracks\u003ca href=\"https://covid19.ca.gov/vaccination-progress-data/\"> vaccination by ZIP code\u003c/a> has shown a similar lag in lower-income neighborhoods.\u003c/p>\n\u003cp>[pullquote size='medium' align='right' citation=\"Dr. Ilan Shapiro, AltaMed health system\"]‘This is a reflection of decades of issues with inequities” in health care. “We saw it with cases — which group got hit the hardest? People in underserved communities. We saw it with cases — which group got hit the hardest? People in underserved communities.’[/pullquote]\u003c/p>\n\u003cp>“This is a reflection of decades of issues with inequities” in health care, said Dr. Ilan Shapiro, a pediatrician and medical director for the AltaMed health system in Southern California.\u003c/p>\n\u003cp>“We saw similar trends with testing — which group was lacking? People in underserved communities,” he said. “We saw it with cases — which group got hit the hardest? People in underserved communities.”\u003c/p>\n\u003cp>One challenge is the mixed messaging, said Dr. James Kyle, medical director for quality, diversity, equity, and inclusion at L.A. Care Health Plan. He said one of the most successful strategies is direct phone calls to members because it gives people the opportunity to ask questions and ease some of their confusion.\u003c/p>\n\u003cp>“People are hearing about the delta variant, about increasing hospitalizations, but at the same time, we’ve reopened businesses, and I think people have genuine confusion,” Kyle said. “They’re trying to decide what’s the right thing to do, so they’re doing nothing.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cimg decoding=\"async\" id=\"republication-tracker-tool-source\" style=\"width: 1px;height: 1px\" src=\"https://calmatters.network/?republication-pixel=true&post=118601&ga=UA-59722930-8\">\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Low-income Californians enrolled in Medi-Cal have been vaccinated at far lower rates than the overall population in all 58 counties, \u003ca href=\"https://www.dhcs.ca.gov/Documents/COVID-19/COVID-19-Vaccine-Stats-07-08-21.pdf\">according to state data\u003c/a>.\u003c/p>\n\u003cp>The disparity reveals a strong economic divide between the vaccinated and unvaccinated throughout California.\u003c/p>\n\u003cp>About 45% of Medi-Cal enrollees eligible for the COVID-19 vaccine (those 12 and older) had received at least one dose as of July 18, compared to about 70% of all eligible Californians, state officials said Thursday.\u003c/p>\n\u003cp>Nearly 14 million Californians are enrolled in Medi-Cal, the state’s health care program for low-income people.\u003c/p>\n\u003cp>The gap in their vaccination rate leaves low-income people once again highly vulnerable to the virus, particularly the more contagious delta variant. And it poses a major obstacle to the state’s efforts to try to reach herd immunity.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Jacey Cooper, the state’s Medicaid director, called the vaccination disparity a “stark reminder of the inequities within our delivery system.”\u003c/p>\n\u003cp>\u003ca href=\"https://www.dhcs.ca.gov/Documents/COVID-19/COVID-19-Vaccine-Stats-07-08-21.pdf\">Medi-Cal vaccination rates \u003c/a>are under 50% in most counties, but the rates are especially low in rural far-northern counties. In Lassen, Shasta, Tehama, Trinity and Modoc counties, less than 30% of Medi-Cal enrollees are vaccinated. Those counties also have low overall vaccination rates for their entire population.\u003c/p>\n\u003cp>In Tulare County, which has one of the largest Medi-Cal populations in the state, 48% of the county’s residents have been vaccinated but only 33% of Medi-Cal enrollees have been. In Los Angeles County, 70% of its overall population is vaccinated, compared to only 49% of people on Medi-Cal.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://calmatters-map-covid-vaccine-medi-cal.netlify.app/#amp=1\" width=\"800\" height=\"1200\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>“It is problematic that this gap exists, but it is \u003ca href=\"https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-profile-of-the-unvaccinated/\">consistent with national trends \u003c/a>that show people with low incomes are less likely to be vaccinated,” said Laurel Lucia, director of the Health Care Program at UC Berkeley’s Labor Center.\u003c/p>\n\u003cp>State and county health officials and nonprofit groups have been struggling to reach people in low-income communities. They are trying mobile vaccination clinics, door-to-door canvassing and monetary incentives.\u003c/p>\n\u003cp>The state’s Department of Health Care Services said it’s doing several things to increase vaccination among Medi-Cal patients, including sharing data with health plans about which enrollees have yet to be vaccinated, encouraging more Medi-Cal providers to sign up to administer the vaccine and working with hospital associations to improve vaccine access in emergency rooms.\u003c/p>\n\u003cp>Experts said one major reason that many people on Medi-Cal may be unvaccinated is that it is harder for them to take time off work.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Low-income workers face significant practical challenges. They often have limited time because of multiple jobs, they may lack childcare, spend a lot of time commuting. And they’re worried about missing work, not just for the appointment but also if they have symptoms from the vaccine,” Lucia said.\u003c/p>\n\u003cp>Amy Jester, a program director at the Humboldt Area Foundation, said it’s particularly a problem among seasonal employees like farmworkers.\u003c/p>\n\u003cp>For example, in Humboldt and surrounding counties, tourism and agriculture workers are in the middle of one of their busiest seasons. For many of them, taking time off during peak season means losing income.\u003c/p>\n\u003cp>Nationwide, adults whose employers either encouraged them to get vaccinated or provided them paid time off to recover from side effects were more likely to be immunized, according to a recent \u003ca href=\"https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-june-2021/#:~:text=Half%20of%20workers%20overall%20say,than%20%2440%2C000%20annually%20(41%25).\">Kaiser Family Foundation poll\u003c/a>.\u003c/p>\n\u003cp>In most California counties, only 25% to 35% of people on Medi-Cal are vaccinated. It’s more than half in only 11 counties, mostly in the Bay Area, but also Orange and Imperial counties.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Alpine County shows the biggest gap — a difference of almost 53 percentage points between Medi-Cal recipients and the county’s total population. The rural county is home to about 1,100 people, so even a few unvaccinated people can make a big difference. Dr. Rick Johnson, the state’s public health officer, said Alpine is seeing high vaccine resistance at American Indian reservations; about 20% of the county’s population lives on a reservation.\u003c/p>\n\u003cp>In the Eastern Sierra’s Inyo County, the vaccination rate is almost twice as high among the general population than among people on Medi-Cal — 58% compared to 32%.\u003c/p>\n\u003cp>But the disparity is not just happening in rural, remote or less affluent counties. Marin County has the highest vaccination rate in California — 88% of all eligible residents. But only 61.5% of its Medi-Cal residents had received at least one shot by July 18. Roughly one out of every five Marin County residents is enrolled in Medi-Cal.\u003c/p>\n\u003cp>San Francisco has the highest percentage of vaccinated Medi-Cal enrollees with 65%, but that’s eclipsed by its overall vaccination rate of 84%.\u003c/p>\n\u003cp>“We believe we can do better, and must do better, to prevent further disparities in COVID infection and death among persons served by Medi-Cal,” a spokesperson for the state health care services agency told CalMatters in an email.\u003c/p>\n\u003cp>Last month, Ohio’s governor, noting a similar disparity in his state’s Medicaid population, challenged health plans \u003ca href=\"https://abc6onyourside.com/news/local/vaccine-incentive-doubles-ohio-medicaid-members-7-26-2021\">to get 900,000 more Medicaid members \u003c/a>vaccinated by Sept. 15. Now, every Medicaid enrollee in Ohio who gets a shot receives a $100 gift card.\u003c/p>\n\u003cp>Health care providers say they are not surprised that Medi-Cal enrollees have fallen behind on vaccination. State data that tracks\u003ca href=\"https://covid19.ca.gov/vaccination-progress-data/\"> vaccination by ZIP code\u003c/a> has shown a similar lag in lower-income neighborhoods.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"link": "/radio/program/bbc-world-service",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2",
"tuneIn": "https://tunein.com/radio/BBC-World-Service-p455581/",
"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
}
},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/californiareport",
"meta": {
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"source": "kqed",
"order": 8
},
"link": "/californiareport",
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"amazon": "https://music.amazon.com/podcasts/26099305-72af-4542-9dde-ac1807fe36d5/kqed-s-the-california-report",
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}
},
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"id": "californiareportmagazine",
"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Magazine-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/californiareportmagazine",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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}
},
"city-arts": {
"id": "city-arts",
"title": "City Arts & Lectures",
"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
"officialWebsiteLink": "https://www.cityarts.net/",
"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
"site": "news",
"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
"subscribe": {
"tuneIn": "https://tunein.com/radio/City-Arts-and-Lectures-p692/",
"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
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"officialWebsiteLink": "/podcasts/closealltabs",
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"order": 1
},
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"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"meta": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy",
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},
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
"site": "news",
"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2",
"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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}
},
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"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"meta": {
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"source": "kqed",
"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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},
"freakonomics-radio": {
"id": "freakonomics-radio",
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"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
"subscribe": {
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
"rss": "https://feeds.feedburner.com/freakonomicsradio"
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},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
"info": "Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.",
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"link": "/radio/program/fresh-air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/381444908/podcast.xml"
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"here-and-now": {
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"rss": "https://feeds.npr.org/510051/podcast.xml"
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},
"hidden-brain": {
"id": "hidden-brain",
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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},
"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
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"source": "npr"
},
"link": "/radio/program/how-i-built-this",
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"npr": "https://rpb3r.app.goo.gl/3zxy",
"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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},
"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"officialWebsiteLink": "/podcasts/hyphenacion",
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"order": 15
},
"link": "/podcasts/hyphenacion",
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"source": "kqed",
"order": 18
},
"link": "/podcasts/jerrybrown",
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"apple": "https://itunes.apple.com/us/podcast/id1492194549",
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
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"source": "npr"
},
"link": "/radio/program/latino-usa",
"subscribe": {
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"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.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
"subscribe": {
"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"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>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
"subscribe": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
"npr": "https://www.npr.org/podcasts/464615685/mind-shift-podcast",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
"imageAlt": "On Our Watch from NPR and KQED",
"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
"site": "news",
"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
"apple": "https://podcasts.apple.com/podcast/id1567098962",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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"stitcher": "https://www.stitcher.com/show/on-our-watch",
"rss": "https://feeds.npr.org/510360/podcast.xml"
}
},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"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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"info": "One of public radio's most dynamic voices, Sam Sanders helped launch The NPR Politics Podcast and hosted NPR's hit show It's Been A Minute. Now, the award-winning host returns with something brand new, The Sam Sanders Show. Every week, Sam Sanders and friends dig into the culture that shapes our lives: what's driving the biggest trends, how artists really think, and even the memes you can't stop scrolling past. Sam is beloved for his way of unpacking the world and bringing you up close to fresh currents and engaging conversations. The Sam Sanders Show is smart, funny and always a good time.",
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