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"content": "\u003cp>Californians who are at least 50 and living in the country without permission are newly eligible for state health care coverage under legislation signed by Gov. Gavin Newsom on Tuesday, part of a record state budget that includes major investments in mental health, homelessness and housing.\u003c/p>\n\u003cp>The legislation to expand Medi-Cal coverage to low-income adults regardless of immigration status builds upon proposals pushed by Democrats to extend the state’s version of federal Medicaid to children in 2016 and to young adults under 26 in 2020.\u003c/p>\n\u003cp>Around 235,000 people are expected to benefit from this legislation.\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"https://www.coveredca.com/health/medi-cal/\">\u003cstrong>Information on who qualifies for Medi-Cal and what are the steps needed to apply.\u003c/strong>\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>“It’s a point of pride, it’s a point of principle, and it’s what marks our values here in the state of California,” Newsom said at the Clinica Sierra Vista Elm Community Health Center in Fresno.\u003c/p>\n\u003cp>“We believe in living together, and advancing and prospering together across every conceivable difference.”\u003c/p>\n\u003cp>The program will begin in May 2022. 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Roughly 1.5 million are unauthorized immigrants, making them \u003ca href=\"https://laborcenter.berkeley.edu/ca-coverage-gains-to-erode-without-further-state-action/\">the largest uninsured group in the state\u003c/a>.\u003c/p>\n\u003cp>California is among a small, but growing, group of states that are expanding health coverage to immigrants without legal status. Advocates of expanded coverage say that health care is a basic need and that the coronavirus pandemic underscored just how essential immigrants are in agriculture, food processing and other critical industries.\u003c/p>\n\u003cp>Detractors say taxpayer money should not be spent on unauthorized immigrants.\u003c/p>\n\u003cp>But immigrants residing without authorization in the United States \u003ca href=\"https://www.americanimmigrationcouncil.org/topics/tax-contributions\">pay billions of dollars in taxes\u003c/a> and often do \u003ca href=\"https://www.fwd.us/news/immigrant-essential-workers/\">essential work\u003c/a> in agriculture, food services, health care and other industries.\u003c/p>\n\u003cp>This population is also excluded from the Affordable Care Act and many \u003ca href=\"https://www.kqed.org/news/11874637/the-stimulus-gap-why-many-undocumented-immigrants-arent-getting-the-golden-state-stimulus-theyre-entitled-to\">missed out on pandemic-related stimulus checks\u003c/a> because they file federal taxes using what’s called an Individual Taxpayer Identification Number and not through a Social Security number.\u003c/p>\n\u003cp>Advocates also \u003ca href=\"https://www.kqed.org/news/11876312/activists-stage-die-in-at-newsom-residence-to-demand-more-relief-for-immigrant-workers\">point out\u003c/a> that throughout the pandemic, immigrants residing in the country without authorization, many of them above 50, have served in essential occupations that put them at greater risk of contracting COVID-19.\u003c/p>\n\u003cp>[aside label ='Related Coverage' tag='immigration']In recent years, the state began offering full-scope Medi-Cal — covering doctor’s visits, prescriptions, eye and dental care and other services — to low-income undocumented children and young adults up to age 26. But older immigrants have only been eligible for limited Medi-Cal, which only covers prenatal care and health emergencies.\u003c/p>\n\u003cp>Beatriz Hernandez, a fellow with the California Immigrant Policy Center, said at the signing event that she is undocumented and knows what it feels like to be denied health care. She is grateful for the new policy.\u003c/p>\n\u003cp>“We all need this access to health care now and when we recover from the pandemic. It doesn’t matter the color of our skin, or where we were born. We all deserve this, and we all contribute to the social fabric of this state,” she said.\u003c/p>\n\u003cp>\u003cem>While this specific Medi-Cal expansion does not begin till May 2022, you can review how to apply for Medi-Cal through the Covered California website in \u003ca href=\"https://www.coveredca.com/health/medi-cal/\">English\u003c/a>, \u003ca href=\"https://www.coveredca.com/espanol/health/medi-cal/\">Spanish\u003c/a>, \u003ca href=\"https://www.coveredca.com/chinese/\">Chinese\u003c/a> and \u003ca href=\"https://www.coveredca.com/tagalog/\">Tagalog\u003c/a>. Other languages are also available.\u003c/em>\u003c/p>\n\u003chr>\n\u003cp>\u003cem>This post includes reporting by KQED’s \u003ca href=\"https://www.kqed.org/author/fjhabvala\">Farida Jhabvala Romero\u003c/a> and The Associated Press.\u003c/em>\u003cbr>\n[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n",
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"excerpt": "Undocumented immigrants over 50 will be eligible for Medi-Cal starting spring of 2022, which could benefit hundreds of thousands of seniors that meet the income requirements.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Californians who are at least 50 and living in the country without permission are newly eligible for state health care coverage under legislation signed by Gov. Gavin Newsom on Tuesday, part of a record state budget that includes major investments in mental health, homelessness and housing.\u003c/p>\n\u003cp>The legislation to expand Medi-Cal coverage to low-income adults regardless of immigration status builds upon proposals pushed by Democrats to extend the state’s version of federal Medicaid to children in 2016 and to young adults under 26 in 2020.\u003c/p>\n\u003cp>Around 235,000 people are expected to benefit from this legislation.\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"https://www.coveredca.com/health/medi-cal/\">\u003cstrong>Information on who qualifies for Medi-Cal and what are the steps needed to apply.\u003c/strong>\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>“It’s a point of pride, it’s a point of principle, and it’s what marks our values here in the state of California,” Newsom said at the Clinica Sierra Vista Elm Community Health Center in Fresno.\u003c/p>\n\u003cp>“We believe in living together, and advancing and prospering together across every conceivable difference.”\u003c/p>\n\u003cp>The program will begin in May 2022. The income threshold to qualify for Medi-Cal is 138% of the federal poverty level or lower. To be eligible, individuals must earn less than $17,609 a year and $36,100 for a family of four.\u003c/p>\n\u003cp>Newsom added that the expansion will have an initial cost of $48 million and eventually cost $1.3 billion per year when the program is fully up and running\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>About 3.2 million people in the state of nearly 40 million are projected to not have health insurance next year, according to the Labor Center at the University of California, Berkeley. Roughly 1.5 million are unauthorized immigrants, making them \u003ca href=\"https://laborcenter.berkeley.edu/ca-coverage-gains-to-erode-without-further-state-action/\">the largest uninsured group in the state\u003c/a>.\u003c/p>\n\u003cp>California is among a small, but growing, group of states that are expanding health coverage to immigrants without legal status. Advocates of expanded coverage say that health care is a basic need and that the coronavirus pandemic underscored just how essential immigrants are in agriculture, food processing and other critical industries.\u003c/p>\n\u003cp>Detractors say taxpayer money should not be spent on unauthorized immigrants.\u003c/p>\n\u003cp>But immigrants residing without authorization in the United States \u003ca href=\"https://www.americanimmigrationcouncil.org/topics/tax-contributions\">pay billions of dollars in taxes\u003c/a> and often do \u003ca href=\"https://www.fwd.us/news/immigrant-essential-workers/\">essential work\u003c/a> in agriculture, food services, health care and other industries.\u003c/p>\n\u003cp>This population is also excluded from the Affordable Care Act and many \u003ca href=\"https://www.kqed.org/news/11874637/the-stimulus-gap-why-many-undocumented-immigrants-arent-getting-the-golden-state-stimulus-theyre-entitled-to\">missed out on pandemic-related stimulus checks\u003c/a> because they file federal taxes using what’s called an Individual Taxpayer Identification Number and not through a Social Security number.\u003c/p>\n\u003cp>Advocates also \u003ca href=\"https://www.kqed.org/news/11876312/activists-stage-die-in-at-newsom-residence-to-demand-more-relief-for-immigrant-workers\">point out\u003c/a> that throughout the pandemic, immigrants residing in the country without authorization, many of them above 50, have served in essential occupations that put them at greater risk of contracting COVID-19.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>In recent years, the state began offering full-scope Medi-Cal — covering doctor’s visits, prescriptions, eye and dental care and other services — to low-income undocumented children and young adults up to age 26. But older immigrants have only been eligible for limited Medi-Cal, which only covers prenatal care and health emergencies.\u003c/p>\n\u003cp>Beatriz Hernandez, a fellow with the California Immigrant Policy Center, said at the signing event that she is undocumented and knows what it feels like to be denied health care. She is grateful for the new policy.\u003c/p>\n\u003cp>“We all need this access to health care now and when we recover from the pandemic. It doesn’t matter the color of our skin, or where we were born. We all deserve this, and we all contribute to the social fabric of this state,” she said.\u003c/p>\n\u003cp>\u003cem>While this specific Medi-Cal expansion does not begin till May 2022, you can review how to apply for Medi-Cal through the Covered California website in \u003ca href=\"https://www.coveredca.com/health/medi-cal/\">English\u003c/a>, \u003ca href=\"https://www.coveredca.com/espanol/health/medi-cal/\">Spanish\u003c/a>, \u003ca href=\"https://www.coveredca.com/chinese/\">Chinese\u003c/a> and \u003ca href=\"https://www.coveredca.com/tagalog/\">Tagalog\u003c/a>. Other languages are also available.\u003c/em>\u003c/p>\n\u003chr>\n\u003cp>\u003cem>This post includes reporting by KQED’s \u003ca href=\"https://www.kqed.org/author/fjhabvala\">Farida Jhabvala Romero\u003c/a> and The Associated Press.\u003c/em>\u003cbr>\n\u003c/p>\u003c/div>",
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"content": "\u003cp>Nearly a quarter of a million undocumented adults and seniors in California – many of whom are or have been essential workers – will gain access to low-cost or free medical services as early as next year under a groundbreaking budget deal approved Monday by the Legislature.\u003c/p>\n\u003cp>California is now positioned to officially become the first state in the nation to offer public health insurance to low-income, undocumented residents ages 50 and older, a highly vulnerable population which has been made even more vulnerable by the deadly COVID-19 pandemic.\u003c/p>\n\u003cp>Gov. Gavin Newsom is expected to sign the agreement into law before July 1.\u003c/p>\n\u003cp>State Insurance Commissioner Ricardo Lara, who as senator introduced the first (unsuccessful) \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201320140SB1005\">bill\u003c/a> in 2014 to end the exclusion of undocumented immigrants from full Medi-Cal benefits, applauded the news as “a dream come true.”\u003c/p>\n\u003cp>“California’s immigrants have given so much to our state and now they’ll have the dignity of accessing health care,” Lara said. “Today the state Legislature and the governor will be erasing a vestige of discrimination against our immigrant communities that so many of us have fought for years to overcome.”\u003c/p>\n\u003cp>The whopping $262.6 billion state budget deal includes spending on a range of programs with an eye toward social equity, including other projects like universal transitional kindergarten, enhanced after-school and summer learning programs and an effort to make the state’s top public universities more accessible to in-state students.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Isabel, 76-year-old farmworker\"]‘I am so thankful. I’m very excited. We worked so much in the fields and we never got any benefits.’[/pullquote]Assembly Budget Chair Phil Ting, D-San Francisco, said the record-breaking budget presents a once-in-a-lifetime opportunity.\u003c/p>\n\u003cp>“This is a budget that really demonstrates that our values are protecting the most vulnerable families, the families who need our help the most in the time of the pandemic. But also well into the future,” Ting said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>One of the \u003ca href=\"https://lao.ca.gov/Publications/Report/4423\">estimated 235,000 undocumented immigrants\u003c/a> who could benefit from low or no-cost health care is Isabel, a 76-year-old former farmworker who did not want her last name used because of her immigration status.\u003c/p>\n\u003cp>“I am so thankful. I’m very excited,” she said, her voice breaking. “We worked so much in the fields and we never got any benefits.”\u003c/p>\n\u003cp>Isabel, who picked crops for more than three decades, said she feared for her life after she became seriously ill with COVID-19. But she did not seek medical care because she lacked insurance and worried about the cost of seeing a doctor, she said in Spanish.\u003c/p>\n\u003cp>“It was very, very difficult,” said Isabel, adding that her daughter, who lives with her, also got sick with the virus. “When we went to sleep, we thought we wouldn’t rise in the morning.”\u003c/p>\n\u003cp>Nearly 1.5 million unauthorized immigrants lacked health insurance last year, the largest group of uninsured in the state, according to a \u003ca href=\"https://laborcenter.berkeley.edu/ca-coverage-gains-to-erode-without-further-state-action/\">report\u003c/a> by the UC Berkeley Labor Center.\u003c/p>\n\u003cp>Undocumented immigrants in the United States \u003ca href=\"https://www.americanimmigrationcouncil.org/topics/tax-contributions\">pay billions of dollars in taxes\u003c/a> and often do \u003ca href=\"https://www.fwd.us/news/immigrant-essential-workers/\">essential work\u003c/a> in agriculture, food services, health care and other industries. But they are excluded from the Affordable Care Act and they cannot purchase subsidized coverage through Covered California, the state’s ACA health exchange.\u003c/p>\n\u003cp>In recent years, the state began offering full-scope Medi-Cal – covering doctor’s visits, prescriptions, eye and dental care and other services – to low-income undocumented children and young adults up to age 26. But older immigrants have only been eligible for limited Medi-Cal, which only covers prenatal care and health emergencies.\u003c/p>\n\u003cp>The earliest newly eligible seniors and older adults could access full coverage is May 2022, according to state Sen. María Elena Durazo, D-Los Angeles, who championed the program’s expansion. It will cost up to $1.3 billion per year, once the changes are fully established, according to the \u003ca href=\"https://abgt.assembly.ca.gov/sites/abgt.assembly.ca.gov/files/Floor%20Report%20of%20the%202021-22%20Budget%20-%20%28June%2028%2C%202021%20Version%29.pdf\">budget agreement\u003c/a>.\u003c/p>\n\u003cp>Durazo and other advocates stressed that because most undocumented adults ages 50 and older are already enrolled in restricted Medi-Cal, the state is responsible for paying the cost of emergency room visits, which are much more expensive than preventive care.\u003c/p>\n\u003cp>“That’s not a smart use of our funds,” said Durazo. “It’s much better to use our funds for preventative, primary health care. And that really matters not only to the individuals, but it matters in terms of dollars and cents.”\u003c/p>\n\u003cp>[aside label='Related Coverage' tag='undocumented-immigrants']The budget deal also includes resources to begin offering regular food assistance benefits to low-income residents, regardless of immigration status.\u003c/p>\n\u003cp>Lawmakers approved funds – up to $280 million by 2023 – to expand the \u003ca href=\"https://www.kqed.org/news/11876704/essential-for-everyone-food-aid-bill-for-undocumented-californians-gains-momentum\">California Food Assistance Program\u003c/a>. CFAP currently provides food aid to thousands of legal immigrants and refugees who have been excluded from federally funded food stamps.\u003c/p>\n\u003cp>“We are grateful to state leaders for seizing this historic opportunity to take tangible steps toward ensuring that undocumented immigrants – our neighbors, friends, colleagues, and important members of our California communities – are no longer denied basic food assistance,” said Jared Call, senior policy advocate with Nourish California, in a statement.\u003c/p>\n\u003cp>Call, whose organization co-leads the Food for All campaign, said California is set to become the first state to offer food assistance to undocumented immigrants via a permanent program.\u003c/p>\n\u003cp>Even before the COVID pandemic in California, children in families that include undocumented immigrants were three to four times more likely to grow up with unmet basic needs compared to children in non-immigrant families, according to a \u003ca href=\"https://calbudgetcenter.org/resources/state-policymakers-can-provide-food-support-to-undocumented-and-mixed-status-california-families-blocked-by-federal-policies/\">report\u003c/a> by the California Budget and Policy Center.\u003c/p>\n\u003cp>Advocates say that the process for newly eligible undocumented people to sign up for state-funded health coverage or food aid will be no different than for others applying for Medi-Cal or CalFresh. Enrollment for food assistance benefits is set to start in 2023.\u003c/p>\n\u003cp>\u003cem>This story includes reporting from KQED’s Katie Orr.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Nearly a quarter of a million undocumented adults and seniors in California – many of whom are or have been essential workers – will gain access to low-cost or free medical services as early as next year under a groundbreaking budget deal approved Monday by the Legislature.\u003c/p>\n\u003cp>California is now positioned to officially become the first state in the nation to offer public health insurance to low-income, undocumented residents ages 50 and older, a highly vulnerable population which has been made even more vulnerable by the deadly COVID-19 pandemic.\u003c/p>\n\u003cp>Gov. Gavin Newsom is expected to sign the agreement into law before July 1.\u003c/p>\n\u003cp>State Insurance Commissioner Ricardo Lara, who as senator introduced the first (unsuccessful) \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201320140SB1005\">bill\u003c/a> in 2014 to end the exclusion of undocumented immigrants from full Medi-Cal benefits, applauded the news as “a dream come true.”\u003c/p>\n\u003cp>“California’s immigrants have given so much to our state and now they’ll have the dignity of accessing health care,” Lara said. “Today the state Legislature and the governor will be erasing a vestige of discrimination against our immigrant communities that so many of us have fought for years to overcome.”\u003c/p>\n\u003cp>The whopping $262.6 billion state budget deal includes spending on a range of programs with an eye toward social equity, including other projects like universal transitional kindergarten, enhanced after-school and summer learning programs and an effort to make the state’s top public universities more accessible to in-state students.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>One of the \u003ca href=\"https://lao.ca.gov/Publications/Report/4423\">estimated 235,000 undocumented immigrants\u003c/a> who could benefit from low or no-cost health care is Isabel, a 76-year-old former farmworker who did not want her last name used because of her immigration status.\u003c/p>\n\u003cp>“I am so thankful. I’m very excited,” she said, her voice breaking. “We worked so much in the fields and we never got any benefits.”\u003c/p>\n\u003cp>Isabel, who picked crops for more than three decades, said she feared for her life after she became seriously ill with COVID-19. But she did not seek medical care because she lacked insurance and worried about the cost of seeing a doctor, she said in Spanish.\u003c/p>\n\u003cp>“It was very, very difficult,” said Isabel, adding that her daughter, who lives with her, also got sick with the virus. “When we went to sleep, we thought we wouldn’t rise in the morning.”\u003c/p>\n\u003cp>Nearly 1.5 million unauthorized immigrants lacked health insurance last year, the largest group of uninsured in the state, according to a \u003ca href=\"https://laborcenter.berkeley.edu/ca-coverage-gains-to-erode-without-further-state-action/\">report\u003c/a> by the UC Berkeley Labor Center.\u003c/p>\n\u003cp>Undocumented immigrants in the United States \u003ca href=\"https://www.americanimmigrationcouncil.org/topics/tax-contributions\">pay billions of dollars in taxes\u003c/a> and often do \u003ca href=\"https://www.fwd.us/news/immigrant-essential-workers/\">essential work\u003c/a> in agriculture, food services, health care and other industries. But they are excluded from the Affordable Care Act and they cannot purchase subsidized coverage through Covered California, the state’s ACA health exchange.\u003c/p>\n\u003cp>In recent years, the state began offering full-scope Medi-Cal – covering doctor’s visits, prescriptions, eye and dental care and other services – to low-income undocumented children and young adults up to age 26. But older immigrants have only been eligible for limited Medi-Cal, which only covers prenatal care and health emergencies.\u003c/p>\n\u003cp>The earliest newly eligible seniors and older adults could access full coverage is May 2022, according to state Sen. María Elena Durazo, D-Los Angeles, who championed the program’s expansion. It will cost up to $1.3 billion per year, once the changes are fully established, according to the \u003ca href=\"https://abgt.assembly.ca.gov/sites/abgt.assembly.ca.gov/files/Floor%20Report%20of%20the%202021-22%20Budget%20-%20%28June%2028%2C%202021%20Version%29.pdf\">budget agreement\u003c/a>.\u003c/p>\n\u003cp>Durazo and other advocates stressed that because most undocumented adults ages 50 and older are already enrolled in restricted Medi-Cal, the state is responsible for paying the cost of emergency room visits, which are much more expensive than preventive care.\u003c/p>\n\u003cp>“That’s not a smart use of our funds,” said Durazo. “It’s much better to use our funds for preventative, primary health care. And that really matters not only to the individuals, but it matters in terms of dollars and cents.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The budget deal also includes resources to begin offering regular food assistance benefits to low-income residents, regardless of immigration status.\u003c/p>\n\u003cp>Lawmakers approved funds – up to $280 million by 2023 – to expand the \u003ca href=\"https://www.kqed.org/news/11876704/essential-for-everyone-food-aid-bill-for-undocumented-californians-gains-momentum\">California Food Assistance Program\u003c/a>. CFAP currently provides food aid to thousands of legal immigrants and refugees who have been excluded from federally funded food stamps.\u003c/p>\n\u003cp>“We are grateful to state leaders for seizing this historic opportunity to take tangible steps toward ensuring that undocumented immigrants – our neighbors, friends, colleagues, and important members of our California communities – are no longer denied basic food assistance,” said Jared Call, senior policy advocate with Nourish California, in a statement.\u003c/p>\n\u003cp>Call, whose organization co-leads the Food for All campaign, said California is set to become the first state to offer food assistance to undocumented immigrants via a permanent program.\u003c/p>\n\u003cp>Even before the COVID pandemic in California, children in families that include undocumented immigrants were three to four times more likely to grow up with unmet basic needs compared to children in non-immigrant families, according to a \u003ca href=\"https://calbudgetcenter.org/resources/state-policymakers-can-provide-food-support-to-undocumented-and-mixed-status-california-families-blocked-by-federal-policies/\">report\u003c/a> by the California Budget and Policy Center.\u003c/p>\n\u003cp>Advocates say that the process for newly eligible undocumented people to sign up for state-funded health coverage or food aid will be no different than for others applying for Medi-Cal or CalFresh. Enrollment for food assistance benefits is set to start in 2023.\u003c/p>\n\u003cp>\u003cem>This story includes reporting from KQED’s Katie Orr.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Laura, 76, has not seen a doctor for years.\u003c/p>\n\u003cp>The former farmworker, who did not want her last name used because of her immigration status, said she is losing her eyesight and her feet are often swollen and in pain.\u003c/p>\n\u003cp>A grandmother, Laura also suffers from headaches and shortness of breath, months after she became seriously ill with COVID-19 during the winter surge. Through it all, she has relied on home remedies and not sought medical care because she lacks health insurance, she said, in Spanish.\u003c/p>\n\u003cp>“I don’t have any money. And at my age, there’s no work,” said Laura, who picked watermelon, zucchini, pumpkin and other crops for more than 20 years in fields in Southern California.\u003c/p>\n\u003cp>But Laura may soon get access to the medical services she desperately needs, at little or no cost.\u003c/p>\n\u003cp>California is on the verge of a historic step to offer public health insurance to low-income undocumented older adults — a population that has been particularly vulnerable during the COVID-19 pandemic but left out of federal assistance programs and other safety nets.\u003c/p>\n\u003cp>Gov. Gavin Newsom and legislative leaders are expected to announce an expansion to the Medi-Cal program in the coming days as part of a final deal on the state budget, according to advocates and legislative aides.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The most recent negotiations in Sacramento have centered on the lower age limit for those who will be newly eligible: 50 and older, as lawmakers have previously proposed; 60 and older, as Newsom offered; or somewhere in between.\u003c/p>\n\u003cp>“We are as certain as we can be that there will be something that comes into the final budget,” said Sarah Dar, who directs health and public benefits policy at the California Immigrant Policy Center. “And it’s really just a matter of ‘What’s the age they land on?‘”\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Luz Gallegos, director of TODEC, a legal center and immigrant justice organization\"]‘California continues to step up and defend all Californians, especially those who are most vulnerable, who don’t have any access to safety nets, but who contribute to our state economy, have been paying taxes… and have seen nothing in return.’[/pullquote]\u003c/p>\n\u003cp>In 2014, then-state Sen. Ricardo Lara introduced the first (unsuccessful) \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=201320140SB1005\">bill\u003c/a> to make undocumented immigrants eligible for public health coverage.\u003c/p>\n\u003cp>Since then, California has enrolled undocumented children in full-scope Medi-Cal, offering free or low-cost preventative care, doctor visits, prescriptions, dental care, vision care and other services. Last year, the state became the first in the nation to offer health coverage to undocumented young adults through age 25.\u003c/p>\n\u003cp>But more than 1.3 million undocumented Californians are projected to lack health insurance next year, remaining the largest uninsured group in the state, according to a \u003ca href=\"https://laborcenter.berkeley.edu/undocumented-californians-projected-to-remain-the-largest-group-of-uninsured-in-the-state-in-2022/\">report\u003c/a> by the UC Berkeley Labor Center.\u003c/p>\n\u003cp>Estimates vary, but depending on the final age cutoff that Newsom and legislative leaders decide for this year’s budget, roughly 80,000 to more than 200,000 undocumented Californians could gain access to Medi-Cal, including many who have worked essential jobs that are key to the state’s economy.\u003c/p>\n\u003cp>Immigrant and health advocates who have pushed California for years to extend health coverage to undocumented immigrants savored the realization that finally, older adults will most likely be eligible for coverage.\u003c/p>\n\u003cp>“At last, justice does prevail. We are in a historic moment as Californians,” said Luz Gallegos, the executive director of TODEC, a legal center and immigrant justice organization in the Inland Empire and Coachella Valley.\u003c/p>\n\u003cp>“California continues to step up and defend all Californians, especially those who are most vulnerable, who don’t have any access to safety nets, but who contribute to our state economy, have been paying taxes … and have seen nothing in return,” she added.\u003c/p>\n\u003cfigure id=\"attachment_11879325\" class=\"wp-caption aligncenter\" style=\"max-width: 1242px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11879325\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/Gallegos.jpg\" alt=\"\" width=\"1242\" height=\"806\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Gallegos.jpg 1242w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Gallegos-800x519.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Gallegos-1020x662.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Gallegos-160x104.jpg 160w\" sizes=\"auto, (max-width: 1242px) 100vw, 1242px\">\u003cfigcaption class=\"wp-caption-text\">Luz Gallegos works on COVID-19 vaccine outreach for farmworkers in Thermal, Calif. this spring. \u003ccite>(Courtesy TODEC)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The governor’s budget \u003ca href=\"http://www.ebudget.ca.gov/2021-22/pdf/Revised/BudgetSummary/HealthandHumanServices.pdf\">revision\u003c/a> from May includes nearly $860 million in annual state funds to expand Medi-Cal to low-income undocumented adults age 60 and older, with some of that funding available next year. The Legislature’s \u003ca href=\"https://abgt.assembly.ca.gov/sites/abgt.assembly.ca.gov/files/Floor%20Report%20of%20the%202021-22%20Budget%20-%20%28June%2011%2C%202021%20Version%29.pdf\">proposal\u003c/a> dedicates $1.3 billion in annual funds to cover undocumented adults age 50 and older once the program is fully established.\u003c/p>\n\u003cp>[aside label='Related Coverage' tag='undocumented-immigrants']Gallegos, who was born in the U.S. to farmworker immigrant parents, said this likely win is personal for her. In recent years, her undocumented uncle died from cancer, she said, after he delayed seeking medical care because he was uninsured. During the pandemic, farmworkers she knows died from COVID-19 while several others became ill with the virus.\u003c/p>\n\u003cp>“We honor their lives by continuing the struggle so we don’t see no more lives taken away from our communities,” said Gallegos, her voice breaking.\u003c/p>\n\u003cp>Currently, low-income undocumented immigrants who are 26 and older are eligible for limited Medi-Cal, which only covers health care emergencies or prenatal care if they are pregnant. Undocumented immigrants are excluded from the Affordable Care Act, and cannot purchase coverage through Covered California, the state’s ACA health exchange.\u003c/p>\n\u003cp>If they are not insured by an employer or able to purchase a private plan, they must generally rely on county health programs, which vary greatly throughout the state.\u003c/p>\n\u003cp>Last year, Gov. Newsom \u003ca href=\"https://www.kqed.org/news/11814885/as-pandemic-batters-californias-economy-plan-to-insure-undocumented-seniors-in-doubt\">proposed\u003c/a> offering full-scope Medi-Cal to undocumented seniors age 65 and older. But the plan didn’t go through, as the state projected a severe economic downturn and tax losses in the billions of dollars.\u003c/p>\n\u003cp>But the financial picture for California is starkly different this year, with the state logging an eye-popping budget surplus of \u003ca href=\"https://www.kqed.org/news/11874125/californias-historic-budget-surplus-is-it-76-billion-or-38-billion\">$76 billion\u003c/a>. In addition, the pandemic highlighted how “interconnected” public health really is, with all of us having to think about whether people around us wore masks, stood far enough apart, or were vaccinated, said Dar, with the California Immigrant Policy Center.\u003c/p>\n\u003cp>“And so to give health care access to this community would mean a healthier and stronger state for all Californians,” said Dar. “Increased productivity, better health outcomes, better public health.”\u003c/p>\n\u003cp>Some opponents have argued that funds to provide health coverage to undocumented people would be better spent on other needs, such as helping struggling U.S. citizens afford their own health insurance.\u003c/p>\n\u003cp>About two in three Californians support the idea of providing health coverage to undocumented immigrants, according to a \u003ca href=\"https://www.ppic.org/wp-content/uploads/ppic-statewide-survey-californians-and-their-government-march-2021.pdf\">recent survey\u003c/a> by the Public Policy Institute of California. But many Republicans oppose it, with nearly eight in 10 saying that they are not in favor.\u003c/p>\n\u003cp>This year, Illinois became the \u003ca href=\"https://www.povertylaw.org/article/health-coverage-available-to-undocumented-seniors-in-illinois/#:~:text=Fortunately%2C%20Illinois%20has%20become%20the,citizens%20age%2065%20or%20older.\">first state\u003c/a> to extend health insurance to undocumented seniors age 65 and older.\u003c/p>\n\u003cp>Former farmworker Laura hopes she will gain access to health coverage — and low-cost medical care — in California, where she has lived since the late 1980s, most recently in Riverside county.\u003c/p>\n\u003cp>“It would help me a lot to go to the doctor and get my eyes checked out,” Laura said. “It would be the best.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Laura, 76, has not seen a doctor for years.\u003c/p>\n\u003cp>The former farmworker, who did not want her last name used because of her immigration status, said she is losing her eyesight and her feet are often swollen and in pain.\u003c/p>\n\u003cp>A grandmother, Laura also suffers from headaches and shortness of breath, months after she became seriously ill with COVID-19 during the winter surge. Through it all, she has relied on home remedies and not sought medical care because she lacks health insurance, she said, in Spanish.\u003c/p>\n\u003cp>“I don’t have any money. And at my age, there’s no work,” said Laura, who picked watermelon, zucchini, pumpkin and other crops for more than 20 years in fields in Southern California.\u003c/p>\n\u003cp>But Laura may soon get access to the medical services she desperately needs, at little or no cost.\u003c/p>\n\u003cp>California is on the verge of a historic step to offer public health insurance to low-income undocumented older adults — a population that has been particularly vulnerable during the COVID-19 pandemic but left out of federal assistance programs and other safety nets.\u003c/p>\n\u003cp>Gov. Gavin Newsom and legislative leaders are expected to announce an expansion to the Medi-Cal program in the coming days as part of a final deal on the state budget, according to advocates and legislative aides.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The most recent negotiations in Sacramento have centered on the lower age limit for those who will be newly eligible: 50 and older, as lawmakers have previously proposed; 60 and older, as Newsom offered; or somewhere in between.\u003c/p>\n\u003cp>“We are as certain as we can be that there will be something that comes into the final budget,” said Sarah Dar, who directs health and public benefits policy at the California Immigrant Policy Center. “And it’s really just a matter of ‘What’s the age they land on?‘”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘California continues to step up and defend all Californians, especially those who are most vulnerable, who don’t have any access to safety nets, but who contribute to our state economy, have been paying taxes… and have seen nothing in return.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In 2014, then-state Sen. Ricardo Lara introduced the first (unsuccessful) \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=201320140SB1005\">bill\u003c/a> to make undocumented immigrants eligible for public health coverage.\u003c/p>\n\u003cp>Since then, California has enrolled undocumented children in full-scope Medi-Cal, offering free or low-cost preventative care, doctor visits, prescriptions, dental care, vision care and other services. Last year, the state became the first in the nation to offer health coverage to undocumented young adults through age 25.\u003c/p>\n\u003cp>But more than 1.3 million undocumented Californians are projected to lack health insurance next year, remaining the largest uninsured group in the state, according to a \u003ca href=\"https://laborcenter.berkeley.edu/undocumented-californians-projected-to-remain-the-largest-group-of-uninsured-in-the-state-in-2022/\">report\u003c/a> by the UC Berkeley Labor Center.\u003c/p>\n\u003cp>Estimates vary, but depending on the final age cutoff that Newsom and legislative leaders decide for this year’s budget, roughly 80,000 to more than 200,000 undocumented Californians could gain access to Medi-Cal, including many who have worked essential jobs that are key to the state’s economy.\u003c/p>\n\u003cp>Immigrant and health advocates who have pushed California for years to extend health coverage to undocumented immigrants savored the realization that finally, older adults will most likely be eligible for coverage.\u003c/p>\n\u003cp>“At last, justice does prevail. We are in a historic moment as Californians,” said Luz Gallegos, the executive director of TODEC, a legal center and immigrant justice organization in the Inland Empire and Coachella Valley.\u003c/p>\n\u003cp>“California continues to step up and defend all Californians, especially those who are most vulnerable, who don’t have any access to safety nets, but who contribute to our state economy, have been paying taxes … and have seen nothing in return,” she added.\u003c/p>\n\u003cfigure id=\"attachment_11879325\" class=\"wp-caption aligncenter\" style=\"max-width: 1242px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11879325\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/Gallegos.jpg\" alt=\"\" width=\"1242\" height=\"806\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Gallegos.jpg 1242w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Gallegos-800x519.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Gallegos-1020x662.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Gallegos-160x104.jpg 160w\" sizes=\"auto, (max-width: 1242px) 100vw, 1242px\">\u003cfigcaption class=\"wp-caption-text\">Luz Gallegos works on COVID-19 vaccine outreach for farmworkers in Thermal, Calif. this spring. \u003ccite>(Courtesy TODEC)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The governor’s budget \u003ca href=\"http://www.ebudget.ca.gov/2021-22/pdf/Revised/BudgetSummary/HealthandHumanServices.pdf\">revision\u003c/a> from May includes nearly $860 million in annual state funds to expand Medi-Cal to low-income undocumented adults age 60 and older, with some of that funding available next year. The Legislature’s \u003ca href=\"https://abgt.assembly.ca.gov/sites/abgt.assembly.ca.gov/files/Floor%20Report%20of%20the%202021-22%20Budget%20-%20%28June%2011%2C%202021%20Version%29.pdf\">proposal\u003c/a> dedicates $1.3 billion in annual funds to cover undocumented adults age 50 and older once the program is fully established.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Gallegos, who was born in the U.S. to farmworker immigrant parents, said this likely win is personal for her. In recent years, her undocumented uncle died from cancer, she said, after he delayed seeking medical care because he was uninsured. During the pandemic, farmworkers she knows died from COVID-19 while several others became ill with the virus.\u003c/p>\n\u003cp>“We honor their lives by continuing the struggle so we don’t see no more lives taken away from our communities,” said Gallegos, her voice breaking.\u003c/p>\n\u003cp>Currently, low-income undocumented immigrants who are 26 and older are eligible for limited Medi-Cal, which only covers health care emergencies or prenatal care if they are pregnant. Undocumented immigrants are excluded from the Affordable Care Act, and cannot purchase coverage through Covered California, the state’s ACA health exchange.\u003c/p>\n\u003cp>If they are not insured by an employer or able to purchase a private plan, they must generally rely on county health programs, which vary greatly throughout the state.\u003c/p>\n\u003cp>Last year, Gov. Newsom \u003ca href=\"https://www.kqed.org/news/11814885/as-pandemic-batters-californias-economy-plan-to-insure-undocumented-seniors-in-doubt\">proposed\u003c/a> offering full-scope Medi-Cal to undocumented seniors age 65 and older. But the plan didn’t go through, as the state projected a severe economic downturn and tax losses in the billions of dollars.\u003c/p>\n\u003cp>But the financial picture for California is starkly different this year, with the state logging an eye-popping budget surplus of \u003ca href=\"https://www.kqed.org/news/11874125/californias-historic-budget-surplus-is-it-76-billion-or-38-billion\">$76 billion\u003c/a>. In addition, the pandemic highlighted how “interconnected” public health really is, with all of us having to think about whether people around us wore masks, stood far enough apart, or were vaccinated, said Dar, with the California Immigrant Policy Center.\u003c/p>\n\u003cp>“And so to give health care access to this community would mean a healthier and stronger state for all Californians,” said Dar. “Increased productivity, better health outcomes, better public health.”\u003c/p>\n\u003cp>Some opponents have argued that funds to provide health coverage to undocumented people would be better spent on other needs, such as helping struggling U.S. citizens afford their own health insurance.\u003c/p>\n\u003cp>About two in three Californians support the idea of providing health coverage to undocumented immigrants, according to a \u003ca href=\"https://www.ppic.org/wp-content/uploads/ppic-statewide-survey-californians-and-their-government-march-2021.pdf\">recent survey\u003c/a> by the Public Policy Institute of California. But many Republicans oppose it, with nearly eight in 10 saying that they are not in favor.\u003c/p>\n\u003cp>This year, Illinois became the \u003ca href=\"https://www.povertylaw.org/article/health-coverage-available-to-undocumented-seniors-in-illinois/#:~:text=Fortunately%2C%20Illinois%20has%20become%20the,citizens%20age%2065%20or%20older.\">first state\u003c/a> to extend health insurance to undocumented seniors age 65 and older.\u003c/p>\n\u003cp>Former farmworker Laura hopes she will gain access to health coverage — and low-cost medical care — in California, where she has lived since the late 1980s, most recently in Riverside county.\u003c/p>\n\u003cp>“It would help me a lot to go to the doctor and get my eyes checked out,” Laura said. “It would be the best.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>With so many Californians losing jobs and health insurance because of the pandemic, the state estimates 2 million more people will sign up for Medi-Cal coverage this year, bringing the total caseload in the health care program for low-income Californians to 14.5 million people.\u003c/p>\n\u003cp>To pay for the increase in enrollment, Gov. Gavin Newsom wants to cut back on some of the benefits patients will receive and the rates doctors will get paid to see them.\u003c/p>\n\u003cp>“There are areas where we clearly can’t do what we wanted to do,” Newsom said during a press conference on Thursday. “We wanted to make more progress with the January budget. Unfortunately, that progress will be delayed.” [pullquote size=\"medium\" align=\"right\" citation=\"Dr. Peter N. Bretan, president of the California Medical Association\"]“This budget will widen the inequality gap between those on public and private insurance at a time when more Californians are struggling, and an additional 2 million low-income Californians will be dependent on Medi-Cal.”[/pullquote]\u003c/p>\n\u003cp>Services like vision care, podiatry, hearing aids, and speech and physical therapy will no longer be covered by Medi-Cal under the governor’s \u003ca href=\"http://www.ebudget.ca.gov/FullBudgetSummary.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">revised budget\u003c/a>. Dental services will also be greatly reduced.\u003c/p>\n\u003cp>Many of these benefits had just been restored – letters went out to recipients in January that some were now available again – after they were cut in the last economic downturn.\u003c/p>\n\u003cp>“We spent a lot of time trying to work our way out of the hole that we dug 10 years ago during the Great Recession,” said Anthony Wright, executive director of Health Access California, an advocacy group. “And we’re looking to repeat the exact same mistakes of making these cuts that have these unintended consequences throughout the health system.”\u003c/p>\n\u003cp>The governor is also proposing to reroute $1.2 billion raised from the state’s tobacco tax. Instead of \u003ca href=\"https://www.kqed.org/stateofhealth/339838/is-the-fight-over-tobacco-tax-money-about-helping-patients-or-enriching-doctors\" target=\"_blank\" rel=\"noopener noreferrer\">increasing payments to doctors\u003c/a> and clinics that treat Medi-Cal patients, as the money was intended when it was passed by voters in 2016 as Proposition 56, the state would like to redirect it to fund the growth in general Medi-Cal costs.[ad fullwidth]\u003c/p>\n\u003cp>Doctors groups, which spent millions to help pass the tobacco tax, say this cut to reimbursement rates will create more pressure and uncertainty on physician practices at a time when many are already facing big drops in revenue because of canceled surgeries and appointments. Doctors say this could force them to limit the number of Medi-Cal patients they see.\u003c/p>\n\u003cp>“This budget will widen the inequality gap between those on public and private insurance at a time when more Californians are struggling, and an additional 2 million low-income Californians will be dependent on Medi-Cal,” said Dr. Peter N. Bretan, president of the California Medical Association. “The governor’s proposal will make it harder for those patients to get the care they need when they need it.” [aside tag=\"health, coronavirus\" label=\"More Related Coverage\"]\u003c/p>\n\u003cp>In addition to the cuts in services and reimbursement rates, the state is also scrapping various plans to expand and protect Medi-Cal coverage for seniors, in particular, for undocumented adults over age 65, which was one of the governor’s main goals in bringing the state closer to universal health coverage. Undocumented children and young adults will still be eligible.\u003c/p>\n\u003cp>Tens of thousands of older Californians who are blind and disabled and earn between $16,332 and $17,609 per year will not be able to get Medi-Cal coverage, as was originally proposed in the governor’s January draft budget. And a policy that would have prevented the state from taking Medi-Cal beneficiaries’ homes or estates as payment was rescinded, serving as a deterrent for some seniors to sign up, said Health Access’ Anthony Wright.\u003c/p>\n\u003cp>“These are cuts to senior care and coverage that are really troubling,” he said, “especially since seniors are the most at risk population in this COVID-19 crisis.”\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>With so many Californians losing jobs and health insurance because of the pandemic, the state estimates 2 million more people will sign up for Medi-Cal coverage this year, bringing the total caseload in the health care program for low-income Californians to 14.5 million people.\u003c/p>\n\u003cp>To pay for the increase in enrollment, Gov. Gavin Newsom wants to cut back on some of the benefits patients will receive and the rates doctors will get paid to see them.\u003c/p>\n\u003cp>“There are areas where we clearly can’t do what we wanted to do,” Newsom said during a press conference on Thursday. “We wanted to make more progress with the January budget. Unfortunately, that progress will be delayed.” \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Services like vision care, podiatry, hearing aids, and speech and physical therapy will no longer be covered by Medi-Cal under the governor’s \u003ca href=\"http://www.ebudget.ca.gov/FullBudgetSummary.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">revised budget\u003c/a>. Dental services will also be greatly reduced.\u003c/p>\n\u003cp>Many of these benefits had just been restored – letters went out to recipients in January that some were now available again – after they were cut in the last economic downturn.\u003c/p>\n\u003cp>“We spent a lot of time trying to work our way out of the hole that we dug 10 years ago during the Great Recession,” said Anthony Wright, executive director of Health Access California, an advocacy group. “And we’re looking to repeat the exact same mistakes of making these cuts that have these unintended consequences throughout the health system.”\u003c/p>\n\u003cp>The governor is also proposing to reroute $1.2 billion raised from the state’s tobacco tax. Instead of \u003ca href=\"https://www.kqed.org/stateofhealth/339838/is-the-fight-over-tobacco-tax-money-about-helping-patients-or-enriching-doctors\" target=\"_blank\" rel=\"noopener noreferrer\">increasing payments to doctors\u003c/a> and clinics that treat Medi-Cal patients, as the money was intended when it was passed by voters in 2016 as Proposition 56, the state would like to redirect it to fund the growth in general Medi-Cal costs.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Doctors groups, which spent millions to help pass the tobacco tax, say this cut to reimbursement rates will create more pressure and uncertainty on physician practices at a time when many are already facing big drops in revenue because of canceled surgeries and appointments. Doctors say this could force them to limit the number of Medi-Cal patients they see.\u003c/p>\n\u003cp>“This budget will widen the inequality gap between those on public and private insurance at a time when more Californians are struggling, and an additional 2 million low-income Californians will be dependent on Medi-Cal,” said Dr. Peter N. Bretan, president of the California Medical Association. “The governor’s proposal will make it harder for those patients to get the care they need when they need it.” \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In addition to the cuts in services and reimbursement rates, the state is also scrapping various plans to expand and protect Medi-Cal coverage for seniors, in particular, for undocumented adults over age 65, which was one of the governor’s main goals in bringing the state closer to universal health coverage. Undocumented children and young adults will still be eligible.\u003c/p>\n\u003cp>Tens of thousands of older Californians who are blind and disabled and earn between $16,332 and $17,609 per year will not be able to get Medi-Cal coverage, as was originally proposed in the governor’s January draft budget. And a policy that would have prevented the state from taking Medi-Cal beneficiaries’ homes or estates as payment was rescinded, serving as a deterrent for some seniors to sign up, said Health Access’ Anthony Wright.\u003c/p>\n\u003cp>“These are cuts to senior care and coverage that are really troubling,” he said, “especially since seniors are the most at risk population in this COVID-19 crisis.”\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"content": "\u003cp>In the midst of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services have\u003ca href=\"https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet\"> expanded access to telemedicine appointments\u003c/a> for their beneficiaries. Thanks to a new waiver, more elderly and low-income people can now receive care from practitioners virtually — and doctors and patients across California are taking advantage of this new leeway.\u003c/p>\n\u003cp>Gabriela Hernandez, who is 38 weeks pregnant, is one of those patients. Normally, she would go to LifeLong Medical Care in Berkeley every few weeks for a check-up with Kim Cardoso, her certified nurse-midwife. But for the past few weeks, their appointments have been over the phone.\u003c/p>\n\u003cp>LifeLong is one of more than 1,000 community health centers in California. Many of these centers have dramatically cut back services under the shelter-in-place order to slow the spread of the novel coronavirus.\u003c/p>\n\u003cp>LifeLong closed all but five of its 14 clinics for in-person visits. Providers still see patients in person for the most urgent cases, but the majority are now virtual.\u003c/p>\n\u003cp>Community health centers like LifeLong depend on partial reimbursements from the Medi-Cal program to provide low-cost or free services. Typically, doctors and nurses have to see their patients in person for the clinic to qualify for those funds — but the recent waiver changed that. Now providers like LifeLong get to care for their patients over the phone, and get reimbursed.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Patients and doctors alike are adapting quickly. Hernandez learned how to take her own blood pressure using a wrist cuff she bought at CVS. She reports the numbers back to Cardoso, who records them into a digital chart.\u003c/p>\n\u003cp>“I think it’s a little high,” Hernandez told Cardoso. “It’s at 150 over 106.”\u003c/p>\n\u003cp>“Oh, I don’t like that,” Cardoso said. She asked Hernandez how she’s been eating and if she’s been exercising. Hernandez said she’s been walking around the backyard every day to stay active.\u003c/p>\n\u003cp>She told Cardoso she dropped off samples she took at a nearby lab, which is the kind of thing a medical assistant would normally do at a clinic.\u003c/p>\n\u003cfigure id=\"attachment_11813263\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11813263\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42853_KimCardoso-qut-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42853_KimCardoso-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42853_KimCardoso-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42853_KimCardoso-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42853_KimCardoso-qut.jpg 1920w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Kim Cardoso meets with patients at the Ashby health center before the coronavirus pandemic. \u003ccite>(Courtesy of LifeLong Medical Care)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The learning curve has been steep for everyone at LifeLong, said Chief Medical Officer Michael Stacey.\u003c/p>\n\u003cp>The ability to provide telemedicine services has been an essential lifeline for clinics like LifeLong, said Carmela Castellano-Garcia, president and CEO of the California Primary Care Association, a group that lobbies on behalf of community health centers.\u003c/p>\n\u003cp>“We’ve completely shifted our model of care,” Stacey said.\u003c/p>\n\u003cp>When Bay Area counties began issuing shelter-in-place orders in mid-March, LifeLong had to provide secure digital access to medical charts for many of its 61,000 patients in a matter of days. The clinic had to make sure its doctors and nurses had access to appropriate technology to spend their days sitting in front of a computer, instead of going from exam room to exam room.\u003c/p>\n\u003cp>The rapid change has put LifeLong and other facilities under financial pressure. The clinic has seen about a 35% reduction in visits, even with the switch to telemedicine. The implications of that are troubling, according to LifeLong Deputy Director Lucinda Bazile.\u003c/p>\n\u003cp>So far, LifeLong has reduced hours or furloughed 100 of its employees.\u003c/p>\n\u003cp>“It’s really stressful,” she said. “This is the work that we all chose and we want to make sure that this population gets the care that we need.”\u003c/p>\n\u003cp>[aside tag=\"coronavirus\" label=\"related coverage\"]\u003c/p>\n\u003cp>The clinic where Cardoso works was one of the sites to transition entirely to telemedicine. She has been adapting to new ways to provide that care, including finding the corners of her house with the best cellphone reception and explaining to patients that they might hear her dogs, chickens or kids in the background.\u003c/p>\n\u003cp>But she said that telemedicine isn’t a long-term or complete solution, particularly when it comes to the violence and depression screenings that are part of the routine care she provides. She can’t be certain that her patients are alone and able to speak freely when she asks them about interpersonal violence.\u003c/p>\n\u003cp>“Can they answer truthfully when I ask them if they’re safe?” Cardoso said.\u003c/p>\n\u003cp>Cardoso relies on visual cues and body language to read patients’ responses to sensitive questions about their mental health, something that’s more difficult to do over the phone.\u003c/p>\n\u003cp>Patients like Hernandez are relieved to have that support from a distance, even if it means a different kind of care.\u003c/p>\n\u003cp>“I really like it,” she said. “But I do miss going to the doctor and feeling the baby’s heartbeat.”\u003c/p>\n\u003ch3>How to Get the Most Out of Your Virtual Visit\u003c/h3>\n\u003cp>Here are some tips to help you know when to call your doctor and how to get the most out of your telemedicine appointment:\u003c/p>\n\u003cul>\n\u003cli>If you don’t have a primary care provider already, now is a good time to find one. Community health clinics like LifeLong Medical Care are still doing patient intake over the phone.\u003c/li>\n\u003cli>Prepare for your appointment. Make a list of what you want to talk about during the phone call or video visit to get the most out of it and help your doctors understand your needs. If you have a thermometer, scale or home blood pressure monitor, have it nearby in case your doctor asks you to use it.\u003c/li>\n\u003cli>Track your symptoms as they occur — write them down in your phone or on a sheet of paper. Pay attention to when the symptoms occur, when they get worse and if anything seems to trigger them.\u003c/li>\n\u003cli>Take pictures. If your symptoms include rashes, bites or moles, your doctor wants to see that. It can be helpful to circle the affected area with a pen.\u003c/li>\n\u003cli>Emergencies are still emergencies, so if you’re experiencing chest pain, weakness in one side of the face or body or a sudden thunder-clap headache, call 911 to speak with a professional who can evaluate you over the phone. Be prepared to describe your symptoms in a few sentences.\u003c/li>\n\u003c/ul>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>NPR’s Mara Gordon contributed to this report.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In the midst of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services have\u003ca href=\"https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet\"> expanded access to telemedicine appointments\u003c/a> for their beneficiaries. Thanks to a new waiver, more elderly and low-income people can now receive care from practitioners virtually — and doctors and patients across California are taking advantage of this new leeway.\u003c/p>\n\u003cp>Gabriela Hernandez, who is 38 weeks pregnant, is one of those patients. Normally, she would go to LifeLong Medical Care in Berkeley every few weeks for a check-up with Kim Cardoso, her certified nurse-midwife. But for the past few weeks, their appointments have been over the phone.\u003c/p>\n\u003cp>LifeLong is one of more than 1,000 community health centers in California. Many of these centers have dramatically cut back services under the shelter-in-place order to slow the spread of the novel coronavirus.\u003c/p>\n\u003cp>LifeLong closed all but five of its 14 clinics for in-person visits. Providers still see patients in person for the most urgent cases, but the majority are now virtual.\u003c/p>\n\u003cp>Community health centers like LifeLong depend on partial reimbursements from the Medi-Cal program to provide low-cost or free services. Typically, doctors and nurses have to see their patients in person for the clinic to qualify for those funds — but the recent waiver changed that. Now providers like LifeLong get to care for their patients over the phone, and get reimbursed.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Patients and doctors alike are adapting quickly. Hernandez learned how to take her own blood pressure using a wrist cuff she bought at CVS. She reports the numbers back to Cardoso, who records them into a digital chart.\u003c/p>\n\u003cp>“I think it’s a little high,” Hernandez told Cardoso. “It’s at 150 over 106.”\u003c/p>\n\u003cp>“Oh, I don’t like that,” Cardoso said. She asked Hernandez how she’s been eating and if she’s been exercising. Hernandez said she’s been walking around the backyard every day to stay active.\u003c/p>\n\u003cp>She told Cardoso she dropped off samples she took at a nearby lab, which is the kind of thing a medical assistant would normally do at a clinic.\u003c/p>\n\u003cfigure id=\"attachment_11813263\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11813263\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42853_KimCardoso-qut-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42853_KimCardoso-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42853_KimCardoso-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42853_KimCardoso-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42853_KimCardoso-qut.jpg 1920w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Kim Cardoso meets with patients at the Ashby health center before the coronavirus pandemic. \u003ccite>(Courtesy of LifeLong Medical Care)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The learning curve has been steep for everyone at LifeLong, said Chief Medical Officer Michael Stacey.\u003c/p>\n\u003cp>The ability to provide telemedicine services has been an essential lifeline for clinics like LifeLong, said Carmela Castellano-Garcia, president and CEO of the California Primary Care Association, a group that lobbies on behalf of community health centers.\u003c/p>\n\u003cp>“We’ve completely shifted our model of care,” Stacey said.\u003c/p>\n\u003cp>When Bay Area counties began issuing shelter-in-place orders in mid-March, LifeLong had to provide secure digital access to medical charts for many of its 61,000 patients in a matter of days. The clinic had to make sure its doctors and nurses had access to appropriate technology to spend their days sitting in front of a computer, instead of going from exam room to exam room.\u003c/p>\n\u003cp>The rapid change has put LifeLong and other facilities under financial pressure. The clinic has seen about a 35% reduction in visits, even with the switch to telemedicine. The implications of that are troubling, according to LifeLong Deputy Director Lucinda Bazile.\u003c/p>\n\u003cp>So far, LifeLong has reduced hours or furloughed 100 of its employees.\u003c/p>\n\u003cp>“It’s really stressful,” she said. “This is the work that we all chose and we want to make sure that this population gets the care that we need.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The clinic where Cardoso works was one of the sites to transition entirely to telemedicine. She has been adapting to new ways to provide that care, including finding the corners of her house with the best cellphone reception and explaining to patients that they might hear her dogs, chickens or kids in the background.\u003c/p>\n\u003cp>But she said that telemedicine isn’t a long-term or complete solution, particularly when it comes to the violence and depression screenings that are part of the routine care she provides. She can’t be certain that her patients are alone and able to speak freely when she asks them about interpersonal violence.\u003c/p>\n\u003cp>“Can they answer truthfully when I ask them if they’re safe?” Cardoso said.\u003c/p>\n\u003cp>Cardoso relies on visual cues and body language to read patients’ responses to sensitive questions about their mental health, something that’s more difficult to do over the phone.\u003c/p>\n\u003cp>Patients like Hernandez are relieved to have that support from a distance, even if it means a different kind of care.\u003c/p>\n\u003cp>“I really like it,” she said. “But I do miss going to the doctor and feeling the baby’s heartbeat.”\u003c/p>\n\u003ch3>How to Get the Most Out of Your Virtual Visit\u003c/h3>\n\u003cp>Here are some tips to help you know when to call your doctor and how to get the most out of your telemedicine appointment:\u003c/p>\n\u003cul>\n\u003cli>If you don’t have a primary care provider already, now is a good time to find one. Community health clinics like LifeLong Medical Care are still doing patient intake over the phone.\u003c/li>\n\u003cli>Prepare for your appointment. Make a list of what you want to talk about during the phone call or video visit to get the most out of it and help your doctors understand your needs. If you have a thermometer, scale or home blood pressure monitor, have it nearby in case your doctor asks you to use it.\u003c/li>\n\u003cli>Track your symptoms as they occur — write them down in your phone or on a sheet of paper. Pay attention to when the symptoms occur, when they get worse and if anything seems to trigger them.\u003c/li>\n\u003cli>Take pictures. If your symptoms include rashes, bites or moles, your doctor wants to see that. It can be helpful to circle the affected area with a pen.\u003c/li>\n\u003cli>Emergencies are still emergencies, so if you’re experiencing chest pain, weakness in one side of the face or body or a sudden thunder-clap headache, call 911 to speak with a professional who can evaluate you over the phone. Be prepared to describe your symptoms in a few sentences.\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Starting this year, routine pediatric visits for millions of California children could involve questions about touchy family topics, such as divorce, unstable housing or a parent who struggles with alcoholism.\u003c/p>\n\u003cp>California now will pay doctors to screen patients for traumatic events known as adverse childhood experiences, or ACEs, if the patient is covered by Medi-Cal.\u003c/p>\n\u003cp>The screening program is rooted in \u003ca href=\"https://californiahealthline.org/news/california-looks-to-lead-nation-aces-screening-childhood-trauma/\" target=\"_blank\" rel=\"noopener noreferrer\">decades of research\u003c/a> that suggests children who endure sustained stress in their day-to-day lives undergo biochemical changes to their brains and bodies that can dramatically increase their risk of developing serious health problems, including heart disease, asthma, depression and cancer.\u003c/p>\n\u003cp>Health and welfare advocates hope that widespread screening of children for ACEs, accompanied by early intervention, will help reduce the ongoing stresses and skirt the onset of physical illness, or at least ensure an illness is treated.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Dr. Dayna Long, a pediatrician at UCSF\"]‘We’re not going to make all the hard things go away, but we can help families build resilience and reduce stress.’[/pullquote]\u003c/p>\n\u003cp>The higher the number of such adverse events — and so, the higher a child’s ACEs “score” — the higher the risk of chronic illness and premature death. About 63% of Californians have experienced at least one adverse childhood event, and nearly 18% have faced four or more, according to state health officials.\u003c/p>\n\u003cp>California is the first state to create a formal reimbursement strategy for ACEs screening, and the program will be open to both children and adults enrolled in Medi-Cal. The initiative is part of a larger \u003ca href=\"https://www.dhcs.ca.gov/Documents/ACEs-AWARE-INITIATIVE.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">ACEs awareness campaign\u003c/a> championed by the state’s first surgeon general, \u003ca href=\"https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime/discussion?CMP\" target=\"_blank\" rel=\"noopener noreferrer\">Dr. Nadine Burke Harris\u003c/a>, who is a national leader in the ACEs movement.\u003c/p>\n\u003cp>The public health impact could be significant as Medi-Cal covers 5.3 million kids — roughly 40% of all California children — and 6.3 million adults.\u003c/p>\n\u003cp>“It is a profound shift that’s going to change the type of prevention and management we do with families,” said Dr. Dayna Long, a pediatrician who is director of the Center for Child and Community Health at UCSF Benioff Children’s Hospital Oakland and helped develop the state-approved screening tool for children and teens. “We’re not going to make all the hard things go away, but we can help families build resilience and reduce stress.”\u003c/p>\n\u003cp>Here are five key things to know about ACEs and the state’s new screening program:\u003c/p>\n\u003ch4>1. How it Works\u003c/h4>\n\u003cp>At a typical well-child visit, parents or caregivers will be asked to fill out a state-approved \u003ca href=\"https://www.acesaware.org/wp-content/uploads/2019/12/PEARLS-Tool-Child-Parent-Caregiver-Report-De-Identified-English.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">questionnaire\u003c/a> about potentially stressful experiences in their children’s lives. For children under age 12, caregivers fill out the survey. Young people ages 12-19 will complete their own questionnaire in addition to their caregivers’ questionnaire.\u003c/p>\n\u003cp>The questions will touch on 10 categories of adversity spanning the first 18 years of life: physical, emotional or sexual abuse; physical or emotional neglect; and experiences that could indicate household dysfunction, such as a parent who has a serious mental illness or addiction, having parents who are incarcerated or living in a home with domestic violence.\u003c/p>\n\u003cp>[aside postID=mindshift_54373 label='Does every moment matter?' hero=\"https://cdn.kqed.org/wp-content/uploads/sites/23/2019/09/happy-childhood-photos-de61f9ac60f2b9d24a1196c86e0d47be30eebaea-1020x765.jpg\"]The screening will measure for experiences that could regularly trigger fear and anxiety, including homelessness, not having enough food or the right kinds of food, and growing up in a neighborhood marred by drugs and violence.\u003c/p>\n\u003cp>Dr. Long acknowledged some caregivers and children might be reluctant or unwilling to disclose sensitive information, particularly if they fear shame or repercussions. “We acknowledge it takes time to build trust,” she said. “But we want to encourage families to have hard conversations with their doctors and to understand how stressful events over the life of the child are impacting that child’s health.”\u003c/p>\n\u003cp>Physicians will review the responses and discuss them with caregivers during the visit. Doctors will have access to free online training on how to communicate with families and connect them to community resources. Physicians will be eligible for a $29 reimbursement for each Medi-Cal patient screened.\u003c/p>\n\u003cp>The responses are considered confidential patient information and won’t be shared with state officials. But researchers hope that aggregated information will be studied to improve care for patients with high ACEs scores.\u003c/p>\n\u003ch4>2. Screenings Are Voluntary\u003c/h4>\n\u003cp>Doctors do not need to offer them, and patients and their caregivers do not have to participate. Doctors will need to complete online training before they can be paid for screening patients. The state will cover the costs of screening once a year for children and once in a lifetime for adults. But children are the main focus of the screening campaign.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003ch4>3. What Happens After the Screening Is Less Clear\u003c/h4>\n\u003cp>Community clinics often have social workers or “navigators” available to connect families to aid like food stamps or counseling. Doctors in private practice, however, are less likely to have those resources, said Dr. Eric Ball, an Orange County pediatrician who served on a committee advising the surgeon general on the ACEs campaign. Ball said local chapters of the American Academy of Pediatrics will work to educate doctors on how to help children who register high ACEs scores, because social services vary so much by county.\u003c/p>\n\u003cp>Doctors “are not going to get rich doing ACEs screenings, that’s not the point,” Ball said. “If we can pick up kids at higher risk for these issues down the road and mitigate it, that’s really exciting to me.”\u003c/p>\n\u003ch4>4. Researchers Aren’t Yet Sure Which Interventions Will Best Help Kids With High ACEs Scores\u003c/h4>\n\u003cp>Long and her UCSF Benioff colleagues are \u003ca href=\"https://clinicaltrials.ucsf.edu/trial/NCT04182906\" target=\"_blank\" rel=\"noopener noreferrer\">continuing to study\u003c/a> how well the ACEs screening works and what interventions might be most effective. It’s one thing to help hungry families sign up for food stamps and free school lunches. It’s less clear how to help a child whose parent is in prison. Researchers have identified protective factors that can help children better resist the effects of toxic stress, including nurturing relationships with trusted adults, such as grandparents or teachers.\u003c/p>\n\u003cp>“The fact of screening is also an intervention,” Long said. “Being able to sit in a room with a pediatrician is not going to make those hard experiences go away, but it creates a freedom to talk about some things that are solvable. That’s therapeutic in and of itself.”\u003c/p>\n\u003ch4>5. Not Everyone Agrees That Widespread ACEs Screening Is a Good Idea\u003c/h4>\n\u003cp>Sociologist David Finkelhor, director of the Crimes against Children Research Center at the University of New Hampshire, is among those who caution that universal screening for ACEs is premature, given there is little consensus about the potential negative effects of screening or the best interventions.\u003c/p>\n\u003cp>[aside postID=\"science_1938819,news_11724781,futureofyou_439851\" label=\"Related Coverage\"]“The good news is that we are focusing on these adversities that are clearly the source of so many downstream health and mental health problems,” Finkelhor said. “But the bad news is we’re moving way too fast, before we know how to best conduct this kind of screening and intervention, and we could get it wrong with pretty disastrous consequences.”\u003c/p>\n\u003cp>“Mostly, we don’t know what to do with somebody who has a high ACE score,” he said. “There are already long waits to get into family counseling or child mental health programs.”\u003c/p>\n\u003cp>For example, a doctor might be legally required to report previous abuse to authorities, upending a family even if the child no longer is exposed to the abuser, Finkelhor said.\u003c/p>\n\u003cp>“These are tough questions,” Long of UCSF acknowledged. Still, she said, screening is important, because it encourages physicians to engage in difficult conversations they might not otherwise have and pushes clinics to create links to supportive services and resources.\u003c/p>\n\u003cp>“That is the next phase, and that is important,” Long said. “We’re doing this because we care about your child and want them to grow into healthy adults.”\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">KHN\u003c/a> story first published on \u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Healthline\u003c/a>, a service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Henry J. Kaiser Family Foundation\u003c/a> which 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>\u003c/p>\n\u003cp>The higher the number of such adverse events — and so, the higher a child’s ACEs “score” — the higher the risk of chronic illness and premature death. About 63% of Californians have experienced at least one adverse childhood event, and nearly 18% have faced four or more, according to state health officials.\u003c/p>\n\u003cp>California is the first state to create a formal reimbursement strategy for ACEs screening, and the program will be open to both children and adults enrolled in Medi-Cal. The initiative is part of a larger \u003ca href=\"https://www.dhcs.ca.gov/Documents/ACEs-AWARE-INITIATIVE.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">ACEs awareness campaign\u003c/a> championed by the state’s first surgeon general, \u003ca href=\"https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime/discussion?CMP\" target=\"_blank\" rel=\"noopener noreferrer\">Dr. Nadine Burke Harris\u003c/a>, who is a national leader in the ACEs movement.\u003c/p>\n\u003cp>The public health impact could be significant as Medi-Cal covers 5.3 million kids — roughly 40% of all California children — and 6.3 million adults.\u003c/p>\n\u003cp>“It is a profound shift that’s going to change the type of prevention and management we do with families,” said Dr. Dayna Long, a pediatrician who is director of the Center for Child and Community Health at UCSF Benioff Children’s Hospital Oakland and helped develop the state-approved screening tool for children and teens. “We’re not going to make all the hard things go away, but we can help families build resilience and reduce stress.”\u003c/p>\n\u003cp>Here are five key things to know about ACEs and the state’s new screening program:\u003c/p>\n\u003ch4>1. How it Works\u003c/h4>\n\u003cp>At a typical well-child visit, parents or caregivers will be asked to fill out a state-approved \u003ca href=\"https://www.acesaware.org/wp-content/uploads/2019/12/PEARLS-Tool-Child-Parent-Caregiver-Report-De-Identified-English.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">questionnaire\u003c/a> about potentially stressful experiences in their children’s lives. For children under age 12, caregivers fill out the survey. Young people ages 12-19 will complete their own questionnaire in addition to their caregivers’ questionnaire.\u003c/p>\n\u003cp>The questions will touch on 10 categories of adversity spanning the first 18 years of life: physical, emotional or sexual abuse; physical or emotional neglect; and experiences that could indicate household dysfunction, such as a parent who has a serious mental illness or addiction, having parents who are incarcerated or living in a home with domestic violence.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The screening will measure for experiences that could regularly trigger fear and anxiety, including homelessness, not having enough food or the right kinds of food, and growing up in a neighborhood marred by drugs and violence.\u003c/p>\n\u003cp>Dr. Long acknowledged some caregivers and children might be reluctant or unwilling to disclose sensitive information, particularly if they fear shame or repercussions. “We acknowledge it takes time to build trust,” she said. “But we want to encourage families to have hard conversations with their doctors and to understand how stressful events over the life of the child are impacting that child’s health.”\u003c/p>\n\u003cp>Physicians will review the responses and discuss them with caregivers during the visit. Doctors will have access to free online training on how to communicate with families and connect them to community resources. Physicians will be eligible for a $29 reimbursement for each Medi-Cal patient screened.\u003c/p>\n\u003cp>The responses are considered confidential patient information and won’t be shared with state officials. But researchers hope that aggregated information will be studied to improve care for patients with high ACEs scores.\u003c/p>\n\u003ch4>2. Screenings Are Voluntary\u003c/h4>\n\u003cp>Doctors do not need to offer them, and patients and their caregivers do not have to participate. Doctors will need to complete online training before they can be paid for screening patients. The state will cover the costs of screening once a year for children and once in a lifetime for adults. But children are the main focus of the screening campaign.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003ch4>3. What Happens After the Screening Is Less Clear\u003c/h4>\n\u003cp>Community clinics often have social workers or “navigators” available to connect families to aid like food stamps or counseling. Doctors in private practice, however, are less likely to have those resources, said Dr. Eric Ball, an Orange County pediatrician who served on a committee advising the surgeon general on the ACEs campaign. Ball said local chapters of the American Academy of Pediatrics will work to educate doctors on how to help children who register high ACEs scores, because social services vary so much by county.\u003c/p>\n\u003cp>Doctors “are not going to get rich doing ACEs screenings, that’s not the point,” Ball said. “If we can pick up kids at higher risk for these issues down the road and mitigate it, that’s really exciting to me.”\u003c/p>\n\u003ch4>4. Researchers Aren’t Yet Sure Which Interventions Will Best Help Kids With High ACEs Scores\u003c/h4>\n\u003cp>Long and her UCSF Benioff colleagues are \u003ca href=\"https://clinicaltrials.ucsf.edu/trial/NCT04182906\" target=\"_blank\" rel=\"noopener noreferrer\">continuing to study\u003c/a> how well the ACEs screening works and what interventions might be most effective. It’s one thing to help hungry families sign up for food stamps and free school lunches. It’s less clear how to help a child whose parent is in prison. Researchers have identified protective factors that can help children better resist the effects of toxic stress, including nurturing relationships with trusted adults, such as grandparents or teachers.\u003c/p>\n\u003cp>“The fact of screening is also an intervention,” Long said. “Being able to sit in a room with a pediatrician is not going to make those hard experiences go away, but it creates a freedom to talk about some things that are solvable. That’s therapeutic in and of itself.”\u003c/p>\n\u003ch4>5. Not Everyone Agrees That Widespread ACEs Screening Is a Good Idea\u003c/h4>\n\u003cp>Sociologist David Finkelhor, director of the Crimes against Children Research Center at the University of New Hampshire, is among those who caution that universal screening for ACEs is premature, given there is little consensus about the potential negative effects of screening or the best interventions.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“The good news is that we are focusing on these adversities that are clearly the source of so many downstream health and mental health problems,” Finkelhor said. “But the bad news is we’re moving way too fast, before we know how to best conduct this kind of screening and intervention, and we could get it wrong with pretty disastrous consequences.”\u003c/p>\n\u003cp>“Mostly, we don’t know what to do with somebody who has a high ACE score,” he said. “There are already long waits to get into family counseling or child mental health programs.”\u003c/p>\n\u003cp>For example, a doctor might be legally required to report previous abuse to authorities, upending a family even if the child no longer is exposed to the abuser, Finkelhor said.\u003c/p>\n\u003cp>“These are tough questions,” Long of UCSF acknowledged. Still, she said, screening is important, because it encourages physicians to engage in difficult conversations they might not otherwise have and pushes clinics to create links to supportive services and resources.\u003c/p>\n\u003cp>“That is the next phase, and that is important,” Long said. “We’re doing this because we care about your child and want them to grow into healthy adults.”\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">KHN\u003c/a> story first published on \u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Healthline\u003c/a>, a service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Henry J. Kaiser Family Foundation\u003c/a> which is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "California Could Lose $2 Billion of Budget Surplus Due to Feud With Trump",
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"content": "\u003cp>California is bracing for a much smaller budget surplus next year because of its ongoing feud with the Trump administration about a tax involving Medicaid, one of the state's chief budget writers said Monday.\u003c/p>\n\u003cp>California is projected to have a $7 billion surplus, with $3 billion of it available to spend on recurring programs.\u003c/p>\n\u003cp>But nearly $2 billion of that amount would only come if California is allowed to keep in place a tax on the companies that manage Medi-Cal, the state's Medicaid program. California needs permission from the federal government to do that — and state lawmakers are not sure they will get it.\u003c/p>\n\u003cp>Democratic state Assemblyman Phil Ting, chairman of the committee that writes the Assembly version of the budget, said lawmakers are planning on Trump declining to approve the tax, meaning only $1 billion of the surplus would be available to spend on recurring programs. \u003c/p>\n\u003cp>Preparing to spend that money while facing such uncertainty “wouldn't be the right thing to do,” Ting said.\u003c/p>\n\u003cp>“Every time there is an opportunity to fight with California, the Trump administration has really taken up that mantle and really tried at every turn to thwart many of our key policy agendas,” Ting said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Sen. Holly Mitchell, chairwoman of the state Senate Budget Committee, said it was too early in the budget process to make such decisions. Gov. Gavin Newsom must send his budget proposal to the Legislature by Jan. 10. After that, the Legislature has until June 15 to pass it.\u003c/p>\n\u003cp>Mitchell said the Trump administration is more likely to oppose the tax if California's legislative leaders publicly say they are planning on that outcome.\u003c/p>\n\u003cp>“That's not a public statement I would have made today, personally,” Mitchell said. California has other issues in the works with the Trump administration, and the Legislature should be “strategic and smart” in its approach to the federal government, she said.\u003c/p>\n\u003cp>California has battled with the Trump administration this year over whether the state can set its own emission standards for cars and trucks and over proposed new rules governing the state's water. Democratic Attorney General Xavier Becerra has sued the administration more than 50 times over various administrative actions.\u003c/p>\n\u003cp>[aside postID=news_11741446 hero='https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/04/Becerra1-1280x800-1020x638.jpg']\u003c/p>\n\u003cp>Ting's comments came as he \u003ca href=\"https://twitter.com/PhilTing/status/1204125212402257920?s=20\">released his annual blueprint\u003c/a> for upcoming state spending. Ting said he wants the state to spend more money on mental health treatment for homeless people and prison inmates. He also wants the state to let low-income adults 65 and older who are living in the country illegally be eligible for the state-funded health insurance program.\u003c/p>\n\u003cp>Ting indicated it could be difficult to accomplish all of those things if the state only has $1 billion in new money that lawmakers can spend on recurring programs.\u003c/p>\n\u003cp>“A billion dollars goes really quickly when you're talking about higher education, health care, housing the homeless,” Ting said.\u003c/p>\n\u003cp>\u003cem>This post has been updated.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California is bracing for a much smaller budget surplus next year because of its ongoing feud with the Trump administration about a tax involving Medicaid, one of the state's chief budget writers said Monday.\u003c/p>\n\u003cp>California is projected to have a $7 billion surplus, with $3 billion of it available to spend on recurring programs.\u003c/p>\n\u003cp>But nearly $2 billion of that amount would only come if California is allowed to keep in place a tax on the companies that manage Medi-Cal, the state's Medicaid program. California needs permission from the federal government to do that — and state lawmakers are not sure they will get it.\u003c/p>\n\u003cp>Democratic state Assemblyman Phil Ting, chairman of the committee that writes the Assembly version of the budget, said lawmakers are planning on Trump declining to approve the tax, meaning only $1 billion of the surplus would be available to spend on recurring programs. \u003c/p>\n\u003cp>Preparing to spend that money while facing such uncertainty “wouldn't be the right thing to do,” Ting said.\u003c/p>\n\u003cp>“Every time there is an opportunity to fight with California, the Trump administration has really taken up that mantle and really tried at every turn to thwart many of our key policy agendas,” Ting said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Sen. Holly Mitchell, chairwoman of the state Senate Budget Committee, said it was too early in the budget process to make such decisions. Gov. Gavin Newsom must send his budget proposal to the Legislature by Jan. 10. After that, the Legislature has until June 15 to pass it.\u003c/p>\n\u003cp>Mitchell said the Trump administration is more likely to oppose the tax if California's legislative leaders publicly say they are planning on that outcome.\u003c/p>\n\u003cp>“That's not a public statement I would have made today, personally,” Mitchell said. California has other issues in the works with the Trump administration, and the Legislature should be “strategic and smart” in its approach to the federal government, she said.\u003c/p>\n\u003cp>California has battled with the Trump administration this year over whether the state can set its own emission standards for cars and trucks and over proposed new rules governing the state's water. Democratic Attorney General Xavier Becerra has sued the administration more than 50 times over various administrative actions.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Ting's comments came as he \u003ca href=\"https://twitter.com/PhilTing/status/1204125212402257920?s=20\">released his annual blueprint\u003c/a> for upcoming state spending. Ting said he wants the state to spend more money on mental health treatment for homeless people and prison inmates. He also wants the state to let low-income adults 65 and older who are living in the country illegally be eligible for the state-funded health insurance program.\u003c/p>\n\u003cp>Ting indicated it could be difficult to accomplish all of those things if the state only has $1 billion in new money that lawmakers can spend on recurring programs.\u003c/p>\n\u003cp>“A billion dollars goes really quickly when you're talking about higher education, health care, housing the homeless,” Ting said.\u003c/p>\n\u003cp>\u003cem>This post has been updated.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"slug": "californias-new-transparency-law-reveals-steep-rise-in-wholesale-drug-prices",
"title": "California’s New Transparency Law Reveals Steep Rise in Wholesale Drug Prices",
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"content": "\u003cp>Drugmakers fought hard against California’s groundbreaking drug price transparency law, passed in 2017. Now, state health officials have released their \u003ca href=\"https://oshpd.ca.gov/visualizations/prescription-drug-wholesale-acquisition-cost-increases/\">first report\u003c/a> on the price hikes those drug companies sought to shield.\u003c/p>\n\u003cp>Pharmaceutical companies raised the “wholesale acquisition cost” of their drugs — the list price for wholesalers without discounts or rebates — by a median of 25.8% from 2017 through the first quarter of 2019, according to the Office of Statewide Health Planning and Development. (The median is a value at the midpoint of data distribution.)\u003c/p>\n\u003cp>Generic drugs saw the largest median increase of 37.6% during that time. By comparison, the annual inflation rate during the period was 2%.\u003c/p>\n\u003cp>[aside link1=\"https://www.kqed.org/stateofhealth/223329/drug-price-transparency-laws-may-not-drive-down-spiraling-costs-for-consumers,Drug Price Transparency Laws May Not Drive Down Spiraling Costs for Consumers\" link2=\"https://www.kqed.org/stateofhealth/361263/other-states-closely-watching-fate-of-californias-drug-price-transparency-bill,Other States Closely Watching Fate of California Drug Price Transparency Bill\" label=\"Drug Price Transparency\"]Several drugs stood out for far heftier price increases: The cost of a generic liquid version of Prozac, for example, rose from $9 to $69 in just the first quarter of 2019, an increase of 667%. Guanfacine, a generic medication for attention deficit hyperactivity disorder (ADHD), on the market since 2010, rose more than 200% in the first quarter of 2019 to $87 for 100 2-milligram pills. Amneal Pharmaceuticals, which makes Guanfacine, cited “manufacturing costs” and “market conditions” as reasons for the price hike.\u003c/p>\n\u003cp>“Even at a time when there is a microscope on this industry, they’re going ahead with drug price increases for hundreds of drugs well above the rate of inflation,” said Anthony Wright, executive director of the California advocacy group Health Access.\u003c/p>\n\u003cp>The national debate over exorbitant prescription drug prices — and how to relieve them — was supposed to take center stage in recent weeks, as House Speaker Nancy Pelosi released \u003ca href=\"https://www.kqed.org/news/11775310/pelosi-unveils-plan-to-lower-prescription-drug-costs-a-rare-priority-shared-with-trump\" target=\"_blank\" rel=\"noopener\">a plan\u003c/a> to negotiate prices for as many as 250 name-brand drugs, including high-priced insulin, for Medicare beneficiaries. Another \u003ca href=\"https://www.cnbc.com/2019/07/23/key-senate-panel-unveils-bipartisan-bill-to-lower-drug-prices-for-seniors.html\">plan\u003c/a> under consideration in the Senate would set a maximum out-of-pocket cost for prescription drugs for Medicare patients and penalize drug companies if prices rose faster than inflation.\u003c/p>\n\u003cp>President Trump has also highlighted drug prices as an issue in his reelection campaign. But lawmakers’ efforts to hammer out legislation are likely to be overshadowed, for now, by presidential impeachment proceedings. In Nevada, health officials in early October \u003ca href=\"https://thenevadaindependent.com/article/nevada-levies-17-million-in-fines-on-drug-companies-for-noncompliance-with-diabetes-drug-transparency-law\">fined companies $17 million\u003c/a> for failing to comply with the state’s 2-year-old transparency law requiring diabetes drug manufacturers to disclose detailed financial and pricing information.\u003c/p>\n\u003cp>California’s new drug law requires companies to report drug price increases quarterly. Only companies that met certain standards — they raised the price of a drug within the first quarter and the price had risen by at least 16% since January 2017 — had to submit data. The companies that met the standards were required to provide pricing data for the previous five years. In its initial report, the state focused its analysis on drug-pricing trends for about 1,000 products from January 2017 through March 2019.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>California’s transparency law also requires drugmakers to state why they are raising prices. Over time, that information, in addition to cost disclosures, could create “one of the more comprehensive and official drug databases on prices that we have nationwide,” Wright said. “That, in itself, is progress, so that we can get better information on the rationale for drug price increases.”\u003c/p>\n\u003cp>But the data does not reflect discounts and rebates for insurers and pharmacy benefit managers and bears little resemblance to what consumers actually pay, said Priscilla VanderVeer, a spokeswoman for the trade group Pharmaceutical Research and Manufacturers of America. The group filed a \u003ca href=\"https://www.documentcloud.org/documents/6440510-PHRMA-v-California-SB-17-COMPLAINT-12-8-17.html\">lawsuit\u003c/a> seeking to overturn the California legislation that has not yet been resolved.\u003c/p>\n\u003cp>“If transparency legislation only looks at one part of the pharmaceutical supply chain, without getting into the various middlemen like insurers and pharmacy benefit managers that ultimately determine what patients have to pay at the pharmacy counter, it won’t help patients access or afford their medicines,” VanderVeer said in an email.\u003c/p>\n\u003cp>State Sen. Richard Pan, D-Sacramento, a pediatrician who chairs the Senate Health Committee, agrees — up to a point.\u003c/p>\n\u003cp>“Transparency always has value,” Pan said. But policymakers need more data on how much insurers and consumers are spending on prescription drugs, he said.\u003c/p>\n\u003cp>And he wonders why the price of generic drugs, including those with plenty of competition, rose at higher rates.\u003c/p>\n\u003cp>His concerns were echoed by University of Southern California policy researchers, who recently published a \u003ca href=\"https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2751892\">study\u003c/a> that concluded most state-level drug-transparency laws are “insufficient” to reveal the true transaction prices for prescription drugs, or where in the distribution system excessive profits lie.\u003c/p>\n\u003cp>[aside postID=\"news_11740765\"]“The question is, why are these prices going up? Typically, there are competing stories for that,” said Neeraj Sood, vice dean of the University of Southern California’s School of Public Policy and an author of the study. “Maybe cost of production is going up,” he said. “Maybe there’s a drug shortage, or some competitors got eliminated. This reporting of [wholesale acquisition cost] data doesn’t really tell us which of these stories is true.”\u003c/p>\n\u003cp>For now, California’s new data is not likely to be of much help to consumers, Pan said. But he said it might help state officials in their bid to overhaul the way the state purchases drugs for 13 million people served by Medi-Cal, the state’s Medicaid program for low-income residents. Gov. Gavin Newsom’s \u003ca href=\"https://www.sfchronicle.com/business/article/Will-Gavin-Newsom-s-plan-lower-prescription-14404947.php\">controversial plan\u003c/a> to have the state, rather than individual Medi-Cal managed-care plans, negotiate directly with drugmakers would save the state an estimated $393 million a year by 2023, according to the administration.\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://khn.org\">KHN\u003c/a> story first published on \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, a service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a> which is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cp>\u003cimg decoding=\"async\" src=\"https://ssl.google-analytics.com/collect?v=1&t=event&ec=Republish&tid=UA-53070700-2&z=1571082607988&cid=2bb4d33e-9a0c-4133-b010-815b74d09391&ea=https%3A%2F%2Fkhn.org%2Fnews%2Fcalifornias-new-transparency-law-reveals-steep-rise-in-wholesale-drug-prices%2F&el=California%E2%80%99s%20New%20Transparency%20Law%20Reveals%20Steep%20Rise%20In%20Wholesale%20Drug%20Prices\">\u003c/p>\n\u003cp>\u003c/p>\n",
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"excerpt": "The first transparency report on drug company pricing shows increases in costs by a median of 25.8% — but a number of advocates say that information might not be enough to help consumers.",
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"nprByline": "\u003cstrong>Barbara Feder Ostrov and Harriet Blair Rowan\u003cbr>\u003ca href=\"https://khn.org/news/californias-new-transparency-law-reveals-steep-rise-in-wholesale-drug-prices/view/republish/\">Kaiser Health News\u003c/a>\u003c/strong>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Drugmakers fought hard against California’s groundbreaking drug price transparency law, passed in 2017. Now, state health officials have released their \u003ca href=\"https://oshpd.ca.gov/visualizations/prescription-drug-wholesale-acquisition-cost-increases/\">first report\u003c/a> on the price hikes those drug companies sought to shield.\u003c/p>\n\u003cp>Pharmaceutical companies raised the “wholesale acquisition cost” of their drugs — the list price for wholesalers without discounts or rebates — by a median of 25.8% from 2017 through the first quarter of 2019, according to the Office of Statewide Health Planning and Development. (The median is a value at the midpoint of data distribution.)\u003c/p>\n\u003cp>Generic drugs saw the largest median increase of 37.6% during that time. By comparison, the annual inflation rate during the period was 2%.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"link1": "https://www.kqed.org/stateofhealth/223329/drug-price-transparency-laws-may-not-drive-down-spiraling-costs-for-consumers,Drug Price Transparency Laws May Not Drive Down Spiraling Costs for Consumers",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Several drugs stood out for far heftier price increases: The cost of a generic liquid version of Prozac, for example, rose from $9 to $69 in just the first quarter of 2019, an increase of 667%. Guanfacine, a generic medication for attention deficit hyperactivity disorder (ADHD), on the market since 2010, rose more than 200% in the first quarter of 2019 to $87 for 100 2-milligram pills. Amneal Pharmaceuticals, which makes Guanfacine, cited “manufacturing costs” and “market conditions” as reasons for the price hike.\u003c/p>\n\u003cp>“Even at a time when there is a microscope on this industry, they’re going ahead with drug price increases for hundreds of drugs well above the rate of inflation,” said Anthony Wright, executive director of the California advocacy group Health Access.\u003c/p>\n\u003cp>The national debate over exorbitant prescription drug prices — and how to relieve them — was supposed to take center stage in recent weeks, as House Speaker Nancy Pelosi released \u003ca href=\"https://www.kqed.org/news/11775310/pelosi-unveils-plan-to-lower-prescription-drug-costs-a-rare-priority-shared-with-trump\" target=\"_blank\" rel=\"noopener\">a plan\u003c/a> to negotiate prices for as many as 250 name-brand drugs, including high-priced insulin, for Medicare beneficiaries. Another \u003ca href=\"https://www.cnbc.com/2019/07/23/key-senate-panel-unveils-bipartisan-bill-to-lower-drug-prices-for-seniors.html\">plan\u003c/a> under consideration in the Senate would set a maximum out-of-pocket cost for prescription drugs for Medicare patients and penalize drug companies if prices rose faster than inflation.\u003c/p>\n\u003cp>President Trump has also highlighted drug prices as an issue in his reelection campaign. But lawmakers’ efforts to hammer out legislation are likely to be overshadowed, for now, by presidential impeachment proceedings. In Nevada, health officials in early October \u003ca href=\"https://thenevadaindependent.com/article/nevada-levies-17-million-in-fines-on-drug-companies-for-noncompliance-with-diabetes-drug-transparency-law\">fined companies $17 million\u003c/a> for failing to comply with the state’s 2-year-old transparency law requiring diabetes drug manufacturers to disclose detailed financial and pricing information.\u003c/p>\n\u003cp>California’s new drug law requires companies to report drug price increases quarterly. Only companies that met certain standards — they raised the price of a drug within the first quarter and the price had risen by at least 16% since January 2017 — had to submit data. The companies that met the standards were required to provide pricing data for the previous five years. In its initial report, the state focused its analysis on drug-pricing trends for about 1,000 products from January 2017 through March 2019.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>California’s transparency law also requires drugmakers to state why they are raising prices. Over time, that information, in addition to cost disclosures, could create “one of the more comprehensive and official drug databases on prices that we have nationwide,” Wright said. “That, in itself, is progress, so that we can get better information on the rationale for drug price increases.”\u003c/p>\n\u003cp>But the data does not reflect discounts and rebates for insurers and pharmacy benefit managers and bears little resemblance to what consumers actually pay, said Priscilla VanderVeer, a spokeswoman for the trade group Pharmaceutical Research and Manufacturers of America. The group filed a \u003ca href=\"https://www.documentcloud.org/documents/6440510-PHRMA-v-California-SB-17-COMPLAINT-12-8-17.html\">lawsuit\u003c/a> seeking to overturn the California legislation that has not yet been resolved.\u003c/p>\n\u003cp>“If transparency legislation only looks at one part of the pharmaceutical supply chain, without getting into the various middlemen like insurers and pharmacy benefit managers that ultimately determine what patients have to pay at the pharmacy counter, it won’t help patients access or afford their medicines,” VanderVeer said in an email.\u003c/p>\n\u003cp>State Sen. Richard Pan, D-Sacramento, a pediatrician who chairs the Senate Health Committee, agrees — up to a point.\u003c/p>\n\u003cp>“Transparency always has value,” Pan said. But policymakers need more data on how much insurers and consumers are spending on prescription drugs, he said.\u003c/p>\n\u003cp>And he wonders why the price of generic drugs, including those with plenty of competition, rose at higher rates.\u003c/p>\n\u003cp>His concerns were echoed by University of Southern California policy researchers, who recently published a \u003ca href=\"https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2751892\">study\u003c/a> that concluded most state-level drug-transparency laws are “insufficient” to reveal the true transaction prices for prescription drugs, or where in the distribution system excessive profits lie.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“The question is, why are these prices going up? Typically, there are competing stories for that,” said Neeraj Sood, vice dean of the University of Southern California’s School of Public Policy and an author of the study. “Maybe cost of production is going up,” he said. “Maybe there’s a drug shortage, or some competitors got eliminated. This reporting of [wholesale acquisition cost] data doesn’t really tell us which of these stories is true.”\u003c/p>\n\u003cp>For now, California’s new data is not likely to be of much help to consumers, Pan said. But he said it might help state officials in their bid to overhaul the way the state purchases drugs for 13 million people served by Medi-Cal, the state’s Medicaid program for low-income residents. Gov. Gavin Newsom’s \u003ca href=\"https://www.sfchronicle.com/business/article/Will-Gavin-Newsom-s-plan-lower-prescription-14404947.php\">controversial plan\u003c/a> to have the state, rather than individual Medi-Cal managed-care plans, negotiate directly with drugmakers would save the state an estimated $393 million a year by 2023, according to the administration.\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://khn.org\">KHN\u003c/a> story first published on \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, a service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a> which is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cp>\u003cimg decoding=\"async\" src=\"https://ssl.google-analytics.com/collect?v=1&t=event&ec=Republish&tid=UA-53070700-2&z=1571082607988&cid=2bb4d33e-9a0c-4133-b010-815b74d09391&ea=https%3A%2F%2Fkhn.org%2Fnews%2Fcalifornias-new-transparency-law-reveals-steep-rise-in-wholesale-drug-prices%2F&el=California%E2%80%99s%20New%20Transparency%20Law%20Reveals%20Steep%20Rise%20In%20Wholesale%20Drug%20Prices\">\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Lawyers for San Francisco and Santa Clara counties, the state of California and other plaintiffs tried to persuade a federal judge in Oakland Wednesday to block a Trump administration rule that would deny green cards to immigrants who use public benefits such as Medi-Cal, food stamps and housing vouchers.\u003c/p>\n\u003cp>The plaintiffs — who also include immigrant service providers, the states of Oregon, Maine and Pennsylvania, and the District of Columbia — say the \"public charge\" rule would cause them irreparable harm, forcing local governments to spend more to protect public health and increasing the likelihood of communicable disease outbreaks because fearful immigrants stop seeking medical care.\u003c/p>\n\u003cp>U.S. District Judge Phyllis Hamilton signaled that she would decide on whether to block the rule before Oct. 15, when it is set to go into effect.\u003c/p>\n\u003cp>But she chided the plaintiffs for failing to make a strong case — in legal briefs or in court — that a nationwide injunction is needed. And she stressed that the 9th U.S. Circuit Court of Appeals last month struck down another judge’s nationwide injunction on a federal asylum restriction.\u003c/p>\n\u003cp>\"You are requesting [this] without giving me the kind of road map that I think the 9th Circuit requires to enter a nationwide injunction,” Hamilton said. “It leads me to believe that you’re not really serious about me granting this if you haven’t addressed the issue.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Plaintiffs’ attorneys responded that if the policy is blocked in only some states, it would create a confusing patchwork of regulation.\u003c/p>\n\u003cp>“Anything short of a nationwide injunction will leave our residents confused, scared and ultimately chilled from [using] these benefits,” said San Francisco Deputy City Attorney Matthew Goldberg.\u003c/p>\n\u003cp>Attorneys for the Trump administration, meanwhile, told the judge that the public charge rule is also being challenged in Chicago, New York, Spokane and elsewhere, and a nationwide ruling would interfere with those courts reaching their own decisions.\u003c/p>\n\u003cp>Wednesday’s hearing centered in part on what the term “public charge” actually means.\u003c/p>\n\u003cp>[aside tag='public-charge' label='Related Coverage']\u003c/p>\n\u003cp>U.S. Department of Justice lawyers argued that the new rule is in keeping with long-standing federal policy that requires immigrants to be self-sufficient in order to be granted legal permanent residence (known as a green card) — a path to eventual citizenship.\u003c/p>\n\u003cp>DOJ Deputy Assistant Attorney General Ethan Davis said the definition of public charge can include “any maintenance or public assistance from public funds.”\u003c/p>\n\u003cp>But plaintiffs argued that for more than 100 years, the government only considered someone a public charge if they had “primary dependence” on the government for survival, including people considered “paupers” and “lunatics.” They said the new rule improperly sweeps in immigrants who accept as little as $180 worth of non-cash assistance — including services such as health care that could actually help them work and become self-sufficient.\u003c/p>\n\u003cp>The states and counties also said they could lose millions of dollars in federal funds if immigrants drop out of Medicaid (known in California as Medi-Cal) for fear of jeopardizing their chance at a green card. San Francisco stands to lose $7.5 million a year and Santa Clara County $4.6 million, said Goldberg, but that doesn’t mean local governments will stop providing health services or nutrition assistance to local residents.\u003c/p>\n\u003cp>“We have a proprietary interest in the public health in our communities,” Goldberg said. “We have legal obligations to provide medical care to people who are uninsured.”\u003c/p>\n\u003cp>Arguing for the Trump administration, Davis countered that if local governments take a hit, it’s because they choose to spend their own funds on social services.\u003c/p>\n\u003cp>“They may spend more money on food pantries and the like, but that’s not a required consequence of the rule,” Davis said.\u003c/p>\n\u003cp>He added that losses by the plaintiffs are “highly speculative.”\u003c/p>\n\u003cp>But Goldberg said immigrants are already giving up public benefits.\u003c/p>\n\u003cp>“It’s the preferred outcome of the rule, the purpose of the rule,” he said.\u003c/p>\n\u003cp>Hamilton suggested she might block the public charge rule, but more narrowly than the plaintiffs requested. She called on both parties to submit additional briefs by Oct. 7 proposing a more limited ruling.\u003c/p>\n\u003cp>“Assuming I don’t issue a nationwide injunction and assuming I do think it should be enjoined,” she said, “I’d like to hear from both sides on what an injunction should look like.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>KQED's Farida Jhabvala Romero contributed to this report.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Lawyers for San Francisco and Santa Clara counties, the state of California and other plaintiffs tried to persuade a federal judge in Oakland Wednesday to block a Trump administration rule that would deny green cards to immigrants who use public benefits such as Medi-Cal, food stamps and housing vouchers.\u003c/p>\n\u003cp>The plaintiffs — who also include immigrant service providers, the states of Oregon, Maine and Pennsylvania, and the District of Columbia — say the \"public charge\" rule would cause them irreparable harm, forcing local governments to spend more to protect public health and increasing the likelihood of communicable disease outbreaks because fearful immigrants stop seeking medical care.\u003c/p>\n\u003cp>U.S. District Judge Phyllis Hamilton signaled that she would decide on whether to block the rule before Oct. 15, when it is set to go into effect.\u003c/p>\n\u003cp>But she chided the plaintiffs for failing to make a strong case — in legal briefs or in court — that a nationwide injunction is needed. And she stressed that the 9th U.S. Circuit Court of Appeals last month struck down another judge’s nationwide injunction on a federal asylum restriction.\u003c/p>\n\u003cp>\"You are requesting [this] without giving me the kind of road map that I think the 9th Circuit requires to enter a nationwide injunction,” Hamilton said. “It leads me to believe that you’re not really serious about me granting this if you haven’t addressed the issue.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>U.S. Department of Justice lawyers argued that the new rule is in keeping with long-standing federal policy that requires immigrants to be self-sufficient in order to be granted legal permanent residence (known as a green card) — a path to eventual citizenship.\u003c/p>\n\u003cp>DOJ Deputy Assistant Attorney General Ethan Davis said the definition of public charge can include “any maintenance or public assistance from public funds.”\u003c/p>\n\u003cp>But plaintiffs argued that for more than 100 years, the government only considered someone a public charge if they had “primary dependence” on the government for survival, including people considered “paupers” and “lunatics.” They said the new rule improperly sweeps in immigrants who accept as little as $180 worth of non-cash assistance — including services such as health care that could actually help them work and become self-sufficient.\u003c/p>\n\u003cp>The states and counties also said they could lose millions of dollars in federal funds if immigrants drop out of Medicaid (known in California as Medi-Cal) for fear of jeopardizing their chance at a green card. San Francisco stands to lose $7.5 million a year and Santa Clara County $4.6 million, said Goldberg, but that doesn’t mean local governments will stop providing health services or nutrition assistance to local residents.\u003c/p>\n\u003cp>“We have a proprietary interest in the public health in our communities,” Goldberg said. “We have legal obligations to provide medical care to people who are uninsured.”\u003c/p>\n\u003cp>Arguing for the Trump administration, Davis countered that if local governments take a hit, it’s because they choose to spend their own funds on social services.\u003c/p>\n\u003cp>“They may spend more money on food pantries and the like, but that’s not a required consequence of the rule,” Davis said.\u003c/p>\n\u003cp>He added that losses by the plaintiffs are “highly speculative.”\u003c/p>\n\u003cp>But Goldberg said immigrants are already giving up public benefits.\u003c/p>\n\u003cp>“It’s the preferred outcome of the rule, the purpose of the rule,” he said.\u003c/p>\n\u003cp>Hamilton suggested she might block the public charge rule, but more narrowly than the plaintiffs requested. She called on both parties to submit additional briefs by Oct. 7 proposing a more limited ruling.\u003c/p>\n\u003cp>“Assuming I don’t issue a nationwide injunction and assuming I do think it should be enjoined,” she said, “I’d like to hear from both sides on what an injunction should look like.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>KQED's Farida Jhabvala Romero contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Last month, Yuri sat in her dining room in San Jose, turned on the TV, and heard something that made her sit up straight and sent her mind racing.\u003c/p>\n\u003cp>The Trump administration, the newscaster announced, had just published a new rule that could make it harder for immigrants to get a green card if they used, or were likely to use, public government benefits like food stamps or Medicaid.\u003c/p>\n\u003cp>Yuri, who came to the United States from Michoacán, Mexico, was enrolled in CalFresh, California’s food stamp program, for her seven children, who range in age from just over a month to 15 and who all were born in this country. But with the new rule, Yuri, wondered, would staying on food stamps imperil her asylum application or get her deported? Would she and her family have to move back to Michoacán, which has some of the worst cartel violence in Mexico?\u003c/p>\n\u003cp>[aside label=\"related coverage\" tag=\"public-charge\"]\u003c/p>\n\u003cp>She decided to terminate food stamps for her kids and to withdraw herself from MediCal, despite some health complications she said accompanied her latest pregnancy. She worries, she said, about how she will keep her children’s bellies full without food stamps. But she doesn’t want the use of social service programs to put her at risk of being deported.\u003c/p>\n\u003cp>Across California, the looming change, known as the “public charge” rule, is sowing confusion and fear within the immigrant community, causing many people to abandon programs for fear of retaliation from immigration authorities, according to nearly two dozen interviews with health care providers, lawyers, nonprofit organizations and social service agencies.\u003c/p>\n\u003cp>The new rule could affect more than 2 million Californians, most of whom are not subject to the regulation, and could result in 765,000 people withdrawing from MediCal and CalFresh, according to UCLA’s Center for Health Policy Research.\u003c/p>\n\u003cp>Yuri, who did not want her last name used for fear of drawing attention to her family, would not be affected by the rule change: Refugees and asylees are\u003ca href=\"https://www.uscis.gov/legal-resources/final-rule-public-charge-ground-inadmissibility\"> exempted\u003c/a> from the policy, as are the food stamps she gets for her children, who are citizens. But many immigrants like her, who are not subject to the rule, are feeling the chilling effect, with some withdrawing from social services unnecessarily.\u003c/p>\n\u003cp>Social service experts describe patients staying away from crucial medical appointments, domestic violence survivors avoiding food stamps, a crime victim with a humanitarian visa dropping health coverage during treatment for cancer and parents considering removing their children from benefits ranging from free and reduced school lunches to health coverage.\u003c/p>\n\u003cp>Currently, green card applicants must prove they will not be a financial burden — or a “public charge” — on the United States through use of cash welfare programs or publicly funded institutional care. The new regulation, which will take effect in mid-October, would expand the public charge definition to include Medicaid, food stamps and housing vouchers. Immigration officials will also consider income, education, English-language abilities and health when making a determination.\u003c/p>\n\u003cp>Claribel Chavez, an outreach worker for the Second Harvest Food Bank of Silicon Valley, said the primary reason the people she talks to resist signing up for food stamps is out of fear of being considered a public charge.\u003c/p>\n\u003cp>“They’re just not doing it because they are scared,” she said. “They say, ‘We would rather struggle than put our name into the system.’ It’s getting bad.”\u003c/p>\n\u003cp>In August, Santa Clara and San Francisco counties\u003ca href=\"https://www.sccgov.org/sites/cco/public-charge/pages/home.aspx\"> sued\u003c/a> the Trump administration over the regulation and filed a motion to block the rule before it takes effect. The\u003ca href=\"https://www.sccgov.org/sites/cco/public-charge/Documents/Counties_Prelimimary_Injunction_Motion.pdf\"> motion\u003c/a> argues that the rule, if implemented, would cause “irreparable harm” to the counties and “will cause individuals to dis-enroll from or forgo critical public benefits out of fear of potential immigration consequences.”\u003c/p>\n\u003cp>California is one of a\u003ca href=\"https://thehill.com/homenews/news/457485-washington-state-ag-files-lawsuit-over-trump-public-charge-rule\"> number\u003c/a> of states suing to block the policy.\u003c/p>\n\u003cp>In its\u003ca href=\"https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-17142.pdf\"> publication\u003c/a> of the rule change, the Department of Homeland Security estimated that 324,000 people in households with non-citizens will withdraw or stay away from public benefits because of the change.\u003c/p>\n\u003cp>[pullquote size='medium' align='right' citation=\"Yuri, an asylum-seeker\"]‘We don’t want to have the risk. You never know what’s going to happen.’[/pullquote]But immigrants’ rights advocates said they expect the affected pool to be much larger, because the effects are trickling down to legal immigrants and mixed-status families who, fearing negative consequences, may now withdraw or stay away from housing assistance, health care or other social services. A recent\u003ca href=\"https://www.kff.org/report-section/estimated-impacts-of-final-public-charge-inadmissibility-rule-on-immigrants-and-medicaid-coverage-key-findings/\"> report\u003c/a> by the Kaiser Family Foundation, for example, estimated that the rule could result in up to 4.7 million people withdrawing from Medicaid and the Children’s Health Insurance Program (CHIP).\u003c/p>\n\u003cp>Although it is difficult to measure the full impacts of the policy before it takes effect, there are some indications that it may already be having an influence.\u003c/p>\n\u003cp>In San Francisco County, according to court records, food stamp enrollment in households with at least one noncitizen dropped sharply when the proposed rule was announced in the fall of 2018, while citizen household enrollment remained relatively steady.\u003c/p>\n\u003cp>In Santa Clara County, data provided in\u003ca href=\"https://www.sccgov.org/sites/cco/public-charge/Documents/Declaration_of_Director_of_DEBS_Angela_Shing.pdf\"> court records\u003c/a> indicates that the number of households receiving food stamps with at least one member who is not a citizen decreased 20% — or from about 15,000 to about 12,000 — from October 2018 to May 2019. During the same time period, food stamp enrollment in citizen households stayed at roughly 26,000. The records also show that MediCal participation in households with at least one noncitizen decreased more than 13% from the fall of 2018 to July 2019, while participation in citizen households increased 6%.\u003c/p>\n\u003cp>For health care providers in the Bay Area, the prospect of patients declining medical care is worrisome. Santa Clara County has the fourth-highest rate of tuberculosis in California, according to Dr. Sara Cody, the county’s director of public health, with almost 10% of that population infected with latent TB. Patients forgoing evaluation and treatment could heighten the risk of spreading infection to county residents, she said.\u003c/p>\n\u003cp>Jane Garcia, the chief executive officer of La Clinica, a health clinic that operates in Alameda, Solano and Contra Costa counties, said health care providers have reported patients skipping appointments and withdrawing from county health programs, as well as from MediCal. She said she gets three to four emails a day from doctors reporting appointment cancellations and no-shows.\u003c/p>\n\u003cp>Greg C. Garrett, the chief policy and external affairs officer of the Alameda Health Consortium, shared the story of a 13-year-old U.S. citizen with severe depression and schizophrenia whose mother withdrew her from health services because she was afraid of the public charge rule.\u003c/p>\n\u003cp>“Her provider told me she is having nightmares, wondering what is happening with this young girl because of her issues,” Garrett said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Asylum-seekers and refugees would be exempt from the current rule, as would victims of domestic violence and trafficking. But advocates and lawyers who work with those populations say that many of them, too, are confused about the 800-plus-page rule and have asked if they should reconsider using benefits.\u003c/p>\n\u003cp>In addition, neither the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) nor free and reduced price school lunch programs would be affected by the change. But social service providers in the Bay Area say recipients of both benefits have expressed concern about continuing their enrollment.\u003c/p>\n\u003cp>As for Yuri, the path forward is one without CalFresh for her children, and although she is seeking the advice of an immigration lawyer, legal consultation seems unlikely to change her mind about withdrawing. For now, she said, it all just seems too uncertain.\u003c/p>\n\u003cp>“We don’t want to have the risk,” she said, rocking her newborn’s pink crib. “You never know what’s going to happen.”\u003c/p>\n\u003cp>\u003cem>Erica Hellerstein is a journalist at The Mercury News in San Jose working for The California Divide, a collaboration among newsrooms examining income inequity and economic survival in California.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Last month, Yuri sat in her dining room in San Jose, turned on the TV, and heard something that made her sit up straight and sent her mind racing.\u003c/p>\n\u003cp>The Trump administration, the newscaster announced, had just published a new rule that could make it harder for immigrants to get a green card if they used, or were likely to use, public government benefits like food stamps or Medicaid.\u003c/p>\n\u003cp>Yuri, who came to the United States from Michoacán, Mexico, was enrolled in CalFresh, California’s food stamp program, for her seven children, who range in age from just over a month to 15 and who all were born in this country. But with the new rule, Yuri, wondered, would staying on food stamps imperil her asylum application or get her deported? Would she and her family have to move back to Michoacán, which has some of the worst cartel violence in Mexico?\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She decided to terminate food stamps for her kids and to withdraw herself from MediCal, despite some health complications she said accompanied her latest pregnancy. She worries, she said, about how she will keep her children’s bellies full without food stamps. But she doesn’t want the use of social service programs to put her at risk of being deported.\u003c/p>\n\u003cp>Across California, the looming change, known as the “public charge” rule, is sowing confusion and fear within the immigrant community, causing many people to abandon programs for fear of retaliation from immigration authorities, according to nearly two dozen interviews with health care providers, lawyers, nonprofit organizations and social service agencies.\u003c/p>\n\u003cp>The new rule could affect more than 2 million Californians, most of whom are not subject to the regulation, and could result in 765,000 people withdrawing from MediCal and CalFresh, according to UCLA’s Center for Health Policy Research.\u003c/p>\n\u003cp>Yuri, who did not want her last name used for fear of drawing attention to her family, would not be affected by the rule change: Refugees and asylees are\u003ca href=\"https://www.uscis.gov/legal-resources/final-rule-public-charge-ground-inadmissibility\"> exempted\u003c/a> from the policy, as are the food stamps she gets for her children, who are citizens. But many immigrants like her, who are not subject to the rule, are feeling the chilling effect, with some withdrawing from social services unnecessarily.\u003c/p>\n\u003cp>Social service experts describe patients staying away from crucial medical appointments, domestic violence survivors avoiding food stamps, a crime victim with a humanitarian visa dropping health coverage during treatment for cancer and parents considering removing their children from benefits ranging from free and reduced school lunches to health coverage.\u003c/p>\n\u003cp>Currently, green card applicants must prove they will not be a financial burden — or a “public charge” — on the United States through use of cash welfare programs or publicly funded institutional care. The new regulation, which will take effect in mid-October, would expand the public charge definition to include Medicaid, food stamps and housing vouchers. Immigration officials will also consider income, education, English-language abilities and health when making a determination.\u003c/p>\n\u003cp>Claribel Chavez, an outreach worker for the Second Harvest Food Bank of Silicon Valley, said the primary reason the people she talks to resist signing up for food stamps is out of fear of being considered a public charge.\u003c/p>\n\u003cp>“They’re just not doing it because they are scared,” she said. “They say, ‘We would rather struggle than put our name into the system.’ It’s getting bad.”\u003c/p>\n\u003cp>In August, Santa Clara and San Francisco counties\u003ca href=\"https://www.sccgov.org/sites/cco/public-charge/pages/home.aspx\"> sued\u003c/a> the Trump administration over the regulation and filed a motion to block the rule before it takes effect. The\u003ca href=\"https://www.sccgov.org/sites/cco/public-charge/Documents/Counties_Prelimimary_Injunction_Motion.pdf\"> motion\u003c/a> argues that the rule, if implemented, would cause “irreparable harm” to the counties and “will cause individuals to dis-enroll from or forgo critical public benefits out of fear of potential immigration consequences.”\u003c/p>\n\u003cp>California is one of a\u003ca href=\"https://thehill.com/homenews/news/457485-washington-state-ag-files-lawsuit-over-trump-public-charge-rule\"> number\u003c/a> of states suing to block the policy.\u003c/p>\n\u003cp>In its\u003ca href=\"https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-17142.pdf\"> publication\u003c/a> of the rule change, the Department of Homeland Security estimated that 324,000 people in households with non-citizens will withdraw or stay away from public benefits because of the change.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>But immigrants’ rights advocates said they expect the affected pool to be much larger, because the effects are trickling down to legal immigrants and mixed-status families who, fearing negative consequences, may now withdraw or stay away from housing assistance, health care or other social services. A recent\u003ca href=\"https://www.kff.org/report-section/estimated-impacts-of-final-public-charge-inadmissibility-rule-on-immigrants-and-medicaid-coverage-key-findings/\"> report\u003c/a> by the Kaiser Family Foundation, for example, estimated that the rule could result in up to 4.7 million people withdrawing from Medicaid and the Children’s Health Insurance Program (CHIP).\u003c/p>\n\u003cp>Although it is difficult to measure the full impacts of the policy before it takes effect, there are some indications that it may already be having an influence.\u003c/p>\n\u003cp>In San Francisco County, according to court records, food stamp enrollment in households with at least one noncitizen dropped sharply when the proposed rule was announced in the fall of 2018, while citizen household enrollment remained relatively steady.\u003c/p>\n\u003cp>In Santa Clara County, data provided in\u003ca href=\"https://www.sccgov.org/sites/cco/public-charge/Documents/Declaration_of_Director_of_DEBS_Angela_Shing.pdf\"> court records\u003c/a> indicates that the number of households receiving food stamps with at least one member who is not a citizen decreased 20% — or from about 15,000 to about 12,000 — from October 2018 to May 2019. During the same time period, food stamp enrollment in citizen households stayed at roughly 26,000. The records also show that MediCal participation in households with at least one noncitizen decreased more than 13% from the fall of 2018 to July 2019, while participation in citizen households increased 6%.\u003c/p>\n\u003cp>For health care providers in the Bay Area, the prospect of patients declining medical care is worrisome. Santa Clara County has the fourth-highest rate of tuberculosis in California, according to Dr. Sara Cody, the county’s director of public health, with almost 10% of that population infected with latent TB. Patients forgoing evaluation and treatment could heighten the risk of spreading infection to county residents, she said.\u003c/p>\n\u003cp>Jane Garcia, the chief executive officer of La Clinica, a health clinic that operates in Alameda, Solano and Contra Costa counties, said health care providers have reported patients skipping appointments and withdrawing from county health programs, as well as from MediCal. She said she gets three to four emails a day from doctors reporting appointment cancellations and no-shows.\u003c/p>\n\u003cp>Greg C. Garrett, the chief policy and external affairs officer of the Alameda Health Consortium, shared the story of a 13-year-old U.S. citizen with severe depression and schizophrenia whose mother withdrew her from health services because she was afraid of the public charge rule.\u003c/p>\n\u003cp>“Her provider told me she is having nightmares, wondering what is happening with this young girl because of her issues,” Garrett said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Asylum-seekers and refugees would be exempt from the current rule, as would victims of domestic violence and trafficking. But advocates and lawyers who work with those populations say that many of them, too, are confused about the 800-plus-page rule and have asked if they should reconsider using benefits.\u003c/p>\n\u003cp>In addition, neither the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) nor free and reduced price school lunch programs would be affected by the change. But social service providers in the Bay Area say recipients of both benefits have expressed concern about continuing their enrollment.\u003c/p>\n\u003cp>As for Yuri, the path forward is one without CalFresh for her children, and although she is seeking the advice of an immigration lawyer, legal consultation seems unlikely to change her mind about withdrawing. For now, she said, it all just seems too uncertain.\u003c/p>\n\u003cp>“We don’t want to have the risk,” she said, rocking her newborn’s pink crib. “You never know what’s going to happen.”\u003c/p>\n\u003cp>\u003cem>Erica Hellerstein is a journalist at The Mercury News in San Jose working for The California Divide, a collaboration among newsrooms examining income inequity and economic survival in California.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>When Jessy Rosales was a sophomore at UC Riverside, she had a boyfriend and she was taking birth control pills. Then out of nowhere, she started feeling sick.\u003c/p>\n\u003cp>“I just thought it was the stomach flu,” she says. “It turns out I was pregnant.”\u003c/p>\n\u003cp>Rosales was clear that she was not ready to have a baby. She wanted a medication abortion, where she would take one pill at the clinic and a second one at home a day or two later to induce a miscarriage.\u003c/p>\n\u003cp>“I just wanted the intimacy of dealing with it on my own, in the privacy of my own home,” she says. “And being able to cry if I wanted to cry or just being able to curl up in my bed right away.”\u003c/p>\n\u003cp>Public university health centers in California do not perform abortions. But state lawmakers are expected to pass\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201920200SB24\"> a bill\u003c/a> in the coming weeks that would require student health centers at all 34 state campuses to provide medication abortions. If the measure becomes law, it will be the first of its kind in the U.S.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The bill’s supporters say they want to remove the obstacles women face accessing medical abortion off campus. For example, Rosales was given three off-campus referrals for abortion providers by her student health center. But the first clinic she called didn’t perform abortions after all. The second didn’t take her insurance.\u003c/p>\n\u003cp>By the time she could get an appointment at a third clinic, she was already into the second trimester of pregnancy — too late for a medication abortion, which can only be done up to 10 weeks. Rosales ended up having a surgical procedure.\u003c/p>\n\u003cp>“The doctor kept telling me to relax … and I couldn’t because it just hurt so bad,” she recalls. “I was just afraid and alone.”\u003c/p>\n\u003cp>Rosales graduated last year and is now advocating for the bill (SB 24) as a reproductive justice activist with the Women’s Foundation of California. She wants other students to have easier access to the abortion pill than she did.\u003c/p>\n\u003cfigure id=\"attachment_11772339\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/09/jessy-rosales_wide-a7286be2cdb043d9198d5277d39ca62e8fe74a3d-800x450.jpg\" alt=\"It took too long for Jessy Rosales to find a clinic near the University of California, Riverside, that would provide a medication abortion and accept her insurance. She's now advocating for a state bill to make the pills available at public university health centers in California.\" width=\"800\" height=\"450\" class=\"size-medium wp-image-11772339\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/09/jessy-rosales_wide-a7286be2cdb043d9198d5277d39ca62e8fe74a3d-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/09/jessy-rosales_wide-a7286be2cdb043d9198d5277d39ca62e8fe74a3d-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/09/jessy-rosales_wide-a7286be2cdb043d9198d5277d39ca62e8fe74a3d-1020x573.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/09/jessy-rosales_wide-a7286be2cdb043d9198d5277d39ca62e8fe74a3d-1200x675.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/09/jessy-rosales_wide-a7286be2cdb043d9198d5277d39ca62e8fe74a3d-1920x1080.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/09/jessy-rosales_wide-a7286be2cdb043d9198d5277d39ca62e8fe74a3d.jpg 1944w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">It took too long for Jessy Rosales to find a clinic near UC Riverside, that would provide a medication abortion and accept her insurance. She’s now advocating for a state bill to make the pills available at public university health centers in California. \u003ccite>(Courtesy of Planned Parenthood )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Opponents of the bill have organized several rallies against it. In August, about 60 protesters in yellow T-shirts gathered outside a church in Sacramento, their heads bowed as a priest led them in prayer. Then they marched around the state’s Capitol, chanting, “Don’t kill babies! Don’t kill babies!”\u003c/p>\n\u003cp>While a consortium of women’s groups that support abortion rights has promised to pay for all the required ultrasound equipment and upfront training costs of providing the abortion pill on campus, eventually universities would likely need to dip into tax dollars or student fees for ongoing costs.\u003c/p>\n\u003cp>Abortion opponents such as Michele LaMonica object to that.\u003c/p>\n\u003cp>“Not on my dime, not on my dime,” LaMonica says. “Tax me to help the homeless. Tax me to help social services, but don’t tax me to pay for the disposal of human life.”\u003c/p>\n\u003cp>[aside postID=\"news_11719509\" label=\"Previous Coverage\"]\u003c/p>\n\u003cp>Insurers are already required to cover abortion under California law, and state tax dollars do go toward abortions provided through Medi-Cal, the state version of Medicaid for low-income patients. However, none of the UC campuses and only some of the CSU campuses get reimbursed for health services through Medi-Cal. University officials testified during legislative hearings on the bill last year that it could be an administrative or fiscal burden to establish billing systems to provide the abortion pill on campus. They predicted that some clinical costs, as well as security and liability costs, could fall directly to the universities and get passed on to students.\u003c/p>\n\u003cp>Up to 519 women at public universities seek a medication abortion every month in California, according to\u003ca href=\"https://www.jahonline.org/article/S1054-139X(18)30185-X/fulltext\"> a study\u003c/a> published last summer in the Journal of Adolescent Health.\u003c/p>\n\u003cp>The same research found that off-campus abortion providers were an average of six miles away from public university campuses in California.\u003c/p>\n\u003cp>Former Gov. Jerry Brown cited this stat when \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=201720180SB320\">he vetoed\u003c/a> a version of the same bill (\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB320\">SB 320\u003c/a>) last year, saying the legislation was not necessary.\u003c/p>\n\u003cp>“Six miles away — that’s like a $5 Uber ride,” said abortion opponent Nick Reynosa, the Northern California regional coordinator for Students for Life of America.\u003c/p>\n\u003cp>He says the campaign is more about politics than need.\u003c/p>\n\u003cp>“Over the last decade, many pro-choice activists feel that in red states, there’s been a lot of momentum toward more abortion restrictions. This is a way to say, ‘No. Here, in blue California, we’re going to affirm or expand [the right to an abortion],’ ” Reynosa says.\u003c/p>\n\u003cp>The bill’s supporters don’t deny it. Phoebe Abramowitz was part of the student team that launched the campus campaign for medication abortions at UC Berkeley four years ago.\u003c/p>\n\u003cp>“Now that we’re doing statewide advocacy, we’re hoping to set a national precedent that we can, even in these really hostile times to women and queer people, move access to abortion forward,” she says. “It’s more important now than it even was a year ago.”\u003c/p>\n\u003cp>When Brown vetoed the bill last year, then-gubernatorial candidate Gavin Newsom said he\u003ca href=\"https://www.sfchronicle.com/politics/article/Gavin-Newsom-splits-with-Jerry-Brown-on-SF-drug-13275997.php\"> would have supported\u003c/a> it. He won the election about a month later, and advocates are optimistic that he will side with them this time around.\u003c/p>\n\u003cp>The state Legislature has until mid-September to pass the bill, and the governor has a month after that to sign or veto it. \u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of NPR’s reporting partnership with KQED and \u003c/em>\u003ca href=\"http://www.kaiserhealthnews.org/\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Jessy Rosales was a sophomore at UC Riverside, she had a boyfriend and she was taking birth control pills. Then out of nowhere, she started feeling sick.\u003c/p>\n\u003cp>“I just thought it was the stomach flu,” she says. “It turns out I was pregnant.”\u003c/p>\n\u003cp>Rosales was clear that she was not ready to have a baby. She wanted a medication abortion, where she would take one pill at the clinic and a second one at home a day or two later to induce a miscarriage.\u003c/p>\n\u003cp>“I just wanted the intimacy of dealing with it on my own, in the privacy of my own home,” she says. “And being able to cry if I wanted to cry or just being able to curl up in my bed right away.”\u003c/p>\n\u003cp>Public university health centers in California do not perform abortions. But state lawmakers are expected to pass\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201920200SB24\"> a bill\u003c/a> in the coming weeks that would require student health centers at all 34 state campuses to provide medication abortions. If the measure becomes law, it will be the first of its kind in the U.S.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The bill’s supporters say they want to remove the obstacles women face accessing medical abortion off campus. For example, Rosales was given three off-campus referrals for abortion providers by her student health center. But the first clinic she called didn’t perform abortions after all. The second didn’t take her insurance.\u003c/p>\n\u003cp>By the time she could get an appointment at a third clinic, she was already into the second trimester of pregnancy — too late for a medication abortion, which can only be done up to 10 weeks. Rosales ended up having a surgical procedure.\u003c/p>\n\u003cp>“The doctor kept telling me to relax … and I couldn’t because it just hurt so bad,” she recalls. “I was just afraid and alone.”\u003c/p>\n\u003cp>Rosales graduated last year and is now advocating for the bill (SB 24) as a reproductive justice activist with the Women’s Foundation of California. She wants other students to have easier access to the abortion pill than she did.\u003c/p>\n\u003cfigure id=\"attachment_11772339\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/09/jessy-rosales_wide-a7286be2cdb043d9198d5277d39ca62e8fe74a3d-800x450.jpg\" alt=\"It took too long for Jessy Rosales to find a clinic near the University of California, Riverside, that would provide a medication abortion and accept her insurance. She's now advocating for a state bill to make the pills available at public university health centers in California.\" width=\"800\" height=\"450\" class=\"size-medium wp-image-11772339\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/09/jessy-rosales_wide-a7286be2cdb043d9198d5277d39ca62e8fe74a3d-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/09/jessy-rosales_wide-a7286be2cdb043d9198d5277d39ca62e8fe74a3d-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/09/jessy-rosales_wide-a7286be2cdb043d9198d5277d39ca62e8fe74a3d-1020x573.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/09/jessy-rosales_wide-a7286be2cdb043d9198d5277d39ca62e8fe74a3d-1200x675.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/09/jessy-rosales_wide-a7286be2cdb043d9198d5277d39ca62e8fe74a3d-1920x1080.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/09/jessy-rosales_wide-a7286be2cdb043d9198d5277d39ca62e8fe74a3d.jpg 1944w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">It took too long for Jessy Rosales to find a clinic near UC Riverside, that would provide a medication abortion and accept her insurance. She’s now advocating for a state bill to make the pills available at public university health centers in California. \u003ccite>(Courtesy of Planned Parenthood )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Opponents of the bill have organized several rallies against it. In August, about 60 protesters in yellow T-shirts gathered outside a church in Sacramento, their heads bowed as a priest led them in prayer. Then they marched around the state’s Capitol, chanting, “Don’t kill babies! Don’t kill babies!”\u003c/p>\n\u003cp>While a consortium of women’s groups that support abortion rights has promised to pay for all the required ultrasound equipment and upfront training costs of providing the abortion pill on campus, eventually universities would likely need to dip into tax dollars or student fees for ongoing costs.\u003c/p>\n\u003cp>Abortion opponents such as Michele LaMonica object to that.\u003c/p>\n\u003cp>“Not on my dime, not on my dime,” LaMonica says. “Tax me to help the homeless. Tax me to help social services, but don’t tax me to pay for the disposal of human life.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Insurers are already required to cover abortion under California law, and state tax dollars do go toward abortions provided through Medi-Cal, the state version of Medicaid for low-income patients. However, none of the UC campuses and only some of the CSU campuses get reimbursed for health services through Medi-Cal. University officials testified during legislative hearings on the bill last year that it could be an administrative or fiscal burden to establish billing systems to provide the abortion pill on campus. They predicted that some clinical costs, as well as security and liability costs, could fall directly to the universities and get passed on to students.\u003c/p>\n\u003cp>Up to 519 women at public universities seek a medication abortion every month in California, according to\u003ca href=\"https://www.jahonline.org/article/S1054-139X(18)30185-X/fulltext\"> a study\u003c/a> published last summer in the Journal of Adolescent Health.\u003c/p>\n\u003cp>The same research found that off-campus abortion providers were an average of six miles away from public university campuses in California.\u003c/p>\n\u003cp>Former Gov. Jerry Brown cited this stat when \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=201720180SB320\">he vetoed\u003c/a> a version of the same bill (\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB320\">SB 320\u003c/a>) last year, saying the legislation was not necessary.\u003c/p>\n\u003cp>“Six miles away — that’s like a $5 Uber ride,” said abortion opponent Nick Reynosa, the Northern California regional coordinator for Students for Life of America.\u003c/p>\n\u003cp>He says the campaign is more about politics than need.\u003c/p>\n\u003cp>“Over the last decade, many pro-choice activists feel that in red states, there’s been a lot of momentum toward more abortion restrictions. This is a way to say, ‘No. Here, in blue California, we’re going to affirm or expand [the right to an abortion],’ ” Reynosa says.\u003c/p>\n\u003cp>The bill’s supporters don’t deny it. Phoebe Abramowitz was part of the student team that launched the campus campaign for medication abortions at UC Berkeley four years ago.\u003c/p>\n\u003cp>“Now that we’re doing statewide advocacy, we’re hoping to set a national precedent that we can, even in these really hostile times to women and queer people, move access to abortion forward,” she says. “It’s more important now than it even was a year ago.”\u003c/p>\n\u003cp>When Brown vetoed the bill last year, then-gubernatorial candidate Gavin Newsom said he\u003ca href=\"https://www.sfchronicle.com/politics/article/Gavin-Newsom-splits-with-Jerry-Brown-on-SF-drug-13275997.php\"> would have supported\u003c/a> it. He won the election about a month later, and advocates are optimistic that he will side with them this time around.\u003c/p>\n\u003cp>The state Legislature has until mid-September to pass the bill, and the governor has a month after that to sign or veto it. \u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of NPR’s reporting partnership with KQED and \u003c/em>\u003ca href=\"http://www.kaiserhealthnews.org/\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>When Daniel Giles blinks, it looks like he might be wearing eye makeup. He has a tattoo across each of his eyelids that says “Born Dead.”\u003c/p>\n\u003cp>“It’s kind of like an existential reminder not to live in the past and to remember that I’m not always promised a tomorrow,” he says of his ink. “They’re a symbol of where I’ve been and what I’ve been through.”\u003c/p>\n\u003cp>[aside postID=\"news_11760625,news_11754493\" label=\"Related Coverage\"]\u003c/p>\n\u003cp>Giles was working in a redwood lumber mill in Humboldt County when his hand got crushed in an accident. He got hooked on the opiate pills the doctor prescribed for pain. Then he graduated to heroin. As he watched his friends overdose, he was afraid he was next.\u003c/p>\n\u003cp>But the drug treatment options there were slim. A friend told him about some great services in San Francisco.\u003c/p>\n\u003cp>“So I came down here. I raised a white flag of surrender, and I just came down here and checked myself in,” he says.\u003c/p>\n\u003cp>Giles has been in treatment since last November. San Francisco is one of the first counties in the state to roll out new updates to the Drug Medi-Cal program. Now the state gets more federal money to provide residential treatment for more people. But each county is responsible for running its own program. So while some bigger counties have gone all in, many rural counties, for financial or political reasons, have implemented the changes on a smaller scale; 18 opted out altogether.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“That creates a really perverse incentive,” says Stanford psychiatry professor Keith Humphreys, warning that some counties could exploit others’ willingness to act by doing nothing.\u003c/p>\n\u003cp>In Santa Clara County, where he lives, services are so generous that patients refer to it as Santa Claus County.\u003c/p>\n\u003cp>“So if you are a county that decides to invest a lot in addiction and mental health, does that lead other counties to say, ‘Why don’t we just give people bus tickets, rather than putting up our own money?’ ” Humphreys says.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Keith Humphreys, Stanford University psychiatry professor \"]“So if you are a county that decides to invest a lot in addiction and mental health, does that lead other counties to say, ‘Why don’t we just give people bus tickets, rather than putting up our own money?’ “[/pullquote]\u003c/p>\n\u003cp>San Francisco was afraid of this. It considered a rule that said people who wanted to come here for treatment had to establish residency in the county first. That can take 60 days.\u003c/p>\n\u003cp>Treatment providers flipped.\u003c/p>\n\u003cp>“They could die! They could literally die between today and tomorrow,” says Vitka Eisen, CEO of HealthRIGHT 360, which has been testing the new Drug Medi-Cal program at its treatment centers in San Francisco for two years.\u003c/p>\n\u003cp>“A person who comes in for substance use disorder treatment today needs it today,” she says. “Because if they don’t, if we put any barrier up, they’re not going to get that treatment. What they might do is go around the corner and use drugs.”\u003c/p>\n\u003cp>In the end, San Francisco decided to admit people from other counties into residential treatment right away, as long as they agree to transfer their Medi-Cal benefits from their home county to San Francisco. But the state doesn’t pay until the transfer goes through, leaving San Francisco on the hook for those bills during the 60-day interim.\u003c/p>\n\u003cp>It’s unclear if other counties in a similar position will be that generous.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Vitka Eisen, CEO of HealthRIGHT 360\"]“A person who comes in for substance use disorder treatment today needs it today. Because if they don’t, if we put any barrier up, they’re not going to get that treatment. What they might do is go around the corner and use drugs.”[/pullquote]\u003c/p>\n\u003cp>“There’s a lot of both confusion and tension around this county-by-county thing, particularly services that not every county has, like methadone treatment for opioid addiction,” says Margaret Kisliuk, the behavioral health administrator at Partnership HealthPlan, the insurer that is working to implement the new Drug Medi-Cal program in rural counties in Northern California. “It’s really hard if some counties are in and some are out.”\u003c/p>\n\u003cp>Humboldt County has an aggressive plan to implement the new program, she says, but it hasn’t yet. So residential treatment wasn’t available to Daniel Giles there when he decided he was ready to get sober. But he says he didn’t really want to do it in Humboldt anyway.\u003c/p>\n\u003cp>“Because I had two years on the streets. I knew a lot of people, and I know myself,” Giles says. “So, when I got out I think that it would have been really hard for me to separate myself in a small town from the people I’d gotten to know.”\u003c/p>\n\u003cp>He was in treatment for seven months — three in intensive residential treatment and four in outpatient treatment while he lived in one of San Francisco’s county-funded transitional housing units. He says, for him, starting his life over was best to do someplace far from home.\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Giles was working in a redwood lumber mill in Humboldt County when his hand got crushed in an accident. He got hooked on the opiate pills the doctor prescribed for pain. Then he graduated to heroin. As he watched his friends overdose, he was afraid he was next.\u003c/p>\n\u003cp>But the drug treatment options there were slim. A friend told him about some great services in San Francisco.\u003c/p>\n\u003cp>“So I came down here. I raised a white flag of surrender, and I just came down here and checked myself in,” he says.\u003c/p>\n\u003cp>Giles has been in treatment since last November. San Francisco is one of the first counties in the state to roll out new updates to the Drug Medi-Cal program. Now the state gets more federal money to provide residential treatment for more people. But each county is responsible for running its own program. So while some bigger counties have gone all in, many rural counties, for financial or political reasons, have implemented the changes on a smaller scale; 18 opted out altogether.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“That creates a really perverse incentive,” says Stanford psychiatry professor Keith Humphreys, warning that some counties could exploit others’ willingness to act by doing nothing.\u003c/p>\n\u003cp>In Santa Clara County, where he lives, services are so generous that patients refer to it as Santa Claus County.\u003c/p>\n\u003cp>“So if you are a county that decides to invest a lot in addiction and mental health, does that lead other counties to say, ‘Why don’t we just give people bus tickets, rather than putting up our own money?’ ” Humphreys says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
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"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
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"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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"perspectives": {
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
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"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
"link": "/radio/program/possible",
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},
"pri-the-world": {
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"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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},
"reveal": {
"id": "reveal",
"title": "Reveal",
"info": "Created by The Center for Investigative Reporting and PRX, Reveal is public radios first one-hour weekly radio show and podcast dedicated to investigative reporting. Credible, fact based and without a partisan agenda, Reveal combines the power and artistry of driveway moment storytelling with data-rich reporting on critically important issues. The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.",
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