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"content": "\u003cp>Living unmedicated with schizophrenia and bipolar disorder, Eugenia Hunter has a hard time recalling how long she’s been staying in the tent she calls home at the bustling intersection of San Pablo Avenue and Martin Luther King Jr. Way in Oakland’s Uptown neighborhood. Craft coffee shops and weed dispensaries are plentiful here, and one-bedroom apartments push $3,000 per month.\u003c/p>\n\u003cp>“At least the rats aren’t all over me in here,” the 59-year-old Oakland native said on a bright August afternoon, stretching her arm to grab the zipper to her front door.\u003c/p>\n\u003cp>It was hot inside and the stench of wildfire smoke hung in the air. Still, after sleeping on a nearby bench for the better part of a year, she felt safer here, Hunter explained as she rolled a joint she’d use to ease the pain from also living with what she said is untreated pancreatic cancer.\u003c/p>\n\u003cfigure id=\"attachment_11887857\" class=\"wp-caption alignnone\" style=\"max-width: 1350px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11887857 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/09/Hunter03.jpg\" alt=\"Woman with no hair sits in door of a tent on a bedframe, looking tired.\" width=\"1350\" height=\"900\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter03.jpg 1350w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter03-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter03-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter03-160x107.jpg 160w\" sizes=\"auto, (max-width: 1350px) 100vw, 1350px\">\u003cfigcaption class=\"wp-caption-text\">Eugenia Hunter lives in Oakland’s Uptown neighborhood surrounded by upscale apartments and hip eateries. She can’t find a place she can afford on the $930 per month she receives in federal disability payments. \u003ccite>(Angela Hart/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hunter has been hospitalized repeatedly, including once last summer after she overdosed on alcohol and lay unconscious on a sidewalk until someone stopped to help. But she is reluctant to see a doctor or use Medi-Cal, California’s health insurance program for low-income and disabled people, largely because it would force her to leave her tent.\u003c/p>\n\u003cp>“My stuff keeps on getting taken when I’m not around and, besides, I’m waiting until I got a place to live to start taking my medication again,” Hunter said, tearing up. “I can’t get anything right out here.”\u003c/p>\n\u003cp>Hunter’s long and complex list of ailments, combined with her mistrust of the health care system, make her an incredibly difficult and expensive patient to treat. But she is exactly the kind of person California intends to prioritize under an ambitious experiment to move Medi-Cal beyond traditional doctor visits and hospital stays into the realm of social services.\u003c/p>\n\u003cfigure id=\"attachment_11887890\" class=\"wp-caption alignnone\" style=\"max-width: 1350px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11887890 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/09/Hunter06.jpg\" alt=\"A row of tents alongside a cement sidewalk in an urban park surrounded by buildings.\" width=\"1350\" height=\"900\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter06.jpg 1350w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter06-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter06-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter06-160x107.jpg 160w\" sizes=\"auto, (max-width: 1350px) 100vw, 1350px\">\u003cfigcaption class=\"wp-caption-text\">Staying in a tent in Oakland’s Uptown neighborhood has been a safer experience for Eugenia Hunter than sleeping on a nearby bench, which was her living situation for most of the year. However, she is reluctant to see a doctor or use Medi-Cal, largely because it would force her to leave her tent. When she has left her tent in the past, her belongings have been stolen. \u003ccite>(Angela Hart/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Under the program, vulnerable patients like Hunter will be assigned a personal care manager to coordinate their health care treatments and daily needs, like paying bills and buying groceries. And they will receive \u003ca href=\"https://californiahealthline.org/wp-content/uploads/sites/3/2021/09/CalAIM-Nontraditional-Services-2022.pdf\">services that aren’t typically covered by health insurance plans\u003c/a>, such as getting security deposits paid, receiving deliveries of fruits and vegetables, and having toxic mold removed from homes to reduce asthma flare-ups.\u003c/p>\n\u003cp>Over the next five years, California is plowing nearly $6 billion in state and federal money into the plan, which will target just a sliver of the 14 million low-income Californians enrolled in Medi-Cal: unhoused individuals or those at risk of losing their homes; heavy users of hospital emergency rooms; children and seniors with complicated physical and mental health conditions; and people in — or at risk of landing in — expensive institutions like jails, nursing homes or mental health crisis centers.\u003c/p>\n\u003cp>[pullquote size='large' align='right']Under the program, vulnerable patients like Hunter will be assigned a personal care manager to coordinate their health care treatments and daily needs, like paying bills and buying groceries.[/pullquote]\u003c/p>\n\u003cp>Gov. Gavin Newsom is trumpeting the first-in-the-nation initiative as the centerpiece of his ambitious health care agenda — and vows it will help fix the mental health and addiction crisis on the streets and get people into housing, all while saving taxpayer money. His top health care advisers have even \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCQMD/CalAIM-Role-in-Addressing-Homelessness-Fact-Sheet-%26-Letter-4-9-21.pdf\">cast it as an antidote to California’s worsening homelessness crisis\u003c/a>.\u003c/p>\n\u003cp>But the first-term Democrat, who faces a Sept. 14 recall election, is making a risky bet.\u003c/p>\n\u003cp>California does not have the evidence to prove this approach will work statewide, nor the workforce or infrastructure to make it happen on such a large scale.\u003c/p>\n\u003cp>[aside postID=\"news_11883165\" hero=\"https://ww2.kqed.org/app/uploads/sites/10/2021/07/041021_FacebookVaccine_AW_09-1020x680.jpeg\"]Critics also fear the program will do nothing to improve care for the millions of other Medi-Cal enrollees who won’t get help from this initiative. Medi-Cal has been slammed for failing to provide basic services, \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2018-111.pdf\">including vaccinations for kids\u003c/a>, \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2018-122.pdf\">timely appointments for rural residents\u003c/a> and \u003ca href=\"https://californiahealthline.org/wp-content/uploads/sites/3/2021/09/Newsom_begins_mental_health_care_crackdown_with_county_sanctions.pdf\">adequate mental health treatment\u003c/a> for Californians in crisis.\u003c/p>\n\u003cp>Yet the managed-care insurance companies responsible for most enrollees’ health will nonetheless be given massive new power as they implement this experiment. The insurers will decide which services to offer and which high-needs patients to target, likely creating disparities across regions and further contributing to an unequal system of care in California.\u003c/p>\n\u003cp>“This will leave a lot of people behind,” said Linda Nguy, a policy advocate at the Western Center on Law & Poverty.\u003c/p>\n\u003cp>“We haven’t seen health plans excel in even providing basic preventative services to healthy people,” she said. “I mean, do your basic job first. How can they be expected to successfully take on these additional responsibilities for people with very high health needs?”\u003c/p>\n\u003cp>This revolution in Medi-Cal’s scope and mission is taking place alongside a parallel initiative to hold insurance companies more accountable for providing quality health care.\u003c/p>\n\u003cp>[pullquote size='large' align='right']If California’s experiment succeeds, other states will likely follow … but if the richest state in the country can’t pull off better health outcomes and cost savings, the movement to put health insurers into the business of social work will falter.[/pullquote]\u003c/p>\n\u003cp>State health officials are forcing Medi-Cal managed-care plans to reapply and meet stricter standards if they want to continue doing business in the program. Together, these initiatives will fundamentally reinvent the biggest Medicaid program in the country, which serves about one-third of the state population at a cost of $124 billion this fiscal year.\u003c/p>\n\u003cp>If California’s \u003ca href=\"https://www.dhcs.ca.gov/provgovpart/Documents/CalAIM-Proposal-03-23-2021.pdf\">experiment succeeds\u003c/a>, other states will likely follow, national Medicaid experts say. But if the richest state in the country can’t pull off better health outcomes and cost savings, the movement to put health insurers into the business of social work will falter.\u003cbr>\n[ad fullwidth]\u003c/p>\n\u003ch3>What it takes to provide ‘whole person care’\u003c/h3>\n\u003cp>When Newsom signed the “California Advancing and Innovating Medi-Cal” initiative into law in late July — “CalAIM” for short — he celebrated it as a “once-in-a-generation opportunity to completely transform the Medicaid system in California.” He declined an interview request.\u003c/p>\n\u003cp>[aside postID=\"news_11877000\" hero=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/RS49414_028_SanRafael_ProjectHomekey_05172021-qut-1020x680.jpg\"]Beginning next year, public and private managed health care plans will pick high-needs Medi-Cal enrollees to receive nontraditional services from among \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCQMD/MCP-ECM-and-ILOS-Contract-Template-Provisions.pdf\">14 broad categories, including housing and food benefits, addiction care and home repairs\u003c/a>.\u003c/p>\n\u003cp>The approach is known as “whole person care,” and insurers will be required to assign patients a personal care manager to help them navigate the system. Insurers will receive incentive payments to offer new services and boost provider networks and, over time, the program will expand to more people and services. For instance, members of Native American tribes will eventually be eligible to receive treatment for substance use disorder, and incarcerated people will be enrolled in Medi-Cal automatically upon release.\u003c/p>\n\u003cp>The insurers — currently 25 are participating — will focus most intensely on developing housing programs to combat the state’s \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCQMD/CalAIM-Role-in-Addressing-Homelessness-Fact-Sheet-%26-Letter-4-9-21.pdf\">worsening homelessness epidemic\u003c/a>. The state was home to at least 162,000 unhoused people in 2020, a 6.8% increase since Newsom took office in 2019.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Jacey Cooper, director of Medicaid for California\"]‘If you generally focus on [the most vulnerable], you will be able to yield better health outcomes for those individuals and, ultimately, cost savings.’[/pullquote]Jacey Cooper, the state’s Medicaid director, said \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCQMD/CalAIM-Role-in-Addressing-Homelessness-Fact-Sheet-%26-Letter-4-9-21.pdf\">all Medi-Cal members will eventually be eligible for housing services\u003c/a>. Initially, though, they will be available only to the costliest patients. State Medi-Cal expenditure data shows that 1% of Medi-Cal enrollees, many of the unhoused patients who frequently land in hospitals, account for a staggering 21% of overall spending. And 5% account for 44% of the budget.\u003c/p>\n\u003cp>“You really need to focus on your top 1% to 5% of utilizers — that’s your most vulnerable,” Cooper said. “If you generally focus on that group, you will be able to yield better health outcomes for those individuals and, ultimately, cost savings.”\u003c/p>\n\u003cp>State officials do not have a savings estimate for the program, nor a projection of how many people will be enrolled.\u003c/p>\n\u003cp>The plan, Cooper said, builds on more than \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/wholepersoncare-report-jan2020.pdf\">25 successful regional experiments underway since 2016\u003c/a>. From Los Angeles to rural Shasta, big and small counties have provided vulnerable Medi-Cal patients with different services based on their communities’ needs, from job placement services to providing a safe place for an unhoused person to get sober.\u003c/p>\n\u003cp>Cooper highlighted \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/wholepersoncare-report-jan2020.pdf\">interim data from the experiments\u003c/a> that showed patients hospitalized due to mental illness were more likely to receive follow-up care, obtain treatment for substance abuse, avoid hospitalizations and emergency department visits, and see improvements in chronic diseases like diabetes.\u003c/p>\n\u003cp>She argued that data — even though it is not comprehensive — is enough to prove the initiative will work on a statewide scale.\u003c/p>\n\u003cp>[aside postID=\"news_11870625\" hero=\"https://ww2.kqed.org/app/uploads/sites/10/2021/04/RS43040_011_KQED_SanFrancisco_TentEncampments_05052020-qut-1020x680.jpg\"]However, studies of similar programs elsewhere have yielded mixed results. New York provided housing services to high-cost Medicaid enrollees with chronic diseases and mental health and substance use disorders and found major reductions in hospital admissions and emergency department visits between 2012 and 2017, and saw a \u003ca href=\"https://www.health.ny.gov/health_care/medicaid/redesign/supportive_housing/evaluation.htm\">15% reduction in Medicaid spending.\u003c/a>\u003c/p>\n\u003cp>In Camden, New Jersey, \u003ca href=\"https://californiahealthline.org/news/despite-new-doubts-hotspotting-help-for-heavy-health-care-users-marches-on/\">an early test of the “whole person care” approach\u003c/a> provided expensive Medicaid patients with intensive care coordination, but not nontraditional services. A \u003ca href=\"https://www.nejm.org/doi/full/10.1056/NEJMsa1906848\">study concluded in 2020 that it hadn’t lowered hospital readmissions\u003c/a> — and thus didn’t save health care dollars.\u003c/p>\n\u003cp>“We found we just couldn’t help people with housing as quickly as they needed help,” said Kathleen Noonan, CEO of the Camden Coalition of Healthcare Providers. “Many of these clients have bad credit, they may have a record, and they’re still using. Those are huge challenges.”\u003c/p>\n\u003cp>California may find success where the coalition hadn’t because it will offer social services, she said, which the coalition has also started doing.\u003c/p>\n\u003cp>But it will take time. California will have five years to prove to the federal government it can save money and improve health care quality. Insurers will be required to track health outcomes and savings, and can boost services over time or drop programs that don’t work.\u003c/p>\n\u003cp>So far, the regional experiments have failed to serve low-income Black and Latino residents, according to the interim assessments conducted by Nadereh Pourat, director of the UCLA Center for Health Policy Research. She concluded that they have \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/wholepersoncare-report-jan2020.pdf\">primarily benefited white, English-speaking, middle-aged men\u003c/a>.\u003c/p>\n\u003cp>[aside postID=\"news_11877585\" hero=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/RS49286_002_LakeCounty_ProjectHomekey_05142021-qut-1020x680.jpg\"]Cooper said \u003ca href=\"https://www.dhcs.ca.gov/provgovpart/Documents/CalAIM-Proposal-03-23-2021.pdf\">the statewide initiative will tackle “systemic racism,” \u003c/a>initially as it targets \u003ca href=\"https://endhomelessness.org/resource/racial-inequalities-homelessness-numbers/\">unhoused individuals, who are disproportionately Black\u003c/a>.\u003c/p>\n\u003cp>Consider Eugenia Hunter, who is African American, and whose many untreated mental and physical illnesses, intertwined with her addictions, mean it will take a herculean effort — and cost — to get her off the street.\u003c/p>\n\u003cp>Hunter has gone without a stable housing situation for at least three years. Or maybe it’s five; her mental illness clouds her memory, and she erupts in anger when pressed for details. She eases her frustration sometimes with sleep, sometimes by smoking crystal meth.\u003c/p>\n\u003cp>A stack of unopened health insurance letters sat beside Hunter one evening in late August. Her eyes were glassy when she struggled to remember when she received a cancer diagnosis — if she ever did at all.\u003c/p>\n\u003ch3>Bringing stakeholders on board\u003c/h3>\n\u003cp>Health insurers will not be required to offer social services to patients like Hunter because federal law requires nontraditional Medicaid services to be optional. But California is enticing insurers with bigger payouts and higher state rankings.\u003c/p>\n\u003cp>“We are asking the plans and providers to stretch. We’re asking them to reform,” Cooper said.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Jacey Cooper, director of Medicaid for California\"]‘We are asking the plans and providers to stretch. We’re asking them to reform.’[/pullquote]The state is urging insurers to start with the roughly 130,500 Medi-Cal patients already enrolled in the local experiments. To prepare, they are cobbling together networks of nonprofits and social service organizations to provide food, housing and other services — much as they do with doctors and hospitals contracted to deliver medical care.\u003c/p>\n\u003cp>\u003ca href=\"https://californiahealthline.org/wp-content/uploads/sites/3/2021/09/CalAIM-Nontraditional-Services-2022.pdf\">Services will also vary by insurer and region.\u003c/a>\u003c/p>\n\u003cp>The Inland Empire Health Plan, for example, will offer some patients home repairs that reduce asthma triggers, such as mold removal and installing air filters. But Partnership HealthPlan of California will not offer those benefits in its wildfire-prone Northern California region because it doesn’t have an adequate network of organizations equipped to provide those services.\u003c/p>\n\u003cp>In interviews with nearly all of California’s Medi-Cal managed-care plans, executives said they support the dual goals of helping patients get healthier while saving money, but “it is a lot to take on,” said Richard Sanchez, CEO of CalOptima, which serves Orange County and will start modestly, primarily with housing services.\u003c/p>\n\u003cp>[pullquote size='large' align='right']Nearly all the health plans will offer housing services right away, focusing on three categories of aid: helping enrollees secure housing and rent subsidies; providing temporary rent and security deposit payments; and helping tenants stay housed.[/pullquote]\u003c/p>\n\u003cp>“The last thing I want to do is make promises that we can do all these things and not come through,” he said.\u003c/p>\n\u003cp>Nearly all the health plans will offer housing services right away, focusing on three categories of aid: helping enrollees secure housing and rent subsidies; providing temporary rent and security deposit payments; and helping tenants stay housed, like intervening with a landlord if a patient misses rent.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Dr. Robert Moore, chief medical officer of Partnership HealthPlan\"]‘It’s a great deal of money for a small number of members … we are building something extraordinarily ambitious quickly, without the infrastructure in place to make it successful.’[/pullquote]Partnership HealthPlan, which serves 616,000 Medi-Cal patients in 14 Northern California counties, will prioritize its most at-risk enrollees with housing services, food deliveries and a “homemaker” benefit to help them cook dinner, do laundry and pay bills.\u003c/p>\n\u003cp>“It’s a great deal of money for a small number of members and, frankly, there’s no guarantee it’s going to work,” said Dr. Robert Moore, the plan’s chief medical officer. “We are building something extraordinarily ambitious quickly, without the infrastructure in place to make it successful.”\u003c/p>\n\u003cp>Even if offering new services costs more money than it saves, it’s a worthwhile investment, said John Baackes, CEO of L.A. Care Health Plan, the largest Medi-Cal plan, which serves more than 2 million patients in Los Angeles County.\u003c/p>\n\u003cp>“When somebody has congestive heart failure, their diet should be structured around alleviating that chronic condition,” he said, explaining his plan to offer patients healthful food. “What are we going to do — let them eat ramen noodles for the rest of their lives?”\u003c/p>\n\u003cp>In Alameda County, two plans are available to serve Hunter. The Alameda Alliance for Health, a public insurer established by the county, and Anthem Blue Cross, a private insurance company, will expand housing services.\u003c/p>\n\u003cp>[aside label ='Related Coverage' tag='healthcare, health care']“People like Eugenia Hunter are exactly who we want to serve, and we’re prepared to go out and help her,” said Scott Coffin, CEO of the Alameda Alliance for Health, who is also on a local street medicine team.\u003c/p>\n\u003cp>But they’d have to find her first — chaos and homeless encampment sweeps force her to move her tent frequently. And then they’d have to win her trust.\u003c/p>\n\u003cp>In one moment, Hunter angrily described how health plans have tried to enroll her in services, but she declined, mistrustful of their motives. In the next moment, fighting back voices in her head, she said she desperately wants care.\u003c/p>\n\u003cp>“Someone is going to help me?” she asked. “All I want to do is pay my rent and succeed.”\u003c/p>\n\u003cp>\u003cem>Kaiser Health News is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at Kaiser Family Foundation, an endowed nonprofit providing information on health issues.\u003c/em>\u003cbr>\n[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"title": "'Whole Person Care': A Major Shift in Medi-Cal's Scope Targets Those Most in Need | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Living unmedicated with schizophrenia and bipolar disorder, Eugenia Hunter has a hard time recalling how long she’s been staying in the tent she calls home at the bustling intersection of San Pablo Avenue and Martin Luther King Jr. Way in Oakland’s Uptown neighborhood. Craft coffee shops and weed dispensaries are plentiful here, and one-bedroom apartments push $3,000 per month.\u003c/p>\n\u003cp>“At least the rats aren’t all over me in here,” the 59-year-old Oakland native said on a bright August afternoon, stretching her arm to grab the zipper to her front door.\u003c/p>\n\u003cp>It was hot inside and the stench of wildfire smoke hung in the air. Still, after sleeping on a nearby bench for the better part of a year, she felt safer here, Hunter explained as she rolled a joint she’d use to ease the pain from also living with what she said is untreated pancreatic cancer.\u003c/p>\n\u003cfigure id=\"attachment_11887857\" class=\"wp-caption alignnone\" style=\"max-width: 1350px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11887857 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/09/Hunter03.jpg\" alt=\"Woman with no hair sits in door of a tent on a bedframe, looking tired.\" width=\"1350\" height=\"900\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter03.jpg 1350w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter03-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter03-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter03-160x107.jpg 160w\" sizes=\"auto, (max-width: 1350px) 100vw, 1350px\">\u003cfigcaption class=\"wp-caption-text\">Eugenia Hunter lives in Oakland’s Uptown neighborhood surrounded by upscale apartments and hip eateries. She can’t find a place she can afford on the $930 per month she receives in federal disability payments. \u003ccite>(Angela Hart/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hunter has been hospitalized repeatedly, including once last summer after she overdosed on alcohol and lay unconscious on a sidewalk until someone stopped to help. But she is reluctant to see a doctor or use Medi-Cal, California’s health insurance program for low-income and disabled people, largely because it would force her to leave her tent.\u003c/p>\n\u003cp>“My stuff keeps on getting taken when I’m not around and, besides, I’m waiting until I got a place to live to start taking my medication again,” Hunter said, tearing up. “I can’t get anything right out here.”\u003c/p>\n\u003cp>Hunter’s long and complex list of ailments, combined with her mistrust of the health care system, make her an incredibly difficult and expensive patient to treat. But she is exactly the kind of person California intends to prioritize under an ambitious experiment to move Medi-Cal beyond traditional doctor visits and hospital stays into the realm of social services.\u003c/p>\n\u003cfigure id=\"attachment_11887890\" class=\"wp-caption alignnone\" style=\"max-width: 1350px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11887890 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/09/Hunter06.jpg\" alt=\"A row of tents alongside a cement sidewalk in an urban park surrounded by buildings.\" width=\"1350\" height=\"900\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter06.jpg 1350w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter06-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter06-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/09/Hunter06-160x107.jpg 160w\" sizes=\"auto, (max-width: 1350px) 100vw, 1350px\">\u003cfigcaption class=\"wp-caption-text\">Staying in a tent in Oakland’s Uptown neighborhood has been a safer experience for Eugenia Hunter than sleeping on a nearby bench, which was her living situation for most of the year. However, she is reluctant to see a doctor or use Medi-Cal, largely because it would force her to leave her tent. When she has left her tent in the past, her belongings have been stolen. \u003ccite>(Angela Hart/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Under the program, vulnerable patients like Hunter will be assigned a personal care manager to coordinate their health care treatments and daily needs, like paying bills and buying groceries. And they will receive \u003ca href=\"https://californiahealthline.org/wp-content/uploads/sites/3/2021/09/CalAIM-Nontraditional-Services-2022.pdf\">services that aren’t typically covered by health insurance plans\u003c/a>, such as getting security deposits paid, receiving deliveries of fruits and vegetables, and having toxic mold removed from homes to reduce asthma flare-ups.\u003c/p>\n\u003cp>Over the next five years, California is plowing nearly $6 billion in state and federal money into the plan, which will target just a sliver of the 14 million low-income Californians enrolled in Medi-Cal: unhoused individuals or those at risk of losing their homes; heavy users of hospital emergency rooms; children and seniors with complicated physical and mental health conditions; and people in — or at risk of landing in — expensive institutions like jails, nursing homes or mental health crisis centers.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Gov. Gavin Newsom is trumpeting the first-in-the-nation initiative as the centerpiece of his ambitious health care agenda — and vows it will help fix the mental health and addiction crisis on the streets and get people into housing, all while saving taxpayer money. His top health care advisers have even \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCQMD/CalAIM-Role-in-Addressing-Homelessness-Fact-Sheet-%26-Letter-4-9-21.pdf\">cast it as an antidote to California’s worsening homelessness crisis\u003c/a>.\u003c/p>\n\u003cp>But the first-term Democrat, who faces a Sept. 14 recall election, is making a risky bet.\u003c/p>\n\u003cp>California does not have the evidence to prove this approach will work statewide, nor the workforce or infrastructure to make it happen on such a large scale.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Critics also fear the program will do nothing to improve care for the millions of other Medi-Cal enrollees who won’t get help from this initiative. Medi-Cal has been slammed for failing to provide basic services, \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2018-111.pdf\">including vaccinations for kids\u003c/a>, \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2018-122.pdf\">timely appointments for rural residents\u003c/a> and \u003ca href=\"https://californiahealthline.org/wp-content/uploads/sites/3/2021/09/Newsom_begins_mental_health_care_crackdown_with_county_sanctions.pdf\">adequate mental health treatment\u003c/a> for Californians in crisis.\u003c/p>\n\u003cp>Yet the managed-care insurance companies responsible for most enrollees’ health will nonetheless be given massive new power as they implement this experiment. The insurers will decide which services to offer and which high-needs patients to target, likely creating disparities across regions and further contributing to an unequal system of care in California.\u003c/p>\n\u003cp>“This will leave a lot of people behind,” said Linda Nguy, a policy advocate at the Western Center on Law & Poverty.\u003c/p>\n\u003cp>“We haven’t seen health plans excel in even providing basic preventative services to healthy people,” she said. “I mean, do your basic job first. How can they be expected to successfully take on these additional responsibilities for people with very high health needs?”\u003c/p>\n\u003cp>This revolution in Medi-Cal’s scope and mission is taking place alongside a parallel initiative to hold insurance companies more accountable for providing quality health care.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "If California’s experiment succeeds, other states will likely follow … but if the richest state in the country can’t pull off better health outcomes and cost savings, the movement to put health insurers into the business of social work will falter.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>State health officials are forcing Medi-Cal managed-care plans to reapply and meet stricter standards if they want to continue doing business in the program. Together, these initiatives will fundamentally reinvent the biggest Medicaid program in the country, which serves about one-third of the state population at a cost of $124 billion this fiscal year.\u003c/p>\n\u003cp>If California’s \u003ca href=\"https://www.dhcs.ca.gov/provgovpart/Documents/CalAIM-Proposal-03-23-2021.pdf\">experiment succeeds\u003c/a>, other states will likely follow, national Medicaid experts say. But if the richest state in the country can’t pull off better health outcomes and cost savings, the movement to put health insurers into the business of social work will falter.\u003cbr>\n\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003ch3>What it takes to provide ‘whole person care’\u003c/h3>\n\u003cp>When Newsom signed the “California Advancing and Innovating Medi-Cal” initiative into law in late July — “CalAIM” for short — he celebrated it as a “once-in-a-generation opportunity to completely transform the Medicaid system in California.” He declined an interview request.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Beginning next year, public and private managed health care plans will pick high-needs Medi-Cal enrollees to receive nontraditional services from among \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCQMD/MCP-ECM-and-ILOS-Contract-Template-Provisions.pdf\">14 broad categories, including housing and food benefits, addiction care and home repairs\u003c/a>.\u003c/p>\n\u003cp>The approach is known as “whole person care,” and insurers will be required to assign patients a personal care manager to help them navigate the system. Insurers will receive incentive payments to offer new services and boost provider networks and, over time, the program will expand to more people and services. For instance, members of Native American tribes will eventually be eligible to receive treatment for substance use disorder, and incarcerated people will be enrolled in Medi-Cal automatically upon release.\u003c/p>\n\u003cp>The insurers — currently 25 are participating — will focus most intensely on developing housing programs to combat the state’s \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCQMD/CalAIM-Role-in-Addressing-Homelessness-Fact-Sheet-%26-Letter-4-9-21.pdf\">worsening homelessness epidemic\u003c/a>. The state was home to at least 162,000 unhoused people in 2020, a 6.8% increase since Newsom took office in 2019.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Jacey Cooper, the state’s Medicaid director, said \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCQMD/CalAIM-Role-in-Addressing-Homelessness-Fact-Sheet-%26-Letter-4-9-21.pdf\">all Medi-Cal members will eventually be eligible for housing services\u003c/a>. Initially, though, they will be available only to the costliest patients. State Medi-Cal expenditure data shows that 1% of Medi-Cal enrollees, many of the unhoused patients who frequently land in hospitals, account for a staggering 21% of overall spending. And 5% account for 44% of the budget.\u003c/p>\n\u003cp>“You really need to focus on your top 1% to 5% of utilizers — that’s your most vulnerable,” Cooper said. “If you generally focus on that group, you will be able to yield better health outcomes for those individuals and, ultimately, cost savings.”\u003c/p>\n\u003cp>State officials do not have a savings estimate for the program, nor a projection of how many people will be enrolled.\u003c/p>\n\u003cp>The plan, Cooper said, builds on more than \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/wholepersoncare-report-jan2020.pdf\">25 successful regional experiments underway since 2016\u003c/a>. From Los Angeles to rural Shasta, big and small counties have provided vulnerable Medi-Cal patients with different services based on their communities’ needs, from job placement services to providing a safe place for an unhoused person to get sober.\u003c/p>\n\u003cp>Cooper highlighted \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/wholepersoncare-report-jan2020.pdf\">interim data from the experiments\u003c/a> that showed patients hospitalized due to mental illness were more likely to receive follow-up care, obtain treatment for substance abuse, avoid hospitalizations and emergency department visits, and see improvements in chronic diseases like diabetes.\u003c/p>\n\u003cp>She argued that data — even though it is not comprehensive — is enough to prove the initiative will work on a statewide scale.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>However, studies of similar programs elsewhere have yielded mixed results. New York provided housing services to high-cost Medicaid enrollees with chronic diseases and mental health and substance use disorders and found major reductions in hospital admissions and emergency department visits between 2012 and 2017, and saw a \u003ca href=\"https://www.health.ny.gov/health_care/medicaid/redesign/supportive_housing/evaluation.htm\">15% reduction in Medicaid spending.\u003c/a>\u003c/p>\n\u003cp>In Camden, New Jersey, \u003ca href=\"https://californiahealthline.org/news/despite-new-doubts-hotspotting-help-for-heavy-health-care-users-marches-on/\">an early test of the “whole person care” approach\u003c/a> provided expensive Medicaid patients with intensive care coordination, but not nontraditional services. A \u003ca href=\"https://www.nejm.org/doi/full/10.1056/NEJMsa1906848\">study concluded in 2020 that it hadn’t lowered hospital readmissions\u003c/a> — and thus didn’t save health care dollars.\u003c/p>\n\u003cp>“We found we just couldn’t help people with housing as quickly as they needed help,” said Kathleen Noonan, CEO of the Camden Coalition of Healthcare Providers. “Many of these clients have bad credit, they may have a record, and they’re still using. Those are huge challenges.”\u003c/p>\n\u003cp>California may find success where the coalition hadn’t because it will offer social services, she said, which the coalition has also started doing.\u003c/p>\n\u003cp>But it will take time. California will have five years to prove to the federal government it can save money and improve health care quality. Insurers will be required to track health outcomes and savings, and can boost services over time or drop programs that don’t work.\u003c/p>\n\u003cp>So far, the regional experiments have failed to serve low-income Black and Latino residents, according to the interim assessments conducted by Nadereh Pourat, director of the UCLA Center for Health Policy Research. She concluded that they have \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/wholepersoncare-report-jan2020.pdf\">primarily benefited white, English-speaking, middle-aged men\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Cooper said \u003ca href=\"https://www.dhcs.ca.gov/provgovpart/Documents/CalAIM-Proposal-03-23-2021.pdf\">the statewide initiative will tackle “systemic racism,” \u003c/a>initially as it targets \u003ca href=\"https://endhomelessness.org/resource/racial-inequalities-homelessness-numbers/\">unhoused individuals, who are disproportionately Black\u003c/a>.\u003c/p>\n\u003cp>Consider Eugenia Hunter, who is African American, and whose many untreated mental and physical illnesses, intertwined with her addictions, mean it will take a herculean effort — and cost — to get her off the street.\u003c/p>\n\u003cp>Hunter has gone without a stable housing situation for at least three years. Or maybe it’s five; her mental illness clouds her memory, and she erupts in anger when pressed for details. She eases her frustration sometimes with sleep, sometimes by smoking crystal meth.\u003c/p>\n\u003cp>A stack of unopened health insurance letters sat beside Hunter one evening in late August. Her eyes were glassy when she struggled to remember when she received a cancer diagnosis — if she ever did at all.\u003c/p>\n\u003ch3>Bringing stakeholders on board\u003c/h3>\n\u003cp>Health insurers will not be required to offer social services to patients like Hunter because federal law requires nontraditional Medicaid services to be optional. But California is enticing insurers with bigger payouts and higher state rankings.\u003c/p>\n\u003cp>“We are asking the plans and providers to stretch. We’re asking them to reform,” Cooper said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The state is urging insurers to start with the roughly 130,500 Medi-Cal patients already enrolled in the local experiments. To prepare, they are cobbling together networks of nonprofits and social service organizations to provide food, housing and other services — much as they do with doctors and hospitals contracted to deliver medical care.\u003c/p>\n\u003cp>\u003ca href=\"https://californiahealthline.org/wp-content/uploads/sites/3/2021/09/CalAIM-Nontraditional-Services-2022.pdf\">Services will also vary by insurer and region.\u003c/a>\u003c/p>\n\u003cp>The Inland Empire Health Plan, for example, will offer some patients home repairs that reduce asthma triggers, such as mold removal and installing air filters. But Partnership HealthPlan of California will not offer those benefits in its wildfire-prone Northern California region because it doesn’t have an adequate network of organizations equipped to provide those services.\u003c/p>\n\u003cp>In interviews with nearly all of California’s Medi-Cal managed-care plans, executives said they support the dual goals of helping patients get healthier while saving money, but “it is a lot to take on,” said Richard Sanchez, CEO of CalOptima, which serves Orange County and will start modestly, primarily with housing services.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "Nearly all the health plans will offer housing services right away, focusing on three categories of aid: helping enrollees secure housing and rent subsidies; providing temporary rent and security deposit payments; and helping tenants stay housed.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The last thing I want to do is make promises that we can do all these things and not come through,” he said.\u003c/p>\n\u003cp>Nearly all the health plans will offer housing services right away, focusing on three categories of aid: helping enrollees secure housing and rent subsidies; providing temporary rent and security deposit payments; and helping tenants stay housed, like intervening with a landlord if a patient misses rent.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘It’s a great deal of money for a small number of members … we are building something extraordinarily ambitious quickly, without the infrastructure in place to make it successful.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Partnership HealthPlan, which serves 616,000 Medi-Cal patients in 14 Northern California counties, will prioritize its most at-risk enrollees with housing services, food deliveries and a “homemaker” benefit to help them cook dinner, do laundry and pay bills.\u003c/p>\n\u003cp>“It’s a great deal of money for a small number of members and, frankly, there’s no guarantee it’s going to work,” said Dr. Robert Moore, the plan’s chief medical officer. “We are building something extraordinarily ambitious quickly, without the infrastructure in place to make it successful.”\u003c/p>\n\u003cp>Even if offering new services costs more money than it saves, it’s a worthwhile investment, said John Baackes, CEO of L.A. Care Health Plan, the largest Medi-Cal plan, which serves more than 2 million patients in Los Angeles County.\u003c/p>\n\u003cp>“When somebody has congestive heart failure, their diet should be structured around alleviating that chronic condition,” he said, explaining his plan to offer patients healthful food. “What are we going to do — let them eat ramen noodles for the rest of their lives?”\u003c/p>\n\u003cp>In Alameda County, two plans are available to serve Hunter. The Alameda Alliance for Health, a public insurer established by the county, and Anthem Blue Cross, a private insurance company, will expand housing services.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“People like Eugenia Hunter are exactly who we want to serve, and we’re prepared to go out and help her,” said Scott Coffin, CEO of the Alameda Alliance for Health, who is also on a local street medicine team.\u003c/p>\n\u003cp>But they’d have to find her first — chaos and homeless encampment sweeps force her to move her tent frequently. And then they’d have to win her trust.\u003c/p>\n\u003cp>In one moment, Hunter angrily described how health plans have tried to enroll her in services, but she declined, mistrustful of their motives. In the next moment, fighting back voices in her head, she said she desperately wants care.\u003c/p>\n\u003cp>“Someone is going to help me?” she asked. “All I want to do is pay my rent and succeed.”\u003c/p>\n\u003cp>\u003cem>Kaiser Health News is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at Kaiser Family Foundation, an endowed nonprofit providing information on health issues.\u003c/em>\u003cbr>\n\u003c/p>\u003c/div>",
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"content": "\u003cp>Low-income Californians enrolled in Medi-Cal have been vaccinated at far lower rates than the overall population in all 58 counties, \u003ca href=\"https://www.dhcs.ca.gov/Documents/COVID-19/COVID-19-Vaccine-Stats-07-08-21.pdf\">according to state data\u003c/a>.\u003c/p>\n\u003cp>The disparity reveals a strong economic divide between the vaccinated and unvaccinated throughout California.\u003c/p>\n\u003cp>About 45% of Medi-Cal enrollees eligible for the COVID-19 vaccine (those 12 and older) had received at least one dose as of July 18, compared to about 70% of all eligible Californians, state officials said Thursday.\u003c/p>\n\u003cp>Nearly 14 million Californians are enrolled in Medi-Cal, the state’s health care program for low-income people.\u003c/p>\n\u003cp>The gap in their vaccination rate leaves low-income people once again highly vulnerable to the virus, particularly the more contagious delta variant. And it poses a major obstacle to the state’s efforts to try to reach herd immunity.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Jacey Cooper, the state’s Medicaid director, called the vaccination disparity a “stark reminder of the inequities within our delivery system.”\u003c/p>\n\u003cp>\u003ca href=\"https://www.dhcs.ca.gov/Documents/COVID-19/COVID-19-Vaccine-Stats-07-08-21.pdf\">Medi-Cal vaccination rates \u003c/a>are under 50% in most counties, but the rates are especially low in rural far-northern counties. In Lassen, Shasta, Tehama, Trinity and Modoc counties, less than 30% of Medi-Cal enrollees are vaccinated. Those counties also have low overall vaccination rates for their entire population.\u003c/p>\n\u003cp>In Tulare County, which has one of the largest Medi-Cal populations in the state, 48% of the county’s residents have been vaccinated but only 33% of Medi-Cal enrollees have been. In Los Angeles County, 70% of its overall population is vaccinated, compared to only 49% of people on Medi-Cal.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://calmatters-map-covid-vaccine-medi-cal.netlify.app/#amp=1\" width=\"800\" height=\"1200\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>“It is problematic that this gap exists, but it is \u003ca href=\"https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-profile-of-the-unvaccinated/\">consistent with national trends \u003c/a>that show people with low incomes are less likely to be vaccinated,” said Laurel Lucia, director of the Health Care Program at UC Berkeley’s Labor Center.\u003c/p>\n\u003cp>State and county health officials and nonprofit groups have been struggling to reach people in low-income communities. They are trying mobile vaccination clinics, door-to-door canvassing and monetary incentives.\u003c/p>\n\u003cp>The state’s Department of Health Care Services said it’s doing several things to increase vaccination among Medi-Cal patients, including sharing data with health plans about which enrollees have yet to be vaccinated, encouraging more Medi-Cal providers to sign up to administer the vaccine and working with hospital associations to improve vaccine access in emergency rooms.\u003c/p>\n\u003cp>Experts said one major reason that many people on Medi-Cal may be unvaccinated is that it is harder for them to take time off work.\u003c/p>\n\u003cp>[pullquote size='medium' align='right' citation=\"Laurel Lucia, UC Berkeley's Labor Center\"]‘Low-income workers face significant practical challenges. They often have limited time because of multiple jobs, they may lack childcare, spend a lot of time commuting.’[/pullquote]\u003c/p>\n\u003cp>“Low-income workers face significant practical challenges. They often have limited time because of multiple jobs, they may lack childcare, spend a lot of time commuting. And they’re worried about missing work, not just for the appointment but also if they have symptoms from the vaccine,” Lucia said.\u003c/p>\n\u003cp>Amy Jester, a program director at the Humboldt Area Foundation, said it’s particularly a problem among seasonal employees like farmworkers.\u003c/p>\n\u003cp>For example, in Humboldt and surrounding counties, tourism and agriculture workers are in the middle of one of their busiest seasons. For many of them, taking time off during peak season means losing income.\u003c/p>\n\u003cp>Nationwide, adults whose employers either encouraged them to get vaccinated or provided them paid time off to recover from side effects were more likely to be immunized, according to a recent \u003ca href=\"https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-june-2021/#:~:text=Half%20of%20workers%20overall%20say,than%20%2440%2C000%20annually%20(41%25).\">Kaiser Family Foundation poll\u003c/a>.\u003c/p>\n\u003cp>In most California counties, only 25% to 35% of people on Medi-Cal are vaccinated. It’s more than half in only 11 counties, mostly in the Bay Area, but also Orange and Imperial counties.\u003c/p>\n\u003cp>[aside label=\"Related Stories\" tag=\"coronavirus-vaccine\"]\u003c/p>\n\u003cp>Alpine County shows the biggest gap — a difference of almost 53 percentage points between Medi-Cal recipients and the county’s total population. The rural county is home to about 1,100 people, so even a few unvaccinated people can make a big difference. Dr. Rick Johnson, the state’s public health officer, said Alpine is seeing high vaccine resistance at American Indian reservations; about 20% of the county’s population lives on a reservation.\u003c/p>\n\u003cp>In the Eastern Sierra’s Inyo County, the vaccination rate is almost twice as high among the general population than among people on Medi-Cal — 58% compared to 32%.\u003c/p>\n\u003cp>But the disparity is not just happening in rural, remote or less affluent counties. Marin County has the highest vaccination rate in California — 88% of all eligible residents. But only 61.5% of its Medi-Cal residents had received at least one shot by July 18. Roughly one out of every five Marin County residents is enrolled in Medi-Cal.\u003c/p>\n\u003cp>San Francisco has the highest percentage of vaccinated Medi-Cal enrollees with 65%, but that’s eclipsed by its overall vaccination rate of 84%.\u003c/p>\n\u003cp>“We believe we can do better, and must do better, to prevent further disparities in COVID infection and death among persons served by Medi-Cal,” a spokesperson for the state health care services agency told CalMatters in an email.\u003c/p>\n\u003cp>Last month, Ohio’s governor, noting a similar disparity in his state’s Medicaid population, challenged health plans \u003ca href=\"https://abc6onyourside.com/news/local/vaccine-incentive-doubles-ohio-medicaid-members-7-26-2021\">to get 900,000 more Medicaid members \u003c/a>vaccinated by Sept. 15. Now, every Medicaid enrollee in Ohio who gets a shot receives a $100 gift card.\u003c/p>\n\u003cp>Health care providers say they are not surprised that Medi-Cal enrollees have fallen behind on vaccination. State data that tracks\u003ca href=\"https://covid19.ca.gov/vaccination-progress-data/\"> vaccination by ZIP code\u003c/a> has shown a similar lag in lower-income neighborhoods.\u003c/p>\n\u003cp>[pullquote size='medium' align='right' citation=\"Dr. Ilan Shapiro, AltaMed health system\"]‘This is a reflection of decades of issues with inequities” in health care. “We saw it with cases — which group got hit the hardest? People in underserved communities. We saw it with cases — which group got hit the hardest? People in underserved communities.’[/pullquote]\u003c/p>\n\u003cp>“This is a reflection of decades of issues with inequities” in health care, said Dr. Ilan Shapiro, a pediatrician and medical director for the AltaMed health system in Southern California.\u003c/p>\n\u003cp>“We saw similar trends with testing — which group was lacking? People in underserved communities,” he said. “We saw it with cases — which group got hit the hardest? People in underserved communities.”\u003c/p>\n\u003cp>One challenge is the mixed messaging, said Dr. James Kyle, medical director for quality, diversity, equity, and inclusion at L.A. Care Health Plan. He said one of the most successful strategies is direct phone calls to members because it gives people the opportunity to ask questions and ease some of their confusion.\u003c/p>\n\u003cp>“People are hearing about the delta variant, about increasing hospitalizations, but at the same time, we’ve reopened businesses, and I think people have genuine confusion,” Kyle said. “They’re trying to decide what’s the right thing to do, so they’re doing nothing.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cimg decoding=\"async\" id=\"republication-tracker-tool-source\" style=\"width: 1px;height: 1px\" src=\"https://calmatters.network/?republication-pixel=true&post=118601&ga=UA-59722930-8\">\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Low-income Californians enrolled in Medi-Cal have been vaccinated at far lower rates than the overall population in all 58 counties, \u003ca href=\"https://www.dhcs.ca.gov/Documents/COVID-19/COVID-19-Vaccine-Stats-07-08-21.pdf\">according to state data\u003c/a>.\u003c/p>\n\u003cp>The disparity reveals a strong economic divide between the vaccinated and unvaccinated throughout California.\u003c/p>\n\u003cp>About 45% of Medi-Cal enrollees eligible for the COVID-19 vaccine (those 12 and older) had received at least one dose as of July 18, compared to about 70% of all eligible Californians, state officials said Thursday.\u003c/p>\n\u003cp>Nearly 14 million Californians are enrolled in Medi-Cal, the state’s health care program for low-income people.\u003c/p>\n\u003cp>The gap in their vaccination rate leaves low-income people once again highly vulnerable to the virus, particularly the more contagious delta variant. And it poses a major obstacle to the state’s efforts to try to reach herd immunity.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Jacey Cooper, the state’s Medicaid director, called the vaccination disparity a “stark reminder of the inequities within our delivery system.”\u003c/p>\n\u003cp>\u003ca href=\"https://www.dhcs.ca.gov/Documents/COVID-19/COVID-19-Vaccine-Stats-07-08-21.pdf\">Medi-Cal vaccination rates \u003c/a>are under 50% in most counties, but the rates are especially low in rural far-northern counties. In Lassen, Shasta, Tehama, Trinity and Modoc counties, less than 30% of Medi-Cal enrollees are vaccinated. Those counties also have low overall vaccination rates for their entire population.\u003c/p>\n\u003cp>In Tulare County, which has one of the largest Medi-Cal populations in the state, 48% of the county’s residents have been vaccinated but only 33% of Medi-Cal enrollees have been. In Los Angeles County, 70% of its overall population is vaccinated, compared to only 49% of people on Medi-Cal.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://calmatters-map-covid-vaccine-medi-cal.netlify.app/#amp=1\" width=\"800\" height=\"1200\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>“It is problematic that this gap exists, but it is \u003ca href=\"https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-profile-of-the-unvaccinated/\">consistent with national trends \u003c/a>that show people with low incomes are less likely to be vaccinated,” said Laurel Lucia, director of the Health Care Program at UC Berkeley’s Labor Center.\u003c/p>\n\u003cp>State and county health officials and nonprofit groups have been struggling to reach people in low-income communities. They are trying mobile vaccination clinics, door-to-door canvassing and monetary incentives.\u003c/p>\n\u003cp>The state’s Department of Health Care Services said it’s doing several things to increase vaccination among Medi-Cal patients, including sharing data with health plans about which enrollees have yet to be vaccinated, encouraging more Medi-Cal providers to sign up to administer the vaccine and working with hospital associations to improve vaccine access in emergency rooms.\u003c/p>\n\u003cp>Experts said one major reason that many people on Medi-Cal may be unvaccinated is that it is harder for them to take time off work.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Low-income workers face significant practical challenges. They often have limited time because of multiple jobs, they may lack childcare, spend a lot of time commuting. And they’re worried about missing work, not just for the appointment but also if they have symptoms from the vaccine,” Lucia said.\u003c/p>\n\u003cp>Amy Jester, a program director at the Humboldt Area Foundation, said it’s particularly a problem among seasonal employees like farmworkers.\u003c/p>\n\u003cp>For example, in Humboldt and surrounding counties, tourism and agriculture workers are in the middle of one of their busiest seasons. For many of them, taking time off during peak season means losing income.\u003c/p>\n\u003cp>Nationwide, adults whose employers either encouraged them to get vaccinated or provided them paid time off to recover from side effects were more likely to be immunized, according to a recent \u003ca href=\"https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-june-2021/#:~:text=Half%20of%20workers%20overall%20say,than%20%2440%2C000%20annually%20(41%25).\">Kaiser Family Foundation poll\u003c/a>.\u003c/p>\n\u003cp>In most California counties, only 25% to 35% of people on Medi-Cal are vaccinated. It’s more than half in only 11 counties, mostly in the Bay Area, but also Orange and Imperial counties.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Alpine County shows the biggest gap — a difference of almost 53 percentage points between Medi-Cal recipients and the county’s total population. The rural county is home to about 1,100 people, so even a few unvaccinated people can make a big difference. Dr. Rick Johnson, the state’s public health officer, said Alpine is seeing high vaccine resistance at American Indian reservations; about 20% of the county’s population lives on a reservation.\u003c/p>\n\u003cp>In the Eastern Sierra’s Inyo County, the vaccination rate is almost twice as high among the general population than among people on Medi-Cal — 58% compared to 32%.\u003c/p>\n\u003cp>But the disparity is not just happening in rural, remote or less affluent counties. Marin County has the highest vaccination rate in California — 88% of all eligible residents. But only 61.5% of its Medi-Cal residents had received at least one shot by July 18. Roughly one out of every five Marin County residents is enrolled in Medi-Cal.\u003c/p>\n\u003cp>San Francisco has the highest percentage of vaccinated Medi-Cal enrollees with 65%, but that’s eclipsed by its overall vaccination rate of 84%.\u003c/p>\n\u003cp>“We believe we can do better, and must do better, to prevent further disparities in COVID infection and death among persons served by Medi-Cal,” a spokesperson for the state health care services agency told CalMatters in an email.\u003c/p>\n\u003cp>Last month, Ohio’s governor, noting a similar disparity in his state’s Medicaid population, challenged health plans \u003ca href=\"https://abc6onyourside.com/news/local/vaccine-incentive-doubles-ohio-medicaid-members-7-26-2021\">to get 900,000 more Medicaid members \u003c/a>vaccinated by Sept. 15. Now, every Medicaid enrollee in Ohio who gets a shot receives a $100 gift card.\u003c/p>\n\u003cp>Health care providers say they are not surprised that Medi-Cal enrollees have fallen behind on vaccination. State data that tracks\u003ca href=\"https://covid19.ca.gov/vaccination-progress-data/\"> vaccination by ZIP code\u003c/a> has shown a similar lag in lower-income neighborhoods.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘This is a reflection of decades of issues with inequities” in health care. “We saw it with cases — which group got hit the hardest? People in underserved communities. We saw it with cases — which group got hit the hardest? People in underserved communities.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“This is a reflection of decades of issues with inequities” in health care, said Dr. Ilan Shapiro, a pediatrician and medical director for the AltaMed health system in Southern California.\u003c/p>\n\u003cp>“We saw similar trends with testing — which group was lacking? People in underserved communities,” he said. “We saw it with cases — which group got hit the hardest? People in underserved communities.”\u003c/p>\n\u003cp>One challenge is the mixed messaging, said Dr. James Kyle, medical director for quality, diversity, equity, and inclusion at L.A. Care Health Plan. He said one of the most successful strategies is direct phone calls to members because it gives people the opportunity to ask questions and ease some of their confusion.\u003c/p>\n\u003cp>“People are hearing about the delta variant, about increasing hospitalizations, but at the same time, we’ve reopened businesses, and I think people have genuine confusion,” Kyle said. “They’re trying to decide what’s the right thing to do, so they’re doing nothing.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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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. 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>[pullquote align=\"right\" size=\"medium\" citation=\"Beatriz Hernandez, California Immigrant Policy Center\"]‘We all need this access to health care now and when we recover from the pandemic … we all contribute to the social fabric of this state.’[/pullquote]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>[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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"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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"title": "'So Thankful': California to Offer Medi-Cal to 235,000 Undocumented Adults | KQED",
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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>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>\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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"slug": "5-things-to-know-as-california-starts-screening-children-for-toxic-stress",
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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>\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>\u003c/p>\u003c/div>",
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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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"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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"excerpt": "A huge chunk of a projected surplus would only materialize if California is allowed to keep a tax on companies that manage Medi-Cal. California needs federal permission to do that — and state lawmakers aren’t sure they’ll get it.",
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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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"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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"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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"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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"disqusTitle": "Federal Judge in Oakland Could Partially Block Trump Rule Targeting Low-Income Immigrants",
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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>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>\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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"title": "Immigrants Afraid of Trump’s 'Public Charge' Rule Are Dropping Food Stamps, MediCal",
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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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"title": "Immigrants Afraid of Trump’s 'Public Charge' Rule Are Dropping Food Stamps, MediCal | KQED",
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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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"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": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"marketplace": {
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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.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
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"masters-of-scale": {
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},
"mindshift": {
"id": "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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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"morning-edition": {
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"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
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"onourwatch": {
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"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"order": 11
},
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"on-the-media": {
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"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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},
"link": "/radio/program/on-the-media",
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},
"pbs-newshour": {
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"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
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},
"perspectives": {
"id": "perspectives",
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"order": 14
},
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"planet-money": {
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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.",
"airtime": "SUN 3pm-4pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/planetmoney.jpg",
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},
"link": "/radio/program/planet-money",
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"apple": "https://itunes.apple.com/us/podcast/planet-money/id290783428?mt=2",
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},
"politicalbreakdown": {
"id": "politicalbreakdown",
"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Political-Breakdown-2024-Podcast-Tile-703x703-1.jpg",
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"order": 5
},
"link": "/podcasts/politicalbreakdown",
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"amazon": "https://music.amazon.com/podcasts/e0c2d153-ad36-4c8d-901d-f1da6a724824/political-breakdown",
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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/",
"meta": {
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"source": "Possible"
},
"link": "/radio/program/possible",
"subscribe": {
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
"pri-the-world": {
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