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"slug": "gov-newsoms-prescription-housing-plan-would-cover-6-months-rent-through-medi-cal",
"title": "Gov. Newsom's Prescription Housing Plan Would Cover 6 Months' Rent Through Medi-Cal",
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"content": "\u003cp>Gov. Gavin Newsom, whose administration is struggling to contain a worsening homelessness crisis despite \u003ca href=\"https://khn.org/news/article/california-homeless-crisis-governor-gavin-newsom-political-future/\">record spending\u003c/a>, is trying something bold: tapping federal health care funding to cover rent for unhoused people and those at risk of losing their housing.\u003c/p>\n\u003cp>States are barred from using federal Medicaid dollars to pay directly for rent, but California’s governor is asking the administration of President Joe Biden, a fellow Democrat, to authorize a new program called “\u003ca href=\"https://ebudget.ca.gov/2023-24/pdf/BudgetSummary/HealthandHumanServices.pdf\">transitional rent (PDF)\u003c/a>,” which would provide up to six months of rent or temporary housing for\u003ca href=\"https://khn.org/news/article/californias-massive-medicaid-program-works-for-some-but-fails-many-others/\"> enrollees with \u003c/a>\u003ca href=\"https://khn.org/news/article/californias-massive-medicaid-program-works-for-some-but-fails-many-others/\">lower incomes\u003c/a> who rely on the state’s health care safety net — a new initiative to fight and prevent homelessness.\u003c/p>\n\u003cp>“I’ve been talking to the president. We cannot do this alone,” Newsom told California Healthline.\u003c/p>\n\u003cp>The governor is pushing California’s version of Medicaid, called Medi-Cal, to fund experimental housing subsidies for people experiencing homelessness, betting that it’s cheaper for taxpayers to cover rent than to allow people to fall into crisis or costly institutional care in hospitals, nursing homes and jails. Early in his tenure, \u003ca href=\"https://www.gov.ca.gov/2020/02/19/governor-newsom-delivers-state-of-the-state-address-on-homelessness/\">Newsom proclaimed\u003c/a> that “doctors should be able to write prescriptions for housing the same way they do for insulin or antibiotics.”\u003c/p>\n\u003cp>But it’s a risky endeavor in a high-cost state where \u003ca href=\"https://www.zillow.com/rental-manager/market-trends/ca/\">median rent is nearly $3,000 a month\u003c/a>, and even higher in coastal regions, where most of California’s unhoused people reside. Experts expect the Biden administration to scrutinize the plan to use health care money to pay rent, and also question its potential effectiveness in light of the state’s \u003ca href=\"https://calmatters.org/housing/2022/10/newsom-california-housing-crisis/\">housing crisis\u003c/a>.\u003c/p>\n\u003cp>“Part of the question is whether this is really Medicaid’s job,” said \u003ca href=\"https://counciloncj.org/vikki-wachino/\">Vikki Wachino\u003c/a>, who served as national Medicaid director in the Obama administration. “But there is a recognition that social factors like inadequate housing are driving health outcomes, and I think the federal government is open to developing approaches to try and address that.”\u003c/p>\n\u003cp>Bruce Alexander, spokesperson for the Centers for Medicare and Medicaid Services, declined to say whether the federal government would approve California’s request. Yet, Biden’s Medicaid officials have approved similar experimental programs in \u003ca href=\"https://www.oregon.gov/oha/HSD/Medicaid-Policy/Pages/Changes.aspx\">Oregon\u003c/a> and \u003ca href=\"https://www.hhs.gov/about/news/2022/10/14/hhs-approves-arizonas-medicaid-interventions-target-health-related-social-needs.html\">Arizona\u003c/a>, and California is modeling its program after them.[aside label=\"Related Stories\" postID=\"news_11934623,news_11932895,news_11927968\"]\u003ca href=\"https://www.ppic.org/blog/homeless-populations-are-rising-around-california/#:~:text=As%20of%202022%2C%2030%25%20of,of%20the%20nation's%20homeless%20population\">California is home to an estimated 30% of unhoused people in the U.S.\u003c/a>, despite representing just 12% of the country’s overall population. And Newsom has acknowledged that the numbers are likely far greater than official homelessness tallies show. Top health officials say that, to contain soaring safety-net spending and to help unhoused people get healthy, Medi-Cal has no choice but to combine social services with housing.\u003c/p>\n\u003cp>Statewide, 5% of Medi-Cal patients account for a staggering 44% of the program’s spending, according to state data. And many of the costliest patients lack stable housing: Nearly half of patients experiencing homelessness visited the emergency room four times or more in 2019 and were more likely than other adults with lower incomes to be admitted to the hospital, and a large majority of visits were covered by Medi-Cal, \u003ca href=\"https://www.ppic.org/publication/how-hospital-discharge-data-can-inform-state-homelessness-policy/\">according to the Public Policy Institute of California\u003c/a>.\u003c/p>\n\u003cp>“What we have today doesn’t work,” said \u003ca href=\"https://www.chhs.ca.gov/about/#secretary\">Dr. Mark Ghaly\u003c/a>, secretary of the California Health and Human Services Agency, explaining his argument that housing is a critical component of health care. “Why do we have to wait so long for people to be so sick?”\u003c/p>\n\u003cp>The federal government has already approved \u003ca href=\"https://khn.org/news/article/california-medicaid-makeover-newsom-california-medi-cal-homeless-public-funds/\">a massive social experiment in California\u003c/a>, known as \u003ca href=\"https://www.dhcs.ca.gov/calaim\">CalAIM\u003c/a>, which is transforming Medi-Cal. Over five years, the initiative is expected to pour $12 billion into new Medi-Cal services delivered outside of traditional health care. In communities across the state, it is already funding services for some patients with lower income, including paying rental security deposits for unhoused people and those facing eviction; \u003ca href=\"https://khn.org/news/article/california-medicaid-medically-tailored-meal-delivery-experiment/\">delivering prepared healthy meals\u003c/a> for people with diabetes; and helping formerly incarcerated people find jobs.\u003c/p>\n\u003cp>The transitional rent program would add another service to \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCQMD/Community-Supports-Elections-by-MCP-and-County.pdf\">those already available (PDF)\u003c/a>, though \u003ca href=\"https://khn.org/news/article/california-governor-newsom-pricey-medicaid-reforms-leave-most-patients-behind/\">only a sliver of the 15.4 million Medi-Cal enrollees\u003c/a> actually receive those new and expensive social services.\u003c/p>\n\u003cp>Rent payments could begin as soon as 2025 and cost roughly $117 million per year once fully implemented. And while state officials say anyone who is homeless or at risk of becoming homeless would be eligible, not everyone who qualifies will receive new services due to capacity limits. Among those who stand to benefit are nearly 11,000 people already enrolled in \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/CalAIM-HHI-a11y.pdf\">Medi-Cal housing services (PDF)\u003c/a>.\u003c/p>\n\u003cp>“The ongoing conversation is how do we convince the federal government that housing is a health care issue,” said \u003ca href=\"https://www.sellersdorsey.com/team-member/cantwell-mari/\">Mari Cantwell\u003c/a>, who served as Medi-Cal director from 2015 to 2020. “You have to convince them that you’re going to save money because you’re not going to have as many people showing up at the emergency room and in long-term hospitalizations.”\u003c/p>\n\u003cp>Health care experiments in California and around the country that funded housing supports have demonstrated early success in reducing costs and making people healthier. But while some programs paid for housing security deposits or participants’ first month of rent, none directly covered rent for an extended period.[pullquote align=\"right\" size=\"medium\" citation=\"Vikki Wachino, former national director, Medicaid\"]‘Part of the question is whether this is really Medicaid’s job. But there is a recognition that social factors like inadequate housing are driving health outcomes, and I think the federal government is open to developing approaches to try and address that.’[/pullquote]“Without that foundational support, we are playing in the margins,” Newsom said.\u003c/p>\n\u003cp>State health officials argue that paying for six months of rent will be even more successful at reducing health care costs and improving enrollees’ health, but experts say that, to work, the initiative must have strict accountability and be bundled with an array of social services.\u003c/p>\n\u003cp>In a precursor to the state’s current initiative, California experimented with a mix of housing assistance programs and social services through its “\u003ca href=\"https://apnews.com/article/california-health-8e353e5539ce36c9068a78f6ee7baeb7\">Whole Person Care\u003c/a>” pilot program. \u003ca href=\"https://healthpolicy.ucla.edu/about/staff/pages/detail.aspx?StaffID=94\">Nadereh Pourat\u003c/a>, of the UCLA Center for Health Policy Research, \u003ca href=\"https://healthpolicy.ucla.edu/publications/search/pages/detail.aspx?PubID=2385\">evaluated the program\u003c/a> for the state concluding that local trials reduced emergency visits and hospitalizations, saving an average of $383 per Medi-Cal beneficiary per year — a meager amount compared with the program’s cost.\u003c/p>\n\u003cp>Over five years, the state spent \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2023/Final-Evaluation-of-CA-Whole-Person-Care-Report.pdf#page=31\">$3.6 billion (PDF)\u003c/a> serving about 250,000 patients enrolled in \u003ca href=\"https://www.dhcs.ca.gov/services/Pages/WholePersonCarePilots.aspx\">local experiments\u003c/a>, Pourat said.\u003c/p>\n\u003cp>And \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/32976633/\">a randomized control trial\u003c/a> in Santa Clara County that provided supportive housing for unhoused people showed reductions in psychiatric emergency room visits and improvements in care. “Lives stabilized and we saw a huge uptick in substance-use care and mental health care, the things that everybody wants people to use to get healthier,” said \u003ca href=\"https://profiles.ucsf.edu/margot.kushel\">Dr. Margot Kushel\u003c/a>, director of the University of California-San Francisco’s Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, who worked on the study.\u003c/p>\n\u003cp>But insurers implementing the broader Medi-Cal initiative say they are skeptical that spending health care money on housing will save the system money. And health care experts say that, while six months of rent can be a bridge while people wait for permanent housing, there’s a bigger obstacle: California’s affordable-housing shortage.\u003c/p>\n\u003cp>“We can design incredible Medicaid policies to alleviate homelessness and pay for all the necessary supportive services, but without the adequate housing, frankly, it’s not going to work,” Kushel said.\u003c/p>\n\u003cp>Newsom acknowledges that criticism. “The crisis of homelessness will never be solved without first solving the crisis of housing,” he said last week, arguing California should plow more money into housing for homeless people with severe mental health conditions or addiction disorders.[pullquote align=\"right\" size=\"medium\" citation=\"Dr. Margot Kushel, UCSF Center for Vulnerable Populations director, ZSFGH\"]‘We can design incredible Medicaid policies to alleviate homelessness and pay for all the necessary supportive services, but without the adequate housing, frankly, it’s not going to work.’[/pullquote]He will ask the legislature to put before voters a \u003ca href=\"https://www.latimes.com/california/story/2023-03-19/newsom-mental-health-housing-bond-measure-services-counties-substance-use-treatment\">2024 ballot initiative\u003c/a> that would infuse California’s mental health system with at least 6,000 new treatment beds and supportive housing units for people struggling with mental health and addiction disorders, \u003ca href=\"https://capitolweekly.net/newsom-takes-another-swing-at-getting-mentally-ill-homeless-off-the-streets/\">many of whom are experiencing homelessness\u003c/a>. The proposed bond measure would generate from $3 billion to $5 billion for psychiatric housing and treatment villages aimed at serving more than 10,000 additional people a year. The initiative also would ask voters to set aside at least $1 billion a year for supportive housing from an \u003ca href=\"https://www.dhcs.ca.gov/services/MH/Pages/MH_Prop63.aspx\">existing tax on California millionaires\u003c/a> that funds local mental health programs.\u003c/p>\n\u003cp>“People who are struggling with these issues, especially those who are on the streets or in other vulnerable conditions, will have more resources to get the help they need,” Newsom said.\u003c/p>\n\u003cp>For transitional rent, six months of payments would be available for select high-need residents enrolled in Medi-Cal, particularly those who are unhoused or at risk of becoming unhoused — and those transitioning from more costly institutions such as mental health crisis centers, jails and prisons, and foster care. Medi-Cal patients at risk of inpatient hospitalization or who frequent the emergency room would also be eligible.\u003c/p>\n\u003cp>“It’s a pretty big challenge; I’m not going to lie,” said \u003ca href=\"https://conference.healthmanagement.com/jacey-cooper/\">Jacey Cooper\u003c/a>, the Medi-Cal director. “But we know that people experiencing homelessness cycle in and out of emergency rooms, so we have a real role to play in both preventing and ending homelessness.”\u003c/p>\n\u003cp>Public health experts say the \u003ca href=\"https://khn.org/news/article/california-homeless-crisis-governor-gavin-newsom-political-future/\">problem will continue to explode\u003c/a> without creative thinking about how to fund housing in health care, but they warn the state must be wary of potential abuses of the program.\u003c/p>\n\u003cp>“It has to be designed carefully because, unfortunately, there are always people looking to game the system,” said \u003ca href=\"https://www.calendow.org/leadership/\">Dr. Tony Iton\u003c/a>, a public health expert who is now a senior vice president at the California Endowment. “Decisions must be made by clinicians — not housing organizations just looking for another source of revenue.”\u003c/p>\n\u003cp>For Stephen Morton, who lives in the Orange County community of Laguna Woods, the journey from homelessness into permanent housing illustrates the amount of public spending it can take for the effort to pay off.\u003c/p>\n\u003cfigure id=\"attachment_11944656\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11944656\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-800x533.jpg\" alt=\"A white middle aged man combs his hair in front of a mirror in a bedroom with a lamp, a speaker, a bottle of eau de toilette anfd a box with a card on a dresser in front of the mirror.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-1920x1280.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy.jpg 2048w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Stephen Morton, who lived in shelters and sometimes in his car for almost 2 years before finding permanent housing, receives weekly deliveries of medically tailored meals as part of a Medi-Cal initiative. Since getting his apartment, Morton says he’s been able to stop taking one diabetes medication and lose weight. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Morton, 60, bounced between shelters and his car for nearly two years and racked up extraordinary Medi-Cal costs due to prolonged hospitalizations and repeated emergency room trips to treat chronic heart disease, asthma and diabetes.\u003c/p>\n\u003cp>Medi-Cal covered Morton’s open-heart surgery and hospital stays, which lasted weeks. He landed temporary housing through a state-sponsored program called \u003ca href=\"https://www.cdss.ca.gov/inforesources/cdss-programs/housing-programs/project-roomkey\">Project Roomkey\u003c/a> before getting permanent housing through a federal low-income housing voucher — an ongoing benefit that covers all but $50 of his rent.\u003c/p>\n\u003cp>Since getting his apartment, Morton said, he’s been able to stop taking one diabetes medication and lose weight. He attributes improvements in his blood sugar levels to his housing and the healthy, home-delivered meals he receives via Medi-Cal.\u003c/p>\n\u003cp>“It’s usually scrambled eggs for breakfast and the fish menu for dinner. I’m shocked it’s so good,” Morton said. “Now I have a microwave and I’m indoors. I’m so grateful and so much healthier.”\u003c/p>\n\u003cp>\u003cem>California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "California's bold new 'transitional rent' plan would save costs from frequent ER visits and lengthy hospital stays for Medi-Cal patients, but Newsom needs to convince Biden, saying, 'We cannot do this alone,' and lack of affordable housing across the state remains a concern.",
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"title": "Gov. Newsom's Prescription Housing Plan Would Cover 6 Months' Rent Through Medi-Cal | KQED",
"description": "California's bold new 'transitional rent' plan would save costs from frequent ER visits and lengthy hospital stays for Medi-Cal patients, but Newsom needs to convince Biden, saying, 'We cannot do this alone,' and lack of affordable housing across the state remains a concern.",
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"headline": "Gov. Newsom's Prescription Housing Plan Would Cover 6 Months' Rent Through Medi-Cal",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Gov. Gavin Newsom, whose administration is struggling to contain a worsening homelessness crisis despite \u003ca href=\"https://khn.org/news/article/california-homeless-crisis-governor-gavin-newsom-political-future/\">record spending\u003c/a>, is trying something bold: tapping federal health care funding to cover rent for unhoused people and those at risk of losing their housing.\u003c/p>\n\u003cp>States are barred from using federal Medicaid dollars to pay directly for rent, but California’s governor is asking the administration of President Joe Biden, a fellow Democrat, to authorize a new program called “\u003ca href=\"https://ebudget.ca.gov/2023-24/pdf/BudgetSummary/HealthandHumanServices.pdf\">transitional rent (PDF)\u003c/a>,” which would provide up to six months of rent or temporary housing for\u003ca href=\"https://khn.org/news/article/californias-massive-medicaid-program-works-for-some-but-fails-many-others/\"> enrollees with \u003c/a>\u003ca href=\"https://khn.org/news/article/californias-massive-medicaid-program-works-for-some-but-fails-many-others/\">lower incomes\u003c/a> who rely on the state’s health care safety net — a new initiative to fight and prevent homelessness.\u003c/p>\n\u003cp>“I’ve been talking to the president. We cannot do this alone,” Newsom told California Healthline.\u003c/p>\n\u003cp>The governor is pushing California’s version of Medicaid, called Medi-Cal, to fund experimental housing subsidies for people experiencing homelessness, betting that it’s cheaper for taxpayers to cover rent than to allow people to fall into crisis or costly institutional care in hospitals, nursing homes and jails. Early in his tenure, \u003ca href=\"https://www.gov.ca.gov/2020/02/19/governor-newsom-delivers-state-of-the-state-address-on-homelessness/\">Newsom proclaimed\u003c/a> that “doctors should be able to write prescriptions for housing the same way they do for insulin or antibiotics.”\u003c/p>\n\u003cp>But it’s a risky endeavor in a high-cost state where \u003ca href=\"https://www.zillow.com/rental-manager/market-trends/ca/\">median rent is nearly $3,000 a month\u003c/a>, and even higher in coastal regions, where most of California’s unhoused people reside. Experts expect the Biden administration to scrutinize the plan to use health care money to pay rent, and also question its potential effectiveness in light of the state’s \u003ca href=\"https://calmatters.org/housing/2022/10/newsom-california-housing-crisis/\">housing crisis\u003c/a>.\u003c/p>\n\u003cp>“Part of the question is whether this is really Medicaid’s job,” said \u003ca href=\"https://counciloncj.org/vikki-wachino/\">Vikki Wachino\u003c/a>, who served as national Medicaid director in the Obama administration. “But there is a recognition that social factors like inadequate housing are driving health outcomes, and I think the federal government is open to developing approaches to try and address that.”\u003c/p>\n\u003cp>Bruce Alexander, spokesperson for the Centers for Medicare and Medicaid Services, declined to say whether the federal government would approve California’s request. Yet, Biden’s Medicaid officials have approved similar experimental programs in \u003ca href=\"https://www.oregon.gov/oha/HSD/Medicaid-Policy/Pages/Changes.aspx\">Oregon\u003c/a> and \u003ca href=\"https://www.hhs.gov/about/news/2022/10/14/hhs-approves-arizonas-medicaid-interventions-target-health-related-social-needs.html\">Arizona\u003c/a>, and California is modeling its program after them.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003ca href=\"https://www.ppic.org/blog/homeless-populations-are-rising-around-california/#:~:text=As%20of%202022%2C%2030%25%20of,of%20the%20nation's%20homeless%20population\">California is home to an estimated 30% of unhoused people in the U.S.\u003c/a>, despite representing just 12% of the country’s overall population. And Newsom has acknowledged that the numbers are likely far greater than official homelessness tallies show. Top health officials say that, to contain soaring safety-net spending and to help unhoused people get healthy, Medi-Cal has no choice but to combine social services with housing.\u003c/p>\n\u003cp>Statewide, 5% of Medi-Cal patients account for a staggering 44% of the program’s spending, according to state data. And many of the costliest patients lack stable housing: Nearly half of patients experiencing homelessness visited the emergency room four times or more in 2019 and were more likely than other adults with lower incomes to be admitted to the hospital, and a large majority of visits were covered by Medi-Cal, \u003ca href=\"https://www.ppic.org/publication/how-hospital-discharge-data-can-inform-state-homelessness-policy/\">according to the Public Policy Institute of California\u003c/a>.\u003c/p>\n\u003cp>“What we have today doesn’t work,” said \u003ca href=\"https://www.chhs.ca.gov/about/#secretary\">Dr. Mark Ghaly\u003c/a>, secretary of the California Health and Human Services Agency, explaining his argument that housing is a critical component of health care. “Why do we have to wait so long for people to be so sick?”\u003c/p>\n\u003cp>The federal government has already approved \u003ca href=\"https://khn.org/news/article/california-medicaid-makeover-newsom-california-medi-cal-homeless-public-funds/\">a massive social experiment in California\u003c/a>, known as \u003ca href=\"https://www.dhcs.ca.gov/calaim\">CalAIM\u003c/a>, which is transforming Medi-Cal. Over five years, the initiative is expected to pour $12 billion into new Medi-Cal services delivered outside of traditional health care. In communities across the state, it is already funding services for some patients with lower income, including paying rental security deposits for unhoused people and those facing eviction; \u003ca href=\"https://khn.org/news/article/california-medicaid-medically-tailored-meal-delivery-experiment/\">delivering prepared healthy meals\u003c/a> for people with diabetes; and helping formerly incarcerated people find jobs.\u003c/p>\n\u003cp>The transitional rent program would add another service to \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCQMD/Community-Supports-Elections-by-MCP-and-County.pdf\">those already available (PDF)\u003c/a>, though \u003ca href=\"https://khn.org/news/article/california-governor-newsom-pricey-medicaid-reforms-leave-most-patients-behind/\">only a sliver of the 15.4 million Medi-Cal enrollees\u003c/a> actually receive those new and expensive social services.\u003c/p>\n\u003cp>Rent payments could begin as soon as 2025 and cost roughly $117 million per year once fully implemented. And while state officials say anyone who is homeless or at risk of becoming homeless would be eligible, not everyone who qualifies will receive new services due to capacity limits. Among those who stand to benefit are nearly 11,000 people already enrolled in \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/CalAIM-HHI-a11y.pdf\">Medi-Cal housing services (PDF)\u003c/a>.\u003c/p>\n\u003cp>“The ongoing conversation is how do we convince the federal government that housing is a health care issue,” said \u003ca href=\"https://www.sellersdorsey.com/team-member/cantwell-mari/\">Mari Cantwell\u003c/a>, who served as Medi-Cal director from 2015 to 2020. “You have to convince them that you’re going to save money because you’re not going to have as many people showing up at the emergency room and in long-term hospitalizations.”\u003c/p>\n\u003cp>Health care experiments in California and around the country that funded housing supports have demonstrated early success in reducing costs and making people healthier. But while some programs paid for housing security deposits or participants’ first month of rent, none directly covered rent for an extended period.\u003c/p>\u003c/div>",
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"content": "‘Part of the question is whether this is really Medicaid’s job. But there is a recognition that social factors like inadequate housing are driving health outcomes, and I think the federal government is open to developing approaches to try and address that.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“Without that foundational support, we are playing in the margins,” Newsom said.\u003c/p>\n\u003cp>State health officials argue that paying for six months of rent will be even more successful at reducing health care costs and improving enrollees’ health, but experts say that, to work, the initiative must have strict accountability and be bundled with an array of social services.\u003c/p>\n\u003cp>In a precursor to the state’s current initiative, California experimented with a mix of housing assistance programs and social services through its “\u003ca href=\"https://apnews.com/article/california-health-8e353e5539ce36c9068a78f6ee7baeb7\">Whole Person Care\u003c/a>” pilot program. \u003ca href=\"https://healthpolicy.ucla.edu/about/staff/pages/detail.aspx?StaffID=94\">Nadereh Pourat\u003c/a>, of the UCLA Center for Health Policy Research, \u003ca href=\"https://healthpolicy.ucla.edu/publications/search/pages/detail.aspx?PubID=2385\">evaluated the program\u003c/a> for the state concluding that local trials reduced emergency visits and hospitalizations, saving an average of $383 per Medi-Cal beneficiary per year — a meager amount compared with the program’s cost.\u003c/p>\n\u003cp>Over five years, the state spent \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2023/Final-Evaluation-of-CA-Whole-Person-Care-Report.pdf#page=31\">$3.6 billion (PDF)\u003c/a> serving about 250,000 patients enrolled in \u003ca href=\"https://www.dhcs.ca.gov/services/Pages/WholePersonCarePilots.aspx\">local experiments\u003c/a>, Pourat said.\u003c/p>\n\u003cp>And \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/32976633/\">a randomized control trial\u003c/a> in Santa Clara County that provided supportive housing for unhoused people showed reductions in psychiatric emergency room visits and improvements in care. “Lives stabilized and we saw a huge uptick in substance-use care and mental health care, the things that everybody wants people to use to get healthier,” said \u003ca href=\"https://profiles.ucsf.edu/margot.kushel\">Dr. Margot Kushel\u003c/a>, director of the University of California-San Francisco’s Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, who worked on the study.\u003c/p>\n\u003cp>But insurers implementing the broader Medi-Cal initiative say they are skeptical that spending health care money on housing will save the system money. And health care experts say that, while six months of rent can be a bridge while people wait for permanent housing, there’s a bigger obstacle: California’s affordable-housing shortage.\u003c/p>\n\u003cp>“We can design incredible Medicaid policies to alleviate homelessness and pay for all the necessary supportive services, but without the adequate housing, frankly, it’s not going to work,” Kushel said.\u003c/p>\n\u003cp>Newsom acknowledges that criticism. “The crisis of homelessness will never be solved without first solving the crisis of housing,” he said last week, arguing California should plow more money into housing for homeless people with severe mental health conditions or addiction disorders.\u003c/p>\u003c/div>",
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"content": "‘We can design incredible Medicaid policies to alleviate homelessness and pay for all the necessary supportive services, but without the adequate housing, frankly, it’s not going to work.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>He will ask the legislature to put before voters a \u003ca href=\"https://www.latimes.com/california/story/2023-03-19/newsom-mental-health-housing-bond-measure-services-counties-substance-use-treatment\">2024 ballot initiative\u003c/a> that would infuse California’s mental health system with at least 6,000 new treatment beds and supportive housing units for people struggling with mental health and addiction disorders, \u003ca href=\"https://capitolweekly.net/newsom-takes-another-swing-at-getting-mentally-ill-homeless-off-the-streets/\">many of whom are experiencing homelessness\u003c/a>. The proposed bond measure would generate from $3 billion to $5 billion for psychiatric housing and treatment villages aimed at serving more than 10,000 additional people a year. The initiative also would ask voters to set aside at least $1 billion a year for supportive housing from an \u003ca href=\"https://www.dhcs.ca.gov/services/MH/Pages/MH_Prop63.aspx\">existing tax on California millionaires\u003c/a> that funds local mental health programs.\u003c/p>\n\u003cp>“People who are struggling with these issues, especially those who are on the streets or in other vulnerable conditions, will have more resources to get the help they need,” Newsom said.\u003c/p>\n\u003cp>For transitional rent, six months of payments would be available for select high-need residents enrolled in Medi-Cal, particularly those who are unhoused or at risk of becoming unhoused — and those transitioning from more costly institutions such as mental health crisis centers, jails and prisons, and foster care. Medi-Cal patients at risk of inpatient hospitalization or who frequent the emergency room would also be eligible.\u003c/p>\n\u003cp>“It’s a pretty big challenge; I’m not going to lie,” said \u003ca href=\"https://conference.healthmanagement.com/jacey-cooper/\">Jacey Cooper\u003c/a>, the Medi-Cal director. “But we know that people experiencing homelessness cycle in and out of emergency rooms, so we have a real role to play in both preventing and ending homelessness.”\u003c/p>\n\u003cp>Public health experts say the \u003ca href=\"https://khn.org/news/article/california-homeless-crisis-governor-gavin-newsom-political-future/\">problem will continue to explode\u003c/a> without creative thinking about how to fund housing in health care, but they warn the state must be wary of potential abuses of the program.\u003c/p>\n\u003cp>“It has to be designed carefully because, unfortunately, there are always people looking to game the system,” said \u003ca href=\"https://www.calendow.org/leadership/\">Dr. Tony Iton\u003c/a>, a public health expert who is now a senior vice president at the California Endowment. “Decisions must be made by clinicians — not housing organizations just looking for another source of revenue.”\u003c/p>\n\u003cp>For Stephen Morton, who lives in the Orange County community of Laguna Woods, the journey from homelessness into permanent housing illustrates the amount of public spending it can take for the effort to pay off.\u003c/p>\n\u003cfigure id=\"attachment_11944656\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11944656\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-800x533.jpg\" alt=\"A white middle aged man combs his hair in front of a mirror in a bedroom with a lamp, a speaker, a bottle of eau de toilette anfd a box with a card on a dresser in front of the mirror.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy-1920x1280.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/stephen_morton-6-resized-copy.jpg 2048w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Stephen Morton, who lived in shelters and sometimes in his car for almost 2 years before finding permanent housing, receives weekly deliveries of medically tailored meals as part of a Medi-Cal initiative. Since getting his apartment, Morton says he’s been able to stop taking one diabetes medication and lose weight. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Morton, 60, bounced between shelters and his car for nearly two years and racked up extraordinary Medi-Cal costs due to prolonged hospitalizations and repeated emergency room trips to treat chronic heart disease, asthma and diabetes.\u003c/p>\n\u003cp>Medi-Cal covered Morton’s open-heart surgery and hospital stays, which lasted weeks. He landed temporary housing through a state-sponsored program called \u003ca href=\"https://www.cdss.ca.gov/inforesources/cdss-programs/housing-programs/project-roomkey\">Project Roomkey\u003c/a> before getting permanent housing through a federal low-income housing voucher — an ongoing benefit that covers all but $50 of his rent.\u003c/p>\n\u003cp>Since getting his apartment, Morton said, he’s been able to stop taking one diabetes medication and lose weight. He attributes improvements in his blood sugar levels to his housing and the healthy, home-delivered meals he receives via Medi-Cal.\u003c/p>\n\u003cp>“It’s usually scrambled eggs for breakfast and the fish menu for dinner. I’m shocked it’s so good,” Morton said. “Now I have a microwave and I’m indoors. I’m so grateful and so much healthier.”\u003c/p>\n\u003cp>\u003cem>California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Starting April 1, Californians who depend on \u003ca href=\"https://www.dhcs.ca.gov/Pages/myMedi-Cal.aspx\">Medi-Cal\u003c/a> — the state’s Medicaid health care program — for their health care expenses will need to once again \u003ca href=\"https://www.dhcs.ca.gov/Pages/Keep-Your-Medi-Cal.aspx\">go through a redetermination process to renew their eligibility and keep their Medi-Cal coverage\u003c/a>.\u003c/p>\n\u003cp>Thanks to \u003ca href=\"https://www.hhs.gov/about/news/2023/02/09/fact-sheet-covid-19-public-health-emergency-transition-roadmap.html\">the federal COVID Public Health Emergency (PHE)\u003c/a> declared in 2020, Medicaid programs around the nation like Medi-Cal have been able to waive annual eligibility requirements. This means that for the past three years, Medicaid beneficiaries had their health care costs covered without having to go through an annual renewal process, which could have found them no longer eligible to receive Medicaid.\u003c/p>\n\u003cp>But at the end of last year, Congress approved the Consolidated Appropriations Act — putting \u003ca href=\"https://www.hhs.gov/about/news/2023/02/09/fact-sheet-covid-19-public-health-emergency-transition-roadmap.html\">an end date of March 31 on automatic Medicaid renewal\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Jump to:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>\u003ca href=\"#keepmedicaid\">What do I need to do to keep my Medi-Cal coverage?\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"#helpmedicaid\">Find my Bay Area county’s Medi-Cal office\u003c/a>\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003ch2>Who will be affected by these Medi-Cal changes?\u003c/h2>\n\u003cp>This change will affect the millions of people nationwide who depend on Medicaid to cover essential care, prescriptions and other health care services, including the 12 million people enrolled in Medi-Cal within California.\u003c/p>\n\u003cp>The Urban Institute, a public policy think tank, released a study at the end of 2022 that estimates that \u003ca href=\"https://www.urban.org/research/publication/impact-covid-19-public-health-emergency-expiration-all-types-health-coverage\">18 million people nationwide may lose their Medicaid\u003c/a> coverage during a 14-month period following the end of the PHE — either because they are found to no longer qualify for Medi-Cal, or because they fail to renew on time. \u003ca href=\"https://www.dhcs.ca.gov/Documents/PHE-UOP/Medi-Cal-COVID-19-PHE-Unwinding-Plan.pdf\">In California, that number could be as high as 3 million.\u003c/a>\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>\u003ca href=\"#tellus\">Tell us: What else do you need information about right now?\u003c/a>\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003cp>Disability rights advocates also worry that the renewal process could leave people without health coverage. “Administrative and procedural barriers can also lead to someone being dis-enrolled, with \u003ca href=\"https://www.teenvogue.com/story/medicaid-coverage-covid\">low-income people and people of color disproportionately at higher risk due to structural inequities\u003c/a>,” wrote San Francisco disability rights activist Alice Wong in a recent column for \u003cem>Teen Vogue.\u003c/em>\u003c/p>\n\u003cp>Individuals who received Medi-Cal benefits before the pandemic began may remember what it’s like to renew eligibility: Your county’s health and human services agency sends to your mailbox a thick packet full of forms to fill out and verify your residency, income, health information and other personal details.\u003c/p>\n\u003cp>But regardless of whether you have been on Medi-Cal for decades, or joined far more recently during the pandemic, \u003ca href=\"https://www.dhcs.ca.gov/Pages/Keep-Your-Medi-Cal.aspx\">the redetermination process will be required for all Medi-Cal beneficiaries\u003c/a>. This means that every single person on Medi-Cal needs to be aware of the coming changes starting in April, to make sure they keep health care coverage in some form.\u003c/p>\n\u003cp>Keep reading for what you need to know.\u003c/p>\n\u003cfigure id=\"attachment_11944676\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11944676\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577.jpg\" alt=\"A photograph shot from behind of two people, whose faces we can't see, operating a laptop to fill out a form.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Changes are coming to Medi-Cal eligibility, and you’ll have to act to keep coverage. \u003ccite>(RODNAE Productions/Pexels)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch2>\u003ca id=\"keepmedicaid\">\u003c/a>On Medi-Cal? Here’s what to expect starting April 1\u003c/h2>\n\u003cp>Nobody will be automatically dropped from their Medi-Cal coverage on April 1, says María Reyes, community health education manager for La Clínica de la Raza, which provides health services to lower-income communities in Alameda, Contra Costa and Solano counties.\u003c/p>\n\u003cp>Instead, that date marks the start of the process to reenroll people on Medi-Cal.\u003c/p>\n\u003cp>Once the Medi-Cal renewal waiver ends on March 31, there will be two ways people can renew their benefits: through the mail or \u003ca href=\"https://www.dhcs.ca.gov/Pages/Keep-Your-Medi-Cal.aspx\">online at the Medi-Cal website\u003c/a>. But it’s important to remember that the deadline to renew will be different for everyone, says Reyes.\u003c/p>\n\u003cp>The deadline to renew your personal coverage, she says, is based on your Medi-Cal “anniversary”:\u003c/p>\n\u003cul>\n\u003cli>If you had Medi-Cal \u003cstrong>before 2020\u003c/strong>, your anniversary is the date when you last renewed your coverage before the pandemic, but:\u003c/li>\n\u003cli>If you enrolled \u003cstrong>after 2020\u003c/strong> and haven’t gone through the renewal process yet, your anniversary falls on the date you first applied.\u003c/li>\n\u003c/ul>\n\u003cp>Reyes recommends that you confirm the exact date of your coverage anniversary — because you should receive a renewal packet in the mail ahead of this date.\u003c/p>\n\u003cp>\u003cstrong>Option 1: Renew your Medi-Cal coverage by mail\u003c/strong>\u003c/p>\n\u003cp>“As people meet their anniversary date, they’ll be getting these packets,” she says, adding that the packets will include a letter with information specific to your coverage. “This letter will let you know you have X amount of time, from the time you receive the letter, to submit your renewal packet and the documents they are requesting from you.”\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org/health/2023/03/medi-cal-eligibility-2/\">These packets will be going out in phases monthly up through June 2024\u003c/a>, and will include \u003ca href=\"https://www.dhcs.ca.gov/formsandpubs/forms/Forms/mc210rv-eng.pdf\">an annual redetermination form (PDF)\u003c/a> which asks for information about a beneficiary’s income, living situation and disability status, among other factors. You may be asked to submit additional documents depending on your circumstances. You should fill it out and return it as soon as possible, if you don’t plan on renewing your Medi-Cal online (see Option 2).\u003c/p>\n\u003cp>“If, for some reason, your county office doesn’t get the packet by the deadline, they’ll send another reminder letter letting you know they haven’t received your documents,” Reyes said, adding that there may be a \u003cem>third\u003c/em> letter in the mail if a beneficiary misses the second deadline. There should, she assures, be several opportunities for people to be reminded of this deadline. “It’s not going to be a sudden stop of services,” she said.\u003c/p>\n\u003cp>\u003cstrong>Option 2: Renew your Medi-Cal coverage online\u003c/strong>\u003c/p>\n\u003cp>In some cases, you may be able to renew online. In the Bay Area, counties use either one of two renewal portals:\u003c/p>\n\u003cul>\n\u003cli>If you live in Alameda, San Francisco, San Mateo, Solano and Sonoma counties, visit \u003ca href=\"https://www.mybenefitscalwin.org/#/home\">MyBenefitsCalWin\u003c/a> to renew your Medi-Cal.\u003c/li>\n\u003cli>If you live in Contra Costa, Marin, Napa or Santa Clara counties, visit \u003ca href=\"https://benefitscal.com/\">BenefitsCal\u003c/a> to renew your Medi-Cal.\u003c/li>\n\u003c/ul>\n\u003cp>If you live somewhere else in California, \u003ca href=\"https://www.dhcs.ca.gov/Pages/Keep-Your-Medi-Cal.aspx\">see which website your county uses for your to renew your Medi-Cal\u003c/a>.\u003c/p>\n\u003ch2>What if I am found to no longer be eligible for Medi-Cal?\u003c/h2>\n\u003cp>If you don’t renew your Medi-Cal by the deadline (see Options 1 and 2, in the previous section), or are found to no longer be eligible, you’ll be removed from Medi-Cal coverage. And if that happens, you’ll have other options for subsidized health care coverage — but at a cost.\u003c/p>\n\u003cp>Yingjia Huang, assistant deputy director for health care benefits and eligibility at the Department of Health Care Services, told CalMatters that \u003ca href=\"https://calmatters.org/health/2023/03/medi-cal-eligibility-2/\">if you no longer qualify for Medi-Cal because your income has gone up, you’ll be “automatically” transitioned\u003c/a> into a similar plan through Covered California. “The system automatically will review their eligibility for Covered California, and Covered California will send out the enrollment notice to the member, informing them of their options and to pay the plan premium,” said Huang. There’ll be “no administrative burden on a member,” she stressed.\u003c/p>\n\u003cp>But of course, this may come with a new monthly premium that many folks on Medi-Cal haven’t had to pay before — and might not feel able to when factoring in their other expenses.\u003c/p>\n\u003cp>The state emphasizes that \u003ca href=\"https://www.coveredca.com/marketing-blog/health-insurance-costs-less-thanks-to-the-inflation-reduction-act/\">nearly half of people getting health care through Covered California pay less than $50\u003c/a>, while nearly a quarter of people don’t pay a monthly premium at all.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003ch2>What happens if I don’t get my renewal packet in the mail?\u003c/h2>\n\u003cp>Reyes is keen to reiterate that no one will be automatically dropped from their Medi-Cal coverage on April 1. “Starting on that date, people should be on the lookout for these renewal packages that they will need to complete,” she said.\u003c/p>\n\u003cp>If your coverage anniversary rolls around and you have not received a renewal packet, there may be several possibilities to explain why:\u003c/p>\n\u003cul>\n\u003cli>You may have the wrong date on file for your anniversary, or:\u003c/li>\n\u003cli>Your county may be sending the packet to an old address (more likely \u003ca href=\"https://www.sfhsa.org/services/health/medi-cal/renew-your-medi-cal-coverage\">if you moved during the pandemic\u003c/a>).\u003c/li>\n\u003c/ul>\n\u003cp>In either case, you should confirm your information with your county directly. You can do this online:\u003c/p>\n\u003cul>\n\u003cli>If you live in Alameda, San Francisco, San Mateo, Solano and Sonoma counties, visit \u003ca href=\"https://www.mybenefitscalwin.org/#/home\">MyBenefitsCalWin\u003c/a> to update your Medi-Cal contact information.\u003c/li>\n\u003cli>If you live in Contra Costa, Marin, Napa or Santa Clara counties, visit \u003ca href=\"https://benefitscal.com/\">BenefitsCal\u003c/a> to update your Medi-Cal contact information.\u003c/li>\n\u003c/ul>\n\u003cp>You can also contact the office in your county that manages Medi-Cal enrollment. Find your county in the list below.\u003c/p>\n\u003ch2>\u003ca id=\"helpmedicaid\">\u003c/a>Get direct assistance with Medi-Cal and update your contact details\u003c/h2>\n\u003cp>\u003cstrong>Alameda County\u003c/strong>: \u003ca href=\"https://www.alamedacountysocialservices.org/our-services/Health-and-Food/Medi-Cal/index\">Social Services Agency\u003c/a>, 24100 Amador Street, Hayward; call (888) 999-4772.\u003c/p>\n\u003cp>\u003cstrong>Contra Costa County\u003c/strong>: \u003ca href=\"https://ehsd.org/benefits/medi-cal-and-health-coverage-options/\">Employment and Human Services\u003c/a>, multiple addresses; call (866) 663-3225.\u003c/p>\n\u003cp>\u003cstrong>Marin County\u003c/strong>: \u003ca href=\"https://www.marinhhs.org/medi-cal\">Health and Human Services\u003c/a>, 120 N. Redwood Drive, San Rafael; call (877) 410-8817.\u003c/p>\n\u003cp>\u003cstrong>Napa County\u003c/strong>: \u003ca href=\"https://www.countyofnapa.org/3304/Self-Sufficiency-Services\">Health and Human Services\u003c/a>, 2751 Napa Valley Corporate Drive, Napa; call (707) 253-4511.\u003c/p>\n\u003cp>\u003cstrong>San Francisco\u003c/strong>: \u003ca href=\"https://www.sfhsa.org/services/health/medi-cal/renew-your-medi-cal-coverage\">Human Services Agency\u003c/a>, 1440 Harrison Street, San Francisco; call (415) 558-4700.\u003c/p>\n\u003cp>\u003cstrong>San Mateo County\u003c/strong>: \u003ca href=\"https://www.smcgov.org/hsa/health-coverage\">Human Services\u003c/a>, 400 Harbor Boulevard, Building B, Belmont; call (800) 223-8383.\u003c/p>\n\u003cp>\u003cstrong>Santa Clara County\u003c/strong>: \u003ca href=\"https://socialservices.sccgov.org/health-coverage\">Social Services Agency\u003c/a>, 1867 Senter Road, San José; call (408) 758-3800.\u003c/p>\n\u003cp>\u003cstrong>Solano County\u003c/strong>: \u003ca href=\"https://www.solanocounty.com/depts/hss/ees/medical/default.asp\">Health and Social Services\u003c/a>, multiple addresses; call (707) 784-3900.\u003c/p>\n\u003cp>\u003cstrong>Sonoma County\u003c/strong>: \u003ca href=\"https://sonomacounty.ca.gov/health-and-human-services/human-services/divisions-and-services/economic-assistance/health-care-benefits/medi-cal-and-county-medical-services-program\">Department of Human Services\u003c/a>, 2550 Paulin Drive, Santa Rosa, or 5350 Old Redwood Highway, Suite 100, Petaluma; call (877) 699-6868.\u003c/p>\n\u003ch2>Remember, you don’t have to go through this alone\u003c/h2>\n\u003cp>If you are a parent or caregiver and managing a family all by yourself, working multiple jobs or managing a chronic illness, the Medi-Cal renewal process is another item on a long list of responsibilities you are already juggling. You might also be facing \u003ca href=\"https://www.kqed.org/news/11943420/your-calfresh-benefits-will-drop-in-april-heres-what-you-can-do\">a drop in your CalFresh benefits (SNAP, or food stamps)\u003c/a> at the same time as this Medi-Cal renewal, starting in April.\u003c/p>\n\u003cp>Many organizations across California are helping folks send their renewal packets in on time and keep their coverage. One of them is La Clínica de la Raza, which has set up a service that provides individual assistance to Medi-Cal recipients living in Alameda, Contra Costa or Solano counties while completing the renewal requirements.\u003c/p>\n\u003cp>“We don’t want people to lose coverage, especially because preventative services are important — particularly for those who have chronic conditions,” said Reyes, from La Clínica. “We want to make sure that they’re not at risk of losing coverage, not being able to see their provider, not able to refill their prescriptions. So taking action as soon as possible is important.”\u003c/p>\n\u003cp>If you are on Medi-Cal and live in Alameda, Contra Costa or Solano counties, contact La Clínica de la Raza at (855) 494-4658. Help is available in both English and Spanish.\u003c/p>\n\u003cp>Reyes adds that your county’s social services agency is also a helpful resource when navigating the renewal process and some counties have even set up service centers to answer reenrollment questions in person. \u003ca href=\"#helpmedicaid\">Find contact information for your county’s social services agency (above).\u003c/a>\u003c/p>\n\u003ch2>\u003ca id=\"tellus\">\u003c/a>Tell us: What else do you need information about?\u003c/h2>\n\u003cp>At KQED News, we know that it can sometimes be hard to track down the answers to navigate life in the Bay Area in 2023. We’ve published \u003ca href=\"https://www.kqed.org/news/tag/coronavirus-resources-and-explainers\">clear, helpful explainers and guides about issues like COVID\u003c/a>, \u003ca href=\"https://www.kqed.org/news/11936674/how-to-prepare-for-this-weeks-atmospheric-river-storm-sandbags-emergency-kits-and-more\">how to cope with intense winter weather\u003c/a> and \u003ca href=\"https://www.kqed.org/news/11821950/how-to-safely-attend-a-protest-in-the-bay-area\">how to exercise your right to protest safely\u003c/a>.\u003c/p>\n\u003cp>So tell us: What do you need to know more about? Tell us, and you could see your question answered online or on social media. What you submit will make our reporting stronger, and help us decide what to cover here on our site, and on KQED Public Radio, too.\u003c/p>\n\u003cp>[hearken id=\"10483\" src=\"https://modules.wearehearken.com/kqed/embed/10483.js\"]\u003c/p>\n\u003cp>\u003cem>KQED’s Carly Severn contributed to this story.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Starting April 1, Californians who depend on \u003ca href=\"https://www.dhcs.ca.gov/Pages/myMedi-Cal.aspx\">Medi-Cal\u003c/a> — the state’s Medicaid health care program — for their health care expenses will need to once again \u003ca href=\"https://www.dhcs.ca.gov/Pages/Keep-Your-Medi-Cal.aspx\">go through a redetermination process to renew their eligibility and keep their Medi-Cal coverage\u003c/a>.\u003c/p>\n\u003cp>Thanks to \u003ca href=\"https://www.hhs.gov/about/news/2023/02/09/fact-sheet-covid-19-public-health-emergency-transition-roadmap.html\">the federal COVID Public Health Emergency (PHE)\u003c/a> declared in 2020, Medicaid programs around the nation like Medi-Cal have been able to waive annual eligibility requirements. This means that for the past three years, Medicaid beneficiaries had their health care costs covered without having to go through an annual renewal process, which could have found them no longer eligible to receive Medicaid.\u003c/p>\n\u003cp>But at the end of last year, Congress approved the Consolidated Appropriations Act — putting \u003ca href=\"https://www.hhs.gov/about/news/2023/02/09/fact-sheet-covid-19-public-health-emergency-transition-roadmap.html\">an end date of March 31 on automatic Medicaid renewal\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Jump to:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>\u003ca href=\"#keepmedicaid\">What do I need to do to keep my Medi-Cal coverage?\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"#helpmedicaid\">Find my Bay Area county’s Medi-Cal office\u003c/a>\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003ch2>Who will be affected by these Medi-Cal changes?\u003c/h2>\n\u003cp>This change will affect the millions of people nationwide who depend on Medicaid to cover essential care, prescriptions and other health care services, including the 12 million people enrolled in Medi-Cal within California.\u003c/p>\n\u003cp>The Urban Institute, a public policy think tank, released a study at the end of 2022 that estimates that \u003ca href=\"https://www.urban.org/research/publication/impact-covid-19-public-health-emergency-expiration-all-types-health-coverage\">18 million people nationwide may lose their Medicaid\u003c/a> coverage during a 14-month period following the end of the PHE — either because they are found to no longer qualify for Medi-Cal, or because they fail to renew on time. \u003ca href=\"https://www.dhcs.ca.gov/Documents/PHE-UOP/Medi-Cal-COVID-19-PHE-Unwinding-Plan.pdf\">In California, that number could be as high as 3 million.\u003c/a>\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>\u003ca href=\"#tellus\">Tell us: What else do you need information about right now?\u003c/a>\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003cp>Disability rights advocates also worry that the renewal process could leave people without health coverage. “Administrative and procedural barriers can also lead to someone being dis-enrolled, with \u003ca href=\"https://www.teenvogue.com/story/medicaid-coverage-covid\">low-income people and people of color disproportionately at higher risk due to structural inequities\u003c/a>,” wrote San Francisco disability rights activist Alice Wong in a recent column for \u003cem>Teen Vogue.\u003c/em>\u003c/p>\n\u003cp>Individuals who received Medi-Cal benefits before the pandemic began may remember what it’s like to renew eligibility: Your county’s health and human services agency sends to your mailbox a thick packet full of forms to fill out and verify your residency, income, health information and other personal details.\u003c/p>\n\u003cp>But regardless of whether you have been on Medi-Cal for decades, or joined far more recently during the pandemic, \u003ca href=\"https://www.dhcs.ca.gov/Pages/Keep-Your-Medi-Cal.aspx\">the redetermination process will be required for all Medi-Cal beneficiaries\u003c/a>. This means that every single person on Medi-Cal needs to be aware of the coming changes starting in April, to make sure they keep health care coverage in some form.\u003c/p>\n\u003cp>Keep reading for what you need to know.\u003c/p>\n\u003cfigure id=\"attachment_11944676\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11944676\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577.jpg\" alt=\"A photograph shot from behind of two people, whose faces we can't see, operating a laptop to fill out a form.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/03/pexels-rodnae-productions-7821577-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Changes are coming to Medi-Cal eligibility, and you’ll have to act to keep coverage. \u003ccite>(RODNAE Productions/Pexels)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch2>\u003ca id=\"keepmedicaid\">\u003c/a>On Medi-Cal? Here’s what to expect starting April 1\u003c/h2>\n\u003cp>Nobody will be automatically dropped from their Medi-Cal coverage on April 1, says María Reyes, community health education manager for La Clínica de la Raza, which provides health services to lower-income communities in Alameda, Contra Costa and Solano counties.\u003c/p>\n\u003cp>Instead, that date marks the start of the process to reenroll people on Medi-Cal.\u003c/p>\n\u003cp>Once the Medi-Cal renewal waiver ends on March 31, there will be two ways people can renew their benefits: through the mail or \u003ca href=\"https://www.dhcs.ca.gov/Pages/Keep-Your-Medi-Cal.aspx\">online at the Medi-Cal website\u003c/a>. But it’s important to remember that the deadline to renew will be different for everyone, says Reyes.\u003c/p>\n\u003cp>The deadline to renew your personal coverage, she says, is based on your Medi-Cal “anniversary”:\u003c/p>\n\u003cul>\n\u003cli>If you had Medi-Cal \u003cstrong>before 2020\u003c/strong>, your anniversary is the date when you last renewed your coverage before the pandemic, but:\u003c/li>\n\u003cli>If you enrolled \u003cstrong>after 2020\u003c/strong> and haven’t gone through the renewal process yet, your anniversary falls on the date you first applied.\u003c/li>\n\u003c/ul>\n\u003cp>Reyes recommends that you confirm the exact date of your coverage anniversary — because you should receive a renewal packet in the mail ahead of this date.\u003c/p>\n\u003cp>\u003cstrong>Option 1: Renew your Medi-Cal coverage by mail\u003c/strong>\u003c/p>\n\u003cp>“As people meet their anniversary date, they’ll be getting these packets,” she says, adding that the packets will include a letter with information specific to your coverage. “This letter will let you know you have X amount of time, from the time you receive the letter, to submit your renewal packet and the documents they are requesting from you.”\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org/health/2023/03/medi-cal-eligibility-2/\">These packets will be going out in phases monthly up through June 2024\u003c/a>, and will include \u003ca href=\"https://www.dhcs.ca.gov/formsandpubs/forms/Forms/mc210rv-eng.pdf\">an annual redetermination form (PDF)\u003c/a> which asks for information about a beneficiary’s income, living situation and disability status, among other factors. You may be asked to submit additional documents depending on your circumstances. You should fill it out and return it as soon as possible, if you don’t plan on renewing your Medi-Cal online (see Option 2).\u003c/p>\n\u003cp>“If, for some reason, your county office doesn’t get the packet by the deadline, they’ll send another reminder letter letting you know they haven’t received your documents,” Reyes said, adding that there may be a \u003cem>third\u003c/em> letter in the mail if a beneficiary misses the second deadline. There should, she assures, be several opportunities for people to be reminded of this deadline. “It’s not going to be a sudden stop of services,” she said.\u003c/p>\n\u003cp>\u003cstrong>Option 2: Renew your Medi-Cal coverage online\u003c/strong>\u003c/p>\n\u003cp>In some cases, you may be able to renew online. In the Bay Area, counties use either one of two renewal portals:\u003c/p>\n\u003cul>\n\u003cli>If you live in Alameda, San Francisco, San Mateo, Solano and Sonoma counties, visit \u003ca href=\"https://www.mybenefitscalwin.org/#/home\">MyBenefitsCalWin\u003c/a> to renew your Medi-Cal.\u003c/li>\n\u003cli>If you live in Contra Costa, Marin, Napa or Santa Clara counties, visit \u003ca href=\"https://benefitscal.com/\">BenefitsCal\u003c/a> to renew your Medi-Cal.\u003c/li>\n\u003c/ul>\n\u003cp>If you live somewhere else in California, \u003ca href=\"https://www.dhcs.ca.gov/Pages/Keep-Your-Medi-Cal.aspx\">see which website your county uses for your to renew your Medi-Cal\u003c/a>.\u003c/p>\n\u003ch2>What if I am found to no longer be eligible for Medi-Cal?\u003c/h2>\n\u003cp>If you don’t renew your Medi-Cal by the deadline (see Options 1 and 2, in the previous section), or are found to no longer be eligible, you’ll be removed from Medi-Cal coverage. And if that happens, you’ll have other options for subsidized health care coverage — but at a cost.\u003c/p>\n\u003cp>Yingjia Huang, assistant deputy director for health care benefits and eligibility at the Department of Health Care Services, told CalMatters that \u003ca href=\"https://calmatters.org/health/2023/03/medi-cal-eligibility-2/\">if you no longer qualify for Medi-Cal because your income has gone up, you’ll be “automatically” transitioned\u003c/a> into a similar plan through Covered California. “The system automatically will review their eligibility for Covered California, and Covered California will send out the enrollment notice to the member, informing them of their options and to pay the plan premium,” said Huang. There’ll be “no administrative burden on a member,” she stressed.\u003c/p>\n\u003cp>But of course, this may come with a new monthly premium that many folks on Medi-Cal haven’t had to pay before — and might not feel able to when factoring in their other expenses.\u003c/p>\n\u003cp>The state emphasizes that \u003ca href=\"https://www.coveredca.com/marketing-blog/health-insurance-costs-less-thanks-to-the-inflation-reduction-act/\">nearly half of people getting health care through Covered California pay less than $50\u003c/a>, while nearly a quarter of people don’t pay a monthly premium at all.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003ch2>What happens if I don’t get my renewal packet in the mail?\u003c/h2>\n\u003cp>Reyes is keen to reiterate that no one will be automatically dropped from their Medi-Cal coverage on April 1. “Starting on that date, people should be on the lookout for these renewal packages that they will need to complete,” she said.\u003c/p>\n\u003cp>If your coverage anniversary rolls around and you have not received a renewal packet, there may be several possibilities to explain why:\u003c/p>\n\u003cul>\n\u003cli>You may have the wrong date on file for your anniversary, or:\u003c/li>\n\u003cli>Your county may be sending the packet to an old address (more likely \u003ca href=\"https://www.sfhsa.org/services/health/medi-cal/renew-your-medi-cal-coverage\">if you moved during the pandemic\u003c/a>).\u003c/li>\n\u003c/ul>\n\u003cp>In either case, you should confirm your information with your county directly. You can do this online:\u003c/p>\n\u003cul>\n\u003cli>If you live in Alameda, San Francisco, San Mateo, Solano and Sonoma counties, visit \u003ca href=\"https://www.mybenefitscalwin.org/#/home\">MyBenefitsCalWin\u003c/a> to update your Medi-Cal contact information.\u003c/li>\n\u003cli>If you live in Contra Costa, Marin, Napa or Santa Clara counties, visit \u003ca href=\"https://benefitscal.com/\">BenefitsCal\u003c/a> to update your Medi-Cal contact information.\u003c/li>\n\u003c/ul>\n\u003cp>You can also contact the office in your county that manages Medi-Cal enrollment. Find your county in the list below.\u003c/p>\n\u003ch2>\u003ca id=\"helpmedicaid\">\u003c/a>Get direct assistance with Medi-Cal and update your contact details\u003c/h2>\n\u003cp>\u003cstrong>Alameda County\u003c/strong>: \u003ca href=\"https://www.alamedacountysocialservices.org/our-services/Health-and-Food/Medi-Cal/index\">Social Services Agency\u003c/a>, 24100 Amador Street, Hayward; call (888) 999-4772.\u003c/p>\n\u003cp>\u003cstrong>Contra Costa County\u003c/strong>: \u003ca href=\"https://ehsd.org/benefits/medi-cal-and-health-coverage-options/\">Employment and Human Services\u003c/a>, multiple addresses; call (866) 663-3225.\u003c/p>\n\u003cp>\u003cstrong>Marin County\u003c/strong>: \u003ca href=\"https://www.marinhhs.org/medi-cal\">Health and Human Services\u003c/a>, 120 N. Redwood Drive, San Rafael; call (877) 410-8817.\u003c/p>\n\u003cp>\u003cstrong>Napa County\u003c/strong>: \u003ca href=\"https://www.countyofnapa.org/3304/Self-Sufficiency-Services\">Health and Human Services\u003c/a>, 2751 Napa Valley Corporate Drive, Napa; call (707) 253-4511.\u003c/p>\n\u003cp>\u003cstrong>San Francisco\u003c/strong>: \u003ca href=\"https://www.sfhsa.org/services/health/medi-cal/renew-your-medi-cal-coverage\">Human Services Agency\u003c/a>, 1440 Harrison Street, San Francisco; call (415) 558-4700.\u003c/p>\n\u003cp>\u003cstrong>San Mateo County\u003c/strong>: \u003ca href=\"https://www.smcgov.org/hsa/health-coverage\">Human Services\u003c/a>, 400 Harbor Boulevard, Building B, Belmont; call (800) 223-8383.\u003c/p>\n\u003cp>\u003cstrong>Santa Clara County\u003c/strong>: \u003ca href=\"https://socialservices.sccgov.org/health-coverage\">Social Services Agency\u003c/a>, 1867 Senter Road, San José; call (408) 758-3800.\u003c/p>\n\u003cp>\u003cstrong>Solano County\u003c/strong>: \u003ca href=\"https://www.solanocounty.com/depts/hss/ees/medical/default.asp\">Health and Social Services\u003c/a>, multiple addresses; call (707) 784-3900.\u003c/p>\n\u003cp>\u003cstrong>Sonoma County\u003c/strong>: \u003ca href=\"https://sonomacounty.ca.gov/health-and-human-services/human-services/divisions-and-services/economic-assistance/health-care-benefits/medi-cal-and-county-medical-services-program\">Department of Human Services\u003c/a>, 2550 Paulin Drive, Santa Rosa, or 5350 Old Redwood Highway, Suite 100, Petaluma; call (877) 699-6868.\u003c/p>\n\u003ch2>Remember, you don’t have to go through this alone\u003c/h2>\n\u003cp>If you are a parent or caregiver and managing a family all by yourself, working multiple jobs or managing a chronic illness, the Medi-Cal renewal process is another item on a long list of responsibilities you are already juggling. You might also be facing \u003ca href=\"https://www.kqed.org/news/11943420/your-calfresh-benefits-will-drop-in-april-heres-what-you-can-do\">a drop in your CalFresh benefits (SNAP, or food stamps)\u003c/a> at the same time as this Medi-Cal renewal, starting in April.\u003c/p>\n\u003cp>Many organizations across California are helping folks send their renewal packets in on time and keep their coverage. One of them is La Clínica de la Raza, which has set up a service that provides individual assistance to Medi-Cal recipients living in Alameda, Contra Costa or Solano counties while completing the renewal requirements.\u003c/p>\n\u003cp>“We don’t want people to lose coverage, especially because preventative services are important — particularly for those who have chronic conditions,” said Reyes, from La Clínica. “We want to make sure that they’re not at risk of losing coverage, not being able to see their provider, not able to refill their prescriptions. So taking action as soon as possible is important.”\u003c/p>\n\u003cp>If you are on Medi-Cal and live in Alameda, Contra Costa or Solano counties, contact La Clínica de la Raza at (855) 494-4658. Help is available in both English and Spanish.\u003c/p>\n\u003cp>Reyes adds that your county’s social services agency is also a helpful resource when navigating the renewal process and some counties have even set up service centers to answer reenrollment questions in person. \u003ca href=\"#helpmedicaid\">Find contact information for your county’s social services agency (above).\u003c/a>\u003c/p>\n\u003ch2>\u003ca id=\"tellus\">\u003c/a>Tell us: What else do you need information about?\u003c/h2>\n\u003cp>At KQED News, we know that it can sometimes be hard to track down the answers to navigate life in the Bay Area in 2023. We’ve published \u003ca href=\"https://www.kqed.org/news/tag/coronavirus-resources-and-explainers\">clear, helpful explainers and guides about issues like COVID\u003c/a>, \u003ca href=\"https://www.kqed.org/news/11936674/how-to-prepare-for-this-weeks-atmospheric-river-storm-sandbags-emergency-kits-and-more\">how to cope with intense winter weather\u003c/a> and \u003ca href=\"https://www.kqed.org/news/11821950/how-to-safely-attend-a-protest-in-the-bay-area\">how to exercise your right to protest safely\u003c/a>.\u003c/p>\n\u003cp>So tell us: What do you need to know more about? Tell us, and you could see your question answered online or on social media. What you submit will make our reporting stronger, and help us decide what to cover here on our site, and on KQED Public Radio, too.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>KQED’s Carly Severn contributed to this story.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "California's Massive Medicaid Program Works for Some, but Fails Many Others",
"headTitle": "California Healthline | KQED News",
"content": "\u003cp>Newborns. Formerly incarcerated people. College students. Pregnant people. People with disabilities. Foster kids. Unhoused people. Single dads.\u003c/p>\n\u003cp>Your neighbor. Your co-worker.\u003c/p>\n\u003cp>You.\u003c/p>\n\u003cp>California’s Medicaid program, called Medi-Cal, serves a whopping 15.4 million people, offering care from cradle to grave: \u003ca href=\"https://www.chcf.org/publication/2021-edition-medi-cal-facts-figures/\">Half of all births are covered by Medi-Cal\u003c/a>, as are more than half of all stays in nursing homes.\u003c/p>\n\u003cp>Everything about Medi-Cal is massive, from its \u003ca href=\"https://ebudget.ca.gov/2023-24/pdf/BudgetSummary/HealthandHumanServices.pdf\">upcoming fiscal year budget of $139 billion (PDF)\u003c/a> to the expansive list of benefits and services it offers. The way the program works — or doesn’t — could spell life or death for many enrollees.\u003c/p>\n\u003cp>“It’s critical, from the single pregnant mom, to the extremely frail elderly population that needs a nursing home,” said Jennifer Kent, former director of the state Department of Health Care Services, which administers Medi-Cal. “If it weren’t for Medi-Cal, so many people would either be dead or would be severely compromised.”\u003c/p>\n\u003cp>In a new series, California Healthline will shed light on Medi-Cal’s successes and failures through the experiences of its enrollees. They include Stephanie Lammers, who can’t get her troubling abdominal symptoms checked at a clinic 50 miles from her small Calaveras County town because the transportation Medi-Cal is supposed to provide isn’t trustworthy; Carolina Morga Tapia, a Fresno woman who credits Medi-Cal with helping her have five healthy children; and Lucas Moreno Ramirez, a Los Angeles County man with stage 4 lung cancer who had to fight to keep his treatment going.\u003c/p>\n\u003cp>Medi-Cal is at a critical juncture as it attempts to serve the needs of a diverse patient population with a dizzying array of medical needs — from childhood vaccinations and cancer screenings to state-of-the-art care for rare genetic disorders. \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/statistics/Documents/FastFacts-March2022.pdf\">Roughly half of enrollees are Hispanic (PDF)\u003c/a>, and, next year, \u003ca href=\"https://californiahealthline.org/news/article/covered-california-bill-undocumented-immigrant-health-insurance/\">California will become the first state to expand eligibility to all immigrants who qualify, regardless of their legal status\u003c/a>.[aside postID=news_11926757 hero='https://ww2.kqed.org/app/uploads/sites/10/2022/09/GettyImages-1340030341.jpg']Medi-Cal is also undertaking several new initiatives that aim to save taxpayer money and improve quality. State \u003ca href=\"https://khn.org/news/article/californias-reboot-of-troubled-medi-cal-puts-pressure-on-health-plans/\">officials are demanding that the 23 health insurers that serve most Medi-Cal patients provide better care\u003c/a> — or face significant penalties, including potential expulsion from the program.\u003c/p>\n\u003cp>The state is also \u003ca href=\"https://khn.org/news/article/california-medicaid-makeover-newsom-california-medi-cal-homeless-public-funds/\">adding innovative social services\u003c/a> that fall outside the traditional realm of medicine, including helping some enrollees pay for rent and buy groceries.\u003c/p>\n\u003cp>“People are watching California,” said Cindy Mann, who served as federal Medicaid director under former President Barack Obama. “What the state is doing is ambitious and very aggressive. It makes a significant mark on health care and health policy, not just because of the size and breadth of its program, but by being very comprehensive.”\u003c/p>\n\u003cp>But only a sliver of enrollees will get the new social services, even as \u003ca href=\"https://khn.org/news/article/california-governor-newsom-pricey-medicaid-reforms-leave-most-patients-behind/\">many patients struggle to obtain basic care\u003c/a> or get in to see their doctors. In reality, the type of care you get in Medi-Cal depends on where you live and which insurer provides your benefits.\u003c/p>\n\u003cp>That means the program is working for some, but failing for many others.\u003c/p>\n\u003cp>If you are in Medi-Cal, \u003ca href=\"https://californiahealthline.org/faces-of-medi-cal-submissions/\">we would like to hear from you\u003c/a>, whether you live in a big city or a rural region, regardless of your age, race or ethnicity, and whatever your medical, dental or mental health condition. Have you had difficulty seeing the right doctor for what ails you, even to the point of putting your life at risk? Or did Medi-Cal provide good care, perhaps sparing you serious harm or disability? Either way, \u003ca href=\"https://californiahealthline.org/faces-of-medi-cal-submissions/\">please consider sharing your experience with us\u003c/a>.\u003c/p>\n\u003cp>Here are snapshots of patients who have used the program at a critical time in their lives.\u003c/p>\n\u003ch2>'I just don't go to the doctor anymore'\u003c/h2>\n\u003cp>When Stephanie Lammers leans over to put on her shoes, it feels as if she’s squishing something inside her abdomen, she said.\u003c/p>\n\u003cp>Lammers, 53, has been suffering from frequent bouts of nausea, pain and bloating for six months.\u003c/p>\n\u003cp>Her gastroenterologist wants to perform diagnostic procedures, including a colonoscopy and, if anything shows up, a biopsy. But Lammers, who lives in a motel with her boyfriend and teenage daughter in the Gold Rush town of San Andreas, doesn’t have a working car and can’t readily get to the clinic — which is 50 miles away.\u003c/p>\n\u003cfigure id=\"attachment_11942519\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942519 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-800x548.jpg\" alt=\"A middle-aged white woman with a long-sleeved shirt with horizontal blue-and-white stripes, with one shoulder pulled down to reveal a tattoo of an eye, looks at the camera as she leans against a door jamb. To her left, a white husky dog looks out from a window.\" width=\"800\" height=\"548\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-800x548.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-1020x699.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-160x110.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-1536x1052.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-2048x1402.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-1920x1315.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Stephanie Lammers says the ride service provided by her Medi-Cal health plan is so bad that she stopped trying to use it about a year ago, after it left her in the lurch multiple times. 'I just don't go to the doctor anymore,' she says. \u003ccite>(Rich Pedroncelli/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For Lammers, like many Medi-Cal enrollees who live in rural areas, lack of transportation is a major impediment to obtaining care. The problem is particularly acute for patients who need to see specialists.\u003c/p>\n\u003cp>Lammers’ dermatologist and eye doctor are over an hour away from San Andreas, the county seat of Calaveras County, about 125 miles northeast of San Francisco. She isn’t seeing a neurologist, despite a series of mini-strokes and stress-related seizures. And she hasn’t been to a podiatrist in two years, even though her toes are twisted over one another and hang down, causing her to trip. She’s often in excruciating pain when she walks.\u003c/p>\n\u003cp>Medi-Cal is supposed to provide \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/Pages/Transportation.aspx\">free transportation to enrollees\u003c/a> who can’t otherwise get to their appointments.\u003c/p>\n\u003cp>But Lammers — whose health plan is California Health and Wellness, owned by Centene, \u003ca href=\"https://khn.org/news/article/centene-political-donations-medicaid-contracts-overbilling-allegations/\">the nation’s largest commercial Medicaid insurer\u003c/a> — stopped using its ride service nearly a year ago, after she missed dozens of appointments because drivers just didn’t show up, she said. She was getting threatening letters from doctors’ offices over the no-shows.\u003c/p>\n\u003cp>Once, she had to hitchhike more than 30 miles home from a counseling appointment. On other occasions, Lammers said, she did not receive the reimbursement she was owed for arranging her own rides.\u003c/p>\n\u003cp>“I just don’t go to the doctor anymore,” Lammers said. “If I go to the doctor, my boyfriend has to take the day off work, and if he takes the day off work, we have no money.”\u003c/p>\n\u003cp>During the last three months of 2022, Lammers canceled five appointments she had scheduled for the diagnostic abdominal procedures because her boyfriend had to work each time and couldn’t take her. She finally stopped rescheduling.\u003c/p>\n\u003cp>California Health and Wellness contracts with ModivCare, a Denver-based medical transportation company that is no stranger to \u003ca href=\"https://khn.org/news/article/medicaid-transportation-nonemergency-benefit-patients-stranded/\">patient complaints and lawsuits\u003c/a>.\u003c/p>\n\u003cp>Before she gave up on the ride service, Lammers said, she would call California Health and Wellness to try to resolve the issue, only to be told that ModivCare was a separate company. “I’m like, ‘If you guys hired them and put them in charge of transportation, who oversees their screwups?,’” she said.\u003c/p>\n\u003cfigure id=\"attachment_11942520\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942520 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-800x614.jpg\" alt=\"A white woman, standing in a crowded room of unmade beds, dishes potatoes onto a plate of biscuits and gravy from a hot plate on a cabinet next to a fridge. \" width=\"800\" height=\"614\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-800x614.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-1020x783.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-160x123.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-1536x1180.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-2048x1573.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-1920x1475.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Stephanie Lammers has serious abdominal symptoms, and her gastroenterologist wants to run diagnostic tests, but she had to cancel five appointments in the last three months of 2022 because she didn't have transportation. \u003ccite>(Rich Pedroncelli/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Courtney Schwyzer, a member of a legal aid team representing Lammers on various Medi-Cal matters, said the failure of medical ride services is a systemic problem. In late February, Schwyzer and her fellow attorneys filed a petition in court that she hopes will force the state Department of Health Care Services to address the problem.\u003c/p>\n\u003cp>California Health and Wellness spokesperson Darrel Ng said the company monitors the quality of its contractors, but a shortage of transportation providers in rural areas “has created unique challenges.”\u003c/p>\n\u003cp>ModivCare provides more than 4 million rides for Medi-Cal recipients annually, and more than 99% are without complaint, said Melody Lai, a company spokesperson.\u003c/p>\n\u003cp>Lammers, who is unemployed and trying to start a custom craft business called Stuff by Steph, said doctors have warned her that if she doesn’t reduce her stress level, it could shorten her life. But arranging medical care is the most stressful thing in her life right now, so she doesn’t try anymore.\u003c/p>\n\u003cp>“In order to keep from dying, I have to not go to the doctor,” she said.\u003c/p>\n\u003ch2>'It's a blessing'\u003c/h2>\n\u003cp>Medi-Cal helped save the life of Carolina Morga Tapia, a 30-year-old full-time mother of five who lives with her family amid almond groves in an agricultural enclave of Fresno.\u003c/p>\n\u003cp>Nine years ago, a bacterial infection triggered premature labor during the 25th week of her second pregnancy, and Morga Tapia almost died. She spiked a fever, bled profusely and needed immediate transfusions and emergency surgery. After several days in critical care, she fully recovered.\u003c/p>\n\u003cfigure id=\"attachment_11942521\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942521 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-800x534.jpg\" alt=\"A Latina woman with a blue cardigan and a black shirt looks at the camera, arms akimbo, standing in a leafless orchard.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-1536x1025.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-2048x1367.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-1920x1281.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Carolina Morga Tapia stands amid almond trees outside her home in Fresno. She, her husband and their five children are enrolled in Medi-Cal, and she says she is very happy with the care it has provided, including emergency surgery that saved her life after she fell gravely ill during her second pregnancy. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But the doctors could not stop the premature birth, and her baby came out weighing just 1 pound. She and her husband, David Nuñez, named her Milagros Guadalupe, and she died four days later, on Sept. 13, 2013.\u003c/p>\n\u003cp>In each of her subsequent pregnancies, Medi-Cal paid for Morga Tapia to get shots of synthetic progesterone, intended to prevent another preterm birth. Those shots — one a week for about 20 weeks — can cost an average of \u003ca href=\"https://www.npr.org/sections/health-shots/2020/01/24/798731110/drug-to-prevent-premature-birth-divides-doctors-insurers-and-fda-experts\">more than $10,000 per pregnancy\u003c/a>.\u003c/p>\n\u003cp>Morga Tapia and Nuñez, a construction worker, signed up for Medi-Cal when she was pregnant with her first child more than a decade ago. They’ve been on the same Anthem Blue Cross Medi-Cal plan ever since.\u003c/p>\n\u003cp>The plan paid for prenatal care through all six of Morga Tapia’s pregnancies, and it has provided all the medical and dental care the family needs, she said.\u003c/p>\n\u003cp>“Without Medi-Cal, we would have to be paying for all of our children,” said Morga Tapia. “It saves a lot of money, and it’s a blessing to have that extra help.”\u003c/p>\n\u003cp>Her children, four girls and a boy, range in age from 1 to 10. They all go to the same children’s clinic and see the same pediatrician.[pullquote align=\"right\" size=\"medium\" citation=\"Carolina Morga Tapia\"]'Without Medi-Cal, we would have to be paying for all of our children. It saves a lot of money, and it's a blessing to have that extra help.'[/pullquote]The kids, all in good health, get routine checkups, vaccinations and other preventive care, Morga Tapia said. She gets appointment reminders via text and cards in the mail notifying her when it’s time for the kids’ vaccinations and wellness checks, as well as her Pap smears, she said.\u003c/p>\n\u003cp>Her family’s experience contrasts sharply with the state’s assessment of their health plan, according to a \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/reports/Documents/Enhancing-Quality-for-Medi-Cal-Members.pdf\">report on quality of care in Medi-Cal issued late last year (PDF)\u003c/a>. The report, which evaluated Medi-Cal health plans on pediatric care, women’s health and chronic disease management, put Anthem Blue Cross in the lowest tier, and below par on multiple measures in numerous counties, including Fresno.\u003c/p>\n\u003cp>Another state report, released in late January, detailed how quickly insurers provide appointments for their patients, and put \u003ca href=\"https://www.dmhc.ca.gov/Portals/0/Docs/OPM/MY2021TAR.pdf\">Anthem Blue Cross’ Medi-Cal plan near the bottom of the heap (PDF)\u003c/a>.\u003c/p>\n\u003cp>Anthem Blue Cross spokesperson Michael Bowman said in a statement that the period covered in the reports coincide with the COVID-19 pandemic, “when our safety net providers dealt with significant challenges with workforce and appointment availability.”\u003c/p>\n\u003cp>Morga Tapia doesn’t give the insurer low marks. “It’s different for everybody. I have a good, healthy family, and what Medi-Cal covers is really fortunate for us,” she said.\u003c/p>\n\u003ch2>'I don't want to die yet'\u003c/h2>\n\u003cp>In late 2021, doctors gave Lucas Moreno Ramirez a few months to live.\u003c/p>\n\u003cp>Struggling with diabetes and late-stage lung cancer, Moreno Ramirez suffered debilitating pain as he hacked and labored for breath. His doctors recommended that he stop treatment and start hospice care.\u003c/p>\n\u003cp>He felt as if they were giving up on him.\u003c/p>\n\u003cp>“They said they’re going to give me opioids for my pain and help me have a comfortable death,” said Moreno Ramirez, 68, who lives in Norwalk, in Los Angeles County. “I told them I don’t believe in that. I don’t want to die yet.”\u003c/p>\n\u003cfigure id=\"attachment_11942525\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942525 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-800x534.jpg\" alt=\"A middle-aged Latino man, with a bushy gray mustache and thick gray hair combed back from his forehead, sits at a long table along a wall, on the other side of which a gauzy white curtain blows inward. He rests his right arm on the table, holding a blue-and-white mug. He looks at the camera, and is surrounded by cabinets with CDs, a massive water bottle, salt-and-pepper shakers, a clock on the wall and a nearby wind chime, and other homey detritus.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-1536x1025.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-2048x1367.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-1920x1281.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Lucas Moreno Ramirez, a former landscaper and factory worker, has been diagnosed with both diabetes and lung cancer. Working alongside a care manager through his Medi-Cal managed-care plan, he has fought for better care and treatment for both conditions. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A former landscaper and factory worker, Moreno Ramirez learned he had to be his own advocate, fighting for the care he believed he deserved from Medi-Cal.\u003c/p>\n\u003cp>He said his Christian faith gave him strength, and over the next few months, he pushed the program and his doctors to keep battling his cancer, using a different treatment with fewer side effects than chemotherapy.\u003c/p>\n\u003cp>“I believe in prayer,” he said. “But I believe in science and medication, too.”\u003c/p>\n\u003cp>Moreno Ramirez is one of the \u003ca href=\"https://www.chcf.org/publication/in-alignment-calaims-plan-coordinate-care-dual-enrollees-medicare-medi-cal/\">roughly 1.6 million Californians enrolled in both Medicare, which covers people who are 65 and older or have disabilities, and Medi-Cal\u003c/a>, which \u003ca href=\"https://www.kff.org/medicare/issue-brief/a-profile-of-medicare-medicaid-enrollees-dual-eligibles/?utm_campaign=KFF-2023-Medicaid&utm_medium=email&_hsmi=243959452&_hsenc=p2ANqtz--_YdJIpoiPQ6BsTqKV7XWKRpOoR_sJTFFsZI7MrJWw-BvXTcEh0PRgAq42XpbIvOpISMXOG8GW_lDUH-w2IgL2Syf6YA&utm_content=243959452&utm_source=hs_email\">kicks in to cover the costs and benefits that Medicare doesn’t\u003c/a>.\u003c/p>\n\u003cp>He also relies on his Medi-Cal insurer to help him navigate the Byzantine system. L.A. Care, the largest Medi-Cal plan with nearly 2.6 million members, connected him with a care manager who worked with him to identify \u003ca href=\"https://www.cancer.gov/publications/dictionaries/cancer-terms/def/tagrisso\">a different treatment called Tagrisso\u003c/a> and advocated for him to get it.[aside label=\"Related Stories\" postID=\"news_11940023,news_11941075,news_1981588\"]Even with the new medication, Moreno Ramirez’s coughing fits returned last year, and his symptoms grew so painful he suspected the cancer was growing. He asked to see his pulmonologist but was told the first appointment would be in June 2023. So he switched doctors and scored an appointment nearly six months sooner.\u003c/p>\n\u003cp>“My old doctor didn’t help me. I didn’t trust him,” Moreno Ramirez said. “He was always too busy for me. I told my doctors, ‘Give me a chance.’”\u003c/p>\n\u003cp>Having taken his care into his own hands, he says he’s not in pain, his cough has subsided and he feels hopeful for the future. “Now I feel good,” he said.\u003c/p>\n\u003cp>He has also sought more attention for his diabetes and received a continuous glucose monitor to measure his blood sugar. It’s better controlled now than it has been in decades, he said.\u003c/p>\n\u003cp>“You have to stand up for yourself and advocate,” said Joann Pacelo, the care manager who helped Moreno Ramirez change doctors, get quicker referrals to specialists and get approved for in-home nursing visits.\u003c/p>\n\u003cp>“A lot of times, it’s difficult with Medi-Cal because the doctors are busy and the reimbursements are so low, but no one should be denied the care they deserve.”\u003c/p>\n\u003cp>\u003cem>California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Serving over 15 million people and with an annual budget of $139 billion, California's massive Medicaid program — Medi-Cal — is at a critical juncture as it attempts to serve the needs of a diverse patient population with a dizzying array of medical needs.",
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"nprByline": "\u003ca href=\"https://californiahealthline.org/news/author/angela-hart/\">Angela Hart\u003c/a> and \u003ca href=\"https://californiahealthline.org/news/author/bernard-j-wolfson/\">Bernard J. Wolfson\u003c/a>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Newborns. Formerly incarcerated people. College students. Pregnant people. People with disabilities. Foster kids. Unhoused people. Single dads.\u003c/p>\n\u003cp>Your neighbor. Your co-worker.\u003c/p>\n\u003cp>You.\u003c/p>\n\u003cp>California’s Medicaid program, called Medi-Cal, serves a whopping 15.4 million people, offering care from cradle to grave: \u003ca href=\"https://www.chcf.org/publication/2021-edition-medi-cal-facts-figures/\">Half of all births are covered by Medi-Cal\u003c/a>, as are more than half of all stays in nursing homes.\u003c/p>\n\u003cp>Everything about Medi-Cal is massive, from its \u003ca href=\"https://ebudget.ca.gov/2023-24/pdf/BudgetSummary/HealthandHumanServices.pdf\">upcoming fiscal year budget of $139 billion (PDF)\u003c/a> to the expansive list of benefits and services it offers. The way the program works — or doesn’t — could spell life or death for many enrollees.\u003c/p>\n\u003cp>“It’s critical, from the single pregnant mom, to the extremely frail elderly population that needs a nursing home,” said Jennifer Kent, former director of the state Department of Health Care Services, which administers Medi-Cal. “If it weren’t for Medi-Cal, so many people would either be dead or would be severely compromised.”\u003c/p>\n\u003cp>In a new series, California Healthline will shed light on Medi-Cal’s successes and failures through the experiences of its enrollees. They include Stephanie Lammers, who can’t get her troubling abdominal symptoms checked at a clinic 50 miles from her small Calaveras County town because the transportation Medi-Cal is supposed to provide isn’t trustworthy; Carolina Morga Tapia, a Fresno woman who credits Medi-Cal with helping her have five healthy children; and Lucas Moreno Ramirez, a Los Angeles County man with stage 4 lung cancer who had to fight to keep his treatment going.\u003c/p>\n\u003cp>Medi-Cal is at a critical juncture as it attempts to serve the needs of a diverse patient population with a dizzying array of medical needs — from childhood vaccinations and cancer screenings to state-of-the-art care for rare genetic disorders. \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/statistics/Documents/FastFacts-March2022.pdf\">Roughly half of enrollees are Hispanic (PDF)\u003c/a>, and, next year, \u003ca href=\"https://californiahealthline.org/news/article/covered-california-bill-undocumented-immigrant-health-insurance/\">California will become the first state to expand eligibility to all immigrants who qualify, regardless of their legal status\u003c/a>.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Medi-Cal is also undertaking several new initiatives that aim to save taxpayer money and improve quality. State \u003ca href=\"https://khn.org/news/article/californias-reboot-of-troubled-medi-cal-puts-pressure-on-health-plans/\">officials are demanding that the 23 health insurers that serve most Medi-Cal patients provide better care\u003c/a> — or face significant penalties, including potential expulsion from the program.\u003c/p>\n\u003cp>The state is also \u003ca href=\"https://khn.org/news/article/california-medicaid-makeover-newsom-california-medi-cal-homeless-public-funds/\">adding innovative social services\u003c/a> that fall outside the traditional realm of medicine, including helping some enrollees pay for rent and buy groceries.\u003c/p>\n\u003cp>“People are watching California,” said Cindy Mann, who served as federal Medicaid director under former President Barack Obama. “What the state is doing is ambitious and very aggressive. It makes a significant mark on health care and health policy, not just because of the size and breadth of its program, but by being very comprehensive.”\u003c/p>\n\u003cp>But only a sliver of enrollees will get the new social services, even as \u003ca href=\"https://khn.org/news/article/california-governor-newsom-pricey-medicaid-reforms-leave-most-patients-behind/\">many patients struggle to obtain basic care\u003c/a> or get in to see their doctors. In reality, the type of care you get in Medi-Cal depends on where you live and which insurer provides your benefits.\u003c/p>\n\u003cp>That means the program is working for some, but failing for many others.\u003c/p>\n\u003cp>If you are in Medi-Cal, \u003ca href=\"https://californiahealthline.org/faces-of-medi-cal-submissions/\">we would like to hear from you\u003c/a>, whether you live in a big city or a rural region, regardless of your age, race or ethnicity, and whatever your medical, dental or mental health condition. Have you had difficulty seeing the right doctor for what ails you, even to the point of putting your life at risk? Or did Medi-Cal provide good care, perhaps sparing you serious harm or disability? Either way, \u003ca href=\"https://californiahealthline.org/faces-of-medi-cal-submissions/\">please consider sharing your experience with us\u003c/a>.\u003c/p>\n\u003cp>Here are snapshots of patients who have used the program at a critical time in their lives.\u003c/p>\n\u003ch2>'I just don't go to the doctor anymore'\u003c/h2>\n\u003cp>When Stephanie Lammers leans over to put on her shoes, it feels as if she’s squishing something inside her abdomen, she said.\u003c/p>\n\u003cp>Lammers, 53, has been suffering from frequent bouts of nausea, pain and bloating for six months.\u003c/p>\n\u003cp>Her gastroenterologist wants to perform diagnostic procedures, including a colonoscopy and, if anything shows up, a biopsy. But Lammers, who lives in a motel with her boyfriend and teenage daughter in the Gold Rush town of San Andreas, doesn’t have a working car and can’t readily get to the clinic — which is 50 miles away.\u003c/p>\n\u003cfigure id=\"attachment_11942519\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942519 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-800x548.jpg\" alt=\"A middle-aged white woman with a long-sleeved shirt with horizontal blue-and-white stripes, with one shoulder pulled down to reveal a tattoo of an eye, looks at the camera as she leans against a door jamb. To her left, a white husky dog looks out from a window.\" width=\"800\" height=\"548\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-800x548.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-1020x699.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-160x110.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-1536x1052.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-2048x1402.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_04-1920x1315.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Stephanie Lammers says the ride service provided by her Medi-Cal health plan is so bad that she stopped trying to use it about a year ago, after it left her in the lurch multiple times. 'I just don't go to the doctor anymore,' she says. \u003ccite>(Rich Pedroncelli/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For Lammers, like many Medi-Cal enrollees who live in rural areas, lack of transportation is a major impediment to obtaining care. The problem is particularly acute for patients who need to see specialists.\u003c/p>\n\u003cp>Lammers’ dermatologist and eye doctor are over an hour away from San Andreas, the county seat of Calaveras County, about 125 miles northeast of San Francisco. She isn’t seeing a neurologist, despite a series of mini-strokes and stress-related seizures. And she hasn’t been to a podiatrist in two years, even though her toes are twisted over one another and hang down, causing her to trip. She’s often in excruciating pain when she walks.\u003c/p>\n\u003cp>Medi-Cal is supposed to provide \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/Pages/Transportation.aspx\">free transportation to enrollees\u003c/a> who can’t otherwise get to their appointments.\u003c/p>\n\u003cp>But Lammers — whose health plan is California Health and Wellness, owned by Centene, \u003ca href=\"https://khn.org/news/article/centene-political-donations-medicaid-contracts-overbilling-allegations/\">the nation’s largest commercial Medicaid insurer\u003c/a> — stopped using its ride service nearly a year ago, after she missed dozens of appointments because drivers just didn’t show up, she said. She was getting threatening letters from doctors’ offices over the no-shows.\u003c/p>\n\u003cp>Once, she had to hitchhike more than 30 miles home from a counseling appointment. On other occasions, Lammers said, she did not receive the reimbursement she was owed for arranging her own rides.\u003c/p>\n\u003cp>“I just don’t go to the doctor anymore,” Lammers said. “If I go to the doctor, my boyfriend has to take the day off work, and if he takes the day off work, we have no money.”\u003c/p>\n\u003cp>During the last three months of 2022, Lammers canceled five appointments she had scheduled for the diagnostic abdominal procedures because her boyfriend had to work each time and couldn’t take her. She finally stopped rescheduling.\u003c/p>\n\u003cp>California Health and Wellness contracts with ModivCare, a Denver-based medical transportation company that is no stranger to \u003ca href=\"https://khn.org/news/article/medicaid-transportation-nonemergency-benefit-patients-stranded/\">patient complaints and lawsuits\u003c/a>.\u003c/p>\n\u003cp>Before she gave up on the ride service, Lammers said, she would call California Health and Wellness to try to resolve the issue, only to be told that ModivCare was a separate company. “I’m like, ‘If you guys hired them and put them in charge of transportation, who oversees their screwups?,’” she said.\u003c/p>\n\u003cfigure id=\"attachment_11942520\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942520 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-800x614.jpg\" alt=\"A white woman, standing in a crowded room of unmade beds, dishes potatoes onto a plate of biscuits and gravy from a hot plate on a cabinet next to a fridge. \" width=\"800\" height=\"614\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-800x614.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-1020x783.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-160x123.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-1536x1180.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-2048x1573.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/Lammers_09-1920x1475.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Stephanie Lammers has serious abdominal symptoms, and her gastroenterologist wants to run diagnostic tests, but she had to cancel five appointments in the last three months of 2022 because she didn't have transportation. \u003ccite>(Rich Pedroncelli/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Courtney Schwyzer, a member of a legal aid team representing Lammers on various Medi-Cal matters, said the failure of medical ride services is a systemic problem. In late February, Schwyzer and her fellow attorneys filed a petition in court that she hopes will force the state Department of Health Care Services to address the problem.\u003c/p>\n\u003cp>California Health and Wellness spokesperson Darrel Ng said the company monitors the quality of its contractors, but a shortage of transportation providers in rural areas “has created unique challenges.”\u003c/p>\n\u003cp>ModivCare provides more than 4 million rides for Medi-Cal recipients annually, and more than 99% are without complaint, said Melody Lai, a company spokesperson.\u003c/p>\n\u003cp>Lammers, who is unemployed and trying to start a custom craft business called Stuff by Steph, said doctors have warned her that if she doesn’t reduce her stress level, it could shorten her life. But arranging medical care is the most stressful thing in her life right now, so she doesn’t try anymore.\u003c/p>\n\u003cp>“In order to keep from dying, I have to not go to the doctor,” she said.\u003c/p>\n\u003ch2>'It's a blessing'\u003c/h2>\n\u003cp>Medi-Cal helped save the life of Carolina Morga Tapia, a 30-year-old full-time mother of five who lives with her family amid almond groves in an agricultural enclave of Fresno.\u003c/p>\n\u003cp>Nine years ago, a bacterial infection triggered premature labor during the 25th week of her second pregnancy, and Morga Tapia almost died. She spiked a fever, bled profusely and needed immediate transfusions and emergency surgery. After several days in critical care, she fully recovered.\u003c/p>\n\u003cfigure id=\"attachment_11942521\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942521 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-800x534.jpg\" alt=\"A Latina woman with a blue cardigan and a black shirt looks at the camera, arms akimbo, standing in a leafless orchard.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-1536x1025.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-2048x1367.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/carolina_tapia-2-1920x1281.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Carolina Morga Tapia stands amid almond trees outside her home in Fresno. She, her husband and their five children are enrolled in Medi-Cal, and she says she is very happy with the care it has provided, including emergency surgery that saved her life after she fell gravely ill during her second pregnancy. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But the doctors could not stop the premature birth, and her baby came out weighing just 1 pound. She and her husband, David Nuñez, named her Milagros Guadalupe, and she died four days later, on Sept. 13, 2013.\u003c/p>\n\u003cp>In each of her subsequent pregnancies, Medi-Cal paid for Morga Tapia to get shots of synthetic progesterone, intended to prevent another preterm birth. Those shots — one a week for about 20 weeks — can cost an average of \u003ca href=\"https://www.npr.org/sections/health-shots/2020/01/24/798731110/drug-to-prevent-premature-birth-divides-doctors-insurers-and-fda-experts\">more than $10,000 per pregnancy\u003c/a>.\u003c/p>\n\u003cp>Morga Tapia and Nuñez, a construction worker, signed up for Medi-Cal when she was pregnant with her first child more than a decade ago. They’ve been on the same Anthem Blue Cross Medi-Cal plan ever since.\u003c/p>\n\u003cp>The plan paid for prenatal care through all six of Morga Tapia’s pregnancies, and it has provided all the medical and dental care the family needs, she said.\u003c/p>\n\u003cp>“Without Medi-Cal, we would have to be paying for all of our children,” said Morga Tapia. “It saves a lot of money, and it’s a blessing to have that extra help.”\u003c/p>\n\u003cp>Her children, four girls and a boy, range in age from 1 to 10. They all go to the same children’s clinic and see the same pediatrician.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The kids, all in good health, get routine checkups, vaccinations and other preventive care, Morga Tapia said. She gets appointment reminders via text and cards in the mail notifying her when it’s time for the kids’ vaccinations and wellness checks, as well as her Pap smears, she said.\u003c/p>\n\u003cp>Her family’s experience contrasts sharply with the state’s assessment of their health plan, according to a \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/reports/Documents/Enhancing-Quality-for-Medi-Cal-Members.pdf\">report on quality of care in Medi-Cal issued late last year (PDF)\u003c/a>. The report, which evaluated Medi-Cal health plans on pediatric care, women’s health and chronic disease management, put Anthem Blue Cross in the lowest tier, and below par on multiple measures in numerous counties, including Fresno.\u003c/p>\n\u003cp>Another state report, released in late January, detailed how quickly insurers provide appointments for their patients, and put \u003ca href=\"https://www.dmhc.ca.gov/Portals/0/Docs/OPM/MY2021TAR.pdf\">Anthem Blue Cross’ Medi-Cal plan near the bottom of the heap (PDF)\u003c/a>.\u003c/p>\n\u003cp>Anthem Blue Cross spokesperson Michael Bowman said in a statement that the period covered in the reports coincide with the COVID-19 pandemic, “when our safety net providers dealt with significant challenges with workforce and appointment availability.”\u003c/p>\n\u003cp>Morga Tapia doesn’t give the insurer low marks. “It’s different for everybody. I have a good, healthy family, and what Medi-Cal covers is really fortunate for us,” she said.\u003c/p>\n\u003ch2>'I don't want to die yet'\u003c/h2>\n\u003cp>In late 2021, doctors gave Lucas Moreno Ramirez a few months to live.\u003c/p>\n\u003cp>Struggling with diabetes and late-stage lung cancer, Moreno Ramirez suffered debilitating pain as he hacked and labored for breath. His doctors recommended that he stop treatment and start hospice care.\u003c/p>\n\u003cp>He felt as if they were giving up on him.\u003c/p>\n\u003cp>“They said they’re going to give me opioids for my pain and help me have a comfortable death,” said Moreno Ramirez, 68, who lives in Norwalk, in Los Angeles County. “I told them I don’t believe in that. I don’t want to die yet.”\u003c/p>\n\u003cfigure id=\"attachment_11942525\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11942525 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-800x534.jpg\" alt=\"A middle-aged Latino man, with a bushy gray mustache and thick gray hair combed back from his forehead, sits at a long table along a wall, on the other side of which a gauzy white curtain blows inward. He rests his right arm on the table, holding a blue-and-white mug. He looks at the camera, and is surrounded by cabinets with CDs, a massive water bottle, salt-and-pepper shakers, a clock on the wall and a nearby wind chime, and other homey detritus.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-1536x1025.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-2048x1367.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2023/03/lucas_ramirez-3-1920x1281.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Lucas Moreno Ramirez, a former landscaper and factory worker, has been diagnosed with both diabetes and lung cancer. Working alongside a care manager through his Medi-Cal managed-care plan, he has fought for better care and treatment for both conditions. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A former landscaper and factory worker, Moreno Ramirez learned he had to be his own advocate, fighting for the care he believed he deserved from Medi-Cal.\u003c/p>\n\u003cp>He said his Christian faith gave him strength, and over the next few months, he pushed the program and his doctors to keep battling his cancer, using a different treatment with fewer side effects than chemotherapy.\u003c/p>\n\u003cp>“I believe in prayer,” he said. “But I believe in science and medication, too.”\u003c/p>\n\u003cp>Moreno Ramirez is one of the \u003ca href=\"https://www.chcf.org/publication/in-alignment-calaims-plan-coordinate-care-dual-enrollees-medicare-medi-cal/\">roughly 1.6 million Californians enrolled in both Medicare, which covers people who are 65 and older or have disabilities, and Medi-Cal\u003c/a>, which \u003ca href=\"https://www.kff.org/medicare/issue-brief/a-profile-of-medicare-medicaid-enrollees-dual-eligibles/?utm_campaign=KFF-2023-Medicaid&utm_medium=email&_hsmi=243959452&_hsenc=p2ANqtz--_YdJIpoiPQ6BsTqKV7XWKRpOoR_sJTFFsZI7MrJWw-BvXTcEh0PRgAq42XpbIvOpISMXOG8GW_lDUH-w2IgL2Syf6YA&utm_content=243959452&utm_source=hs_email\">kicks in to cover the costs and benefits that Medicare doesn’t\u003c/a>.\u003c/p>\n\u003cp>He also relies on his Medi-Cal insurer to help him navigate the Byzantine system. L.A. Care, the largest Medi-Cal plan with nearly 2.6 million members, connected him with a care manager who worked with him to identify \u003ca href=\"https://www.cancer.gov/publications/dictionaries/cancer-terms/def/tagrisso\">a different treatment called Tagrisso\u003c/a> and advocated for him to get it.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Even with the new medication, Moreno Ramirez’s coughing fits returned last year, and his symptoms grew so painful he suspected the cancer was growing. He asked to see his pulmonologist but was told the first appointment would be in June 2023. So he switched doctors and scored an appointment nearly six months sooner.\u003c/p>\n\u003cp>“My old doctor didn’t help me. I didn’t trust him,” Moreno Ramirez said. “He was always too busy for me. I told my doctors, ‘Give me a chance.’”\u003c/p>\n\u003cp>Having taken his care into his own hands, he says he’s not in pain, his cough has subsided and he feels hopeful for the future. “Now I feel good,” he said.\u003c/p>\n\u003cp>He has also sought more attention for his diabetes and received a continuous glucose monitor to measure his blood sugar. It’s better controlled now than it has been in decades, he said.\u003c/p>\n\u003cp>“You have to stand up for yourself and advocate,” said Joann Pacelo, the care manager who helped Moreno Ramirez change doctors, get quicker referrals to specialists and get approved for in-home nursing visits.\u003c/p>\n\u003cp>“A lot of times, it’s difficult with Medi-Cal because the doctors are busy and the reimbursements are so low, but no one should be denied the care they deserve.”\u003c/p>\n\u003cp>\u003cem>California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Federal regulators have agreed to continue to hold off on patient discharges and transfers out of Laguna Honda Hospital and Rehabilitation Center until at least May 19, 2023, San Francisco officials confirmed on Wednesday.\u003c/p>\n\u003cp>The reprieve comes just one day ahead of when the pause on patient transfers was set to expire.\u003c/p>\n\u003cp>“The transfers and discharge of residents has been arduous as many have complex healthcare needs, and Laguna Honda and City leadership have strongly advocated against the involuntary transfers,” a statement released Wednesday from Laguna Honda officials reads. “The vast majority of residents and their families are fighting to remain at Laguna Honda and this continued reprieve of involuntary transfers provides stability, continuity of care, and short-term relief.”\u003c/p>\n\u003cp>City leaders, residents and their loved ones celebrated the decision.\u003c/p>\n\u003cp>“Laguna Honda is a critical part of San Francisco’s ability to care for our most vulnerable residents and is essential to the future of our city,” said Mayor London Breed, whose grandmother lived the final years of her life at Laguna Honda. “We appreciate that CMS has agreed to continue this pause of transfers from Laguna Honda while we work collaboratively towards recertification,” she said, referring to the regulatory body, the Centers for Medicare and Medicaid Services.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Joe Urban, whose mother-in-law was a resident at Laguna Honda, said CMS “did the right thing.”\u003c/p>\n\u003cp>“Restarting the discharges would have killed a lot of San Franciscans,” Urban said. “There’s no need to do it if Laguna Honda is making progress towards recertification.”\u003c/p>\n\u003cp>But relief may be temporary. The hospital is still working to regain certification with CMS to participate in government-subsidized health care plans like Medicare and Medi-Cal, which cover the majority of patients at Laguna Honda.\u003c/p>\n\u003cp>“I’m worried that May will be here before you know it and we will go through this again,” said Tony Chicotel, staff attorney with California Advocates for Nursing Home Reform. “With each extension, [another extension] become increasingly unlikely, and at some point I think it will stop happening.”\u003c/p>\n\u003cp>[aside label='Related Coverage' tag='laguna-honda-hospital']In April 2022, CMS decertified Laguna Honda after a series of inspections found the hospital out of compliance with safety measures for a skilled nursing facility. The hospital was then required to create and implement a closure plan, which included transferring or discharging all of its residents by September 2022.\u003c/p>\n\u003cp>The hospital, city leaders and senior advocates pushed hard against the transfers, citing how it can be physically and emotionally traumatic for older people and people with disabilities to be uprooted.\u003c/p>\n\u003cp>Laguna Honda transferred 41 residents to other skilled nursing facilities and discharged an additional 16 residents. Of those, 12 people died — eight of them within weeks, and four within months, of leaving Laguna Honda.\u003c/p>\n\u003cp>After reports came in that some residents had died after being transferred, San Francisco sued the federal government for failing to provide adequate time to repeal the original citations.\u003c/p>\n\u003cp>The city and CMS came to an agreement in July 2022 to pause transfers until Feb. 2, 2023.\u003c/p>\n\u003cp>The hospital maintains that it is working to prepare for recertification in the meantime.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“This is the humane and compassionate thing to do for the residents of Laguna Honda, their families and staff,” said San Francisco City Attorney David Chiu. “We certainly hope we don’t cut things as close next time. I know that the staff at Laguna Honda will work and do everything they can to address the issues and get us to that recertification. Our hope is we aren’t in this place again.”\u003c/p>\n\n",
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"excerpt": "San Francisco officials had raised alarm bells about having to resume relocating the hospital's more than 550 remaining patients, many of whom are elderly and lower-income, to other facilities as early as Friday.\r\n",
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"title": "Feds Grant Reprieve on Laguna Honda Patient Transfers Until May | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Federal regulators have agreed to continue to hold off on patient discharges and transfers out of Laguna Honda Hospital and Rehabilitation Center until at least May 19, 2023, San Francisco officials confirmed on Wednesday.\u003c/p>\n\u003cp>The reprieve comes just one day ahead of when the pause on patient transfers was set to expire.\u003c/p>\n\u003cp>“The transfers and discharge of residents has been arduous as many have complex healthcare needs, and Laguna Honda and City leadership have strongly advocated against the involuntary transfers,” a statement released Wednesday from Laguna Honda officials reads. “The vast majority of residents and their families are fighting to remain at Laguna Honda and this continued reprieve of involuntary transfers provides stability, continuity of care, and short-term relief.”\u003c/p>\n\u003cp>City leaders, residents and their loved ones celebrated the decision.\u003c/p>\n\u003cp>“Laguna Honda is a critical part of San Francisco’s ability to care for our most vulnerable residents and is essential to the future of our city,” said Mayor London Breed, whose grandmother lived the final years of her life at Laguna Honda. “We appreciate that CMS has agreed to continue this pause of transfers from Laguna Honda while we work collaboratively towards recertification,” she said, referring to the regulatory body, the Centers for Medicare and Medicaid Services.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Joe Urban, whose mother-in-law was a resident at Laguna Honda, said CMS “did the right thing.”\u003c/p>\n\u003cp>“Restarting the discharges would have killed a lot of San Franciscans,” Urban said. “There’s no need to do it if Laguna Honda is making progress towards recertification.”\u003c/p>\n\u003cp>But relief may be temporary. The hospital is still working to regain certification with CMS to participate in government-subsidized health care plans like Medicare and Medi-Cal, which cover the majority of patients at Laguna Honda.\u003c/p>\n\u003cp>“I’m worried that May will be here before you know it and we will go through this again,” said Tony Chicotel, staff attorney with California Advocates for Nursing Home Reform. “With each extension, [another extension] become increasingly unlikely, and at some point I think it will stop happening.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>In April 2022, CMS decertified Laguna Honda after a series of inspections found the hospital out of compliance with safety measures for a skilled nursing facility. The hospital was then required to create and implement a closure plan, which included transferring or discharging all of its residents by September 2022.\u003c/p>\n\u003cp>The hospital, city leaders and senior advocates pushed hard against the transfers, citing how it can be physically and emotionally traumatic for older people and people with disabilities to be uprooted.\u003c/p>\n\u003cp>Laguna Honda transferred 41 residents to other skilled nursing facilities and discharged an additional 16 residents. Of those, 12 people died — eight of them within weeks, and four within months, of leaving Laguna Honda.\u003c/p>\n\u003cp>After reports came in that some residents had died after being transferred, San Francisco sued the federal government for failing to provide adequate time to repeal the original citations.\u003c/p>\n\u003cp>The city and CMS came to an agreement in July 2022 to pause transfers until Feb. 2, 2023.\u003c/p>\n\u003cp>The hospital maintains that it is working to prepare for recertification in the meantime.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“This is the humane and compassionate thing to do for the residents of Laguna Honda, their families and staff,” said San Francisco City Attorney David Chiu. “We certainly hope we don’t cut things as close next time. I know that the staff at Laguna Honda will work and do everything they can to address the issues and get us to that recertification. Our hope is we aren’t in this place again.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "'Down to the Wire Again': SF Officials Blast Feds for Silence on Laguna Honda Patient-Transfer Decision, Just Days Before Deadline",
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"content": "\u003cp>\u003cstrong>Update, 6 p.m. Tuesday: \u003c/strong>Federal officials have yet to say whether they will allow San Francisco to continue postponing the transfer of hundreds of Laguna Honda Hospital patients to other skilled nursing facilities, frustrated city leaders said Tuesday.[pullquote align=\"right\" size=\"medium\" citation=\"San Francisco Supervisor Myrna Melgar\"]‘It is entirely possible that on Friday, Feb. 3, hundreds of San Franciscans residing at Laguna Honda will face the trauma of possible relocation again from being discharged.’[/pullquote]\u003c/p>\n\u003cp>The clock is ticking. If the Biden administration rejects the city’s requests to continue halting transfers, the hospital could be required to resume relocating its more than 550 remaining patients, many of whom are elderly and lower-income, to other skilled nursing facilities as early as Friday.\u003c/p>\n\u003cp>“It is entirely possible that on Friday, Feb. 3, hundreds of San Franciscans residing at Laguna Honda will face the trauma of possible relocation again from being discharged,” San Francisco Supervisor Myrna Melgar, whose district includes the hospital, said at Tuesday’s Board of Supervisors hearing. “The rigid bureaucracy of the U.S. government has put us into this position.”\u003c/p>\n\u003cp>Hospital officials have said they have no plans to resume transferring patients unless compelled to do so. Twelve of the 57 patients who were initially transferred from the hospital last summer — some of whom had dementia and limited physical and cognitive ability — died within weeks or months of being relocated.\u003c/p>\n\u003cp>“Laguna Honda strongly advocated against these transfers. We warned CMS (the Center for Medicare and Medicaid Services) that the four-month deadline to transfer nearly 700 residents to other facilities was entirely insufficient given the complex nature of our resident population and the lack of available beds at SNFs (skilled nursing facilities) anywhere in the region or the state,” hospital officials said in a public statement earlier this month in response to regulatory citations it received following the deaths of the transferred patients.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Roland Pickens, Laguna Honda’s interim CEO, said he is hopeful the current pause on patient transfers will be extended, allowing the hospital to continue working to address deficiencies cited by state and federal regulators.\u003c/p>\n\u003cp>At Tuesday’s hearing, other San Francisco leaders blasted federal officials for so far failing to respond to the city’s extension request, just days before the hospital could be required to resume patient transfers.\u003c/p>\n\u003cp>“This is a powerful and unaccountable bureaucracy,” Supervisor Rafael Mandelman said. “They [CMS] have done significant harm. They have created a ton of stress and anxiety for hundreds more people.”\u003c/p>\n\u003cp>\u003cstrong>Original story, 6 a.m. Tuesday: \u003c/strong>San Francisco officials are expected to find out this week whether federal regulators will allow the city to continue postponing the transfer of patients out of Laguna Honda Hospital.\u003c/p>\n\u003cp>An extension would allow patients and their families to breathe a temporary sigh of relief, just days before the recently decertified hospital could be required to resume relocating its more than 550 remaining charges.\u003c/p>\n\u003cp>\u003ca href=\"https://www.kqed.org/news/11920121/sf-officials-outraged-over-laguna-honda-patient-deaths-following-federally-mandated-transfers\">Regulators paused their initial transfer requirement\u003c/a> in July 2022, after reports that some of the 57 patients who had initially been moved from the hospital had died. In total, 12 former patients are confirmed to have died, nearly all of whom had been transferred last year to other skilled nursing facilities.\u003c/p>\n\u003cp>San Francisco City Attorney David Chiu is now requesting that the pause on transfers extend until at least May 30, 2023, and the status of the relocation plan is scheduled to be addressed at a Board of Supervisors hearing on Tuesday afternoon.\u003c/p>\n\u003cp>“There is a moral and ethical imperative to not continue the transfers,” said Joseph Urban, a health care consultant whose mother-in-law, Betty Campbell, was a resident at Laguna Honda. “We’re down to the wire again.”\u003c/p>\n\u003cp>Citing Campbell’s frail state, Urban and his spouse turned down the hospital’s offer last summer to relocate her. The 86-year-old died recently at the hospital.\u003c/p>\n\u003cp>Opened in 1866, Laguna Honda is one of the oldest and largest public skilled nursing facilities in the country, treating a wide range of medical conditions including dementia, stroke, mental illness and HIV.\u003c/p>\n\u003cp>Although the hospital is still licensed, it was decertified last year by the federal Centers for Medicare and Medicaid Services (CMS) for a series of safety violations. That means it is no longer in good standing with government-provided health care options like Medicare and Medi-Cal, which fund medical costs for the vast majority of its patients.\u003c/p>\n\u003cp>After Laguna Honda lost certification, CMS required the hospital to create and implement a closure plan, including the transfer of all of its nearly 700 patients, many of them elderly and frail.\u003c/p>\n\u003cp>[aside label=\"related coverage\" tag=\"laguna-honda-hospital\"]At the same time, the hospital has been working with consultants to prepare for recertification.\u003c/p>\n\u003cp>“The focus of this meeting needs to be primarily on how the Board of Supervisors can be a force for protecting the most vulnerable: those who are now residents at Laguna Honda and those of us could need a bed there at any time,” Teresa Palmer, a former Laguna Honda physician and geriatrician, wrote in a letter to the board ahead of its Tuesday hearing. “Administration at Laguna Honda and consultants obviously need more time to ‘turn the ship around.’ In order to prevent death and harm to current and future residents, this time needs to be made available by CMS.”\u003c/p>\n\u003cp>Last month, the California Department of Public Health fined Laguna Honda $36,000 for providing inadequate care to the patients who died after their transfers. Nearly all of those patients, who ranged in age from 63 to 100, were considered severely disabled, including some who were on feeding tubes, living with dementia or nonverbal, the agency’s citations show.\u003c/p>\n\u003cp>The citations also noted that the patients who died were identified as “not discharge ready” because they were frail or otherwise not in a condition to be relocated.\u003c/p>\n\u003cp>The \u003ca href=\"https://abc7news.com/amp/laguna-honda-hospital-san-francisco-funding-mayor-london-breed-press-conference-healthcare-in-sf/11747735/\">current regulatory crisis facing Laguna Honda\u003c/a> began last spring, when federal regulators decertified the hospital after conducting a series of safety inspections triggered by two nonfatal drug overdoses the previous year.\u003c/p>\n\u003cp>Because San Francisco lacks an adequate supply of skilled nursing options, especially for people who rely on government health care plans like Medicare, most of those 57 patients were transferred out of the county. Two of the patients were sent to homeless shelters after discharge.\u003c/p>\n\u003cp>In August, city leaders responded to the relocation requirement and subsequent deaths by \u003ca href=\"https://www.kqed.org/news/11921717/san-francisco-sues-feds-over-forced-closure-of-laguna-honda-hospital/\">suing the federal government\u003c/a>, arguing that CMS had imposed an arbitrary and unrealistic closure deadline that didn’t give the city enough time to appeal the original infractions.\u003c/p>\n\u003cp>Several months later, however, the city agreed to drop the lawsuit in exchange for federal regulators temporarily halting the transfers and continuing to pay the $18 million in monthly Medicare and Medi-Cal costs for the remaining residents through November 2023.\u003c/p>\n\u003cp>Patricia McGinnis, executive director of California Advocates for Nursing Home Reform, called out the hurried transfers as a form of abuse and criticized state and federal regulators for pressuring the hospital to carry out the closure plan, despite the severe risk it posed to many patients.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“We call on CMS to stop the Laguna Honda closure before more residents are killed, and the Legislature to investigate CDPH and hold its leaders accountable,” she said.\u003c/p>\n\n",
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"excerpt": "Federal regulators, who decertified the public skilled nursing facility last year due to a series of safety violations, could order the city to resume transferring its hundreds of remaining patients as early as Friday. As of Tuesday, however, city officials had received no word of that decision.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update, 6 p.m. Tuesday: \u003c/strong>Federal officials have yet to say whether they will allow San Francisco to continue postponing the transfer of hundreds of Laguna Honda Hospital patients to other skilled nursing facilities, frustrated city leaders said Tuesday.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The clock is ticking. If the Biden administration rejects the city’s requests to continue halting transfers, the hospital could be required to resume relocating its more than 550 remaining patients, many of whom are elderly and lower-income, to other skilled nursing facilities as early as Friday.\u003c/p>\n\u003cp>“It is entirely possible that on Friday, Feb. 3, hundreds of San Franciscans residing at Laguna Honda will face the trauma of possible relocation again from being discharged,” San Francisco Supervisor Myrna Melgar, whose district includes the hospital, said at Tuesday’s Board of Supervisors hearing. “The rigid bureaucracy of the U.S. government has put us into this position.”\u003c/p>\n\u003cp>Hospital officials have said they have no plans to resume transferring patients unless compelled to do so. Twelve of the 57 patients who were initially transferred from the hospital last summer — some of whom had dementia and limited physical and cognitive ability — died within weeks or months of being relocated.\u003c/p>\n\u003cp>“Laguna Honda strongly advocated against these transfers. We warned CMS (the Center for Medicare and Medicaid Services) that the four-month deadline to transfer nearly 700 residents to other facilities was entirely insufficient given the complex nature of our resident population and the lack of available beds at SNFs (skilled nursing facilities) anywhere in the region or the state,” hospital officials said in a public statement earlier this month in response to regulatory citations it received following the deaths of the transferred patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Roland Pickens, Laguna Honda’s interim CEO, said he is hopeful the current pause on patient transfers will be extended, allowing the hospital to continue working to address deficiencies cited by state and federal regulators.\u003c/p>\n\u003cp>At Tuesday’s hearing, other San Francisco leaders blasted federal officials for so far failing to respond to the city’s extension request, just days before the hospital could be required to resume patient transfers.\u003c/p>\n\u003cp>“This is a powerful and unaccountable bureaucracy,” Supervisor Rafael Mandelman said. “They [CMS] have done significant harm. They have created a ton of stress and anxiety for hundreds more people.”\u003c/p>\n\u003cp>\u003cstrong>Original story, 6 a.m. Tuesday: \u003c/strong>San Francisco officials are expected to find out this week whether federal regulators will allow the city to continue postponing the transfer of patients out of Laguna Honda Hospital.\u003c/p>\n\u003cp>An extension would allow patients and their families to breathe a temporary sigh of relief, just days before the recently decertified hospital could be required to resume relocating its more than 550 remaining charges.\u003c/p>\n\u003cp>\u003ca href=\"https://www.kqed.org/news/11920121/sf-officials-outraged-over-laguna-honda-patient-deaths-following-federally-mandated-transfers\">Regulators paused their initial transfer requirement\u003c/a> in July 2022, after reports that some of the 57 patients who had initially been moved from the hospital had died. In total, 12 former patients are confirmed to have died, nearly all of whom had been transferred last year to other skilled nursing facilities.\u003c/p>\n\u003cp>San Francisco City Attorney David Chiu is now requesting that the pause on transfers extend until at least May 30, 2023, and the status of the relocation plan is scheduled to be addressed at a Board of Supervisors hearing on Tuesday afternoon.\u003c/p>\n\u003cp>“There is a moral and ethical imperative to not continue the transfers,” said Joseph Urban, a health care consultant whose mother-in-law, Betty Campbell, was a resident at Laguna Honda. “We’re down to the wire again.”\u003c/p>\n\u003cp>Citing Campbell’s frail state, Urban and his spouse turned down the hospital’s offer last summer to relocate her. The 86-year-old died recently at the hospital.\u003c/p>\n\u003cp>Opened in 1866, Laguna Honda is one of the oldest and largest public skilled nursing facilities in the country, treating a wide range of medical conditions including dementia, stroke, mental illness and HIV.\u003c/p>\n\u003cp>Although the hospital is still licensed, it was decertified last year by the federal Centers for Medicare and Medicaid Services (CMS) for a series of safety violations. That means it is no longer in good standing with government-provided health care options like Medicare and Medi-Cal, which fund medical costs for the vast majority of its patients.\u003c/p>\n\u003cp>After Laguna Honda lost certification, CMS required the hospital to create and implement a closure plan, including the transfer of all of its nearly 700 patients, many of them elderly and frail.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>At the same time, the hospital has been working with consultants to prepare for recertification.\u003c/p>\n\u003cp>“The focus of this meeting needs to be primarily on how the Board of Supervisors can be a force for protecting the most vulnerable: those who are now residents at Laguna Honda and those of us could need a bed there at any time,” Teresa Palmer, a former Laguna Honda physician and geriatrician, wrote in a letter to the board ahead of its Tuesday hearing. “Administration at Laguna Honda and consultants obviously need more time to ‘turn the ship around.’ In order to prevent death and harm to current and future residents, this time needs to be made available by CMS.”\u003c/p>\n\u003cp>Last month, the California Department of Public Health fined Laguna Honda $36,000 for providing inadequate care to the patients who died after their transfers. Nearly all of those patients, who ranged in age from 63 to 100, were considered severely disabled, including some who were on feeding tubes, living with dementia or nonverbal, the agency’s citations show.\u003c/p>\n\u003cp>The citations also noted that the patients who died were identified as “not discharge ready” because they were frail or otherwise not in a condition to be relocated.\u003c/p>\n\u003cp>The \u003ca href=\"https://abc7news.com/amp/laguna-honda-hospital-san-francisco-funding-mayor-london-breed-press-conference-healthcare-in-sf/11747735/\">current regulatory crisis facing Laguna Honda\u003c/a> began last spring, when federal regulators decertified the hospital after conducting a series of safety inspections triggered by two nonfatal drug overdoses the previous year.\u003c/p>\n\u003cp>Because San Francisco lacks an adequate supply of skilled nursing options, especially for people who rely on government health care plans like Medicare, most of those 57 patients were transferred out of the county. Two of the patients were sent to homeless shelters after discharge.\u003c/p>\n\u003cp>In August, city leaders responded to the relocation requirement and subsequent deaths by \u003ca href=\"https://www.kqed.org/news/11921717/san-francisco-sues-feds-over-forced-closure-of-laguna-honda-hospital/\">suing the federal government\u003c/a>, arguing that CMS had imposed an arbitrary and unrealistic closure deadline that didn’t give the city enough time to appeal the original infractions.\u003c/p>\n\u003cp>Several months later, however, the city agreed to drop the lawsuit in exchange for federal regulators temporarily halting the transfers and continuing to pay the $18 million in monthly Medicare and Medi-Cal costs for the remaining residents through November 2023.\u003c/p>\n\u003cp>Patricia McGinnis, executive director of California Advocates for Nursing Home Reform, called out the hurried transfers as a form of abuse and criticized state and federal regulators for pressuring the hospital to carry out the closure plan, despite the severe risk it posed to many patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We call on CMS to stop the Laguna Honda closure before more residents are killed, and the Legislature to investigate CDPH and hold its leaders accountable,” she said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Almost 2 million of California’s lowest-income and most medically fragile residents may have to switch health insurers as a result of a new strategy by the state to improve care in its Medicaid program, called Medi-Cal.\u003c/p>\n\u003cp>A first-ever statewide contracting competition to participate in Medi-Cal required commercial managed-care plans to rebid for their contracts and compete against others hoping to take those contracts away. The contracts will be revamped to require insurers to offer new benefits and meet stiffer benchmarks for care.\u003c/p>\n\u003cp>The long-planned reshuffle of insurers is likely to come with short-term pain. Four of the managed-care insurers, including Health Net and Blue Shield of California, stand to \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/MCP-County-Enrollment-Table.pdf\">lose Medi-Cal contracts\u003c/a> in a little over a year, according to the \u003ca href=\"https://www.dhcs.ca.gov/formsandpubs/publications/oc/Documents/2022/22-10-MCP-Selections-8-25-22.pdf\">preliminary results of the bidding\u003c/a>, announced in late August. If the results stand, some enrollees in rural Alpine and El Dorado counties, as well as in populous Los Angeles, San Diego, Sacramento and Kern counties, will have to change health plans — and possibly doctors.[aside label='Related Coverage' tag='medicaid']“I’m still shocked and I’m still reeling from it,” said John Sturm, \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/MCP-County-Enrollment-Table.pdf\">one of about 325,000 members of Community Health Group\u003c/a>, the largest Medi-Cal plan in San Diego County, which could lose its contract. “Which doctors can I keep? How long is it going to take me to switch plans? Are there contingency plans when, inevitably, folks slip through the cracks?”\u003c/p>\n\u003cp>Sturm, 54, who has three mental health conditions, largely because of childhood sexual abuse, said finding a psychologist and psychiatrist he could trust took a lot of time and effort. He pointed to \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-patients-struggle-to-fill-prescriptions-medi-cal-rx/\">the disruption caused by the rollout of Medi-Cal’s new prescription drug program\u003c/a> this year, despite assurances it would go smoothly.\u003c/p>\n\u003cp>“I have concerns, and I know other people in the community have concerns about what we’re being told versus what the reality is going to be,” Sturm said.\u003c/p>\n\u003cp>Arguably, the biggest loser in the bidding is Health Net, the largest commercial insurer in Medi-Cal, which stands to lose half its enrollees — including more than 1 million in Los Angeles County alone. St. Louis-based Centene Corp., which \u003ca href=\"https://www.latimes.com/california/story/2022-04-07/california-investigating-corporation-took-over-medicaid-drug-program\">California is investigating\u003c/a> over allegations it overcharged the state for prescription drugs, \u003ca href=\"https://www.prnewswire.com/news-releases/centene-completes-acquisition-of-health-net-300241037.html\">bought Health Net\u003c/a> in 2016, in part for its Medicaid business, of which LA is the crown jewel.\u003c/p>\n\u003cp>But the state’s health plan selections are not set in stone. The losing insurers are fiercely contesting the results in formal appeals that read like declarations of war on their competitors and on the state. Some of the losers essentially call their winning rivals liars.\u003c/p>\n\u003cp>The stakes are high, with contracts in play worth billions of dollars annually. Insurers that lose their appeals with the state Department of Health Care Services, which runs Medi-Cal, are likely to take their complaints to court. That could delay final decisions by months or years, causing a headache for the department, which wants coverage under the new contracts to start Jan. 1, 2024.\u003c/p>\n\u003cp>State officials hope to spend the rest of this year and all of 2023 ensuring that the chosen health plans are up to the task, which includes having enough participating providers to minimize disruptions in care.\u003c/p>\n\u003cp>“Member access and continuity are really our top priorities as part of this transition, and we have dedicated teams that will be working with the health plans on the transition planning and the continuity planning,” Michelle Baass, director of the department, told KHN.[pullquote size=\"medium\" align=\"right\" citation=\"John Sturm, Medi-Cal recipient\"]‘I have concerns, and I know other people in the community have concerns about what we’re being told versus what the reality is going to be.’[/pullquote]Baass also noted that enrollees have continuity-of-care rights. “For example, if a member is currently under the care of a doctor during the prior 12 months, the member has the right to continue seeing that doctor for up to 12 months, if certain conditions are met,” she said.\u003c/p>\n\u003cp>The competitive bidding process is an effort by the department to address persistent complaints that \u003ca href=\"https://californiahealthline.org/news/article/californias-reboot-of-troubled-medi-cal-puts-pressure-on-health-plans/\">it has not effectively monitored subpar health plans\u003c/a>.\u003c/p>\n\u003cp>Eight commercial insurers bid for Medi-Cal business in 21 counties. They were required to submit voluminous documents detailing every aspect of their operations, including past performance; the scope of their provider networks; and their capacity to meet the terms of the new, stricter contracts.\u003c/p>\n\u003cp>The new contracts contain numerous provisions intended to bolster quality, health care equity and transparency — and to boost accountability of the subcontractors to whom \u003ca href=\"https://californiahealthline.org/news/article/layers-of-subcontracted-services-confuse-and-frustrate-medi-cal-patients/\">health plans often outsource patient care\u003c/a>. For example, the plans and their subcontractors will be required to reach or exceed \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCP-RFP-Issue-Brief.pdf\">the 50th percentile\u003c/a> among Medicaid plans nationally on a host of pediatric and maternal care measures — or face financial penalties.\u003c/p>\n\u003cp>They will also be on the hook for providing nonmedical social services that address socioeconomic factors, such as homelessness and food insecurity, in an ambitious $8.7 billion, \u003ca href=\"https://khn.org/news/article/california-medicaid-makeover-newsom-california-medi-cal-homeless-public-funds/\">five-year Medi-Cal initiative known as CalAIM\u003c/a>, that is already underway.\u003c/p>\n\u003cp>Local, publicly governed Medi-Cal plans, which cover about 70% of the \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/statistics/Documents/FastFacts-March2022.pdf\">12.4 million Medi-Cal members who are in managed care\u003c/a>, did not participate in the bidding, though their performance has not always been top-notch. Kaiser Permanente, which this year negotiated a controversial deal with the state for an \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-contract-kaiser-permanente-key-details-missing/\">exclusive Medi-Cal contract\u003c/a> in 32 counties, was also exempt from the bidding. (KHN is not affiliated with Kaiser Permanente.)\u003c/p>\n\u003cp>But all Medi-Cal health insurers, including KP and the local plans, will have to commit to the same goals and requirements.\u003c/p>\n\u003cp>In addition to Health Net, both Blue Shield of California and Community Health Group — which have contracts with Medi-Cal only in San Diego County — are also big losers, as is Aetna, which lost bids in 10 counties.\u003c/p>\n\u003cp>Blue Shield, which lost in all 13 counties where it submitted bids, filed a fiercely worded appeal that accuses its rivals Anthem Blue Cross, Molina and Health Net of failing to disclose hundreds of millions of dollars in penalties against them. It accused those three plans of poor performance “and even mendacity” and said they filled their bids with “puffery,” which the state “bought, hook, line and sinker,” without “an iota of independent analysis.”\u003c/p>\n\u003cfigure id=\"attachment_11926773\" class=\"wp-caption alignnone\" style=\"max-width: 724px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11926773\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/09/GettyImages-1279766844.jpg\" alt=\"A hand in the foreground holds a card as someone reaches out to hold it from across a table.\" width=\"724\" height=\"483\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/09/GettyImages-1279766844.jpg 724w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/09/GettyImages-1279766844-160x107.jpg 160w\" sizes=\"(max-width: 724px) 100vw, 724px\">\u003cfigcaption class=\"wp-caption-text\">The competitive bidding process is an effort by the state Department of Health Care Services to address persistent complaints that it has not effectively monitored subpar health plans. \u003ccite>(Willie B. Thomas/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Health Net’s appeal slammed Molina, which beat it out in LA, Sacramento, Riverside and San Bernardino counties. Molina’s bid, Health Net said, “contains false, inaccurate and misleading information.” The whole bidding process, it said, was “highly flawed,” resulting in “erroneous contract awards that jeopardize the stability of Medi-Cal.”\u003c/p>\n\u003cp>In particular, Health Net said, the Department of Health Care Services “improperly reopened the procurement” after the deadline, which allowed Molina to make “comprehensive changes” that raised its score.\u003c/p>\n\u003cp>The protesting health plans are requesting that they be awarded contracts or that the bidding process start over from scratch.\u003c/p>\n\u003cp>Joseph Garcia, chief operating officer for Community Health Group, said, “It would be easiest for all concerned if they just added us. They don’t have to remove anybody.”\u003c/p>\n\u003cp>Community Health Group has garnered an outpouring of support from hospital executives, physician groups, community clinics and the heads of multiple publicly governed Medi-Cal plans, \u003ca href=\"https://californiahealthline.org/wp-content/uploads/sites/3/2022/09/Medi-Cal-Reprocurement-Letter-of-Support-for-CHG-1.pdf\">who sent a letter to Baass\u003c/a> saying they were “shocked, concerned, and very disappointed” by the state’s decision. They called Community Health Group “our strongest partner of 40 years,” for whom “equity is not a buzzword or a new priority,” noting that more than 85% of its staff is bilingual and multicultural.\u003c/p>\n\u003cp>Community Health Group noted in its appeal that it had lost by less than a point to Health Net, which won a San Diego contract — “a minuscule difference that in itself resulted from deeply flawed scoring.”\u003c/p>\n\u003cp>Garcia said that if Community Health Group loses its appeal, it will “absolutely” sue in state court. A hearing officer appointed by Baass to consider the appeals has set deadlines to receive written responses and rebuttals by October 7.\u003c/p>\n\u003cp>There is ample precedent for protracted legal battles in bidding for Medicaid contracts. In Louisiana, Centene and Aetna \u003ca href=\"https://www.thecentersquare.com/louisiana/rejected-bidders-for-louisiana-medicaid-contracts-file-protests-alleging-bias/article_2fe6ecec-c44c-11e9-833d-331f84e9c8f0.html\">protested the results of a 2019 rebidding process\u003c/a>, which led the state to nullify its awards and restart the bidding. The \u003ca href=\"https://ldh.la.gov/news/ldh-mco-contracts\">new results\u003c/a> were announced this year, with Centene and Aetna among the winners. In Kentucky, the state court of appeals \u003ca href=\"https://www.courier-journal.com/story/news/local/2022/09/15/kentucky-medicaid-contracts-upheld-by-court-anthem-is-out-as-mco/69494863007/\">issued a ruling\u003c/a> this month in a contested Medicaid procurement that had been held two years earlier.\u003c/p>\n\u003cp>Another factor could delay the new contract: California is juggling several massive Medi-Cal changes at the same time. Among them are the implementation of CalAIM and the \u003ca href=\"https://lao.ca.gov/Publications/Report/4423\">anticipated enrollment of nearly 700,000 unauthorized immigrants age 26-49\u003c/a> by January 2024, on top of nearly a quarter-million unauthorized immigrants age 50 and older who \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-older-unauthorized-immigrants/\">became eligible this year\u003c/a>. And then there’s the recalculation of enrollees’ eligibility, which will take place whenever the federal COVID-19-related public health emergency ends. That could push \u003ca href=\"https://www.dhcs.ca.gov/Documents/PHE-UOP/Medi-Cal-COVID-19-PHE-Unwinding-Plan.pdf\">2 million to 3 million\u003c/a> Californians out of Medi-Cal.\u003c/p>\n\u003cp>“Just hearing you list all those things gave me a minor panic attack,” said Abigail Coursolle, a senior attorney at the National Health Law Program. “They are making a lot of work for themselves in a short amount of time.”\u003c/p>\n\u003cp>But, Coursolle added, the state has “a very positive vision for improving access and improving the quality of services that people in Medi-Cal receive, and that’s very important.”\u003c/p>\n\u003cp>\u003cem>California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Almost 2 million of California’s lowest-income and most medically fragile residents may have to switch health insurers as a result of a new strategy by the state to improve care in its Medicaid program, called Medi-Cal.\u003c/p>\n\u003cp>A first-ever statewide contracting competition to participate in Medi-Cal required commercial managed-care plans to rebid for their contracts and compete against others hoping to take those contracts away. The contracts will be revamped to require insurers to offer new benefits and meet stiffer benchmarks for care.\u003c/p>\n\u003cp>The long-planned reshuffle of insurers is likely to come with short-term pain. Four of the managed-care insurers, including Health Net and Blue Shield of California, stand to \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/MCP-County-Enrollment-Table.pdf\">lose Medi-Cal contracts\u003c/a> in a little over a year, according to the \u003ca href=\"https://www.dhcs.ca.gov/formsandpubs/publications/oc/Documents/2022/22-10-MCP-Selections-8-25-22.pdf\">preliminary results of the bidding\u003c/a>, announced in late August. If the results stand, some enrollees in rural Alpine and El Dorado counties, as well as in populous Los Angeles, San Diego, Sacramento and Kern counties, will have to change health plans — and possibly doctors.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“I’m still shocked and I’m still reeling from it,” said John Sturm, \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/MCP-County-Enrollment-Table.pdf\">one of about 325,000 members of Community Health Group\u003c/a>, the largest Medi-Cal plan in San Diego County, which could lose its contract. “Which doctors can I keep? How long is it going to take me to switch plans? Are there contingency plans when, inevitably, folks slip through the cracks?”\u003c/p>\n\u003cp>Sturm, 54, who has three mental health conditions, largely because of childhood sexual abuse, said finding a psychologist and psychiatrist he could trust took a lot of time and effort. He pointed to \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-patients-struggle-to-fill-prescriptions-medi-cal-rx/\">the disruption caused by the rollout of Medi-Cal’s new prescription drug program\u003c/a> this year, despite assurances it would go smoothly.\u003c/p>\n\u003cp>“I have concerns, and I know other people in the community have concerns about what we’re being told versus what the reality is going to be,” Sturm said.\u003c/p>\n\u003cp>Arguably, the biggest loser in the bidding is Health Net, the largest commercial insurer in Medi-Cal, which stands to lose half its enrollees — including more than 1 million in Los Angeles County alone. St. Louis-based Centene Corp., which \u003ca href=\"https://www.latimes.com/california/story/2022-04-07/california-investigating-corporation-took-over-medicaid-drug-program\">California is investigating\u003c/a> over allegations it overcharged the state for prescription drugs, \u003ca href=\"https://www.prnewswire.com/news-releases/centene-completes-acquisition-of-health-net-300241037.html\">bought Health Net\u003c/a> in 2016, in part for its Medicaid business, of which LA is the crown jewel.\u003c/p>\n\u003cp>But the state’s health plan selections are not set in stone. The losing insurers are fiercely contesting the results in formal appeals that read like declarations of war on their competitors and on the state. Some of the losers essentially call their winning rivals liars.\u003c/p>\n\u003cp>The stakes are high, with contracts in play worth billions of dollars annually. Insurers that lose their appeals with the state Department of Health Care Services, which runs Medi-Cal, are likely to take their complaints to court. That could delay final decisions by months or years, causing a headache for the department, which wants coverage under the new contracts to start Jan. 1, 2024.\u003c/p>\n\u003cp>State officials hope to spend the rest of this year and all of 2023 ensuring that the chosen health plans are up to the task, which includes having enough participating providers to minimize disruptions in care.\u003c/p>\n\u003cp>“Member access and continuity are really our top priorities as part of this transition, and we have dedicated teams that will be working with the health plans on the transition planning and the continuity planning,” Michelle Baass, director of the department, told KHN.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Baass also noted that enrollees have continuity-of-care rights. “For example, if a member is currently under the care of a doctor during the prior 12 months, the member has the right to continue seeing that doctor for up to 12 months, if certain conditions are met,” she said.\u003c/p>\n\u003cp>The competitive bidding process is an effort by the department to address persistent complaints that \u003ca href=\"https://californiahealthline.org/news/article/californias-reboot-of-troubled-medi-cal-puts-pressure-on-health-plans/\">it has not effectively monitored subpar health plans\u003c/a>.\u003c/p>\n\u003cp>Eight commercial insurers bid for Medi-Cal business in 21 counties. They were required to submit voluminous documents detailing every aspect of their operations, including past performance; the scope of their provider networks; and their capacity to meet the terms of the new, stricter contracts.\u003c/p>\n\u003cp>The new contracts contain numerous provisions intended to bolster quality, health care equity and transparency — and to boost accountability of the subcontractors to whom \u003ca href=\"https://californiahealthline.org/news/article/layers-of-subcontracted-services-confuse-and-frustrate-medi-cal-patients/\">health plans often outsource patient care\u003c/a>. For example, the plans and their subcontractors will be required to reach or exceed \u003ca href=\"https://www.dhcs.ca.gov/Documents/MCP-RFP-Issue-Brief.pdf\">the 50th percentile\u003c/a> among Medicaid plans nationally on a host of pediatric and maternal care measures — or face financial penalties.\u003c/p>\n\u003cp>They will also be on the hook for providing nonmedical social services that address socioeconomic factors, such as homelessness and food insecurity, in an ambitious $8.7 billion, \u003ca href=\"https://khn.org/news/article/california-medicaid-makeover-newsom-california-medi-cal-homeless-public-funds/\">five-year Medi-Cal initiative known as CalAIM\u003c/a>, that is already underway.\u003c/p>\n\u003cp>Local, publicly governed Medi-Cal plans, which cover about 70% of the \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/statistics/Documents/FastFacts-March2022.pdf\">12.4 million Medi-Cal members who are in managed care\u003c/a>, did not participate in the bidding, though their performance has not always been top-notch. Kaiser Permanente, which this year negotiated a controversial deal with the state for an \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-contract-kaiser-permanente-key-details-missing/\">exclusive Medi-Cal contract\u003c/a> in 32 counties, was also exempt from the bidding. (KHN is not affiliated with Kaiser Permanente.)\u003c/p>\n\u003cp>But all Medi-Cal health insurers, including KP and the local plans, will have to commit to the same goals and requirements.\u003c/p>\n\u003cp>In addition to Health Net, both Blue Shield of California and Community Health Group — which have contracts with Medi-Cal only in San Diego County — are also big losers, as is Aetna, which lost bids in 10 counties.\u003c/p>\n\u003cp>Blue Shield, which lost in all 13 counties where it submitted bids, filed a fiercely worded appeal that accuses its rivals Anthem Blue Cross, Molina and Health Net of failing to disclose hundreds of millions of dollars in penalties against them. It accused those three plans of poor performance “and even mendacity” and said they filled their bids with “puffery,” which the state “bought, hook, line and sinker,” without “an iota of independent analysis.”\u003c/p>\n\u003cfigure id=\"attachment_11926773\" class=\"wp-caption alignnone\" style=\"max-width: 724px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11926773\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/09/GettyImages-1279766844.jpg\" alt=\"A hand in the foreground holds a card as someone reaches out to hold it from across a table.\" width=\"724\" height=\"483\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/09/GettyImages-1279766844.jpg 724w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/09/GettyImages-1279766844-160x107.jpg 160w\" sizes=\"(max-width: 724px) 100vw, 724px\">\u003cfigcaption class=\"wp-caption-text\">The competitive bidding process is an effort by the state Department of Health Care Services to address persistent complaints that it has not effectively monitored subpar health plans. \u003ccite>(Willie B. Thomas/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Health Net’s appeal slammed Molina, which beat it out in LA, Sacramento, Riverside and San Bernardino counties. Molina’s bid, Health Net said, “contains false, inaccurate and misleading information.” The whole bidding process, it said, was “highly flawed,” resulting in “erroneous contract awards that jeopardize the stability of Medi-Cal.”\u003c/p>\n\u003cp>In particular, Health Net said, the Department of Health Care Services “improperly reopened the procurement” after the deadline, which allowed Molina to make “comprehensive changes” that raised its score.\u003c/p>\n\u003cp>The protesting health plans are requesting that they be awarded contracts or that the bidding process start over from scratch.\u003c/p>\n\u003cp>Joseph Garcia, chief operating officer for Community Health Group, said, “It would be easiest for all concerned if they just added us. They don’t have to remove anybody.”\u003c/p>\n\u003cp>Community Health Group has garnered an outpouring of support from hospital executives, physician groups, community clinics and the heads of multiple publicly governed Medi-Cal plans, \u003ca href=\"https://californiahealthline.org/wp-content/uploads/sites/3/2022/09/Medi-Cal-Reprocurement-Letter-of-Support-for-CHG-1.pdf\">who sent a letter to Baass\u003c/a> saying they were “shocked, concerned, and very disappointed” by the state’s decision. They called Community Health Group “our strongest partner of 40 years,” for whom “equity is not a buzzword or a new priority,” noting that more than 85% of its staff is bilingual and multicultural.\u003c/p>\n\u003cp>Community Health Group noted in its appeal that it had lost by less than a point to Health Net, which won a San Diego contract — “a minuscule difference that in itself resulted from deeply flawed scoring.”\u003c/p>\n\u003cp>Garcia said that if Community Health Group loses its appeal, it will “absolutely” sue in state court. A hearing officer appointed by Baass to consider the appeals has set deadlines to receive written responses and rebuttals by October 7.\u003c/p>\n\u003cp>There is ample precedent for protracted legal battles in bidding for Medicaid contracts. In Louisiana, Centene and Aetna \u003ca href=\"https://www.thecentersquare.com/louisiana/rejected-bidders-for-louisiana-medicaid-contracts-file-protests-alleging-bias/article_2fe6ecec-c44c-11e9-833d-331f84e9c8f0.html\">protested the results of a 2019 rebidding process\u003c/a>, which led the state to nullify its awards and restart the bidding. The \u003ca href=\"https://ldh.la.gov/news/ldh-mco-contracts\">new results\u003c/a> were announced this year, with Centene and Aetna among the winners. In Kentucky, the state court of appeals \u003ca href=\"https://www.courier-journal.com/story/news/local/2022/09/15/kentucky-medicaid-contracts-upheld-by-court-anthem-is-out-as-mco/69494863007/\">issued a ruling\u003c/a> this month in a contested Medicaid procurement that had been held two years earlier.\u003c/p>\n\u003cp>Another factor could delay the new contract: California is juggling several massive Medi-Cal changes at the same time. Among them are the implementation of CalAIM and the \u003ca href=\"https://lao.ca.gov/Publications/Report/4423\">anticipated enrollment of nearly 700,000 unauthorized immigrants age 26-49\u003c/a> by January 2024, on top of nearly a quarter-million unauthorized immigrants age 50 and older who \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-older-unauthorized-immigrants/\">became eligible this year\u003c/a>. And then there’s the recalculation of enrollees’ eligibility, which will take place whenever the federal COVID-19-related public health emergency ends. That could push \u003ca href=\"https://www.dhcs.ca.gov/Documents/PHE-UOP/Medi-Cal-COVID-19-PHE-Unwinding-Plan.pdf\">2 million to 3 million\u003c/a> Californians out of Medi-Cal.\u003c/p>\n\u003cp>“Just hearing you list all those things gave me a minor panic attack,” said Abigail Coursolle, a senior attorney at the National Health Law Program. “They are making a lot of work for themselves in a short amount of time.”\u003c/p>\n\u003cp>But, Coursolle added, the state has “a very positive vision for improving access and improving the quality of services that people in Medi-Cal receive, and that’s very important.”\u003c/p>\n\u003cp>\u003cem>California Healthline is a service of the California Health Care Foundation produced by Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Poverty and Uninsured Rates Drop, Thanks to Pandemic-Era Policies",
"title": "Poverty and Uninsured Rates Drop, Thanks to Pandemic-Era Policies",
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"content": "\u003cp>The Census Bureau released some heartening news Tuesday.\u003c/p>\n\u003cp>Child poverty is at a historic low, according to the bureau's \u003ca href=\"https://www.census.gov/newsroom/press-releases/2022/income-poverty-health-insurance-coverage.html\">annual report\u003c/a> on income, poverty and health insurance. And the rate of Americans without health insurance also dropped in 2021 compared to the previous year.\u003c/p>\n\u003cp>But the good news may be short lived. Both gains were driven by temporary pandemic-related policies, and without action by policymakers, they could quickly unravel.\u003c/p>\n\u003ch2>Child tax credit key to drop in poverty\u003c/h2>\n\u003cp>Childhood poverty dropped substantially in 2021, falling from 9.7% in 2020 down to 5.2%. The overall poverty rate for all age groups was just under 8% — a decline from 9.2% in 2020.\u003c/p>\n\u003cp>These figures are based on the \u003ca href=\"https://www.npr.org/2011/11/07/142105558/new-measure-shows-higher-poverty-rate-in-u-s\">Supplemental Poverty Measure\u003c/a>, which takes into account all kinds of expenses families have, as well as that range of pandemic aid many families received.\u003cspan style=\"font-weight: 400\">[pullquote size=\"medium\" align=\"right\" citation=\"Sabrina Corlette, Georgetown University Center on Health Insurance Reforms\"]'As soon as the public health emergency is declared over – which could be as early as January – that safety net that was in that COVID relief bill goes away.'[/pullquote]\u003c/span>Poverty experts attribute much of this improvement to the child tax credit which Congress boosted in 2021 in the American Rescue Plan. Congress also expanded it to include millions more low-income families.\u003c/p>\n\u003cp>The child tax credit gives families more money to spend on essentials, says \u003ca href=\"https://www.cbpp.org/about/our-staff/sharon-parrott\">Sharon Parrott\u003c/a>, who has researched the issue for the Center on Budget and Policy Priorities.\u003c/p>\n\u003cp>\"They spend it on their housing, food, education, they're able to do some of those extracurricular activities that high income families take for granted,\" she says. \"They are investing in their kids and their families are able to make ends meet in really important ways.\"\u003c/p>\n\u003cp>And Parrott says all these things can have long term benefits for kids, like doing better in school and being healthier.\u003c/p>\n\u003ch2>Uninsured rate approaches record lows, thanks to Medicaid\u003c/h2>\n\u003cp>The census numbers show 8.3% of Americans – or 27.2 million people – did not have any health insurance in 2021. That's an improvement from 2020, when 8.6% of people were uninsured.\u003c/p>\n\u003cp>The force behind this trend is Medicaid, the public health insurance option for people with low incomes, according to census officials who briefed reporters Tuesday.\u003c/p>\n\u003cp>\"The reason the Medicaid rates have increased is because of a COVID relief bill that Congress passed in March of 2020,\" says \u003ca href=\"https://chir.georgetown.edu/faculty_sabrina_corlette/\">Sabrina Corlette\u003c/a> of the Georgetown University Center on Health Insurance Reforms.\u003c/p>\n\u003cp>The Families First Coronavirus Response Act essentially mandated that state Medicaid programs not force enrollees to requalify for the program – so states could enroll new people but not kick anyone off. Because of this \"continuous enrollment provision,\" Medicaid has grown significantly.\u003c/p>\n\u003cp>Another area of growth was Medicare, though census officials noted that that's due to more people turning 65 and becoming eligible, not because of a policy change.\u003c/p>\n\u003ch2>What happens when pandemic measures end\u003c/h2>\n\u003cp>Policy experts say this week's good news may be fleeting. The expanded child tax credit ended in December, just as inflation was starting to climb to historic highs. The policy supporting more people getting health insurance is set to run out in a few months.\u003c/p>\n\u003cp>\"As soon as the public health emergency is declared over – which could be as early as January – that safety net that was in that COVID relief bill goes away,\" says Corlette. \"And so we could see this historic increase in the rates of the insured be reversed.\"\u003cspan style=\"font-weight: 400\">[aside label='Related Articles' tag='poverty']\u003c/span>More than 15 million people could lose Medicaid, according to an estimate from the Department of Health and Human Services \u003ca href=\"https://aspe.hhs.gov/sites/default/files/documents/60f0ac74ee06eb578d30b0f39ac94323/aspe-end-mcaid-continuous-coverage.pdf?_ga=2.168159075.310828479.1663022160-418932185.1663022160\">released last month\u003c/a>. The analysis suggests nearly half of those losing coverage will be because of administrative issues – such as challenges with filling out the paperwork to reapply – and not because they no longer qualify for coverage. Some will be able to get coverage elsewhere, but millions more may become uninsured.\u003c/p>\n\u003cp>When it comes to poverty, inflation could start to affect these rates. In fact, one group already is seeing more poverty in the 2021 numbers and that is seniors. Census officials say this is likely because they're on fixed incomes, and already last year inflation was starting to tick up, really squeezing their budgets.\u003c/p>\n\u003cp>But again, Census officials stressed that Social Security did keep more than 26 million people out of poverty, and that includes several million children being raised by grandparents.\u003c/p>\n\u003ch2>How to hold on to temporary gains\u003c/h2>\n\u003cp>In terms of U.S. trends over time, the Census numbers released Tuesday on child poverty and health insurance are encouraging, experts say, and it's now up to policymakers to act to keep these gains.\u003c/p>\n\u003cp>\"Any of the improvements that we see – whether it's insurance or poverty – are a reflection of political choices,\" says \u003ca href=\"https://government.cornell.edu/jamila-michener\">Jamila Michener\u003c/a> – a professor of government at Cornell and an expert on Medicaid.\u003c/p>\n\u003cp>The Biden administration and many Democrats would like to make the expanded child tax credit permanent. The U.S. House passed such a measure but it did not survive in the Senate. Several Republican Senators have proposed more limited ways to expand the child tax credit.\u003c/p>\n\u003cp>\"What we don't know is the trade-offs,\" says Angela Rachidi, a senior fellow at the American Enterprise Institute. \"We know inflation increased dramatically over the past year. To what extent did all this government transfer of income contribute to that, I think, is still a question.\"\u003c/p>\n\u003cp>Some researchers note that the U.S. has a long way to go with gains in health and insurance rates, when compared to similar high-income countries.\u003c/p>\n\u003cp>\"[Among] our peer countries, we have one of the highest rates of uninsurance in the world and also poorer health outcomes,\" notes Corlette. \"And that's been an issue for us even before the pandemic.\"\u003c/p>\n\u003cp>A \u003ca href=\"https://nap.nationalacademies.org/catalog/13497/us-health-in-international-perspective-shorter-lives-poorer-health\">landmark study in 2013\u003c/a> enumerated the many ways Americans don't have as healthy or long lives as people do in similarly wealthy countries.\u003c/p>\n\u003cp>One striking illustration of this came with the new life expectancy numbers released two weeks ago. Countries all over the world had a drop in life expectancy after the first year of the pandemic, but many have been able to rebound.\u003c/p>\n\u003cp>America has not – instead life expectancy \u003ca href=\"https://www.npr.org/sections/health-shots/2022/08/31/1120192583/life-expectancy-in-the-u-s-continues-to-drop-driven-by-covid-19\">dropped for two years\u003c/a> in a row, the first time that's happened in the U.S. in a century.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Census Bureau released some heartening news Tuesday.\u003c/p>\n\u003cp>Child poverty is at a historic low, according to the bureau's \u003ca href=\"https://www.census.gov/newsroom/press-releases/2022/income-poverty-health-insurance-coverage.html\">annual report\u003c/a> on income, poverty and health insurance. And the rate of Americans without health insurance also dropped in 2021 compared to the previous year.\u003c/p>\n\u003cp>But the good news may be short lived. Both gains were driven by temporary pandemic-related policies, and without action by policymakers, they could quickly unravel.\u003c/p>\n\u003ch2>Child tax credit key to drop in poverty\u003c/h2>\n\u003cp>Childhood poverty dropped substantially in 2021, falling from 9.7% in 2020 down to 5.2%. The overall poverty rate for all age groups was just under 8% — a decline from 9.2% in 2020.\u003c/p>\n\u003cp>These figures are based on the \u003ca href=\"https://www.npr.org/2011/11/07/142105558/new-measure-shows-higher-poverty-rate-in-u-s\">Supplemental Poverty Measure\u003c/a>, which takes into account all kinds of expenses families have, as well as that range of pandemic aid many families received.\u003cspan style=\"font-weight: 400\">\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/span>Poverty experts attribute much of this improvement to the child tax credit which Congress boosted in 2021 in the American Rescue Plan. Congress also expanded it to include millions more low-income families.\u003c/p>\n\u003cp>The child tax credit gives families more money to spend on essentials, says \u003ca href=\"https://www.cbpp.org/about/our-staff/sharon-parrott\">Sharon Parrott\u003c/a>, who has researched the issue for the Center on Budget and Policy Priorities.\u003c/p>\n\u003cp>\"They spend it on their housing, food, education, they're able to do some of those extracurricular activities that high income families take for granted,\" she says. \"They are investing in their kids and their families are able to make ends meet in really important ways.\"\u003c/p>\n\u003cp>And Parrott says all these things can have long term benefits for kids, like doing better in school and being healthier.\u003c/p>\n\u003ch2>Uninsured rate approaches record lows, thanks to Medicaid\u003c/h2>\n\u003cp>The census numbers show 8.3% of Americans – or 27.2 million people – did not have any health insurance in 2021. That's an improvement from 2020, when 8.6% of people were uninsured.\u003c/p>\n\u003cp>The force behind this trend is Medicaid, the public health insurance option for people with low incomes, according to census officials who briefed reporters Tuesday.\u003c/p>\n\u003cp>\"The reason the Medicaid rates have increased is because of a COVID relief bill that Congress passed in March of 2020,\" says \u003ca href=\"https://chir.georgetown.edu/faculty_sabrina_corlette/\">Sabrina Corlette\u003c/a> of the Georgetown University Center on Health Insurance Reforms.\u003c/p>\n\u003cp>The Families First Coronavirus Response Act essentially mandated that state Medicaid programs not force enrollees to requalify for the program – so states could enroll new people but not kick anyone off. Because of this \"continuous enrollment provision,\" Medicaid has grown significantly.\u003c/p>\n\u003cp>Another area of growth was Medicare, though census officials noted that that's due to more people turning 65 and becoming eligible, not because of a policy change.\u003c/p>\n\u003ch2>What happens when pandemic measures end\u003c/h2>\n\u003cp>Policy experts say this week's good news may be fleeting. The expanded child tax credit ended in December, just as inflation was starting to climb to historic highs. The policy supporting more people getting health insurance is set to run out in a few months.\u003c/p>\n\u003cp>\"As soon as the public health emergency is declared over – which could be as early as January – that safety net that was in that COVID relief bill goes away,\" says Corlette. \"And so we could see this historic increase in the rates of the insured be reversed.\"\u003cspan style=\"font-weight: 400\">\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/span>More than 15 million people could lose Medicaid, according to an estimate from the Department of Health and Human Services \u003ca href=\"https://aspe.hhs.gov/sites/default/files/documents/60f0ac74ee06eb578d30b0f39ac94323/aspe-end-mcaid-continuous-coverage.pdf?_ga=2.168159075.310828479.1663022160-418932185.1663022160\">released last month\u003c/a>. The analysis suggests nearly half of those losing coverage will be because of administrative issues – such as challenges with filling out the paperwork to reapply – and not because they no longer qualify for coverage. Some will be able to get coverage elsewhere, but millions more may become uninsured.\u003c/p>\n\u003cp>When it comes to poverty, inflation could start to affect these rates. In fact, one group already is seeing more poverty in the 2021 numbers and that is seniors. Census officials say this is likely because they're on fixed incomes, and already last year inflation was starting to tick up, really squeezing their budgets.\u003c/p>\n\u003cp>But again, Census officials stressed that Social Security did keep more than 26 million people out of poverty, and that includes several million children being raised by grandparents.\u003c/p>\n\u003ch2>How to hold on to temporary gains\u003c/h2>\n\u003cp>In terms of U.S. trends over time, the Census numbers released Tuesday on child poverty and health insurance are encouraging, experts say, and it's now up to policymakers to act to keep these gains.\u003c/p>\n\u003cp>\"Any of the improvements that we see – whether it's insurance or poverty – are a reflection of political choices,\" says \u003ca href=\"https://government.cornell.edu/jamila-michener\">Jamila Michener\u003c/a> – a professor of government at Cornell and an expert on Medicaid.\u003c/p>\n\u003cp>The Biden administration and many Democrats would like to make the expanded child tax credit permanent. The U.S. House passed such a measure but it did not survive in the Senate. Several Republican Senators have proposed more limited ways to expand the child tax credit.\u003c/p>\n\u003cp>\"What we don't know is the trade-offs,\" says Angela Rachidi, a senior fellow at the American Enterprise Institute. \"We know inflation increased dramatically over the past year. To what extent did all this government transfer of income contribute to that, I think, is still a question.\"\u003c/p>\n\u003cp>Some researchers note that the U.S. has a long way to go with gains in health and insurance rates, when compared to similar high-income countries.\u003c/p>\n\u003cp>\"[Among] our peer countries, we have one of the highest rates of uninsurance in the world and also poorer health outcomes,\" notes Corlette. \"And that's been an issue for us even before the pandemic.\"\u003c/p>\n\u003cp>A \u003ca href=\"https://nap.nationalacademies.org/catalog/13497/us-health-in-international-perspective-shorter-lives-poorer-health\">landmark study in 2013\u003c/a> enumerated the many ways Americans don't have as healthy or long lives as people do in similarly wealthy countries.\u003c/p>\n\u003cp>One striking illustration of this came with the new life expectancy numbers released two weeks ago. Countries all over the world had a drop in life expectancy after the first year of the pandemic, but many have been able to rebound.\u003c/p>\n\u003cp>America has not – instead life expectancy \u003ca href=\"https://www.npr.org/sections/health-shots/2022/08/31/1120192583/life-expectancy-in-the-u-s-continues-to-drop-driven-by-covid-19\">dropped for two years\u003c/a> in a row, the first time that's happened in the U.S. in a century.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>\u003cem>Editor’s note: KHN is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cp>Gov. Gavin Newsom’s administration has negotiated a secret deal to give Kaiser Permanente a special Medicaid contract that would allow the health care behemoth to expand its reach in California and largely continue selecting the enrollees it wants, which other health care plans say leaves them with a disproportionate share of the program’s sickest and costliest patients.\u003c/p>\n\u003cp>The deal, hammered out behind closed doors between Kaiser Permanente and senior officials in Newsom’s office, could complicate a long-planned and expensive transformation of Medi-Cal, the state’s Medicaid program, which covers roughly 14 million lower-income Californians.\u003c/p>\n\u003cp>It has infuriated executives of other managed-care insurance plans in Medi-Cal, who say they stand to lose hundreds of thousands of patients and millions of dollars a year. The deal allows KP to limit enrollment primarily to its previous enrollees, except in the case of kids in foster care and people who are eligible for both Medicare and Medi-Cal.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Jarrod McNaughton, CEO, Inland Empire Health Plan\"]‘[This deal] has caused a massive amount of frenzy.’[/pullquote]\u003c/p>\n\u003cp>“It has caused a massive amount of frenzy,” said Jarrod McNaughton, CEO of the Inland Empire Health Plan, which covers about 1.5 million Medi-Cal enrollees in Riverside and San Bernardino counties. “All of us are doing our best to implement the most transformational Medi-Cal initiative in state history, and to put all this together without a public process is very disconcerting.”\u003c/p>\n\u003cp>Linnea Koopmans, CEO of the Local Health Plans of California, echoed McNaughton’s concerns.\u003c/p>\n\u003cp>Insurance plans got wind of the backroom talks when broad outlines of the deal were leaked days before the state briefed their executives Thursday.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Dr. Bechara Choucair, Kaiser Permanente’s chief health officer, argued \u003ca href=\"https://khn.org/wp-content/uploads/sites/2/2022/02/Kaiser-Permanente-response-to-KHN-inquiry.pdf\">in a prepared written response\u003c/a> on behalf of KP that because it operates both as a health insurer and a health care provider, KP should be treated differently from other commercial health care plans that participate in Medi-Cal. Doing business directly with the state will eliminate complexity and improve the quality of care for the Medi-Cal patients it serves, he said.\u003c/p>\n\u003cp>“We are not seeking to turn a profit off Medi-Cal enrollment,” Choucair said. “Kaiser Permanente participates in Medi-Cal because it is part of our mission to improve the health of the communities we serve. We participate in Medi-Cal despite incurring losses every year.”\u003c/p>\n\u003cp>His statement cited nearly $1.8 billion in losses in the program in 2020 and said KP had donated $402 million to help care for uninsured people that year.\u003c/p>\n\u003cp>Kaiser Permanente, the state’s largest managed-care organization, is one of Newsom’s most generous supporters and close political allies.\u003c/p>\n\u003cp>The new, five-year contract, confirmed to KHN by administration officials and expected to be announced publicly Friday, will take effect in 2024 pending approval from the Legislature — and will make KP the only insurer with a statewide Medi-Cal contract. It allows KP to solidify its position before California’s other commercial Medi-Cal plans participate in a \u003ca href=\"https://californiahealthline.org/news/article/californias-reboot-of-troubled-medi-cal-puts-pressure-on-health-plans/\">statewide bidding process\u003c/a> — and after those plans have spent many months and considerable resources developing their bidding strategies.\u003c/p>\n\u003cp>[aside postID=news_11902149 hero='https://ww2.kqed.org/app/uploads/sites/10/2022/01/RS53217_034_Richmond_LifelongCOVIDClinic_01192022-qut-1020x680.jpg']Other health care plans fear the contract could also muddle a massive and expensive initiative called \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-makeover-calaim-homeless-whole-body-care/\">CalAIM\u003c/a> that seeks to provide social services to the state’s most vulnerable patients, including home-delivered meals, housing aid for unhoused people, and \u003ca href=\"https://californiahealthline.org/news/article/mattresses-and-mold-removal-medi-cal-to-offer-unconventional-treatments-to-asthma-patients/\">mold removal\u003c/a> from homes. Under its new contract, KP must provide some of those services. But some executives at other health care plans say KP will not have to enroll a large number of sick patients who need such services because of how it limits enrollment.\u003c/p>\n\u003cp>Critics of the deal noted Newsom’s close relationship with KP, which has given nearly $100 million in charitable funding and grant money to boost Newsom’s efforts against homelessness, COVID response and wildfire relief since 2019, according to state records and KP news releases. The health care giant was also one of two hospital systems awarded a no-bid contract from the state to run a \u003ca href=\"https://about.kaiserpermanente.org/our-story/news/announcements/innovative-partnership-creates-los-angeles-surge-hospital\">field hospital in Los Angeles\u003c/a> during the early days of the COVID pandemic, and it got \u003ca href=\"https://khn.org/news/article/blue-shield-spent-years-cultivating-a-relationship-with-newsom-it-got-the-state-vaccine-contract/\">a special agreement\u003c/a> from the Newsom administration to help vaccinate Californians last year.\u003c/p>\n\u003cp>Jim DeBoo, Newsom’s executive secretary, \u003ca href=\"https://cal-access.sos.ca.gov/Lobbying/Firms/Detail.aspx?id=1364764&session=2019\">used to lobby for KP\u003c/a> before joining the administration. Toby Douglas, a former director of the state Department of Health Care Services, which runs Medi-Cal, is now Kaiser Permanente’s vice president for national Medicaid.\u003c/p>\n\u003cp>https://twitter.com/Paul_Erskine/status/1218294697593933825?s=20&t=VHrby3saI4V4EOHIQJNoWg\u003c/p>\n\u003cp>Still, many critics agree that Kaiser Permanente is a linchpin of the state’s health care system, with its strong focus on preventive care and high marks for quality of care. Many of the public insurance plans upset by the deal subcontract with KP for patient care and acknowledge that their overall quality scores will likely decline when KP goes its own way.\u003c/p>\n\u003cp>Michelle Baass, director of the state Department of Health Care Services, said Medi-Cal had risked losing KP’s “high quality” and “clinical expertise” altogether had it been required to accept all enrollees, as the other health plans must. But she said KP will have to comply with all other conditions that other plans must meet, including tightened requirements on access, quality, consumer satisfaction and health equity.\u003c/p>\n\u003cp>The state will also have greater oversight over patient care, she said.\u003c/p>\n\u003cp>“This proposal is a way to help ensure Kaiser treats more low-income patients, and that more low-income patients have access to Kaiser’s high-quality services,” Baass said.\u003c/p>\n\u003cp>Though Kaiser Permanente has 9 million enrollees, close to a quarter of all Californians, only about 900,000 of them are Medi-Cal members.\u003c/p>\n\u003cp>Under the current system, 12 of the 24 other managed care insurance plans that participate in Medi-Cal subcontract with KP to care for a subset of their patients, keeping a small slice of the Medi-Cal dollars earmarked for those patients. Under the new contract, KP can take those patients away and keep all the money.\u003c/p>\n\u003cp>In its subcontracts, and in counties where it enrolls patients directly, KP accepts only people who are recent Kaiser Permanente members and, in some cases, their family members. It is the only health plan that can limit its Medi-Cal enrollment in this way.\u003c/p>\n\u003cp>The new contract allows KP to continue this practice, but it also requires Kaiser Permanente to take on more children in foster care and complex, expensive patients who are eligible for both Medi-Cal and Medicare. It allows KP to expand its geographic reach in Medi-Cal to do so.\u003c/p>\n\u003cp>Baass said the state expects KP’s Medi-Cal enrollment to increase 25% over the life of the contract.\u003c/p>\n\u003cp>KP defended the practice of limiting enrollment primarily to its previous members, arguing that it provides “continuity of care when members transition into and out of Medi-Cal.”\u003c/p>\n\u003cp>[aside label='More Health Coverage' tag='health']The state has long pushed for a larger KP footprint in Medi-Cal, citing its high quality ratings, its strong integrated network, and its huge role on the broader health care landscape.\u003c/p>\n\u003cp>“Kaiser Permanente historically has not played a very big role in Medi-Cal, and the state has long recognized that we would benefit from having them more engaged because they get better health outcomes and focus on prevention,” said Daniel Zingale, a former Newsom administration official and health insurance regulator who now advises a lobbying firm that has Kaiser Permanente as a client.\u003c/p>\n\u003cp>But by accepting primarily people who have been KP members in the recent past, the health care system has been able to limit its share of high-need, expensive patients, say rival health plan executives and former state health officials.\u003c/p>\n\u003cp>The executives fear the deal could saddle them with even more of these patients in the future, including unhoused people and those with mental illnesses — and make it harder to provide adequate care for them. Many of those patients will join Medi-Cal for the first time under the CalAIM initiative, and KP will not be required to accept many of them.\u003c/p>\n\u003cp>“Awarding a no-bid Medi-Cal contract to a statewide commercial plan with a track record of ‘cherry picking’ members and offering only limited behavioral health and community support benefits not only conflicts with the intent and goals of CalAIM but undermines publicly organized health care,” according to an internal document prepared by the Inland Empire Health Plan.\u003c/p>\n\u003cp>The plan said it stands to lose the roughly 144,000 Medi-Cal members it delegates to KP and about $10 million in annual revenue. LA Care, the nation’s largest Medicaid health plan, with 2.4 million enrollees in Los Angeles County, will lose its 244,000 KP members, based on data shared by the plan.\u003c/p>\n\u003cp>The state had been scheduled on Wednesday to release final details and instructions for the commercial plans that are submitting bids for new contracts starting in 2024. But it delayed the release a week to make the KP deal public beforehand.\u003c/p>\n\u003cp>Baass said the state agreed to exempt KP from the bidding process because the standardized contract expected to result from it would have required the insurer to accept all enrollees, which Kaiser Permanente does not have the capacity to do.\u003c/p>\n\u003cp>“It’s not surprising to me that the state will go to extraordinary means to make sure that Kaiser is in the mix, given it has been in the vanguard of our health care delivery system,” Zingale said.\u003c/p>\n\u003cp>Having a direct statewide Medi-Cal contract will greatly reduce the administrative workload for KP, which will now deal with only one agency on reporting and oversight, rather than the 12 public plans it currently subcontracts with.\u003c/p>\n\u003cp>And the new contract will give it an even closer relationship with Newsom and state health officials.\u003c/p>\n\u003cp>In 2020, \u003ca href=\"https://about.kaiserpermanente.org/community-health/news/25m-pledge-to-california-governors-housing-fund\">KP gave $25 million to one of Newsom’s key initiatives\u003c/a>, a state homelessness fund to move people off the streets and into hotel rooms, according to a KHN analysis of charitable payments filed with the California \u003ca href=\"https://www.fppc.ca.gov/transparency/behested-payments.html\">Fair Political Practices Commission\u003c/a>. The same year, it donated $9.75 million to a state COVID relief fund.\u003c/p>\n\u003cp>In summer 2020, when local and state public health departments struggled to contain COVID spread, the health care giant pledged \u003ca href=\"https://about.kaiserpermanente.org/community-health/news/kaiser-permanente-commits-63m-to-support-contact-tracing-in-california\">$63 million in grant funding to help contract-tracing efforts\u003c/a>.\u003c/p>\n\u003cp>KP’s influence extends beyond its massive charitable giving. Its CEO, Greg Adams, landed an appointment on the governor’s economic recovery task force early in the pandemic, and Newsom has showcased KP hospitals at vaccine media events throughout the state.\u003c/p>\n\u003cp>https://twitter.com/KPSCALnews/status/1338603794062438400?s=20&t=4dpVkiilzowe4ESRlCyPOg\u003c/p>\n\u003cp>“In California and across the U.S., the campaign contributions and the organizing, the lobbying, all of that stuff is important,” said Andrew Kelly, an assistant professor of health policy at California State University, East Bay. “But there’s a different type of power that comes from your ability to have this privileged position within public programs.”\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"https://khn.org/\">KHN\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003cem>KHN is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Editor’s note: KHN is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cp>Gov. Gavin Newsom’s administration has negotiated a secret deal to give Kaiser Permanente a special Medicaid contract that would allow the health care behemoth to expand its reach in California and largely continue selecting the enrollees it wants, which other health care plans say leaves them with a disproportionate share of the program’s sickest and costliest patients.\u003c/p>\n\u003cp>The deal, hammered out behind closed doors between Kaiser Permanente and senior officials in Newsom’s office, could complicate a long-planned and expensive transformation of Medi-Cal, the state’s Medicaid program, which covers roughly 14 million lower-income Californians.\u003c/p>\n\u003cp>It has infuriated executives of other managed-care insurance plans in Medi-Cal, who say they stand to lose hundreds of thousands of patients and millions of dollars a year. The deal allows KP to limit enrollment primarily to its previous enrollees, except in the case of kids in foster care and people who are eligible for both Medicare and Medi-Cal.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It has caused a massive amount of frenzy,” said Jarrod McNaughton, CEO of the Inland Empire Health Plan, which covers about 1.5 million Medi-Cal enrollees in Riverside and San Bernardino counties. “All of us are doing our best to implement the most transformational Medi-Cal initiative in state history, and to put all this together without a public process is very disconcerting.”\u003c/p>\n\u003cp>Linnea Koopmans, CEO of the Local Health Plans of California, echoed McNaughton’s concerns.\u003c/p>\n\u003cp>Insurance plans got wind of the backroom talks when broad outlines of the deal were leaked days before the state briefed their executives Thursday.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Dr. Bechara Choucair, Kaiser Permanente’s chief health officer, argued \u003ca href=\"https://khn.org/wp-content/uploads/sites/2/2022/02/Kaiser-Permanente-response-to-KHN-inquiry.pdf\">in a prepared written response\u003c/a> on behalf of KP that because it operates both as a health insurer and a health care provider, KP should be treated differently from other commercial health care plans that participate in Medi-Cal. Doing business directly with the state will eliminate complexity and improve the quality of care for the Medi-Cal patients it serves, he said.\u003c/p>\n\u003cp>“We are not seeking to turn a profit off Medi-Cal enrollment,” Choucair said. “Kaiser Permanente participates in Medi-Cal because it is part of our mission to improve the health of the communities we serve. We participate in Medi-Cal despite incurring losses every year.”\u003c/p>\n\u003cp>His statement cited nearly $1.8 billion in losses in the program in 2020 and said KP had donated $402 million to help care for uninsured people that year.\u003c/p>\n\u003cp>Kaiser Permanente, the state’s largest managed-care organization, is one of Newsom’s most generous supporters and close political allies.\u003c/p>\n\u003cp>The new, five-year contract, confirmed to KHN by administration officials and expected to be announced publicly Friday, will take effect in 2024 pending approval from the Legislature — and will make KP the only insurer with a statewide Medi-Cal contract. It allows KP to solidify its position before California’s other commercial Medi-Cal plans participate in a \u003ca href=\"https://californiahealthline.org/news/article/californias-reboot-of-troubled-medi-cal-puts-pressure-on-health-plans/\">statewide bidding process\u003c/a> — and after those plans have spent many months and considerable resources developing their bidding strategies.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Other health care plans fear the contract could also muddle a massive and expensive initiative called \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-makeover-calaim-homeless-whole-body-care/\">CalAIM\u003c/a> that seeks to provide social services to the state’s most vulnerable patients, including home-delivered meals, housing aid for unhoused people, and \u003ca href=\"https://californiahealthline.org/news/article/mattresses-and-mold-removal-medi-cal-to-offer-unconventional-treatments-to-asthma-patients/\">mold removal\u003c/a> from homes. Under its new contract, KP must provide some of those services. But some executives at other health care plans say KP will not have to enroll a large number of sick patients who need such services because of how it limits enrollment.\u003c/p>\n\u003cp>Critics of the deal noted Newsom’s close relationship with KP, which has given nearly $100 million in charitable funding and grant money to boost Newsom’s efforts against homelessness, COVID response and wildfire relief since 2019, according to state records and KP news releases. The health care giant was also one of two hospital systems awarded a no-bid contract from the state to run a \u003ca href=\"https://about.kaiserpermanente.org/our-story/news/announcements/innovative-partnership-creates-los-angeles-surge-hospital\">field hospital in Los Angeles\u003c/a> during the early days of the COVID pandemic, and it got \u003ca href=\"https://khn.org/news/article/blue-shield-spent-years-cultivating-a-relationship-with-newsom-it-got-the-state-vaccine-contract/\">a special agreement\u003c/a> from the Newsom administration to help vaccinate Californians last year.\u003c/p>\n\u003cp>Jim DeBoo, Newsom’s executive secretary, \u003ca href=\"https://cal-access.sos.ca.gov/Lobbying/Firms/Detail.aspx?id=1364764&session=2019\">used to lobby for KP\u003c/a> before joining the administration. Toby Douglas, a former director of the state Department of Health Care Services, which runs Medi-Cal, is now Kaiser Permanente’s vice president for national Medicaid.\u003c/p>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>Still, many critics agree that Kaiser Permanente is a linchpin of the state’s health care system, with its strong focus on preventive care and high marks for quality of care. Many of the public insurance plans upset by the deal subcontract with KP for patient care and acknowledge that their overall quality scores will likely decline when KP goes its own way.\u003c/p>\n\u003cp>Michelle Baass, director of the state Department of Health Care Services, said Medi-Cal had risked losing KP’s “high quality” and “clinical expertise” altogether had it been required to accept all enrollees, as the other health plans must. But she said KP will have to comply with all other conditions that other plans must meet, including tightened requirements on access, quality, consumer satisfaction and health equity.\u003c/p>\n\u003cp>The state will also have greater oversight over patient care, she said.\u003c/p>\n\u003cp>“This proposal is a way to help ensure Kaiser treats more low-income patients, and that more low-income patients have access to Kaiser’s high-quality services,” Baass said.\u003c/p>\n\u003cp>Though Kaiser Permanente has 9 million enrollees, close to a quarter of all Californians, only about 900,000 of them are Medi-Cal members.\u003c/p>\n\u003cp>Under the current system, 12 of the 24 other managed care insurance plans that participate in Medi-Cal subcontract with KP to care for a subset of their patients, keeping a small slice of the Medi-Cal dollars earmarked for those patients. Under the new contract, KP can take those patients away and keep all the money.\u003c/p>\n\u003cp>In its subcontracts, and in counties where it enrolls patients directly, KP accepts only people who are recent Kaiser Permanente members and, in some cases, their family members. It is the only health plan that can limit its Medi-Cal enrollment in this way.\u003c/p>\n\u003cp>The new contract allows KP to continue this practice, but it also requires Kaiser Permanente to take on more children in foster care and complex, expensive patients who are eligible for both Medi-Cal and Medicare. It allows KP to expand its geographic reach in Medi-Cal to do so.\u003c/p>\n\u003cp>Baass said the state expects KP’s Medi-Cal enrollment to increase 25% over the life of the contract.\u003c/p>\n\u003cp>KP defended the practice of limiting enrollment primarily to its previous members, arguing that it provides “continuity of care when members transition into and out of Medi-Cal.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The state has long pushed for a larger KP footprint in Medi-Cal, citing its high quality ratings, its strong integrated network, and its huge role on the broader health care landscape.\u003c/p>\n\u003cp>“Kaiser Permanente historically has not played a very big role in Medi-Cal, and the state has long recognized that we would benefit from having them more engaged because they get better health outcomes and focus on prevention,” said Daniel Zingale, a former Newsom administration official and health insurance regulator who now advises a lobbying firm that has Kaiser Permanente as a client.\u003c/p>\n\u003cp>But by accepting primarily people who have been KP members in the recent past, the health care system has been able to limit its share of high-need, expensive patients, say rival health plan executives and former state health officials.\u003c/p>\n\u003cp>The executives fear the deal could saddle them with even more of these patients in the future, including unhoused people and those with mental illnesses — and make it harder to provide adequate care for them. Many of those patients will join Medi-Cal for the first time under the CalAIM initiative, and KP will not be required to accept many of them.\u003c/p>\n\u003cp>“Awarding a no-bid Medi-Cal contract to a statewide commercial plan with a track record of ‘cherry picking’ members and offering only limited behavioral health and community support benefits not only conflicts with the intent and goals of CalAIM but undermines publicly organized health care,” according to an internal document prepared by the Inland Empire Health Plan.\u003c/p>\n\u003cp>The plan said it stands to lose the roughly 144,000 Medi-Cal members it delegates to KP and about $10 million in annual revenue. LA Care, the nation’s largest Medicaid health plan, with 2.4 million enrollees in Los Angeles County, will lose its 244,000 KP members, based on data shared by the plan.\u003c/p>\n\u003cp>The state had been scheduled on Wednesday to release final details and instructions for the commercial plans that are submitting bids for new contracts starting in 2024. But it delayed the release a week to make the KP deal public beforehand.\u003c/p>\n\u003cp>Baass said the state agreed to exempt KP from the bidding process because the standardized contract expected to result from it would have required the insurer to accept all enrollees, which Kaiser Permanente does not have the capacity to do.\u003c/p>\n\u003cp>“It’s not surprising to me that the state will go to extraordinary means to make sure that Kaiser is in the mix, given it has been in the vanguard of our health care delivery system,” Zingale said.\u003c/p>\n\u003cp>Having a direct statewide Medi-Cal contract will greatly reduce the administrative workload for KP, which will now deal with only one agency on reporting and oversight, rather than the 12 public plans it currently subcontracts with.\u003c/p>\n\u003cp>And the new contract will give it an even closer relationship with Newsom and state health officials.\u003c/p>\n\u003cp>In 2020, \u003ca href=\"https://about.kaiserpermanente.org/community-health/news/25m-pledge-to-california-governors-housing-fund\">KP gave $25 million to one of Newsom’s key initiatives\u003c/a>, a state homelessness fund to move people off the streets and into hotel rooms, according to a KHN analysis of charitable payments filed with the California \u003ca href=\"https://www.fppc.ca.gov/transparency/behested-payments.html\">Fair Political Practices Commission\u003c/a>. The same year, it donated $9.75 million to a state COVID relief fund.\u003c/p>\n\u003cp>In summer 2020, when local and state public health departments struggled to contain COVID spread, the health care giant pledged \u003ca href=\"https://about.kaiserpermanente.org/community-health/news/kaiser-permanente-commits-63m-to-support-contact-tracing-in-california\">$63 million in grant funding to help contract-tracing efforts\u003c/a>.\u003c/p>\n\u003cp>KP’s influence extends beyond its massive charitable giving. Its CEO, Greg Adams, landed an appointment on the governor’s economic recovery task force early in the pandemic, and Newsom has showcased KP hospitals at vaccine media events throughout the state.\u003c/p>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>“In California and across the U.S., the campaign contributions and the organizing, the lobbying, all of that stuff is important,” said Andrew Kelly, an assistant professor of health policy at California State University, East Bay. “But there’s a different type of power that comes from your ability to have this privileged position within public programs.”\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"https://khn.org/\">KHN\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003cem>KHN is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "With Little Chance of Success, Single-Payer Health Care Bill Withdrawn Ahead of Vote in State Legislature",
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"content": "\u003cp>California Democrats decided not to advance a bill that would make the government pay for everybody’s health care in the nation’s most populous state. Assemblymember Ash Kalra announced that he would withdraw AB 1400, California Guaranteed Health Care for All Act (CalCare), from a vote today after it became clear there would not be enough votes for it to pass.\u003c/p>\n\u003cp>“Despite heavy opposition and substantial misinformation from those that stand to profit from our current healthcare system, we were able to ignite a realistic and achievable path toward single-payer and bring AB 1400 to the floor of the Assembly,” said Kalra in a news release. “Although the bill did not pass the Assembly by today’s deadline, this is only a pause for the single-payer movement; our coalition, including the mighty California Nurses Association, will continue the fight for accessible, affordable, and equitable healthcare for all Californians.”\u003c/p>\n\u003cp>The bill would have created the nation’s only statewide universal health care system and set its rules — but it would not have paid for it. There’s another bill that would do that. It has a different deadline and does not have to pass on Monday.[pullquote size=\"medium\" align=\"right\" citation=\"Assemblymember Ash Kalra, D-San Jose\"]‘Although the bill did not pass the Assembly by today’s deadline, this is only a pause for the single-payer movement; our coalition, including the mighty California Nurses Association, will continue the fight for accessible, affordable, and equitable healthcare for all Californians.’[/pullquote]There were still many unanswered questions about financing, quality and how doctors would make decisions. Monday’s debate would likely have been dominated by concerns about cost. The latest estimate says it would cost taxpayers at least $356.5 billion per year to pay for the health care of nearly 40 million residents. California’s total operating budget — which pays for public schools, courts, roads and bridges and other important services — is roughly $262 billion this year.\u003c/p>\n\u003cp>In light of the news that the Assembly failed to vote on the bill, the California Nurses Association released a statement condemning the decision.\u003c/p>\n\u003cp>“Today, elected leaders in California had the opportunity to put patients first and set an example for the whole country by passing AB 1400, the California Guaranteed Health Care for All Act, in the State Assembly. Instead, Assembly Member Ash Kalra, the main author of the bill, chose not to hold a vote on this bill at all, providing cover for those who would have been forced to go on the record about where they stand on guaranteed health care for all people in California. Nurses condemn this failure by elected representatives to put patients above profits, especially during the worst surge of COVID-19 yet, at a time when it’s more clear than ever before that health care must be a right, not just a privilege for those who can afford it.”\u003c/p>\n\u003cp>Assembly Republican Leader Marie Waldron lauded Democrats who stood up to their base and joined Republicans to put an end to the bill she referred to as a “foolhardy plan.”\u003c/p>\n\u003cp>“Better late than never,” said Waldron in a news release. “The fact that a proposal for a government takeover of our state’s entire health care system even made it this far shows just how out of touch the Democratic party is from the needs of everyday Californians. Even though this plan is dead for now, every Democrat who supported it will have to answer for their effort to end Medicare, kick 20 million Californians off their existing plans, require the largest tax increase in state history and put bureaucrats in charge of health care.”\u003c/p>\n\u003cp>Other coalitions opposed to the bill expressed concern that its passage would have done more harm than good.\u003c/p>\n\u003cp>“Californians are already facing higher inflation and taxes while struggling with the many difficulties/hardships that the pandemic has caused,” said Ned Wigglesworth, a spokesperson for the Protect California Health Care coalition, in a news statement. “They should have the right to choose the coverage they want, and deserve a stable health care system they can always rely on. AB 1400 would have eliminated both Medicare for seniors and private coverage for everyone, with no guarantee that patients could keep their doctor. The bill would have irreparably damaged the health care that millions of Californians rely on every day — all in the middle of a pandemic. Today’s vote in the Assembly was a vote to protect their constituents from higher taxes and chaos in our health care system.”\u003c/p>\n\u003cp>Earlier this month, Democrats filed a proposed amendment to the state Constitution that would impose hefty new taxes on businesses and individuals to pay for the system. The taxes would generate roughly $163 billion per year, and the amendment would give lawmakers the power to raise those taxes to keep up with costs. Supporters hoped both proposals — the bill to create the system and the bill to pay for it — would move forward together this year.\u003c/p>\n\u003cp>But Monday’s deadline was only on the bill that would create the system.\u003c/p>\n\u003cp>Supporters say Californians and their employers are already paying exorbitant amounts for health care through high deductibles, co-pays and monthly insurance premiums. The bill would have eliminated all of those and replace them with taxes.\u003c/p>\n\u003cp>“Sure, there is sticker shock. But there should be sticker shock for how much we are paying now,” said Stephanie Roberson, director of government relations for the California Nurses Association.\u003c/p>\n\u003cp>“What are we getting? People are still uninsured. People are still underinsured. People are going into medical debt. People have to reach tens of thousands of dollars of deductibles. We’ll eliminate that under this program,” she said.\u003c/p>\n\u003cp>Right now, lots of people pay for California’s health care system, including patients, insurance companies and employers. The bill before the Legislature would change that to a single payer — the government. If enacted, it would unravel the private health insurance market. Private health insurance would still be allowed, but only for services not covered by the government.\u003c/p>\n\u003cp>Progressives have long dreamed of a single-payer health system in the U.S., believing it would control costs and save lives. But it’s never happened. Vermont enacted the nation’s first single-payer health care system in 2011, but later abandoned it because of the cost. Proposals in Congress have gone nowhere.[aside postID=\"news_11902591,news_11901347,news_11902585\" label=\"Related Posts\"]In California, voters overwhelmingly rejected a single-payer system in a 1994 ballot initiative. State lawmakers tried again in the 2000s, twice passing single-payer legislation only to have both bills vetoed by then-Gov. Arnold Schwarzenegger, a Republican. Another attempt in 2017 passed the Senate but died in the Assembly.\u003c/p>\n\u003cp>This year’s vote wouldn’t have been easy, even in famously liberal California. While this bill had the support of some Democratic leaders and powerful labor unions, it had intense opposition from business groups that are pressuring more moderate Democrats not to vote for it.\u003c/p>\n\u003cp>The bill needed 41 votes to survive on Monday. Democrats have 56 of the 80 seats in the Assembly. But they are missing three of their more liberal members, who have recently resigned to take other jobs, leaving little room for defections. The current idea for financing includes new taxes, and legislators will need to get voter approval for that.\u003c/p>\n\u003cp>Supporters did not get a boost from Newsom, who they thought would be an important ally. Newsom campaigned for a universal health care system during his 2018 run for governor. But since taking office, Newsom has focused mostly on expanding access to insurance coverage.\u003c/p>\n\u003cp>Newsom has said he still supports a single-payer system. A commission he established to study the idea is due to release its report later this year. But Newsom remained silent on this latest proposal ahead of Monday’s deadline.\u003c/p>\n\u003cp>“What we need right now is support from the governor on this bill,” Roberson said before the bill was withdrawn. “We welcome him to make good on his campaign promise.”\u003c/p>\n\u003cp>\u003cem>KQED’s April Dembosky contributed to this story.\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California Democrats decided not to advance a bill that would make the government pay for everybody’s health care in the nation’s most populous state. Assemblymember Ash Kalra announced that he would withdraw AB 1400, California Guaranteed Health Care for All Act (CalCare), from a vote today after it became clear there would not be enough votes for it to pass.\u003c/p>\n\u003cp>“Despite heavy opposition and substantial misinformation from those that stand to profit from our current healthcare system, we were able to ignite a realistic and achievable path toward single-payer and bring AB 1400 to the floor of the Assembly,” said Kalra in a news release. “Although the bill did not pass the Assembly by today’s deadline, this is only a pause for the single-payer movement; our coalition, including the mighty California Nurses Association, will continue the fight for accessible, affordable, and equitable healthcare for all Californians.”\u003c/p>\n\u003cp>The bill would have created the nation’s only statewide universal health care system and set its rules — but it would not have paid for it. There’s another bill that would do that. It has a different deadline and does not have to pass on Monday.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>There were still many unanswered questions about financing, quality and how doctors would make decisions. Monday’s debate would likely have been dominated by concerns about cost. The latest estimate says it would cost taxpayers at least $356.5 billion per year to pay for the health care of nearly 40 million residents. California’s total operating budget — which pays for public schools, courts, roads and bridges and other important services — is roughly $262 billion this year.\u003c/p>\n\u003cp>In light of the news that the Assembly failed to vote on the bill, the California Nurses Association released a statement condemning the decision.\u003c/p>\n\u003cp>“Today, elected leaders in California had the opportunity to put patients first and set an example for the whole country by passing AB 1400, the California Guaranteed Health Care for All Act, in the State Assembly. Instead, Assembly Member Ash Kalra, the main author of the bill, chose not to hold a vote on this bill at all, providing cover for those who would have been forced to go on the record about where they stand on guaranteed health care for all people in California. Nurses condemn this failure by elected representatives to put patients above profits, especially during the worst surge of COVID-19 yet, at a time when it’s more clear than ever before that health care must be a right, not just a privilege for those who can afford it.”\u003c/p>\n\u003cp>Assembly Republican Leader Marie Waldron lauded Democrats who stood up to their base and joined Republicans to put an end to the bill she referred to as a “foolhardy plan.”\u003c/p>\n\u003cp>“Better late than never,” said Waldron in a news release. “The fact that a proposal for a government takeover of our state’s entire health care system even made it this far shows just how out of touch the Democratic party is from the needs of everyday Californians. Even though this plan is dead for now, every Democrat who supported it will have to answer for their effort to end Medicare, kick 20 million Californians off their existing plans, require the largest tax increase in state history and put bureaucrats in charge of health care.”\u003c/p>\n\u003cp>Other coalitions opposed to the bill expressed concern that its passage would have done more harm than good.\u003c/p>\n\u003cp>“Californians are already facing higher inflation and taxes while struggling with the many difficulties/hardships that the pandemic has caused,” said Ned Wigglesworth, a spokesperson for the Protect California Health Care coalition, in a news statement. “They should have the right to choose the coverage they want, and deserve a stable health care system they can always rely on. AB 1400 would have eliminated both Medicare for seniors and private coverage for everyone, with no guarantee that patients could keep their doctor. The bill would have irreparably damaged the health care that millions of Californians rely on every day — all in the middle of a pandemic. Today’s vote in the Assembly was a vote to protect their constituents from higher taxes and chaos in our health care system.”\u003c/p>\n\u003cp>Earlier this month, Democrats filed a proposed amendment to the state Constitution that would impose hefty new taxes on businesses and individuals to pay for the system. The taxes would generate roughly $163 billion per year, and the amendment would give lawmakers the power to raise those taxes to keep up with costs. Supporters hoped both proposals — the bill to create the system and the bill to pay for it — would move forward together this year.\u003c/p>\n\u003cp>But Monday’s deadline was only on the bill that would create the system.\u003c/p>\n\u003cp>Supporters say Californians and their employers are already paying exorbitant amounts for health care through high deductibles, co-pays and monthly insurance premiums. The bill would have eliminated all of those and replace them with taxes.\u003c/p>\n\u003cp>“Sure, there is sticker shock. But there should be sticker shock for how much we are paying now,” said Stephanie Roberson, director of government relations for the California Nurses Association.\u003c/p>\n\u003cp>“What are we getting? People are still uninsured. People are still underinsured. People are going into medical debt. People have to reach tens of thousands of dollars of deductibles. We’ll eliminate that under this program,” she said.\u003c/p>\n\u003cp>Right now, lots of people pay for California’s health care system, including patients, insurance companies and employers. The bill before the Legislature would change that to a single payer — the government. If enacted, it would unravel the private health insurance market. Private health insurance would still be allowed, but only for services not covered by the government.\u003c/p>\n\u003cp>Progressives have long dreamed of a single-payer health system in the U.S., believing it would control costs and save lives. But it’s never happened. Vermont enacted the nation’s first single-payer health care system in 2011, but later abandoned it because of the cost. Proposals in Congress have gone nowhere.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>In California, voters overwhelmingly rejected a single-payer system in a 1994 ballot initiative. State lawmakers tried again in the 2000s, twice passing single-payer legislation only to have both bills vetoed by then-Gov. Arnold Schwarzenegger, a Republican. Another attempt in 2017 passed the Senate but died in the Assembly.\u003c/p>\n\u003cp>This year’s vote wouldn’t have been easy, even in famously liberal California. While this bill had the support of some Democratic leaders and powerful labor unions, it had intense opposition from business groups that are pressuring more moderate Democrats not to vote for it.\u003c/p>\n\u003cp>The bill needed 41 votes to survive on Monday. Democrats have 56 of the 80 seats in the Assembly. But they are missing three of their more liberal members, who have recently resigned to take other jobs, leaving little room for defections. The current idea for financing includes new taxes, and legislators will need to get voter approval for that.\u003c/p>\n\u003cp>Supporters did not get a boost from Newsom, who they thought would be an important ally. Newsom campaigned for a universal health care system during his 2018 run for governor. But since taking office, Newsom has focused mostly on expanding access to insurance coverage.\u003c/p>\n\u003cp>Newsom has said he still supports a single-payer system. A commission he established to study the idea is due to release its report later this year. But Newsom remained silent on this latest proposal ahead of Monday’s deadline.\u003c/p>\n\u003cp>“What we need right now is support from the governor on this bill,” Roberson said before the bill was withdrawn. “We welcome him to make good on his campaign promise.”\u003c/p>\n\u003cp>\u003cem>KQED’s April Dembosky contributed to this story.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"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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"disqusTitle": "California Could Lose $2 Billion of Budget Surplus Due to Feud With Trump",
"title": "California Could Lose $2 Billion of Budget Surplus Due to Feud With Trump",
"headTitle": "The California Report | KQED News",
"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>Diabetics skipping regular checkups. Young asthmatics not getting preventive care. A surge in expensive emergency room visits.\u003c/p>\n\u003cp>Doctors and public health experts warn of poor health and rising costs they say will come from sweeping Trump administration changes that would deny green cards to many immigrants who use Medicaid, as well as food stamps and other forms of public assistance.\u003c/p>\n\u003cp>Some advocates say they’re already seeing the fallout even before the complex 837-page rule takes effect in October.\u003c/p>\n\u003cp>President Donald Trump’s administration trumpeted its aggressive \u003ca href=\"https://apnews.com/f440cbe61eb642c99f4d9a47e437c526\" target=\"_blank\" rel=\"noopener\">approach\u003c/a> this past week as a way to keep only self-sufficient immigrants in the country, but health experts argue it could force potentially millions of low-income migrants to choose between needed services and their bid to stay legally in the U.S.\u003c/p>\n\u003cp>“People are going to be sicker. They’re not going to go get health care, or not until they have to go to an emergency room,” said Lisa David, president and CEO of Public Health Solutions, New York’s largest public health organization. “It’s going to cost the system a lot of money.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Immigrants who want permanent legal status, commonly called a green card, have long been required to prove they won’t be “a public charge.”\u003c/p>\n\u003cp>The Trump administration announced Monday that would redefine the term to mean those who are “more likely than not” to receive public benefits over a certain period. U.S. Citizenship and Immigration Services will also now consider other factors, including income, education and English proficiency.\u003c/p>\n\u003cp>“We want to see people coming to this country who are self-sufficient,” said Ken Cuccinelli, the agency’s acting director. “That’s a core principle of the American dream. It’s deeply embedded in our history, and particularly our history related to legal immigration.”\u003c/p>\n\u003cp>\u003ca href=\"https://apnews.com/21e2d0d8ebad45d5932f400184a566fd\" target=\"_blank\" rel=\"noopener\">Two\u003c/a> California counties and attorneys general in 13 states sued, \u003ca href=\"https://apnews.com/a185c08acfd84c548e8a679f57b07305\" target=\"_blank\" rel=\"noopener\">saying\u003c/a> the changes will increase public health risks.\u003c/p>\n\u003cp>There are signs that is already happening in cities including Chicago, Detroit and New York, immigrant advocates say.\u003c/p>\n\u003cp>Within hours of the announcement, a Minnesota immigration attorney said she received a flurry of calls from worried clients about whether to leave Medicaid.\u003c/p>\n\u003cp>A Detroit nonprofit helping Latinos and immigrants with social services said its usually jam-packed lobby was empty the day after the rules were unveiled.\u003c/p>\n\u003cp>New York’s largest public health organization, Public Health Solutions, which serves a large immigrant population, reported a 20% drop in food stamps enrollment since the rule was first proposed in the fall.\u003c/p>\n\u003cp>There is precedent for such a chilling effect.\u003c/p>\n\u003cp>After 1996 welfare and immigration changes that limited public assistance for some immigrants, the use of benefits dropped steeply among U.S. citizen children and refugees, groups who were still eligible.\u003c/p>\n\u003cp>Studies based on data following that change showed people disenrolled from Medicaid at rates ranging from 15% to 35%, according to Harvard University’s François-Bagnoud Center for Health and Human Rights. And, it found, this came at a high cost: Asthma-related school absences in 1996 led to $719 million in lost parental productivity.\u003c/p>\n\u003cp>Federico Mason, who emigrated from Mexico over two decades ago, said he is worried about the new criteria because he is low-income and doesn’t speak English well. The Chicago resident said he has no immediate plans to remove his 8- and 15-year-old sons, who are U.S. citizens, from Medicaid, but the new rule has made him more fearful about providing for his family and about applying for a green card.\u003c/p>\n\u003cp>“If one day I want to adjust my status, it will be more difficult because of these unfair policies that continue to discriminate against me,” he said in Spanish.\u003c/p>\n\u003cp>Overall, non-citizen low-income immigrants use public benefits at a much \u003ca href=\"https://www.apnews.com/460423ab286a4014bfe458a6989cc3f9\" target=\"_blank\" rel=\"noopener\">lower rate\u003c/a> than low-income U.S.-born citizens, but there’s the possibility that millions of people could drop benefits out of fear or confusion.\u003c/p>\n\u003cp>Estimates vary. It could be as high as 24 million people, according to the nonpartisan Fiscal Policy Institute, which includes in its count anyone in a family that has received food, health or housing support and where at least one person is a non-citizen.\u003c/p>\n\u003cp>Dr. Deanna Behrens, a pediatric critical-care physician in suburban Chicago who wrote public testimony opposing the rule change, said children are the most vulnerable.\u003c/p>\n\u003cp>She said non-citizen parents might hesitate to apply for their children who are U.S. citizens, mistakenly fearing that if their children get benefits it will destroy their own chances of getting a green card and tear their families apart.\u003c/p>\n\u003cp>That will lead to people being unable to afford care for chronic diseases like asthma and diabetes, as well as preventative measures. Instead, they’ll rely on far more costly emergency rooms.\u003c/p>\n\u003cp>“This has forced the immigrant families into an impossible choice,” Behrens said. Roughly 544,000 people apply for green cards annually, with about 382,000 falling into categories that would be subject to the new review, according to the government.\u003c/p>\n\u003cp>Esperanza Health Centers, which runs four Chicago-based clinics that serve low-income and largely immigrant populations, has seen an increase in the number of uninsured children. Since a draft of the new rule was released in the fall, the clinics report having 600 children without insurance, including those who have disenrolled from Medicaid. Typically, it’s about 200, according to Jessica Boland, director of behavioral health.\u003c/p>\n\u003cp>“We’re condemning people to having a much more unhealthy lifestyles because we believe that there is something awful about their request for what we think for most people is a right and not a privilege: health care,” said Dr. Kenneth Davis, president and CEO of Mount Sinai Health System, which covers eight hospitals in New York.\u003c/p>\n\u003cp>Over a dozen major patient groups, including the March of Dimes and the American Heart Association, have written fierce opposition to the rule.\u003c/p>\n\u003cp>The issue is personal for Dr. Jasmine Saavedra, a pediatrician who works at an Esperanza clinic in a heavily Latino Chicago neighborhood.\u003c/p>\n\u003cp>She is convinced that if new Trump administration criteria were in effect for her parents three decades ago, she would have had a far different future. Her parents emigrated from Mexico in the 1980s unable to speak English and with little education.\u003c/p>\n\u003cp>While working low-wage jobs, they relied on food stamps for a short time to get by. Her mother later quit public assistance because of the stigma, but Saavedra said there were days when her mother wouldn’t eat so her children could. She believes that helped her become a doctor and her two sisters become an accountant and a nurse.\u003c/p>\n\u003cp>“Maybe when certain people think about immigrant families, they do think of it as a burden on this country, the way people would tell my mom she was when she was receiving assistance,” Saavedra said.\u003c/p>\n\u003cp>“But my parents, with no education, not speaking this language, being impoverished with a little bit assistance when they could, got us out and they have three successful daughters.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Associated Press video journalist Mike Householder in Detroit contributed to this report.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Diabetics skipping regular checkups. Young asthmatics not getting preventive care. A surge in expensive emergency room visits.\u003c/p>\n\u003cp>Doctors and public health experts warn of poor health and rising costs they say will come from sweeping Trump administration changes that would deny green cards to many immigrants who use Medicaid, as well as food stamps and other forms of public assistance.\u003c/p>\n\u003cp>Some advocates say they’re already seeing the fallout even before the complex 837-page rule takes effect in October.\u003c/p>\n\u003cp>President Donald Trump’s administration trumpeted its aggressive \u003ca href=\"https://apnews.com/f440cbe61eb642c99f4d9a47e437c526\" target=\"_blank\" rel=\"noopener\">approach\u003c/a> this past week as a way to keep only self-sufficient immigrants in the country, but health experts argue it could force potentially millions of low-income migrants to choose between needed services and their bid to stay legally in the U.S.\u003c/p>\n\u003cp>“People are going to be sicker. They’re not going to go get health care, or not until they have to go to an emergency room,” said Lisa David, president and CEO of Public Health Solutions, New York’s largest public health organization. “It’s going to cost the system a lot of money.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Immigrants who want permanent legal status, commonly called a green card, have long been required to prove they won’t be “a public charge.”\u003c/p>\n\u003cp>The Trump administration announced Monday that would redefine the term to mean those who are “more likely than not” to receive public benefits over a certain period. U.S. Citizenship and Immigration Services will also now consider other factors, including income, education and English proficiency.\u003c/p>\n\u003cp>“We want to see people coming to this country who are self-sufficient,” said Ken Cuccinelli, the agency’s acting director. “That’s a core principle of the American dream. It’s deeply embedded in our history, and particularly our history related to legal immigration.”\u003c/p>\n\u003cp>\u003ca href=\"https://apnews.com/21e2d0d8ebad45d5932f400184a566fd\" target=\"_blank\" rel=\"noopener\">Two\u003c/a> California counties and attorneys general in 13 states sued, \u003ca href=\"https://apnews.com/a185c08acfd84c548e8a679f57b07305\" target=\"_blank\" rel=\"noopener\">saying\u003c/a> the changes will increase public health risks.\u003c/p>\n\u003cp>There are signs that is already happening in cities including Chicago, Detroit and New York, immigrant advocates say.\u003c/p>\n\u003cp>Within hours of the announcement, a Minnesota immigration attorney said she received a flurry of calls from worried clients about whether to leave Medicaid.\u003c/p>\n\u003cp>A Detroit nonprofit helping Latinos and immigrants with social services said its usually jam-packed lobby was empty the day after the rules were unveiled.\u003c/p>\n\u003cp>New York’s largest public health organization, Public Health Solutions, which serves a large immigrant population, reported a 20% drop in food stamps enrollment since the rule was first proposed in the fall.\u003c/p>\n\u003cp>There is precedent for such a chilling effect.\u003c/p>\n\u003cp>After 1996 welfare and immigration changes that limited public assistance for some immigrants, the use of benefits dropped steeply among U.S. citizen children and refugees, groups who were still eligible.\u003c/p>\n\u003cp>Studies based on data following that change showed people disenrolled from Medicaid at rates ranging from 15% to 35%, according to Harvard University’s François-Bagnoud Center for Health and Human Rights. And, it found, this came at a high cost: Asthma-related school absences in 1996 led to $719 million in lost parental productivity.\u003c/p>\n\u003cp>Federico Mason, who emigrated from Mexico over two decades ago, said he is worried about the new criteria because he is low-income and doesn’t speak English well. The Chicago resident said he has no immediate plans to remove his 8- and 15-year-old sons, who are U.S. citizens, from Medicaid, but the new rule has made him more fearful about providing for his family and about applying for a green card.\u003c/p>\n\u003cp>“If one day I want to adjust my status, it will be more difficult because of these unfair policies that continue to discriminate against me,” he said in Spanish.\u003c/p>\n\u003cp>Overall, non-citizen low-income immigrants use public benefits at a much \u003ca href=\"https://www.apnews.com/460423ab286a4014bfe458a6989cc3f9\" target=\"_blank\" rel=\"noopener\">lower rate\u003c/a> than low-income U.S.-born citizens, but there’s the possibility that millions of people could drop benefits out of fear or confusion.\u003c/p>\n\u003cp>Estimates vary. It could be as high as 24 million people, according to the nonpartisan Fiscal Policy Institute, which includes in its count anyone in a family that has received food, health or housing support and where at least one person is a non-citizen.\u003c/p>\n\u003cp>Dr. Deanna Behrens, a pediatric critical-care physician in suburban Chicago who wrote public testimony opposing the rule change, said children are the most vulnerable.\u003c/p>\n\u003cp>She said non-citizen parents might hesitate to apply for their children who are U.S. citizens, mistakenly fearing that if their children get benefits it will destroy their own chances of getting a green card and tear their families apart.\u003c/p>\n\u003cp>That will lead to people being unable to afford care for chronic diseases like asthma and diabetes, as well as preventative measures. Instead, they’ll rely on far more costly emergency rooms.\u003c/p>\n\u003cp>“This has forced the immigrant families into an impossible choice,” Behrens said. Roughly 544,000 people apply for green cards annually, with about 382,000 falling into categories that would be subject to the new review, according to the government.\u003c/p>\n\u003cp>Esperanza Health Centers, which runs four Chicago-based clinics that serve low-income and largely immigrant populations, has seen an increase in the number of uninsured children. Since a draft of the new rule was released in the fall, the clinics report having 600 children without insurance, including those who have disenrolled from Medicaid. Typically, it’s about 200, according to Jessica Boland, director of behavioral health.\u003c/p>\n\u003cp>“We’re condemning people to having a much more unhealthy lifestyles because we believe that there is something awful about their request for what we think for most people is a right and not a privilege: health care,” said Dr. Kenneth Davis, president and CEO of Mount Sinai Health System, which covers eight hospitals in New York.\u003c/p>\n\u003cp>Over a dozen major patient groups, including the March of Dimes and the American Heart Association, have written fierce opposition to the rule.\u003c/p>\n\u003cp>The issue is personal for Dr. Jasmine Saavedra, a pediatrician who works at an Esperanza clinic in a heavily Latino Chicago neighborhood.\u003c/p>\n\u003cp>She is convinced that if new Trump administration criteria were in effect for her parents three decades ago, she would have had a far different future. 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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"soldout": {
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