L.A. County Votes to Create Foster Youth ‘Bill of Rights’

July 20, 2017 by · Leave a Comment 

The Board of Supervisors voted Tuesday to create a “bill of rights” for foster youth that lays out rights, resources and services available to kids and their foster parents.

California has its own such bill, but county officials said it’s outdated and doesn’t include county programs.

Supervisor Janice Hahn championed the move.

“The former foster youth who spoke at (Tuesday’s) meeting told us how frustrating it can be maneuvering the foster care system when you do not know your own rights or the resources available to you,” Hahn said. “This bill of rights will be a way for both foster youth and foster parents to know every tool, service and program that has been created to support them.”

Examples include a policy that allows social workers to act in lieu of a parent to help a foster child get a driver’s license and the fact that foster youth have access to MediCal until age 26.

Six current and former foster youth will join the bill of rights working group. Hahn had originally proposed two representatives but upped the total based on feedback at the board meeting.

The group, to be led by the Department of Children and Family Services, is also expected to include county lawyers, mental health workers, probation officers, health care professionals and representatives of various community- based organizations.

Advocates said that concerns about navigating the foster care system deter some potential foster parents at a time when the need is great.

Others noted the complexities of the foster care system.

“I’m a 40-something-year-old woman, a lawyer and a mom. I’ve worked and volunteered in the child welfare system for over 15 years and I still struggle to keep up with what the laws are,” Wende Nichols-Julien told the board. “The people within the system, the people affected by these laws deserve to know what the laws say.”

In Nichols-Julien’s case, understanding the laws helped a girl she was mentoring avoid moving into a group home while she was working to reunite with her family.

A state effort to reform foster care requires that foster youth have access to specialized mental health treatment, transitional support as they move from foster to permanent home placement, connections with siblings and extended family members and transportation to school.

Roughly 35,000 children and young adults receive child welfare services from the Department of Children and Family Services. A little less than half live outside their homes in a foster care or group home.

A report back is expected in 120 days.

MALDEF Sues State for Substandard Medi-Cal Care

July 19, 2017 by · Leave a Comment 

Civil rights advocates sued California last week, alleging that care provided by Medi-Cal, the state’s health program for low-income people, is substandard and disproportionately hurts Latinos — by far the largest group of enrollees.

The lawsuit, filed in Alameda County Superior Court by the Mexican American Legal Defense and Educational Fund (MALDEF) and the Civil Rights Education and Enforcement Center, says Medi-Cal participants have “substantially worse access to health care than their counterparts” in employer-based insurance plans or Medicare, the federal program for seniors and people with disabilities. State and federal laws require Medi-Cal to provide a level of care that is on par with that available to the general population, according to the court filing.

The two groups that filed the case hope to get it certified as a class-action lawsuit on behalf of all Medi-Cal enrollees.

The lawsuit plaintiffs include Rebecca Binsfeld, far right, and her husband, Carlos de Jesus, center, seen here with their kids. Binsfeld suffers from lupus and de Jesus has chronic back pain. (Kim Rescate/SEIU-UHW)

The lawsuit plaintiffs include Rebecca Binsfeld, far right, and her husband, Carlos de Jesus, center, seen here with their kids. Binsfeld suffers from lupus and de Jesus has chronic back pain. (Kim Rescate/SEIU-UHW)

The complaint claims that beneficiaries of Medi-Cal, the state’s version of the Medicaid program, often experience delays in care or are denied care altogether. And, it says, they may have to travel longer distances to find medical providers who are willing to see them.

“As a result, Medi-Cal participants suffer from greater pain, illness, and undiagnosed and untreated serious medical conditions — with significant impact to their overall health — than do their fellow Californians with other insurance,” according to the suit. The bottom line, it says, is that “California has created a separate and unequal system of health care, one for the insurance program with the largest proportion of Latinos (Medi-Cal), and one for the other principal insurance plans, whose recipients are disproportionately white.”

The Department of Health Care Services, which runs Medi-Cal and is named as a defendant in the lawsuit, said in a statement that it has “not identified any systemic problems with patient access to services in the Medi-Cal program, nor has the federal Centers for Medicare and Medicaid Services identified any issues.”

The department said it “routinely monitors access and network adequacy in the contracting Medi-Cal Managed Care Plans.” The lawsuit blames the alleged obstacles to health care access on low reimbursement rates, which it says discourages doctors from accepting Medi-Cal patients. The suit also says the state has failed to provide adequate monitoring to ensure that beneficiaries have timely access to care.

The plaintiffs do not request specific monetary damages, other than attorney fees and other legal costs. Rather, they seek systemic changes, including “adequate” pay for doctors treating Medi-Cal beneficiaries and better monitoring and enforcement to ensure patients get care when they need it.

Plaintiffs Analita Jimenez Perea and her son, Saul, speak in Los Angeles about MALDEF's lawsuit alleging that care provided by Medi-Cal is substandard and disproportionately hurts Latinos. (Kim Rescate/SEIU-UHW)

Plaintiffs Analita Jimenez Perea and her son, Saul, speak in Los Angeles about MALDEF’s lawsuit alleging that care provided by Medi-Cal is substandard and disproportionately hurts Latinos. (Kim Rescate/SEIU-UHW)

The suit follows a federal administrative complaint filed by the same groups in December 2015 with the U.S. Department of Health and Human Services. That case did not lead to an investigation, MALDEF said. The new lawsuit is a different approach to address the same problem, said Thomas Saenz, the group’s president and chief lawyer.

In a May 2016 letter responding to the federal complaint, California’ s Office of the Attorney General noted that current law “provides a number of remedies that provide relief if a Medi-Cal patient is denied timely access to needed care and services.” For example, they can submit a complaint to their health plan that must be resolved within 30 days, the letter said.

The attorney general’s office also said it had no evidence to show Latinos were treated differently than other Medi-Cal beneficiaries.

As of January 2017, 48 percent of California’s 13.5 million Medi-Cal beneficiaries were Latino, according to data from the Department of Health Care Services.

“This is a problem faced by all Medi-Cal patients,” Saenz said. “But it is occurring in the one insurance system where Latinos are overrepresented.”

The lawsuit names five individual plaintiffs, including a Sacramento couple — Rebecca Binsfeld, 35, and her husband, Carlos de Jesus, 43 — who said they have experienced delays in care. Binsfeld suffers from lupus and de Jesus has chronic back pain. They also have a 16-year-old daughter with scoliosis.

The family used to get primary care at UC Davis Medical Center, until their Medi-Cal managed care plan under Health Net terminated its contract with the hospital in 2015.

They sought primary care elsewhere but had difficulty finding a doctor willing to take new Medi-Cal patients, Binsfeld said. She eventually found help at a local community clinic in Sacramento, but it took 10 months for her to be seen by a rheumatologist — more than double the recommended time between such visits. And she experienced debilitating symptoms while she waited, she said.

“The first thing they tell you about lupus is that you need to avoid stress, and this was very stressful for me,” Binsfeld said. “I found myself in the ER quite a few times.”

Darin Ranahan, Binsfeld’s attorney, said the point of the lawsuit is “for the state to stop discriminating against people with Medi-Cal” and make sure that access to care is the same as for people with other types of insurance. “That means the state will need to allocate money for reimbursement rates and also remove barriers to care,” he said.

But state legislators, the medical industry and Gov. Jerry Brown wrangled over Medi-Cal rates earlier this year — and not to the entire satisfaction of doctors or patient advocates.

Last month, Brown approved a state budget that sets aside $465 million of tobacco tax money to boost Medi-Cal payments for doctors and dentists. That’s about one-third of the $1.2 billion the tax is expected to raise in its first year. Health care advocates and doctors had initially hoped that entire amount would be used to raise providers’ pay, and during the debate over the budget they argued that voters had approved the tax last November with the same idea in mind.

Tom Saenz, MALDEF president and chief lawyer, speaks at a press conference in Los Angeles on July 12, 2017. (Courtesy of SEIU-UHW)

Tom Saenz, MALDEF president and chief lawyer, speaks at a press conference in Los Angeles on July 12, 2017. (Courtesy of SEIU-UHW)

MALDEF’s Saenz said the amount ultimately allocated is “not going to make much of a dent in the problem.”

Saenz said that while boosting Medi-Cal provider rates is an essential part of improving access to care for Medi-Cal patients, it is not the entire solution. There are also systemic and administrative hurdles to overcome, he said. They include long application processing times and the challenge of ensuring that physicians and specialists have the capacity to see new patients, he said.

There is also a big question mark hanging over the whole Medi-Cal program, given efforts in Congress to cut Medicaid funding and roll back the program’s expansion under Obamacare. Saenz said that it is difficult at this point to assess how such changes would affect California’s ability to improve access and quality of care for its Medi-Cal population.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Abucheos en California por el proyecto de salud del Senado

June 29, 2017 by · Leave a Comment 

Políticos, proveedores de atención médica y defensores de los consumidores en California tuvieron ásperas críticas para el flamante proyecto de ley de salud del Senado revelado el jueves 22 de junio, argumentando que podría hacer que la cobertura sea inaccesible para los residentes más pobres, a la vez que recortaría impuestos para los ricos.

“Este proyecto no es un proyecto de atención de salud, dijo Ed Hernandez, demócrata y presidente del comité de salud del Senado estatal. “Este es un proyecto de ley de impuestos que beneficiaría a los individuos más ricos a expensas de aquellos que más necesitan atención de salud: los trabajadores pobres y los adultos mayores”.

El gobernador demócrata Jerry Brown dijo en un mensaje en Twitter que el proyecto de ley tenía el mismo “olor fétido” del proyecto de ley aprobado por la Cámara Baja el mes pasado. “Millones perderán cobertura de atención médica, mientras que los millonarios ganarán”. “El pueblo estadounidense merece algo mejor”.

El proyecto de ley de 142 páginas, revelado el jueves por la mañana, reemplazaría a la Ley de Cuidado de Salud Asequible (ACA) y rechazaría los impuestos establecidos para pagar por muchos de los beneficios de la ley. La legislación propuesta también reduciría de manera significativa los fondos para el Medicaid, el programa para las personas de bajos ingresos, y eliminaría gradualmente la expansión masiva del programa, que se inició con ACA.

También limitaría la elegibilidad para obtener subsidios en forma de créditos impositivos para comprar seguro de salud en los mercados federal y estatales, y permitiría a las aseguradoras cobrar a los adultos mayores hasta cinco veces más que a los consumidores más jóvenes, comparado con tres veces más bajo ACA.

El proyecto de ley del Senado es sustancialmente similar al aprobado por la Cámara el mes pasado, pero difiere en algunos aspectos clave. La medida del Senado propone un calendario más lento para la eliminación gradual de la expansión del Medicaid, y elimina por completo el requisito de que las personas estén aseguradas en vez de simplemente cobrarle más a los consumidores que estuvieron un tiempo sin cobertura, como lo hace el proyecto de ley de la Cámara. También reduciría el gasto federal en el Medicaid a largo plazo, de manera más profunda que el proyecto de ley de la Cámara.

Los dos proyectos también manejan subsidios a las primas de manera diferente: la versión de la Cámara los basaría solamente en la edad, mientras que la propuesta del Senado inlcuiría factores como edad, ingreso y lugar de residencia.

Cerca de un tercio de los residentes de California -13,5 millones de personas- están bajo el Medicaid, conocido como Medi-Cal en el estado. Cerca de 3,8 millones de ellos han ganado cobertura desde que ACA, también conocida como Obamacare, entrara en vigencia en 2014. Otros 1,3 millones tienen cobertura de salud a través de Covered California, el mercado de seguros estatal.

Bajo el proyecto de ley del Senado, las compañías de seguros tendrían que aceptar a todas las personas independientemente de sus condiciones preexistentes. Sin embargo, la medida permitiría a los estados eliminar los “beneficios esenciales de salud” que se requieren bajo el Obamacare, tales como visitas al hospital y beneficios de salud mental. Algunos expertos en salud creen que las aseguradoras podrían usar eso como una excusa para excluir a las personas con historial de enfermedad, simplemente vendiendo pólizas que no incluyan la cobertura que necesitan.

Eso preocupa a personas como Cory Dobbs, cajero en un supermercado Grocery Outlet, quien tiene VIH y cáncer.

“Para algunos de nosotros es la vida o la muerte”, dijo Dobbs, de 42 años, un paciente de Medi-Cal que va a la clínica Cares Community Health en Sacramento. “Algunos de nosotros hasta posiblemente nos vayamos a morir por este proyecto de ley. Es solo la verdad.”

Los críticos de la Ley del Cuidado de Salud Asequible argumentan que el gobierno federal necesita controlar los costos y que los estados deben asumir más responsabilidad para proveer atención de salud. Por ejemplo, los estados podrían derivar el presupuesto destinado a otras áreas si quieren continuar con la expansión del Medicaid, dijo Lanhee Chen, experto en políticas de salud en Hoover Institution.

“Tiendo a tener una respuesta negativa a la idea de que la alternativa del Obamacare dará lugar a que la gente pierda cobertura”, dijo Chen sobre el empuje republicano para derogar la ley. “Esto no es sólo una cuestión de lo que hace el gobierno federal con el financiamiento del Medicaid, sino lo que el estado puede hacer si los cambios de financiamiento se convierten en ley”.

Sin embargo, Sarah de Guia, directora ejecutiva del grupo de defensa California Pan-Ethnic Health Network, dijo que el estado Dorado ha establecido un estándar alto en términos de cobertura bajo ACA, y que los esfuerzos de los republicanos amenazan esa cobertura.

“California es obviamente líder”, dijo. “Pero con los cortes potenciales… es inevitable que el estado tenga que tomar algunas decisiones realmente difíciles”.

En el programa Medi-Cal, eso podría significar ofrecer menos beneficios, disminuir la elegibilidad o reducir los reembolsos para los proveedores, que ya están entre los más bajos de la nación. Eso ha causado ansiedad entre el personal de clínicas comunitarias, hospitales de seguridad social y hogares de ancianos.

“Las clínicas comunitarias continuarán y tratarán de mantenerse abiertas, pero es como sacar la alfombra que tenemos debajo”, dijo Deena Lahn, vicepresidente de política y defensa del San Francisco Community Clinic Consortium. “Ahora, Medicaid es la base financiera de nuestro trabajo”.

El doctor Jay Lee, médico jefe de la Venice Family Clinic con sede en Los Angeles, estuvo el jueves en una marcha de “guardapolvos blancos”, en Washington, DC, en oposición a los esfuerzos de los republicanos por “derogar y reemplazar” el Obamacare.

El proyecto de ley del Senado “básicamente agita al Medicaid” y hace que sea más difícil para los médicos hacer su trabajo, dijo Lee. “Yo también podría escribir mis papeles [de recetas] en tinta invisible si los pacientes no pueden pagar por los medicamentos”.

En el mercado de seguros individual, decenas de miles de personas que reciben subsidios federales ya no calificarían para ayuda debido a una disposición en el proyecto de ley del Senado que reduce los umbrales de ingreso para ser elegible.

Funcionarios de Covered California, el mercado estatal, dijeron que el proyecto de ley podría tener un amplio impacto en los beneficiarios. “A primera vista, no sólo proporcionaría una cobertura de salud mucho más escasa que la que se ofrece hoy, sino que millones de personas no tendrían cobertura alguna”, dijo Peter V. Lee, director ejecutivo de Covered California, en una declaración escrita.

Algunos consumidores apoyan un rechazo de ACA. Sarah Foster, de 83 años, se opone a las propuestas de salud del Senado y de la Cámara de Representantes, pero por una razón diferente: no piensa que vayan tan lejos como para revocar totalmente el Obamacare.

Foster, residente de Sacramento que está en Medicare y Medi-Cal, dijo que nunca tuvo problemas para encontrar un médico antes de ACA. La mujer dijo que, después que la ley se aprobó, pareció que muchos médicos entraron en atención especializada debido a la “burocracia” asociada con la ley.

Ahora, dijo, no tiene médico de atención primaria. “Así que estoy corriendo por ahí tratando de encontrar una persona [de medicina] interna”.

Los hospitales de redes de seguridad, que también se han beneficiado de ACA, temen el impacto de una revisión republicana. Los hospitales públicos de California podrían perder apoyo por más de $2 mil millones al año si se deroga la expansión del Medicaid, según la California Association of Public Hospitals and Health Systems.

El proyecto de ley es un “esfuerzo inútil para ahorrar dinero”, dijo Erica Murray, presidenta y CEO del grupo, en un comunicado. “Simplemente negarse a gastar dinero en atención médica no reduce el costo de la atención, ni la necesidad”.

El doctor Matthew Hickey, de 30 años, residente médico de la Universidad de California en San Francisco, que trabaja en el Hospital General de San Francisco, el hospital de la red de seguridad de la ciudad, dijo que le preocupa que la ley “reduzca drásticamente tanto la cobertura como la calidad de la cobertura”.

Agregó: “En particular los recortes al Medicaid son bastante preocupantes. Muchos de los pacientes que atiendo y que recibieron cobertura a través de la expansión del Medicaid no podrán verme”.

Financiación Futura de Medi-Cal En Riesgo

April 6, 2017 by · Leave a Comment 

La población con seguro de salud en California ha crecido enormemente en los últimos años con Medi-Cal, el seguro médico subsidiado por el estado, aunque el futuro de su financiación no está claro, indica un estudio presentado hoy.

El análisis, “Financiando el programa Medi-Cal”, elaborado por el Instituto de Política Pública de California (PPIC), señala que cada vez California debe disponer de más fondos para mantenerlo al nivel actual, que representa el segundo gasto después de la educación en el presupuesto general.

“Mientras el Gobierno federal ha financiado una gran parte del crecimiento del programa, los costos estatales también han aumentado”, señaló Shannon McConville, autora del informe junto con Paul Warren y Caroline Danielson.

“Este aumento de costos combinado con una política mayor de cambios todavía concebibles a nivel federal, ha creado incertidumbre adicional acerca del futuro de la financiación de medical Medi-Cal”, anotó la analista de PPIC.

Según señala el estudio, actualmente Medi-Cal representa el 15% del total general de gastos del presupuesto del estado, el segundo mayor después de la educación de kínder a preparatoria.

El análisis destacó también que en la última década el costo del programa, conocido en el resto del país como Medicare, aumentó de 40.000 millones de dólares en el período 2005-2006 a cerca de $100.000 millones en el 2016-2017.

En ese mismo período, la participación en la financiación por parte de California ha disminuido de cerca del 40% hasta aproximadamente el 20% y “adicionalmente, la financiación de otras fuentes incluyendo gobiernos locales y proveedores ha aumentado”.

Igualmente el estudio señaló que el Gobierno federal en los años 2014 a 2016 de implementación de la Ley de Salud Asequible (ACA), pagó el 100% de los costos de la cobertura de Medi-Cal para el nuevo grupo elegible, básicamente adultos de bajos ingresos sin niños dependientes.

Sin embargo, bajo los términos de la ley actual, esa aportación federal disminuirá gradualmente para llegar a 90% en 2020.

Otra ayuda federal establecida por ACA representó entre el 2010 y 2015 más de $10.000 millones en pagos a hospitales que atienden un alto número de usuarios de Medi-Cal y pacientes sin seguro médico.

No obstante, de continuar esa ayuda, se reducirá a cerca de $6.000 millones para el 2020, en algunos casos con la obligación de una participación igual por parte de los gobiernos locales o los proveedores de los servicios de salud.

El análisis calcula que actualmente los gobiernos locales pagan cerca de $5.000 millones cada año, equivalentes a un 20% de los fondos de Medi-Cal, a través principalmente de pagos de los sistemas hospitalarios, que provienen mayoritariamente de otros fondos del gobierno como las universidades públicas.

Con la “volatilidad de los ingresos previstos” en el presupuesto general de California, el tema de Medi-Cal se torna un punto de importante discusión en la próxima aprobación del Plan de Gastos.

El estudio recomienda que se busquen fuentes de financiación para Medi-Cal “que puedan ser ofrecidas consistentemente a largo plazo” y que también sean “económicamente eficientes y simples”, entre otras características.

California Braces For Medi-Cal’s Future Under Trump And The GOP

December 1, 2016 by · Leave a Comment 

California Healthline – California grabbed the first opportunity to expand Medicaid and ran with it, helping cut the number of uninsured people in half in a few short years.

Thanks in part to billions of dollars in federal funding, a third of California’s residents — including half its children — are insured by Medi-Cal, the state’s version of Medicaid.

Now, with the election of Donald Trump and a Republican-controlled Congress, the state that bet so heavily on the Medicaid expansion is bracing to see how much of its work will be undone. While no one knows yet exactly what will happen, many policymakers and advocates fear the federal government will end or severely limit funding for the expansion.

“There are no easy cuts in Medi-Cal,” said Stan Rosenstein, a former Medi-Cal administrator. Reduced federal funding “could have a major impact on the uninsurance rate, on the viability of our hospitals, and it could have a very negative impact on the economy.”

Medi-Cal cuts could restrict who is eligible for coverage, slash health care benefits, limit access to doctors and reduce payment rates to medical providers — already among the lowest in the nation, health policy experts and advocates said. Medi-Cal covers a host of services for low-income residents, including maternity care, prescription drugs, long-term care services, mental health treatment and hospital stays.

Laurel Lucia, a health care program manager at the University of California, Berkeley Labor Center, said a well-funded Medicaid program benefits everyone, not just those currently on the program.

“A lot of people are just a layoff away from needing Medicaid,” she said. “The Republican plans for Medicaid threaten to undermine that safety net.”

Critics of the Affordable Care Act argue, however, that the Medicaid program has grown too big and expensive. They also want states to have more autonomy with their Medicaid programs and believe enrollees should become more self-sufficient.

“Any agenda to reduce dependency and increase self-sufficiency of those populations, Medicaid needs to be a piece of that,” said Ed Haislmaier, senior research fellow at the Heritage Foundation, a conservative think tank.

The eligibility worker at the Department of Public Social Services county office tells Marcy she needs proof that she was in foster care, Wednesday, Jan. 8, 2014, in El Monte, California. Without a universal database for foster children, social service providers have difficulty finding their records.

Trump pledged during the election campaign to repeal and replace the Affordable Care Act. The health law allowed states to expand their Medicaid programs, and California received more than $15 billion from the federal government for the expansion in 2016-17, according to the state Department of Health Care Services.

Trump also has said he supports funding Medicaid with block grants, essentially annual lump sum payments to states. Block grants would give states more flexibility in running their Medicaid programs but leave them responsible for covering any costs that exceeded the amount allocated. In addition, Republicans have expressed support for caps on spending per enrollee.

A new report by the Commonwealth Fund said that establishing limits on federal Medicaid spending would “effectively reverse a 50-year trend of expanding Medicaid in order to protect the most vulnerable Americans.” Block grants or per-capita caps would create funding gaps for states, likely cutting the number of Medicaid-eligible people and reducing coverage for beneficiaries, the report said.

California has made tough choices in the past in response to budget shortfalls. Health officials have cut dental coverage, frozen children’s enrollment, reduced doctor payments and closed adult day centers. But this time, the state could be forced to slice deeply into a much bigger program.

More than 5 million people have gained coverage in California since 2014, including 3.7 million who qualified as a direct result of expanded eligibility under the Affordable Care Act. Now, 13.6 million Californians are insured by Medi-Cal.

Largely because of the Medi-Cal expansion, taxpayers now cover about 70 percent of health care spending in California, according to the UCLA Center for Health Policy Research.

Given the state’s reliance on federal government support, state officials are fretting about what comes next.

“It all comes down to the dollar figure,” said Sen. Ed Hernandez, chairman of the Senate Committee on Health. “If there is not enough money, unfortunately the state is going to have to make some difficult decisions.”

The Medicaid program is paid for through a mix of federal and state funds, and anybody who qualifies under income and other guidelines can receive services. The federal government pays half the cost of care for most people who were eligible for Medi-Cal before the Affordable Care Act. It now picks up the whole tab for those who qualified under the expanded eligibility but will start decreasing its share in 2017 under the health reform law.

Officials at the Department of Health Care Services, which administers the Medi-Cal program, declined to be interviewed for this story, saying they didn’t want to speculate.

For the past several years, consumer advocates have lobbied state lawmakers to restore funding for Medi-Cal benefits cut during the recession. They appealed successfully to voters in November with Prop. 56, the new tobacco tax that is expected to raise up to $1 billion dollars a year for Medi-Cal.

Some enrollees are worried about coming changes.

Terri Anderson, a resident of Riverside, Calif., fears losing her health insurance, saying she couldn’t afford medical care without it. “And I am at that delicate age where things start to fall apart.”

Anderson, 60, said she had been uninsured for many years before getting Medi-Cal coverage last year. She has a family history of breast cancer and has relied on Medi-Cal for mammograms and help to quit smoking.

When uninsured people get coverage, they are more likely to seek preventive services and less likely to end up in costly emergency rooms, said Lucia of UC Berkeley. Losing coverage could result in the opposite, she said.

Dean Clancy, a former Republican health policy analyst for President George W. Bush, welcomes changes in the approach to Medicaid. He said he favors the block grant approach, long advocated by Republicans.

“The state has an incentive to focus the money on the people who need it the most and to cut out waste,” Clancy said. “By getting rid of federal micromanagement, you give the states the freedom they need to do whatever they think is best for their citizens.”

Even before the 2010 health law, California was a leader in piloting different approaches to care, frequently applying for “waivers” that allow states to use federal funding for programs not typically allowed under Medicaid. California got permission, for example, to use federal funding to expand coverage for its uninsured population before Obamacare took effect. The state is also using waivers to revamp addiction treatment and keep high-risk populations out of emergency rooms.

Erica Murray, CEO of the California Association of Public Hospitals and Health Systems, said successful innovation depends on adequate federal funding. An increase in the uninsured population, a drop in reimbursements or a block grant funding system could have “dire financial consequences” for public hospitals and health systems, Murray said.

Block grants don’t account for economic downturns, when more people lose their jobs and job-related insurance and turn to Medi-Cal, she said. “People’s health status doesn’t change when the economy changes.”

The Heritage Foundation’s Haislmaier said he and his colleagues prefer a premium support model, in which beneficiaries get a contribution to help them buy coverage. That would encourage people to be more independent and give them greater choice, he said.

Linda Nguy, policy advocate for the Western Center on Law and Poverty, said she and others are fighting to preserve the current system. “We do not want to see the gains made for so many people pulled back,” she said.


Kaiser Health News Senior Correspondent Chad Terhune and Correspondent Ana Ibarra contributed to this story. This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.


Newly Covered By Medi-Cal, Undocumented Children Also Seek Dental Care

September 22, 2016 by · Leave a Comment 

Eight-year-old Erika Andalon recently started treatment for six cavities at an AltaMed dental clinic in eastern Los Angeles near her home. She hadn’t been to a dentist for more than a year. Yet her younger sister, Elaine, has visited the dentist regularly since she was six months old.

The difference? Access to coverage.

Eight-year-old Erika Andalon, left, is again receiving dental care since a state law allows children living in California without papers to enroll in the state’s public health program. She is pictured with her sister Elaine, 4, and mother, Erika, in their Los Angeles home.  (Ana B. Ibarra/California Healthline)

Eight-year-old Erika Andalon, left, is again receiving dental care since a state law allows children living in California without papers to enroll in the state’s public health program. She is pictured with her sister Elaine, 4, and mother, Erika, in their Los Angeles home. (Ana B. Ibarra/California Healthline)

Erika was brought to the U.S. from Jalisco, Mexico, five years ago. Elaine, on the other hand, was born in California, which makes her a U.S. citizen. Because of her citizenship status, and because of her family’s low income, she always has received full benefits under Medi-Cal, the state’s version of Medicaid.

Since May 1, a new law (SB 75) has given Erika and other children living in the United States without legal immigration papers full access to Medi-Cal benefits, including dental services.

Now Erika gets the same benefits as her little sister — including dental care.

“It’s been a huge relief,” Erika’s mother, also named Erika, said Wednesday. “Elaine goes to the dentist twice a year, now we can do the same with [Erika].”

Young Erika is one of almost 138,000 undocumented children in California who have gained Medi-Cal coverage under the so-called “Health for All Kids” law, which provides health care for all California children regardless of their immigration status.

Dental coverage under the state’s Denti-Cal program is included in the expanded benefits, and there is widespread hope that it will improve pediatric oral care in California. But delivering on that promise could be a stiff challenge for a program in which more than half of children who were covered before the law took effect had not seen a dentist in the previous year.

The lack of access has created an “epidemic of tooth disease in which toddlers by the thousands have mouthfuls of cavities,” according to a searing report by the Little Hoover Commission, an independent oversight agency, released earlier this year. A big reason for Denti-Cal’s dysfunction, the report said, are low reimbursement rates that have “thoroughly alienated the dental profession.”

The head of Denti-Cal, Alani Jackson, told California Healthline earlier this year that newly enrolled children should have no problem getting an appointment with a dentist.

But dental professionals said this week that it is still too early to tell how the program will stand up to the new stress of the additional beneficiaries.

Before the new law took effect four months ago, immigrant children qualified only for “emergency” Medi-Cal, which gave them coverage for emergency room care. Some qualified for county-level health programs that did not tap Medi-Cal funding.

Erika Andalon’s mom relied heavily on free dental exams offered at school to get baseline dental care for her older daughter.

“But we had no idea” about the six cavities, she said. “It wasn’t until she got a proper exam with dental X-rays that we learned about the problem.”

As more children enroll in Medi-Cal and Denti-Cal as a result of the new law, dental offices and clinics are beginning to see more young patients like Erika.

Dr. Rosa Arzu, the dental director at AltaMed, a network of clinics in Los Angeles and Orange counties, said the 24-clinic group has extended hours for patients, including opening on Saturdays.

While the clinics are not tracking the number of new immigrant children needing care, Arzu said the dentists at AltaMed have noted that previously uninsured kids who had not visited in years are now in need of more intensive care.

AltaMed dentists already had seen many of the children before they qualified for Medi-Cal, because of the clinics’ “sliding fee” – a payment option in which the cost of services depends on the family’s income.

“But even though this payment was low, many families were struggling, so they delayed treatment,” Arzu said. Some patients still don’t realize that dental services are included in their newly insured children’s benefits, she said.

While all eyes are on the new law, it might be too early to gauge its impact, said Dr. Roseann Mulligan, associate dean of Community Health Programs and Hospital Affairs at the University of Southern California’s dental school.

There are still a few “wrinkles,” and newly enrolled families are still figuring out the system, Mulligan said.

As members of the USC dental school’s Children’s Health and Maintenance Program (CHAMP), Mulligan and other staff visit Head Start child care centers and WIC nutrition offices, where they provide screenings and refer families to nearby dentists.

At those locations, CHAMP staff members have met families who are not aware they are enrolled in an HMO dental plan and therefore can only see certain dentists. If they want a specific dentist, or more options, they must enroll in a fee-for-service plan, and that can take more time, Mulligan explained.

Another 64,500 immigrant children are expected to sign up for full Medi-Cal and Denti-Cal benefits within the next year.

Contact the author at aibarra@kff.org .


El Desafío de la Salud en Hogares Con Estatus Mixtos

June 9, 2016 by · Leave a Comment 

La residente de Huntington Park Stephanie Martínez tenía sólo cinco años de edad cuando sus padres la trajeron a vivir a EE.UU. como indocumentada. Ahora a sus 23 años, ella es una de las aproximadamente 853.000 personas en el país que tienen un estatus temporal cuasi-legal a través de la Acción Diferida para los Llegados en la Infancia (DACA) promulgada por el presidente Obama en 2012.

También hoy en día ella tiene un seguro de salud, pero al igual que muchos en su situación el camino hacia la cobertura estuvo lleno de obstáculos complicado por el estatus mixto de inmigración de su familia y un ingreso familiar combinado considerado demasiado alto para calificar para los subsidios de salud, pero demasiado bajo para pagar un seguro privado.

Read this article in English: Dreamers in Search of Affordable Health Care

Bajo DACA, los jóvenes entre 16 y 31 años de edad que fueron traídos al país ilegalmente cuando eran niños pueden evitar temporalmente la deportación y trabajar legalmente en EE.UU. siempre y cuando cumplan con ciertos requisitos, como asistir o terminar la preparatoria y pasar una prueba de antecedentes criminales.

Para muchos que han calificado hay un sentido de normalidad, de no vivir más bajo la sombra de la sociedad, a menos que al igual que Stephanie vivan en un hogar de “estatus mixto”, donde algunos miembros de la familia son ciudadanos, residentes legales, o beneficiarios de DACA, pero otros son indocumentados.

Cuando fue promulgada en 2014, la Ley de Asistencia Asequible (ACA)—también conocida como Obamacare—los beneficiarios de DACA, comúnmente conocidos como “soñadores”, y los inmigrantes indocumentados quedaron explícitamente excluidos para comprar cobertura de salud a través de los planes patrocinados por el gobierno ni a recibir créditos tributarios de primas u otros ahorros en el mercado.

“Es política,” dijo a EGP Gabrielle Lessard, abogada de política de salud con el Centro Nacional de Leyes de Inmigración, explicando que la Administración Obama sabía que se enfrentaría a una reacción violenta si se permitiera a los indocumentados y beneficiarios de DACA participar en el programa, pese a que pagan impuestos, los mismos que ayudan con subsidios a la cobertura.

A su corta edad, Stephanie no estaba preocupada por no tener seguro de salud; después de todo, es joven y saludable. Sin embargo, no se podía decir lo mismo de su padre Álvaro Martínez, quien sufre de diabetes y necesita atención médica constante. Él enfrenta una lucha para obtener atención médica asequible debido a su estatus de indocumentado.

La familia Martínez es considerada una familia de estatus mixto donde los padres son indocumentados y los hijos son beneficiarios de DACA. (Cortesía de Stephanie Martínez)

La familia Martínez es considerada una familia de estatus mixto donde los padres son indocumentados y los hijos son beneficiarios de DACA. (Cortesía de Stephanie Martínez)

Así que el año pasado, cuando el padre de Stephanie le pidió que solicitara cobertura de salud para la familia a través del seguro de salud del estado, Covered California, ella aceptó  y llenó la solicitud en una feria de salud patrocinada por AltaMed.

Laura Ochoa coordinadora de mercadeo, trabaja en el programa de AltaMed “Soñadores y Medi-Cal” que revisa si beneficiarios de DACA son elegibles para el programa de Medi-Cal del estado para familias de bajos ingresos, incluyendo a beneficiarios de DACA que pudieran calificar para la cobertura bajo el reconocimiento del estado de individuos que se encuentran residiendo permanentemente en EE.UU. protegidos por la ley de color (PRUCOL por sus siglas en inglés), una categoría de elegibilidad para beneficios públicos creado por los tribunales.

Según los funcionarios de inmigración de EE.UU., “un individuo puede ser elegible para Medicaid (Medi-Cal), si es un extranjero que reside en EE.UU. con el conocimiento y permiso del Servicio de Inmigración y Naturalización (INS) y el INS no contempla exigir la salida del extranjero”, como es el caso de los beneficiarios de DACA.

Los destinatarios de DACA de California y Nueva York cumplen con la norma PRUCOL, dijo Lessard.

Algunos requisitos para calificar para el Medi-Cal de California para los beneficiarios de DACA incluye que tengan un permiso de trabajo válido, un número de seguro social, identificación y prueba de sus ingresos, dijo Ochoa.

Pero el caso de Stephanie era más complicado. Los ingresos combinados de la familia de $46,000 superó el máximo nivel de pobreza federal (FPL) del 138%, o $33.534 al año para una familia de cuatro. Su estado migratorio mixto—sus padres son indocumentados—también hizo que la cobertura de grupo a través del mercado de salud fuera poco probable. El seguro privado es demasiado caro, dijo Stephanie.

Un estudio realizado por el Dream Resource Center del UCLA Labor Center encontró que uno de cada diecisiete niños en EEUU viven en hogares de estatus mixto migratorio.

“Las familias de estatus mixto son un grupo demográfico que crece en Estados Unidos” y su resultado de salud proporciona información sobre el futuro de la salud de la población de EEUU, de acuerdo al estudio “Sin Papeles y Sin Seguro; Un informe de cinco partes sobre jóvenes inmigrantes y la lucha por cuidados de salud en California”.

Stephanie estudia en el Colegio de Santa Mónica y trabaja a tiempo parcial. Dice que es todavía depende de su familia en necesidades básicas como comida y techo.

Según Ochoa, la mejor opción para Stephanie era aplicar como un individuo. Ella dijo que los estudiantes que ganan alrededor de $10.000 podrían calificar para Medi-Cal incluso si sus padres los reclaman como dependientes.

“Si son estudiantes de medio tiempo y trabajadores de medio tiempo, lo más probable es que son elegibles”, agregó.

A principios de este año Stephanie aplicó de nuevo pero esta vez sola y fue aprobada para la cobertura de Medi-Cal mediante L.A. Care Health Plan comenzando el primero de junio.

Stephanie Martinez revisa los documentos que recibió de Medi-Cal (EGP foto por Jacqueline García)

Stephanie Martinez revisa los documentos que recibió de Medi-Cal (EGP foto por Jacqueline García)

Mientras exploraban opciones para la familia, Stephanie también descubrió que el Sr. Martínez califica para la cobertura mediante el programa Capacidad de Pago (ATP) del condado de Los Ángeles, que ofrece servicios de salud asequibles para los residentes del condado de LA que no califican para planes de Medi-Cal, Medicare o Covered California independientemente de su situación migratoria.

El programa es gratis para “individuos con ingresos iguales o menores de $1.367 por mes” y tiene una “[opción] de bajo costo para las personas con ingresos por encima de $1.367 por mes”, como es el caso del Sr. Martínez.

Los solicitantes de ATP sólo pagan por el mes que visitan el hospital o sus clínicas asociadas. Los servicios incluyen visitas al médico y de emergencia, pruebas y medicamentos, explica la página de Internet de Servicios de Salud del Condado de Los Ángeles.

El estudio “Sin Papeles y Sin Seguro”, afirma que la salud de los californianos indocumentados es crucial para el bienestar del estado.

Los investigadores recomiendan expandir ACA a todos los californianos sin importar su estatus migratorio o nivel de ingresos.

“No hay tal cosa como la salud individual; toda la salud es pública y común”, afirma el estudio.

El proyecto de ley SB 10, la exención de la salud para todos, del senador estatal Ricardo Lara, fue recientemente aprobada por los legisladores del estado y podría permitir que los inmigrantes indocumentados compren cobertura de salud a través del mercado de Covered California, pero requeriría primero la aprobación federal.

Martínez le dijo a EGP que ella esta contenta ahora tiene un seguro de salud, pero todavía se preocupa por los problemas de salud de su padre. “Él tiene más necesidad que yo”, dijo.


La serie de tres partes fue producida como un proyecto para California Health Journalism Fellowship, un programa del Centro de Periodismo de la Salud de la Escuela de Comunicaciones y Periodismo de USC Annenberg.


Para leer Parte 1:  DACA y Obamacare: ¿Quién Califica?

Para leer Parte 3: ¿Vale la pena la SB10? ¿Qué es una exención?


Twitter @jackiereporter


The Health Challenge In Mixed-Status Homes

June 9, 2016 by · Leave a Comment 

Huntington Park resident Stephanie Martinez was just five years old when her parents brought her illegally to live in the United States. Now 23, she’s one of an estimated 853,000 people in the country who have temporary, quasi-legal status through President Obama’s Deferred Action for Childhood Arrivals (DACA) program enacted in 2012.

Today she has health insurance, but like so many in her situation the road to coverage was filled with obstacles, complicated by her family’s mixed-immigration status and a combined household income slightly too high to qualify for health subsidies but too low to pay for private insurance.

Under DACA, young people between the ages of 16 and 31 who were brought to the country illegally as children can temporarily avoid deportation and work legally in the U.S., provided they meet certain eligibility requirements, such as attending or completing high school and passing a criminal background check.

Lea este artículo en Español: Soñadores en Busca de Cuidado Asequible

For many who have qualified there’s a sense of normalcy, of no longer living in society’s shadow, that is unless like Stephanie you live in a “mixed-status” home, where some members of your family are citizens, legal residents, or DACA recipients, but others are undocumented.

When enacted in 2014, the Affordable Care Act (ACA)—also known as Obamacare—explicitly excluded DACA recipients – often referred to as “dreamers” – and undocumented immigrants from buying health insurance from state or federally sponsored health insurance marketplaces and the premium tax credits, subsidies and other savings on marketplace plans.

“It’s political,” Gabrielle Lessard, a health policy attorney with the National Immigration Law Center told EGP, explaining that the Obama Administration knew it would face a backlash if the undocumented and DACA recipients were allowed to take part in the program, even though they pay into the tax pool that subsides the coverage.

In her early twenties, Stephanie wasn’t worried about not having health insurance; after all, she’s young and healthy. The same couldn’t be said for her father Alvaro Martinez who suffers from diabetes and needs ongoing medical attention, but struggles to get care because he is undocumented.

So last year, when Stephanie’s father asked her to apply for health coverage for the family through the state’s health exchange, Covered California, she gladly filled out the application at a local health fair sponsored by AltaMed.

Marketing Coordinator Laura Ochoa works on AltaMed’s “Dreamers and Medi-Cal” program, which screens DACA recipients for eligibility for the state’s Medi-Cal program for low-income families. DACA recipients can qualify for coverage under the state’s recognition of the Permanently Residing in the United States Under Color of Law (PRUCOL), a public benefits eligibility category created by the courts.

According to US immigration officials, “an individual may be eligible for Medicaid (Medi-Cal), if the individual is an alien residing in the United States with the knowledge and permission of the Immigration and Naturalization Services (INS) and the INS does not contemplate enforcing the alien’s departure,” as in the case of DACA recipients.

California and New York see DACA recipients as having met the PRUCOL standard, Lessard said.

Stephanie Martinez reviews the Medi-Cal documents she received by mail. (EGP photo by Jacqueline Garcia)

Stephanie Martinez reviews the Medi-Cal documents she received by mail. (EGP photo by Jacqueline Garcia)

Requirements to qualify for California Medi-Cal for DACA recipients include having a valid work permit, a social security number, identification and proof they are low-income, Ochoa told EGP.

But Stephanie’s case was more complicated. Her family’s combined household income of $46,000 exceeded the maximum Federal Poverty Level (FPL) of 138%, or $33,534 a year for a family of four to qualify for Medi-Cal. Their mixed-immigration status, her parents are still undocumented, also made group coverage through the health exchange unlikely. Private insurance is too expensive, Stephanie said.

A study by the UCLA Labor Center’s Dream Resource Center found that one in seventeen children in the U.S. live in mixed-immigration status homes.

“Mixed-status families are a growing demographic in the United States” and their health outcome provides insight into the health of the future of the U.S. population, according to “Undocumented and Uninsured; A five part Report on Immigrant Youth and the Struggle to Access Health Care in California.”

Stephanie attends Santa Monica College and works part-time. She says she’s still dependent on her family for necessities like food and the roof over her head.

According to Ochoa, Stephanie’s best option is to apply as an individual. She said students who earn about $10,000 could qualify for Medi-Cal even if their parents claim them as deductions.

“If they are part-time students and part-time workers, most likely they are eligible,” she added.

Earlier this year, Stephanie applied as an individual and was approved for Medi-Cal coverage effective June 1 through the L.A. Care Health Plan.

While exploring her family’s options, Stephanie also discovered that Mr. Martinez qualifies for coverage under Los Angeles County’s Ability to Pay (ATP) program, which offers affordable health services to L.A. county residents who do not qualify for Medi-Cal, Medicare or Covered California plans, regardless of their immigration status.

The program is free to “individuals with incomes at or below $1,367 per month” and has a “low-cost [option] for individuals with incomes above $1,367 per month,” which works for Mr. Martinez.

ATP applicants only pay for the month they visit the hospital or its partner clinics. Services include doctor and ER visits, hospital care, tests and medicines, explains the Health Services of L.A. County website.

The “Undocumented and Uninsured” study states that the health of undocumented Californians is crucial to the wellbeing of the state.

They recommend expanding ACA to all Californians regardless of their immigration status or income level.

“There’s no such thing as individual health; all health is public and communal,” states the study.

A bill by state Sen. Ricardo Lara, SB 10, the Health For All Waiver, recently approved by state lawmakers, could allow undocumented immigrants to buy health coverage through the Covered California online marketplace, but would first require federal approval.

Martinez told EGP she is happy she now has health insurance, but still worries about her father’s ongoing health issues. “He has more need than me,” she said.

Immigrants with one of the following statuses qualify to use the Marketplace:
•Lawful Permanent Resident (LPR/Green Card holder)

•Asylee •Refugee •Battered Spouse, Child and Parent

•Victim of Trafficking and his/her Spouse, Child, Sibling or Parent

•Individual with Non-immigrant Status, includes worker visas and student visas

•Deffered Action Status (Exeption: Deferred Action For Childhood Arrivals -DACA)

[For a full list of eligible statuses visit https://www.healthcare.gov/immigrants/immigration-status/]


The three-part series was produced as a project for the California Health Journalism Fellowship, a program of the Center for Health Journalism at the USC Annenberg School for Communication and Journalism.


To read Part 1: DACA and Obamacare: Who Qualifies?

To read Part 3: SB10 is it worth it? What is an exemption?


Twitter @jackiereporter


Dreamers In Search of Affordable Health Care

June 2, 2016 by · Leave a Comment 

June 15, 2012 was a historic day for thousands of young immigrants who under President Obama’s executive action became eligible for temporary relief from deportation.

“These are young people who study in our schools … they pledge allegiance to our flag. They are Americans in their heart, in their minds, in every single way but one: on paper,” said Obama when he introduced Deferred Action for Childhood Arrivals (DACA), a program making nearly 1.5 million youth brought to the country illegally as children eligible for a reprieve from deportation and a work permit, both renewable every two years.

Lea este artículo en Español: Soñadores en Busca de Cuidado de Salud Asequible

Over 853,000 immigrants between the ages of 16 and 31, often referred to as “dreamers,” have applied for DACA status since the president’s announcement. For many, with the ability to work legally came the hope of higher wages and perhaps benefits.

Getting health insurance, however, has not been easy for some. For others, it’s not a priority.

The Affordable Care Act (ACA) enacted in 2014—commonly known as Obamacare— excluded DACA recipients from coverage because they are not permanent legal U.S. residents or citizens.

In this three-part series, EGP looks at some of the challenges this group of dreamers face in their search for affordable health care and the options they have to access services.


DACA and Obamacare: Who Qualifies?
Los Angeles resident Nidia Torres was brought illegally to the U.S. when she was six years old. She lived in the shadows for over two decades, hoping not to be discovered or deported back to Mexico, a country she does not call home.

In 2013, everything changed. Torres was granted DACA status and excitedly started planning for the future. The opportunities a work permit, driver’s license and social security number would bring to her life were endless, including providing a better future for her U.S. born daughter, Torres told EGP.

“No more shame for being undocumented,” she recalls thinking when her work permit arrived in the mail.

Nidia Torres, 34 with her four-year old daughter said DACA has provided her great opportunities, in this country, which she consider home. She just needs to find an option for medical insurance. (Courtesy of Nidia Torres)

Nidia Torres, 34 with her four-year old daughter said DACA has provided her great opportunities, in this country, which she considers home. She just needs to find an option for medical insurance. (Courtesy of Nidia Torres)

Torres soon landed a job waitressing at a national restaurant chain where she was paid minimum wage plus tips, but did not offer health insurance.

“I can work legally, my daughter has Medi-Cal, so I think I’m OK,” she told EGP, explaining that after years of low-paying jobs and long hours that left her little time for her daughter, the new job was a big step forward.

“I just wanted a job,” she told EGP. “Plus I don’t really get sick,” so health insurance was not a big deal, she said, adding she had no idea where to get coverage on her own.

Torres, who speaks both English and Spanish and has some college education has since been promoted to manager and is earning more money, but still has no health benefits.

The goal of the Affordable Care Act was to increase “the quality, availability, and affordability” of private and public health insurance to the then over 44 million uninsured Americans, providing they are legal permanent residents or U.S. citizens. To keep costs down, large numbers of young, healthy individuals — the same group targeted by DACA — would have to be enrolled, yet undocumented immigrants and DACA recipients are ineligible to buy health coverage through government sponsored health exchanges or receive premium tax credits or other savings on marketplace plans, even though they pay into the tax system.

Gabrielle Lessard, a health policy attorney with the National Immigration Law Center, calls the policy unjust. DACA recipients are working and paying taxes for a service that they can’t apply for, she told EGP.

“The exclusion of DACA recipients probably increases the price of insurance for all other people,” Lessard said.

In California, however, some low-income undocumented immigrants and DACA recipients may qualify for Medi-Cal, a state funded health insurance program for low-income families, people with disabilities, pregnant women, children in foster care and low-income adults who meet certain requirements.



Torres is not one of them. According to the California Department of Health Care Services and federal eligibility requirements, Torres’ $23,000 a year income puts her just slightly above the $22,108 maximum Federal Poverty Level (FLP) for a family of two, making her ineligible for Medi-Cal.

Like many other DACA recipients with incomes “too high” for health insurance subsidies, Torres’ options for health coverage are limited, and the process for finding affordable coverage can be complex, according to the UC Berkley study, “Realizing the Dream for Californians Eligible for Deferred Action for Childhood Arrivals: Health Needs and Access to Health Care.”

Many DACA recipients don’t even know they have options, the study found. The lack of information reflects “the complexity” of the network of programs available and the process to access them, researchers stated.

Getting health care doesn’t have to be a problem, says Irene Holguin, director of community relations with Arroyo Vista Family Center, a network of five clinics serving the east and northeast side of Los Angeles.

During a free family health fair Friday at Arroyo Vista’s clinic in Lincoln Heights, Holguin told EGP there are options for everyone, regardless of immigration status or income.

When people arrive at one of our clinics for the first time they undergo a financial screening to determine what types of programs they are eligible for, she said. “We don’t turn anyone away,” she added. She explained that the clinic offers discount programs and fees to those who not qualify for state or federal funded program.

For example, if a patient can only pay $10, Arroyo Vista will help them set up an affordable payment plan for the balance, Holguin said.
The Arroyo Vista clinics provide primary health care in communities where approximately 98% of families are Latino and many of them low-income, explained Holguin.

“There’s a lot [more] that needs to be done in regard to informing the community and encouraging people to be proactive and seek preventive health services,” she said, “because a lot of people have illnesses that they don’t even know they have.”

As for Torres, she told EGP she would be open to going to a clinic like Arroyo Vista to look into her what her options are. “Better safe than sorry,” she said.


The three-part series was produced as a project for the California Health Journalism Fellowship, a program of the Center for Health Journalism at the USC Annenberg School for Communication and Journalism.


To read Part 2: The Health Challenge In Mixed-Status Homes

To read Part 3: SB10 is it worth it? What is an exemption?


Twitter @jackiereporter


CA Sen. Lara Urges Undocumented Parents to Sign Kids Up For Health Care

May 19, 2016 by · Leave a Comment 

New America Media – Kicking off his statewide tour to promote California’s Health for All Kids program, the new law’s author, State Sen. Ricardo Lara, D-Bell Gardens, said undocumented parents should set their fears aside and enroll their children in the program. The legislation would expand the state’s health insurance program for low-income people.

“There’s a misconception among immigrants,” Lara said, that asking for government help could land them in trouble. He made this observation during a May 12 media presentation at San Francisco’s Mission Neighborhood Health Center.

Mindful of this, the Health for All Kids program – which launched on Tuesday — was designed so children who currently have limited access to health care through the Emergency Medi-Cal, Healthy San Francisco or Healthy Kids programs would “seamlessly transition” into full-scope Medi-Cal (California’s version of Medicaid), said Lara. He was flanked on the podium by State Sen. Mark Leno, D-San Francisco, and Democrat Assemblymembers Phil Tang and David Chiu.

Representatives of such health advocacy groups as Children Now, Health Access, California Pan-Ethnic Health Network, Asians Advancing Justice and California Immigrant Policy Center also spoke at the media briefing.

 California State Sen. Lara at a press conference promoting the California Health for All Kids program. Photo courtesy Jesse Melgar)

California State Sen. Lara at a press conference promoting the California Health for All Kids program. Photo courtesy Jesse Melgar)

170,000 California Children Eligible
An estimated 170,000 undocumented children are eligible to enroll in the state-funded program, expected to cost $40 million in the first year of its operation, and $137 million annually “in perpetuity,” Lara said.

Lara drew on his experience growing up in the United States as the child of poor undocumented immigrants from Mexico to emphasize why it’s important to have children enrolled in health insurance.

“Children shouldn’t have to worry about how their parents are going to pay for a broken arm or for a dentist,” the lawmaker said.
Leno, who chairs the Senate Budget Committee, said the importance of the Health For All Kids program can not be overemphasized because illnesses make no distinction between documented and undocumented people.

“Our bodies, viruses, bacteria don’t know what our immigration status is,” Leno said. He noted that dental problems alone results in around 500,000 children in California missing school each year.

He also observed, “Without a high school diploma, a child is more likely to find his way into the criminal justice system.”

‘Get a Clue, Donald Trump’
Leno’s elicited laughter when he quipped, “Get a clue, Donald Trump.” He was referring to the Republican presidential presumptive GOP nominee’s vow to upend the Affordable Care Act (ACA) should he become president.

Undocumented Bay Area resident Teresa Lopez, a mother of four children, said she would be relieved to see her Mexico-born daughter, Litzy, age 15, enroll in the full-scope Medi-Cal program and enjoy accessing health care the way her two U.S.-born children currently do.
“Having to make copayments for every visit, and for medications is taking a toll on my family,” said Lopez, speaking in Spanish, through an interpreter. “It will be nice when all my children have the same kind of health care benefits.”

Lara noted earlier this week that the California Department of Health Care Services, which operates Medi-Cal, has said it is ready for the influx of thousands of children when the Health For All Kids program begins next week.

Lara is hopeful that Gov. Jerry Brown will sign his second bill, SB 10, which is currently making its way through the Legislature. It would allow the state’s undocumented adults to buy unsubsidized health insurance on Covered California, the online marketplace set up under ACA, with their own money. More than 2 million people currently have no access to health care, Lara said.

California has sought a federal waiver to allow its undocumented population to purchase health insurance on the marketplace.

“We hope we get the waiver before the administration in Washington changes,” Lara said, suggesting that the next U.S. president might either dismantle ACA or make drastic changes to it.

Teresa Lopez with her U.S.-born child, said she hopes to enroll her Mexico-born daughter, age 15, into the new Health For All Kids Program.  (Photo courtesy Jesse Melgar)

Teresa Lopez with her U.S.-born child, said she hopes to enroll her Mexico-born daughter, age 15, into the new Health For All Kids Program. (Photo courtesy Jesse Melgar)

Medi-Cal Provider Shortage
In the wake of the new Health For All Kids program, Lara was asked how the state could cope with the large influx of new Medi-Cal enrollees when there is already a shortage of doctors and dentists in the Medi-Cal network.

He said that said he hopes lawmakers would make the program more attractive to health care providers by increasing reimbursement rates, currently among the lowest in the nation.

“We are going to keep pushing for this,” Lara said.

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