By Chris Richard
California Health Report
By the time national health-care reform takes effect next year, Los Angeles County health officials expect to enroll 300,000 people in an expanded Medi-Cal program.
But some estimates put the number of people eligible for the low-income insurance coverage countywide at more than half a million.
To help make up the difference, a coalition of churches, synagogues and nonprofits has launched an enrollment drive that invites people to sign up at the neighborhood church.
“Depending on the policy decision at the state and county level, [health-care reform] can merely be an exchange that provides more insurance and still leaves a million or so people out, or there can really be an aim to provide health-care coverage for everybody in LA county,” said Tom Holler, executive director and lead organizer at OneLA.
“And that was the decision the OneLA leaders made, to make sure the enrollment is done in a way that eventually provides insurance for everybody.”
Los Angeles County’s Medi-Cal expansion, Healthy Way LA, provides free primary and specialty care, mental health services, chronic disease management, medication and emergency treatment.
Enrollment is open to citizens or permanent legal residents between the ages of 19 and 64 who earn less than 133 percent of the federal poverty benchmark. That’s about $14,500 for an individual and $29,700 for a family of four.
Lambreni Waddell, who organizes OneLA’s church recruitment events, said working through relationships in a congregation makes it easier to correct widespread ignorance about the program.
“Our strategy is actually going to the people who are not yet at the point of needing health-care coverage,” she said.
“It’s meeting them when they’re healthy, when they’re bringing their kids to confirmation class, and saying, ‘Hey, why not begin now learning what your options are? Let’s get you connected now.’”
At an enrollment fair Sunday at St. Agnes Church south of downtown Los Angeles, Adelaida Macias, 59, brought a thick sheaf of documents, including her United States citizenship naturalization certificate. A volunteer from OneLa took about half an hour to help her complete her Medi-Cal enrollment forms.
“I’ve been worrying a lot,” Macias said, explaining that she suffers from severe bronchitis and arthritic knees. “So when I heard at Mass about this event, I signed up right away.”
Until now, only Los Angeles County health department employees or professional enrollment agents employed by county-authorized community clinics could enter new people into the county’s Healthy Way LA database, said Katie Murphy, supervising attorney at Neighborhood Legal Services of Los Angeles County.
“This project is the first time that community leaders are being trained to help people in their own communities,” Murphy said. “So it’s really about building capacity.”
Waddell said some 15 churches and other organizations will hold enrollment events in coming months, hoping to begin the insurance qualification process for several thousand people.
Amy Luftig-Viste, director of the county health services department’s community partner program, noted that one problem with enrolling people exclusively within the clinic setting is that by definition, that means signing people up once they are already sick.
“Part of what we are trying to do here is help people get their health coverage (and understand it) well before they need it,” Luftig-Viste wrote in an email.
Neighborhood Legal Services already trains county and community clinic staff to help people with the insurance signup process. OneLA’s enroller training is based upon the same instruction, Murphy said. Volunteers learn the range of public insurance programs, what documentation is required for each program and how to enter applicants into the county’s online enrollment system. They also sign the same confidentiality agreements required of professional staff.
Brother Lucio Cruz, whose Mary Immaculate Catholic Church in Pacoima hosted the first enrollment event in early March, said parishioners clearly are more comfortable completing the insurance documents with the help of OneLA volunteers they already know in his congregation.
“When it comes to a church where they go for Mass, people come because they trust,” he said. “They come because they know this is a safe place. And it’s the same for this program.”
Ellen Israel, who chairs the social justice committee at Temple Judea, a Tarzana synagogue and OneLA member, thinks the local effort could offer a broader model.
“We really look at Los Angeles as being ground zero for all of this health care reform,” she said. “We have such a big population and so many uninsured individuals that this is a good place to do a pilot. We’ll see. We’ll see. But it looks to me like it’s going to be successful.”
Luftig-Viste, the county health official, said county officials plan their own variation on the OneLA model, training about 200 certified application assisters to help people complete applications at centers of community throughout the county. These agents are more familiar with the application procedures than is the typical volunteer and should be able to complete application materials more easily, Luftig-Viste said.
Even as OneLA presses for broader enrollment, Holler said, the organization’s leaders are concerned that Gov. Jerry Brown has yet to sign state legislation enabling the full Medi-Cal expansion once national healthcare reform takes effect.
At first, the federal government will cover nearly the entire program cost as part of the Affordable Care Act. Starting in 2017, California would be required to pay a maximum 10 percent of care costs, as well as half the program’s administrative expenses. By 2020, the state would pay about $600 million in exchange for a health care package valued at $6 billion.
Holler said he’s confident Brown will eventually come to an agreement with local officials throughout the state on paying California’s share. But if discussions extend into May, that could cause interruptions in health coverage for people already enrolled in Medi-Cal transitional programs, he said.
“For the bureaucrats, that may be OK,” Holler said. “But if you’ve got a disease and you’ve got to go to the hospital, that’s not OK.”
He said OneLA leaders are discussing a coordinated series of sermons this month on the need for a speedy resolution to the impasse.