By Tim Moran
Californians who don’t have health insurance through work and can’t afford to buy it themselves can find themselves negotiating a maze of government-subsidized programs.
They might qualify for Medi-Cal, the state’s version of the federal Medicaid program. They might be classified as a Medically Indigent Adult, or MIA, depending on what county they live in and what the income requirements of that county are, and get limited health care services.
Many California residents who don’t currently have health coverage will get coverage in 2014 through the federal health reform act. And now a federally-funded state program will get hundreds of thousands of low income adults coverage earlier than that through a program called the California Bridge to Reform. Under that program, patients are put into a Low Income Health Program, or LIHP.
Does the alphabet soup of acronyms and bureaucratic program names, income and property requirements leave low-income residents confused?
Not so far, according to several patients at a Stanislaus County clinic, although most are not aware of the California Bridge to Reform.
“It’s difficult to get started,” said Shaun Lezer of Modesto, 29. “Once you are in the program, it’s OK.” Lezer is on Stanislaus County’s Medically Indigent Adult program. “There’s a lot of waiting just to get signed up,” he said.
Once in the program, he is reviewed every three to four months, and must bring in proof of income to continue getting health services. Lezer admitted that he didn’t know what the income criteria was, he just brings the information and “They say yes or no.”
Jerry Smith, 58, of Modesto, said the current system isn’t complicated at all. Smith is disabled, and on Medi-Cal.
“It’s one of the best things that could happen to low income people. It’s been a life saver for me,” he said. “It’s not tough to qualify, to get on it and go through Social Security and all that stuff.”
Most people don’t delve into the details of the program, Smith added. “They understand that they can continue to get health care. As far as the politics of it, they don’t know. They just know they are able to go to a doctor.”
Counties help in navigating the system
Getting people into the programs without burying them with program names and details is the job of California’s counties. Tammy Moss Chandler, Merced County’s director of public health, agrees that the program names and details can be daunting.
“It gets more complicated by the day…people need health navigation support,” Chandler said.
The Central California Alliance for Health administers health programs for Merced, Monterey and Santa Cruz counties. Part of that job is translating a lot of the legalese into understandable English for low-income patients.
Alan McKay, executive director of the Alliance for Health, breaks it down to two questions: how do you get in to the system, and what do you do once you are in?
California counties will be in charge of getting people into the California Bridge to Reform program, through their Medically Indigent Adult program eligibility offices, McKay said.
The Central California Alliance for Health is an example of how the programs get translated to patients once they are signed up, McKay said.
“We sit down with people face-to-face, to help them understand what they are eligible for, “ he said. The Alliance has an office in Merced with member service representatives who can communicate in Spanish and Hmong as well as in English, McKay said.
The information includes how to use a primary care doctor in the most effective way, he said, and there is a grievance process for members who have problems.
The bureaucratic language comes with the territory, McKay noted. “The county is involved with the state, which is involved with the feds,” he noted.
“Usually, the counties select a name that’s a little more client-friendly. We send out literature to members in a manner accessible to lower levels of education,” McKay said. “It’s really not information unless members can understand it.”
For a client population that may have accessed health care only through emergency room visits when problems became dire, there is a learning curve, McKay said.
“The newly insured are accustomed to putting off care, or going to the ER later than they should. We are keen to have members use their primary care home, where they do intake, see what the medical needs are, do preventive care and referrals to specialists.”
That can be a big leap for those who have never had a primary care doctor. “It’s not intuitive,” McKay said. “They have survival behaviors that have to be unlearned.”
Warding off fraud
Maggie Mejia, legislative chair of the Latino Community Roundtable in Modesto, is worried about another aspect of the federal health care reform act and the California Bridge to Reform: The potential for fraud.
“Those of us who are educated and read the language can’t understand all of it, how can someone who doesn’t speak the language?” she asked.
“My biggest fear, there are a lot of Latinos pushing, professionals in health care insurance. They will intimidate people who don’t know the language, push them to buy health care insurance.”
Mejia pointed to the fraud that accompanied immigration reform efforts. “There were a lot of scams, people saying they were professionals, Latinos scamming Latinos,” Mejia said.
Many Latinos don’t bother with the health care system in California at all, she added. “They go back to Mexico for treatment. It’s cheaper in Mexico. At the border, you get a wisdom tooth pulled, or new glasses. A doctor appointment here is $100. It’s $25 in Mexicali.”
In an emergency, those same patients fill the emergency room at Doctor’s Medical Center in Modesto, which contracts with Stanislaus County to provide emergency services for the poor.
“I wish there was one good agency we could depend on,” Mejia said. “Golden Valley (a federally qualified health clinic that accepts low income patients) doesn’t have hospitalization, you have to go to Doctors Medical Center. If you are not on welfare or Medi-Cal, you will have a super high bill. What about the family of four or five, and a child breaks a leg playing soccer?”
Directing patients to preventative care
Elaine Taylor of Ceres agreed that there needs to be a liaison or some coordination. She has been trying to get her granddaughter, Michaela Green of Modesto, the immunizations she needs to enroll in junior college.
Green is 19, and without health insurance. She doesn’t qualify for the county Medically Indigent Adult program until she is 21, and miscommunication between the school and the clinic caused her to get unnecessary immunizations.
“The whole system needs an overhaul,” Taylor said. “I’m glad we have some sort of system, this is a great country, but for people who come to places like this, it’s horrendous. Even with an appointment, you wait two hours.
“There’s a list of places you can go, and you have to qualify for each one. You may not meet the qualifications of each one, but you go and wait anyway. They need a liaison. The information could be given to you over the phone,” she said.
The language used to describe the programs is confusing as well, Taylor said. “They use words that are not commonly used. Can’t they just simplify this? It takes an attorney to understand what it says. Sometimes we forget that fewer words or simpler words are better for anyone.”
Counties are trying. Moss Chandler said new low-income patients in Merced County can access a web site for information, and they get a handbook written to a basic literacy level. A newsletter is sent to homes, and incentives are offered for patients to participate in their health care.
California counties are in the process of deciding how to structure enrollment in the California Bridge to Reform.