HealthyCal.org

Photo: emrank/Flickr

By Lynn Graebner
California Health Report

Low income children in Santa Cruz County already have a tough time getting in to see a dentist. As the state prepares to start transitioning 6,791 Santa Cruz County children covered under the state’s Healthy Families Program to Medi-Cal in 2013, dental options for those kids could get even slimmer.

In June Governor Jerry Brown signed a state budget eliminating the Healthy Families Program. That requires that 875,000 children be transitioned in 2013 from their Healthy Families plans to Medi-Cal. For dental service those kids will now be covered by Medi-Cal’s Denti-Cal program.

Some dental providers predict that historically poor performance by Denti-Cal and the fact that California has one of the lowest Medicaid reimbursement rates for providers in the nation, will result in less access to dentists for low and middle income children because many dentists won’t take Denti-Cal.

Pediatric dentist Marc Grossman, one of the founders of Dientes Community Dental Care, a Santa Cruz safety net clinic, now has a private practice with his partner James M. Smith in Freedom, next to Watsonville. They were taking Denti-Cal patients but stopped because the system was difficult to work with and the low reimbursement rates of 20 percent to 30 percent of their fees, Grossman said.

“It had gotten to the point where you were forced to use different materials and treat people differently than I wanted to treat people,” Smith said.

They still take children covered by the Healthy Families Program even though the reimbursement rate is only 40 percent to 50 percent of their normal fees because the
program is managed so much better than Denti-Cal and is easier to work with, Grossman said.

He is disheartened that he’ll have to say goodbye to many of his Healthy Families patients who he’s watched grow up because he can’t afford the reimbursements or the headaches that come with Denti-Cal. In that system, everything is based on fraud prevention, he said.

“They required us to take photos of an 11-month-old to prove there was decay. Why would I fake that?” he said.

The California Department of Healthcare Services said it is reaching out to Healthy Families providers, newly-licensed dentists and current Medi-Cal dental providers to ensure that the 875,000 kids entering Denti-Cal will get service.

An analysis of that outreach effort will be released to the public, but the department is not sure when that will be, wrote Norman Williams, Deputy Director of the Office of Public Affairs at the California Department of Healthcare Services in an e-mail response to questions.

The department stated that 82 percent of Healthy Families providers already accept Medi-Cal patients and that this transition simplifies coverage options and reduces costs for children at certain income levels. It is also estimated to save the state $13 million in 2012-2013, $58 million in 2013-2014 and $71 million annually after that, Williams responded.

Despite the state’s claims that most Healthy Families providers will also accept Medi-Cal, there simply aren’t enough providers, especially specialists, in Santa Cruz County taking Denti-Cal to serve the need, providers say.

Only two federally qualified health centers, also known as safety net clinics, Western Dental Services Inc. and a few private practitioners in Santa Cruz County, take Denti-Cal patients. And currently thousands of low-income children in the county with public health insurance are not accessing dental care, said Laura Marcus, Executive Director of Dientes Community Dental Care in Santa Cruz.

“No matter how big we grow no matter how many chairs we add we’re not catching up,” she said. “For sure there will be longer waiting lists,” she said.

Dientes is a federally qualified health center and gets compensated by Medicaid at a higher rate than private dentists taking Denti-Cal patients. It offers full service dentistry to low income, no income and both publically insured and uninsured individuals and sees about 3,500 children a year.

Maria-Elena Mexicano’s three children are Dientes patients. She originally applied for Denti-Cal coverage for them but when she didn’t like the way she was treated by staff at the Medi-Cal human resources offices in Salinas, she looked into other plans and found Healthy Families. Because Dientes also takes Denti-Cal, her family won’t have to switch providers.

Unfortunately Mexicano can’t get dental coverage for herself. The federal government considers most adult dental services optional and in 2009 the California Legislature cut adult dental services under Denti-Cal as a result of the budget crisis.

Even when Mexicano had coverage under Denti-Cal she was only using it for emergencies because she didn’t know she was eligible for cleanings and other preventative services.

“That’s the big failure with Medi-Cal, they don’t communicate effectively with beneficiaries,” Marcus said.

Another program for low and middle income kids in the county is the Healthy Kids Program. It takes families who wouldn’t have previously qualified for Denti-Cal because their income is too high. Healthy Kids beneficiaries have incomes below 300 percent of the federal poverty level, $69,000 for a family of four.

The Central California Alliance for Health, a locally operated public health plan administers Healthy Kids which is funded by the county as well as hospitals, nonprofits and foundations. But its capacity is limited. Currently 1,246 children in the county are enrolled in that program and 430 are on a waiting list, said Maria Love, an administrative analyst for the Santa Cruz County Health Services Agency.

Like Marcus, she says even with Healthy Families there were already thousands of children in the county not receiving dental services.

“The dental part [of the Healthy Families transition to Medi-Cal] will be one of the biggest challenges for sure,” she said.

Typically the Healthy Families Program provides a higher rate of compensation to dentists than Denti-Cal. Medi-Cal is matched 50-50 with federal funds while federal funds provide two thirds of the funding for the Healthy Families Program, Williams stated.

Anthony Wright, Executive Director for Health Access California, a nonprofit consumer advocacy coalition in Sacramento, said his organization doesn’t think Medicaid is an awful program. He said there’s clear evidence that a majority of people with Medicaid coverage are satisfied and appreciative of it.

But in the scenario with Healthy Families, the fact that beneficiaries will be moved from a dental program with a higher reimbursement rate to a program with a lower one will have a significant affect, he said.

“At the end of the day it’s a cut and will inevitably have an impact on the access,” he said.

“The rates paid in the Denti-Cal program are well below the cost of providing care, this has a tremendous impact on the number of dentists that can participate in the program,” stated the California Dental Association in an e-mail response to questions.

“Many of our members have expressed frustration with the Denti-Cal program, including exceptionally low rates, the cumbersome process needed to become an approved Denti-Cal provider and the challenges in ensuring a pediatric specialist can see children when needed,” the Association reported.

In terms of Medicaid reimbursement levels to providers, California is almost at the bottom, ranking 46th in the country, Williams wrote.

“Fees have just gotten so ridiculously low it’s easier for me to convince dentists to take patients paying nothing than to do Medi-Cal,” said Hugo Ferlito, Associate Chief Operating Officer of Salud Para La Gente, a Watsonville-based federally qualified health center. It’s a nonprofit safety net clinic like Dientes that cares for patients regardless of their ability to pay.

Salud operates three physical clinics as well as 14 school-based clinics and is in the process of opening clinics at Cabrillo and Live Oak Elementary Schools and in Seaside.
Last year Salud had an operating budget of $13 million and did an additional $4 million in uncompensated care, Ferlito said.

“If someone is in pain, we take care of them,” he said. So Salud employs a full-time grant writer, gets money from the cities of Watsonville and Santa Cruz and Santa Cruz County. “It’s just a scramble,” he said.

“Many of our members provide a great amount of work pro bono rather than trying to maneuver through the financial and administrative barriers to providing Denti-Cal services, the California Dental Association stated. But that’s not a workable replacement for a functional statewide dental system.

“California must develop a true dental system of care that meets the needs of its citizens,”
the association contends.

By Robin Urevich
California Health Report

Gang intervention workers and cops are working together to curb gang violence in Los Angeles. But trust between the two groups hasn’t come easily as some 40 Los Angeles Police Department officers and LA County Sheriff’s deputies made clear during a recent all-day training session on the topic.

Early in the day, LAPD Deputy Chief Pat Gannon, a 34-year LAPD vet who’s since retired, quickly established his tough cop bona fides before describing his growing support for gang intervention.

At the beginning of his career, Gannon said, “I really had a good time in South LA locking up knuckleheads. I had a blast.”

The officers – most of them young and casually dressed in jeans and t-shirts – listened politely, but many sat with arms crossed in front of their chests, their body language betraying their skepticism.

Gang intervention workers and cops have historically regarded each other with apprehension. After all, the ex-gangsters who do the work often don’t trust law enforcement, while police have questioned whether the workers, who mingle with gang members for a living, still dabble in crime.

Gannon, a third generation LAPD officer, said that as he got older, he realized he was focused too narrowly on arrests and he wondered if he was really making progress.

“I still want to put bad guys in jail but i also want to stop gang shootings.”

The reason?

“We won’t solve homicides if we have retaliatory shootings,” Gannon said. Caseloads for detectives become too overwhelming.

Los Angeles is known as the gang capital of the world with 700 gangs and 40,000 gang members, according to a 2007 report by the Advancement Project, the non-profit that sponsored the law enforcement training.

Working with gang interventionists—most of them ex-gangsters-turned-peacemakers—can help stem the violence, Gannon argued. Their job is to persuade those most likely to seek revenge not to. They show up at the scenes of gang shootings to stop retaliation, broker peace deals between rival gangs, and aim to defuse potentially violent situations.

Gannon’s embrace of gang intervention represents a major cultural shift among the top brass at the LAPD. But the enthusiasm has yet to filter down to the department’s rank and file.

“Everybody’s kind of skeptical,” said Tony Batras, an LAPD detective who attended the session.

Cops wonder whether intervention workers, most of whom are ex-gangsters, have really cut their criminal ties, Batras said.

“Are they going to jeopardize our investigation or warn about our serving a search warrant?”

In recent years, a few high profile cases have reinforced police suspicions.
In 2008, a director of an anti-gang group called No Guns pleaded guilty to illegal weapons sales, while the head of another intervention group is currently fighting what some high profile supporters say are trumped-up federal charges of posing as a peacemaker while calling shots and ordering a murder for the MS-13 gang.

Now, the Advancement Project has turned its attention to eliminating mistrust of gang intervention by creating a training academy and establishing professional standards.

The group, which claims credit for convincing the city to add violence prevention and community policing to its suppression-heavy approach to gangs through the Mayor’s Office of Gang Reduction and Youth Development, has trained 1200 gang intervention workers in its Los Angeles Violence Intervention Training Academy.

Graduates train for 14 weeks in such topics as hospital intervention and law enforcement dynamics, submit to drug tests and background checks to weed out sex offenders and recent parolees and probationers, and adhere to a code of conduct.

It starts with looking the part, said Paul Carrillo, a former gang member who could pass for a young corporate exec.

“Dress is very important,” Carillo said. Workers are encouraged to wear a polo shirt. No ties, and no gang attire whatsoever.

Carrillo outlined the rules, including keep promises, be honest, no drugs, no alcohol on the job, no weapons, no dating those who you work with.

Never cross the yellow tape that police string up at a crime scene. Don’t spread rumors or let yourself be drawn into an argument. Dialog with anyone. Always promote peace and don’t take sides. Work is 24/7/365.

“If you’re home sleeping, you will be called at any time of the night,” Carrillo said

Gannon noted that it’s now standard practice to call an intervention worker after a gang-related shooting.

Strong relationships between gang intervention workers and police are key to an effective anti-gang strategy, said Fernando Rejon who runs the Advancement Project’s training programs.

But the close collaboration doesn’t mean gang intervention workers will help cops solve their cases. They’ll never say who committed a crime, even if they know, Rejon said. “They won’t snitch.” To do so would destroy their credibility with gang members

“In any major city, law enforcement basically runs the streets,” Rejon said. Already tense situations can blow up, he noted, “if cops perceive gang intervention workers as adversaries or don’t understand their work.”

The police training is aimed at both building that understanding and introducing the officers to some of the gangsters-turned peacemakers.

Carrillo along with a handful of others shared their own stories of transformation – to help the cops understand that change is possible, Rejon said

“I promised myself that if I ever had kids, I wouldn’t raise them the way my father raised me,” Carrillo said, adding that his children know nothing of his past. They’ve never even seen him shirtless because of his gang tattoos.

Late in the day, some of the officers appeared to be listening more intently. Then, during a Q and A, they seemed to wrestle out loud with conflicting feelings.

Angelica Gutierrez, an LAPD officer who works the gang unit at East LA’s Hollenbeck Station said she liked what she heard from the presenters, but noted that not all gang intervention workers have gotten the professionalism memo. Gutierrez, who’s been on the force six years, said she’s currently dealing with an intervention worker who’s smoking weed and interfering with her investigations. How do you handle that? she asked.

Another officer described a gang interventionist who crosses police lines to talk to the captain and a second one who appeared under the influence at work.

Police commanders argued that accountability is built in: the city’s gang program managers can handle issues, while contract agencies who hire gang intervention workers risk losing city funding if their employees are out of line, and they advised the front line cops on who to call when there are problems.

The Advancement Project and the Mayor’s Office tout their success: An Urban Institute evaluation of the city’s gang program found that after the second year gang violence was down more sharply in the 12 parts of the city that the mayor’s program targeted than in the rest of LA, although rates of gang crime have dropped citywide.

While interviews with those involved show the program has brought positive change, researchers have been unable to measure gang intervention program results. Rejon said such metrics are being developed.

“I’m all for it,” Gutierrez said. “I grew up in a gang-infested area, so I appreciate what you [anti-gang workers] do.”

Martha Munoz speaks to Dr. Felix Aguilar. Photo: Robert Fulton/California Health Report

By Robert Fulton
California Health Report

South Los Angeles, maybe best remembered as ground zero for the 1992 Rodney King riots, now boasts an unexpected draw.

Patients are traveling from other parts of Los Angeles to seek care at the South Central Family Health Center, a clinic that provides health care to the uninsured – and is using grants from the Recovery Act and the Affordable Care Act to innovate and grow.

When seeking treatment for her hemophilia and his Guillain-Barre Syndrome, Martha and Rafael Munoz made what was for them an easy decision. Despite living in Hawthorne, the husband and wife chose to receive healthcare at South Central Family Health Center, twelve miles away.

“We’d been going to a lot of clinics and hospitals like Harbor and we didn’t like how they treated us as patients,” Martha Munoz, 51, said during an interview on a busy Wednesday afternoon in September at the South Central Family Health Center. “I feel that they treat us as a file number.”

That wasn’t Martha and Rafael’s experience at the South Central Family Health Center. In addition to a familiar doctor in a familiar location, the Munoz family walked into a comprehensive primary health care facility focused on prevention, exercise and nutrition. More recently the clinic has implemented electronic medical records, more exam rooms, student-age outreach and dental care. The center also boasts comprehensive prenatal care.

Founded in 1981 as a small clinic at the corner of San Pedro Place and South Main Street, the non-profit moved into its current location – a vacated meat market – early last decade. The mission of the federally qualified health center is “to provide quality healthcare services for the uninsured and to the under insured population of Los Angeles County, specifically South Los Angeles,” according to Jerra Ferguson, South Central Family Health Center’s Development Director.

Dr. Aguilar said the clinic sees between 250 and 300 patients on a given day, but still has to turn away between 20 and 50 people. He said he talks to a number of patients who were once insured.

“The demand is much greater than the medical resources that we have,” Dr. Aguilar said. “We just don’t have enough providers. We just don’t have enough resources to be able to take care of them. We wish we could. As time goes by we have new services, but the demand for healthcare services is great.”

South Central Family Health Center boasts 11 providers and more than 20 exam rooms.

“Every day we turn people away,” Dr. Aguilar continued. “We try to do our best. A nurse checks them out to make sure it’s nothing serious that cannot wait, but it’s something that’s a daily occurrence here. We’re always looking for ways to innovate, to find new manners of service to augment and do more.”

Genevieve Filmardirossian, SCFHC Chief Operations Officer, estimates that more than 60 percent of the patients the clinic sees are uninsured, and the remainder are either insured, under insured or receive Medi-Cal or some other type of assistance. Martha and Rafael Munoz, who sell hardware supplies at a local swap meet, rely on Medi-Cal.

Filmardirossian emphasized the clinic’s focus on prevention and education.

“Our model is to heal, to empower and to educate the community,” Filmardirossian said, echoing the clinic’s motto. “We empower these patients to take care of themselves so they are healthy and they have better outcomes. If you take care of yourself and are able to control the illness that you suffer, you will not be a frequent user of the ER. We believe that staying healthy and prevention is the key to being healthy.”

South Central Family Health Center has been able to increase services thanks to a number of federal grants. In recent years, the clinic received Recovery Act assistance through the Health Resources and Services Administration, including $1.3 million in a New Access Point grant, $304,000 for an Increased Demand for Services grant and $1.6 million for additional construction, renovation, equipment and health IT.

With the added funding, SCFHC opened the Huntington Park Family Health Center in 2010, remodeled and expand its main location; added mammography and radiology rooms; added staff; and extend hours. The primary location is now open from 7 a.m. to 7 p.m. Monday through Friday and from 7 a.m. to 6 p.m. on Saturday.

More recently, SCFHC received Affordable Care Act funds through Health & Human Services. The $500,000 grant received in May will go to the Huntington site and allow the clinic to provide dental care.

“It’s just allowed us to meet the expanding need,” Ferguson said. “We have to grow to meet that growth in the community. There’s challenges that come along with that and we’re continuing to do what we can to try and meet those challenges.”

One of the advancements that SCFHC has made is in the department of medical records. Each exam room includes a computer terminal, where providers can enter updates, go over medication, schedule appointments and more.

“The fact that a patient can call me and ask me a question about his labs, I can just look it up in the computer in a manner of a couple of minutes,” Dr. Aguilar said.

South Central Family Health Center also runs two school-based clinics at Jefferson High School and The Accelerated School, both in South Los Angeles. Ferguson stressed the relationship between education and health care, from primary care to addressing sexually transmitted diseases and teen pregnancy.

While the clinic works to keep up with demand, South Central Family Health Center leadership wants to learn what it can do better and to get the word out about its services. To do so, the clinic has formed a Patient Advisory Committee.

“The main purpose for this is to have the patients be the voice of the clinic and to bring any concerns,” Filmardirossian said. “They volunteer to do work in the clinic. They provide information in the front office. They are all volunteers for the clinic. They are basically the voice of the community.”

Fanny Ramirez, 58, has been a patient at SCFHC for approximately six months now. She works part-time as a housekeeper and does not have insurance. Ramirez lives in the area and heard about the clinic from a friend.

“I wasn’t being attended very well in the other place I was attending,” Ramirez said through a translator. Ramirez sought treatment for her an irregular heartbeat, as well as arthritis, poor blood circulation and cholesterol. She plans to join the Patient Advisory Committee.

Rafael and Martha Munoz are also both on the Patient Advisory Committee.

“There is something important for why we are in the committee,” Rafael Munoz said, with translation from his wife. He emphasized keeping the community healthy and out of the emergency room. “If the community is receiving good medical service, they won’t be in the emergency rooms of the hospitals. If there are people not getting sick it’s going to be more productive to the country.”

Patients braved searing heat for free medical services at the Flying Doctors clinic. Photo: Suzanne Potter/California Health Report

By Suzanne Potter
California Health Report

On a recent Saturday hundreds of families waited patiently in punishing 108 degree heat – for the chance to get an eye exam and a pair of glasses – at Desert Mirage High School in Thermal, California. The line for medical exams snaked out the door, and the entire gym was packed with people waiting to see a dentist, nurse, podiatrist or Ob-Gyn. In other rooms physicians provided physical therapy, chiropractic exams, mental health evaluations, HIV tests, hearing tests, physicals and more.

In all, more than fifteen hundred people jammed into the free clinic offered by Los Medicos Voladores, also known as the Flying Doctors. Normally the group runs clinics in third world villages in Central and South America. But 17 years ago a local Nurse Practitioner named Rosa Lucas invited them to visit the rural communities in the eastern Coachella Valley (about 30 miles outside of Palm Springs) where entire families toil in the fields with little pay and no health insurance.

Lucas is now on the board of a group called Coachella Valley Volunteers in Medicine (CVVIM), which runs the only free clinic in the Coachella Valley.* “The Flying Doctors saw the conditions in our trailer parks,” Lucas says “and saw that they were just like the pueblos in Mexico that they were already serving. So they agreed to come here, too.”

Salvador Ceja Cervantes is an undocumented farmworker with bad vision and shoulder pain. He came to see an optometrist and a chiropractor. “I can’t bring my arm up over my head because of shoulder problems,” he said, in Spanish. His wife Elsa needs dental work. Their four kids were born here so they qualify for insurance through a low-cost insurance plan subsidized by Riverside County.

Ana Bautista, an undocumented retired farmworker, depends on the Flying Doctors for health care. “I have a rash on my face. It’s been there a week. I need the doctor to check it and I need glasses. It’s wonderful that they do this for the community. Without it I’d have to wait to get treated until I can save up the money to see a doctor or maybe go to Mexicali to see someone there where it’s cheaper.”

Sixty-one-year-old Francisca Rojas came with her husband and sister to get glasses. “I am a housekeeper. I work on my own so I don’t have insurance. An event like this is very necessary. Thanks to God it is here. Without it I don’t know where we’d be. That’s the truth. ”

Many of the patients at the fair are American citizens who say they’re struggling in this tough economy. Nita Carranza is a 29-year-old substitute teacher with a degree from UC Berkeley who came to see the doctor for an ear infection and a rash. “It’s really hard to get a full-time job that has benefits. I’m just trying to survive like everyone else. With all the budget cuts at the schools in California a lot of my hours have gone down. I’m thinking about going back to school to do something different.”

She’s worried about her hometown of Coachella. “A lot of people here do not have any type of insurance coverage. And they need it. It doesn’t matter, citizens or not, there are a lot of children and senior citizens in need of health care. It’s not just farmworkers, Mexican immigrants trying to get free health care. There are a lot of American citizens, definitely.”

Mayra Gonzalez is a homemaker and mother of three girls under the age of six. Her husband works full-time as a skilled carpenter but gets no benefits. “The kids have insurance but we don’t, so that’s why we are here. I feel glad to get this opportunity, because if we are sick we can’t pay for a doctor visit. Now we have this so at least once a year we can get our teeth and eyes checked. I have a hole in my tooth. I don’t want it to get infected.”

Valerie Bailey is 27 and has six kids – ranging in age from 11 to just 7 months old. She’s a full-time college student – studying criminal justice. Her husband just found work but the family’s health benefits haven’t kicked in yet. She’s got terrible vision, so on this day we find her in line for a vision check and a free pair of glasses at the health fair.

“I think it’s a great thing that they’re doing. I really appreciate it. I have been in college for more than a year now and it’s been a struggle the whole time. Cause I don’t have any insurance and it’s been too expensive to get glasses. It’s been very hard. I have to sit way in the front by the teacher.”

Alan Kuehn, a dentist with the Borrego Community Health Foundation, has volunteered at this event for four years. “There are obviously some severe needs in the community. A lot of them have multiple needs, surgery, restorative work, really bad periodontal problems, cleanings. The amazing thing is that you have this many people donate their time. The effort is enormous and it’s going well. I feel I have to give something back to this community. That’s the way America should be.”

Lucy Moreno, with Clinicas de Salud Del Pueblo, did most of the work organizing this massive event, coordinating with more than 130 doctors from the Flying Doctors, plus 150 local doctors, registered nurses, nurse practitioners, medical students and administrative volunteers. CVVIM also helped with pre-planning and contributed half a dozen doctors and ten dental assistants to the event.*

Moreno says she makes the effort because the need is so great in the Coachella Valley. “It’s just the ratio of doctors to patients. We’re lacking in resources and access to affordable health services. Our clinic does provide those services but it’s just not enough.”

Quite a few families who have medical insurance showed up at the health fair anyway. “Many are underinsured. The most important things at this fair are dental and vision, because those are the ones that almost no insurance covers,” Moreno explained.

Many families qualify for free or low-cost insurance but don’t realize it. Medi-Cal covers the disabled and very low-income families. Riverside County Health Care (which debuted in January) helps patients who make slightly too much to qualify for Medi-Cal. And the county-run MISP (Medically Indigent Services Program) gives emergency care and preventative medicine to low-income adults, regardless of their immigration status. MISP is designed to save money by reducing costly visits to the emergency room by desperate patients. Clinicas De Salud del Pueblo set up a table at the health fair to help families start the paperwork to qualify for those programs.

Moreno says she’s saddened by the number uninsured people in Riverside County. “The system really needs to be fixed. Something needs to be done. In the meantime if we can have people come volunteer for things like this I’m all for it.”

Quite a few local non-profits set up booths to offer their services, including the FIND food bank, The Braille Institute, and Molina Health Care. Eduardo Guevara, community organizer for a group called Promotores Communitarios del Desierto, brought a contingent of volunteers to help with logistics, setting up tables, helping with supplies, and directing people to the correct waiting areas. “We’re trying to fill the gap in the medical services here in the area. We’re seeing each year more and more people coming.”

In fact, the next Flying Doctors clinic in the area will take place April 4-7, and will be held at an even bigger venue: the Riverside County Fairgrounds in Indio.

Guevara says he’s seen patients of all ages, infants to seniors and every age in between.
He says that for many people, this health fair is the only health care they get all year.
“Actually I know people who have to wait from one event like this until the next because they don’t have any money for medication. They wait six months, eight months, mostly related to diabetes and heart disease.”

To remedy that problem, CVVIM offered patients appointments for follow-up care at its free clinic in Indio, the first time that has been done at a local Flying Doctors’ event.

CVVIM Board Member Rosa Lucas says, “Since Coachella Valley Volunteers in Medicine provides no-cost high-quality health care to those who qualify for no other coverage, a hole in the delivery of health care has been filled. Our volunteers deliver care not only for patients identified at Flying Doctors but also for the thousands of individuals who are referred to us by clinics, pharmacies, and individuals.”

Lucas has studied the reasons why patients flock to the Flying Doctors’ events and the CVVIM clinic. “A lot of them are working class people who lost their jobs, lost their homes, etc. And a lot of them have had to take their Social Security benefits at age 62 because they lost their job. But they aren’t 65 so they don’t have Medicare yet.”

Martha Rossmann coordinated the trip for the local chapter of the Flying Doctors. She credits a public assistance health organization called Tzu Chi for providing critical infrastructure support.

“They brought in all of the dental supplies and dental chairs. They did all the set-up, including cubicles for the doctors. They even brought with them an acupuncturist to help with matters such as pain and stress relief, joint problems, carpal tunnel… all kinds of problems that people might have.” The Coachella Valley School District opened up Desert Mirage High School to provide the clinic with an air-conditioned space with free electricity and water.

The Flying Doctors started in 1975 as a group of doctors who are also pilots. The Coachella Valley is their only stop in the United States, although they’d like to expand.

“There are a lot of places that need this help and they’re not all third world,” Rossmann says. “We’re looking at possibilities of working in other areas in California. But it is a difficult environment. Because the regulatory issues: the insurance issue, questions about where doctors and dentists are licensed to practice by boards, those all have to be considered.”

*The story has been changed and updated to include the role of Coachella Valley Volunteers in Medicine in organizing the Flying Doctors event.

Photo: 4rank/Flickr

By Helen Afrasiabi
California Health Report

A discount drug card offered by the city of Santa Ana to help shoulder the exorbitant costs of prescription drugs has left some users asking “where is the discount?”

Cary, North Carolina-based Paramount Rx was chosen by the city among a few dozen proposals reviewed to contract with local pharmacies and facilitate this discount.

As a consumer prescription benefits manager, Paramount has a roster of commercial pharmacies it contracts with, including several operating in Santa Ana such as CVS and Walgreens. The discount card gives customers an incentive to have their prescriptions filled at those pharmacies. The pharmacies, in turn, share with Paramount the revenue generated by the increased customer volume brought in by way of the discount card.

Paramount extends some of that shared revenue to the city, according to spokesperson Scott Yates, who manages public relations for Paramount. This money received from Paramount will go entirely towards exercise facilities and programs that the city plans to provide, said City of Santa Ana Recreation Supervisor Jeannie Jurado.

“We thought a good way to use these programs we want to provide is to have people be healthy from the start,” Jurado said. “And we asked well how do we do that? So we brainstormed and this is the idea that came out of it.”

According to the Census Bureau’s 2009 survey, an estimated 33 percent of Santa Ana’s 320,837 residents are uninsured, with a median household income of $55,000. Obstacles to obtaining medications for these families include co-payments that are too large or a lack of insurance altogether. There is also the existing problem of Medicare patients who fall within the “donut” hole or gap between the time their prescription coverage dollar limit has been reached and resumes, making them responsible for up to $3,600 out of pocket.

Thus it began that Jurado, along with Executive Director Gerardo Mouet and councilwoman Michelle Martinez pursued efforts to help Santa Ana residents who may not be up for even a free fitness class because financial struggles force them to skip out on their medications.

But residents say the card has not been easy to use. After picking up the free membership cards at local pharmacies, libraries and senior and recreation centers, residents say they have presented them at pharmacies only to be denied discounts at the registers. The program is promoted as covering all FDA-approved drugs with a 15 percent discount on brand name drugs and a 40 percent discount on generic drug prices.

Lidia Soderman, a senior who works at the Santa Ana Senior Center, says the card is “not worth the paper it’s written on.” Though all of her medications are covered between her Medicare and supplementary insurance, her 47-year-old son’s situation is very different from her own. She thought this card was the answer to getting him medication at a price he could better afford.

Earlier this year a massive stroke forced the single father to quit his job, go on disability as well as Medi-Cal and move in with his mother. As a result of the stroke, he is now very dependent upon the pricey blood pressure medication Diovan. And it happens to be the one medication he needs for which there is no generic. Paying out of pocket to date, it has been costing him over $200 per month to stay on it. Using the Paramount Rx card, he came back from the pharmacy empty-handed, as he says he was told it wasn’t one of the drugs Paramount covered.

“These are the ones that matter,” Soderman says, “not the generics that already cost peanuts anyways.” Soderman, who is on a fixed income of $2,500 per month herself, says stretching her already tight budget to help her son, she says, borders on stretching her resources too thin.

Paramount representatives say Soderman was either given bad information or misunderstood the pharmacist. Diovan, they say, is one of the drugs covered by the program, and he should have received a discount.

Customer experiences at one Santa Ana CVS location and that of seniors at the Santa Ana Senior Center, however, suggest that Soderman is not the only person having trouble using her card.

At the South Main Street CVS store, Francisco Gomez carefully shuffles through a stack of discount cards he pulls out of his wallet when picking up his rheumatoid arthritis prescription at the counter. A senior with multiple ailments, Gomez explains in broken English that the card he is using is essential for him to afford that particular prescription. That card, however, is not Paramount’s. It is that of prescription discount provider California Rx. With regard to the Paramount Rx card, he dismisses it as “no good,” expressing that with Paramount Rx, drug costs still amount to “too much money.”

A pharmacy technician who wished to remain unnamed said that in her experience, Paramount Rx has hardly proven to be competitive compared to that of California Rx, which provides up to 75 percent off all brand name prescriptions compared with Paramount’s 15 percent discount.

“This one [Paramount] just sits in here,” she says, pointing to a drawer under the cash register. “California Rx is the one we see pretty much all the time.”

Santa Ana Senior Center aide Yolanda Carillo also tried to promote Paramount Rx, in hopes that it would help the many seniors she personally knows who struggle with high cost of living, not the least of which is the cost of prescriptions.

“I’ve had two people come back and throw it in front of me,” Carillo said. She said one was an elderly man who claimed to be turned away for something as basic as insulin with the Paramount Rx card.

Others, Carillo said, have returned the card saying the discount was so low that it wasn’t worth the time.

Carillo believes for those who have not gotten anything out of it, some of the problems associated with using the card may be language-related. She says many of the people coming through the Senior Center both have multiple chronic illnesses and speak little to no English. They don’t have the wherewithal to persist when it comes to a solution or clarifying any miscommunication with their pharmacies, Carillo said.

Jurado believes it’s too soon to write Paramount off. She said the city will be measuring residents’ progress quarterly, and conduct an analysis of how they could get the most out of the card. That analysis will also uncover any impediments resulting from a language barrier which includes familiarity with how the card works.

“We will also be looking at that point on how to educate the public on the card’s usage,” Jurado said, acknowledging that there may be a learning curve in understanding the nature of prescription costs and the degree of savings people can expect.

Overall, she says, since it just launched in August, the 60 documented users aren’t enough for the city to assess how well the card is working.

Yates says that all FDA approved medications are covered and that the company’s numbers tell a different story. Those numbers show that Santa Ana residents have saved an average of 31 percent off of pharmacy retail prices for the month of August, he says.

“I can’t offer perspective about how the consumer got the wrong impression,” he said, suggesting that consumers refer to the Paramount web site for pricing and availability questions.

One source of misunderstanding might be that people on Medi-Cal already get discounts that might exceed what they would get by using the Paramount card. Also, many pharmacies give discounts to the uninsured on their own, and these, too, might mean that the Paramount card would not qualify a customer for a better deal, Yates added.

For now, Soderman says none of this is a consolation given what she faces at home with her son.

“My son is not one of the people that will be using the health centers right away even if his Diovan was covered,” Soderman said. “But they need to have compassion when they offer us something, offer something we can use.”

By Clare Noonan
California Health Report

It wasn’t easy for David Arceo to let his firstborn, Lizandra, leave home to attend UC Santa Cruz. His wife, Blanca, graduated from Fresno State and teaches first grade, but David attended school only through eighth grade because of illness. “I worry about it,” he said as his 17-year-old prepared to move away from home in Merced to attend the fall quarter. Still, he added, “I think if other kids did it, she can do it.”

A major reason he’s fine with the idea of college is the Parent Empowerment Program (PEP) run by the UC Merced Center for Educational Partnerships.

The 10-year-old center targets valley students, many of whom might not otherwise see college as a goal, and prepares them and their parents for higher education. “Our clear commitment is to fundamentally change the opportunity to learn,” said Jorge Aguilar, the UC Merced associate vice chancellor for educational and community partnerships.

Arceo and his wife attended PEP workshops that demystified all aspects of getting into and attending college: what courses and exams high-school students have to take in order to be admitted, how to fill out financial forms, what college courses to sign up for.

“It educates parents about college life for their children,” said Patrick Durr. “It takes away the fear of what college life will be like.” The social science teacher at Modesto High School coordinated the empowerment program that began there last year and will be held again in the spring. Presentations were given in English and Spanish, with the Spanish-speaking parents the most consistent participants, he said. An average of 40-45 parents attended each session and 36 earned a certificate of completion. Because the two-hour workshops were held in the evening, parents sacrificed to attend, Durr said. “It testifies to how important it is to them.”

English is not the first language for more than 67 percent of parents in the program, according to statistics on the center’s web site. The existence of such language and cultural barriers can make higher education seem an intimidating and unreachable goal. “Sometimes a kid is qualified but the parent says, ‘No, I’ve heard crazy things,’ “ Durr said.

PEP targets just that mom and dad, “unwilling parents of willing students,” vice chancellor Aguilar said with a laugh.

That could describe David Arceo, who said, “If it was me, I want her to stay here.”

Going to college “was a decision she made,” he said of Lizandra, who is interested in studying law. He said he told his daughter “it’s good you be a lawyer. You fight all the time.”

This is followed by his pointing out that Lizandra went to preschool at the tender age of 2 years, 7 months. She’s still his baby.

Spending time on a college campus made him more comfortable with the idea of her going away to college. A perk for parents who attend a majority of the eight PEP sessions is a bus trip to a guided tour of a college campus. It might include stops at a police station and a dorm cafeteria. The idea is to address parents’ concerns about safety as well as provide a feel for their student’s everyday life.

Over the years, Arceo has toured the campuses of CSUs Fresno, Sacramento and Monterey Bay, and UC Davis. “I liked them all,” he said, despite his opinion of UC Davis as being “too big, too many bikes. I’ve never seen so many bikes at a university.”

Lizandra has been involved since middle school in the Center for Educational Partnership’s initial program — UC Scholar EAOP (Early Academic Opportunity Program). It aims to get youngsters thinking about college early and, as they move to high school, get them into courses that will qualify them for higher education.

The group workshops in middle school turn into several annual one-on-one sessions with an advisor as the young scholars go through high school. That’s a good thing, Lizandra said, because “some kids didn’t feel good talking about their grades” in front of other students. The advisors “never say they’re too busy, no,” she said. “They always listen.” Center staff help high-school seniors apply for college and learn to write personal statements, according to Aguilar.

Lizandra attended a weekslong workshop that taught how to write effective college applications. She said her UC Scholars advisors provided “extra hope and a source I can go to.” Without the program, Lizandra said she would “kind of be lost in the application process. I probably wouldn’t be ready.”

“If parents go to the program it makes it easier for parents and the kids,” she added, explaining that in her mother’s college days, applications went snail mail while everything now is computerized. Lizandra said she takes comfort in the PEP sessions illustrating to her parents that even though computers will make some of her college chores faster and easier, “I’m still working hard.”

UC Scholars was the center’s first program. “It taught us that it was extremely difficult to work only with students and not other stakeholders,” said Aguilar. A cornerstone of the center now is its liaisons with families and school districts in a far-flung area that ranges from Bakersfield to Modesto, Avenal to Strathmore. Other programs at the center include one that compiles data on student enrollment and success, and another that looks for talented low-income students to help them become among the first generation in their family to attend college.

The center has brought in $15 million in grants over its 10-year history, Aguilar said, and served 10,000-plus people with that money. An additional 14,000 “benefit from our presence,” he said.

“College attendance is abysmally low in the valley,” Aguilar pointed out. So, while the center is part of UC Merced and started with a program called UC Scholars, the center wants to serve area students’ “overall college needs no matter where they go,” he stressed. “Many of our students enroll at CSU.”