Medi-Cal

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New Bill Would Extend Health Coverage to Undocumented Immigrants

(Getty Images)

(Getty Images)

Anna Gorman, Kaiser Health News

In a push to cover immigrants excluded from the nation’s health reform law, a California state senator has proposed legislation that would offer health insurance for all Californians, including those living here illegally.

The bill, SB 1005, would extend state-funded Medi-Cal to low-income immigrants who, because they are in the country without permission, are now eligible only for emergency and pregnancy coverage. It would also create a marketplace similar to Covered California to offer insurance policies to higher income immigrants who lack legal status.

It’s not clear how much the new coverage would cost or how the state would fund it.

Sen. Ricardo Lara, a Democrat who represents Long Beach and southeast Los Angeles, announced the proposed legislation at a press conference Friday. He said immigrants contribute to the California economy and deserve to have access to health insurance. Continue reading

New Health Plan for the Poor and Elderly Raises Questions

Christina Kahn, manager of the San Mateo Health Insurance Counseling and Advocacy Program, returns phone calls to local seniors.

Christina Kahn, manager of the San Mateo Health Insurance Counseling and Advocacy Program, returns phone calls to local seniors. (April Dembosky/KQED)

A new experiment in managing the health of older Californians is causing a lot of confusion among seniors. Letters have been hitting mailboxes around the state this week with information about the changes. It’s the second letter in a series of three — the first went out in January — and they have been inspiring a lot of calls to county health insurance counseling centers.

“Why do they keep doing this to us old people?” asks a woman named Andrea, a 72-year-old resident of San Carlos. She called San Mateo County’s counseling office when she received her first letter, telling her she was going to be automatically enrolled in a new health plan — one she’d never heard of and never intended to sign up for.

“We get used to one thing and now we have to do something else?” she said. “I’ve gotta call quick. Otherwise I’ll get something, and maybe I don’t want that.”

Christina Kahn, manager of the Health Insurance Counseling and Advocacy Program of San Mateo County, has been returning phone calls like Andrea’s to explain. Continue reading

Medi-Cal Expansion Opens Doors to Care for Transgender Patients

Darryl Avery is a transgender man seeking medical care to complete his transition. (Angela Hart/KQED)

Darryl Avery is a transgender man seeking medical care to complete his transition. (Angela Hart/KQED)

By Angela Hart

Among those estimated to enroll in the expansion of Medi-Cal, some of those most likely to benefit are among the most stigmatized in health care — transgender patients. Darryl Avery, 48, is one of them. Avery was born female, but identifies as a man. Several years ago, he began his transition. He moved to San Francisco where he sought medical care, stable housing, culinary schooling, and eventually, sex reassignment surgery.

“I’ve seen so many trans people with mental health problems, they get access to treatment, and it’s like you’ve flipped a light switch on.” 
“Where I grew up in New Jersey, there were no resources for me,” Avery said. “I never had anyone I could relate to until I moved here. I was no longer called a freak.”

Avery lives without a steady source of income. Because California is expanding its Medicaid program, known as Medi-Cal here, Avery now has access to health insurance. More than one million Californians are newly enrolled as of January 1.

And for people like Avery, who are seeking transgender care and sex-reassignment surgery, it’s a “big deal” says Dawn Harbatkin, Avery’s primary care physician who is also executive director for Lyon Martin Health Services, an LGBT-focused community health clinic on Market Street near San Francisco’s Hayes Valley neighborhood.

Continue reading

Signing up the Homeless, One at a Time

Man sits in Skid Row area of Los Angeles. Advocates say homeless people tend to have complex health problems. (Kevork Djansezian/Getty Images)

Man sits in Skid Row area of Los Angeles. Advocates say homeless people tend to have complex health problems. (Kevork Djansezian/Getty Images)

By Anna Gorman, Kaiser Health News

On a recent winter morning, health outreach worker Christopher Mack walked through the streets and alleys of the city’s Skid Row, passing a man pulling a rusty shopping cart and a woman asleep on a crumpled blue tarp. The smell of marijuana wafted through the cold air.

“Do you have health insurance?” Mack, a towering man with long dreadlocks, asked one woman. “Do you go to the doctor?” he asked another.

Homeless men and women who didn’t qualify for insurance in the past now have the chance to sign up, and Mack — who was once homeless himself — is there to help.

The Affordable Care Act allows states to expand Medicaid to include poor people without children or disabilities who haven’t been able to get the free insurance in the past. Experts say determining how many homeless people are eligible for Medicaid is difficult but estimates range from about 500,000 to as many as 1.2 million. California is one of the 25 states (plus Washington, D.C.) that is expanding its Medicaid program, called Medi-Cal here. Continue reading

Obamacare FAQ: When Can You Buy or Switch Insurance?

(Getty Images)

(Getty Images)

Editor’s note: For people buying on the individual market who want health insurance starting Jan. 1, the deadline to sign up is Monday, Dec. 23. We are running one post a day with questions and answers on the Affordable Care Act and Covered California until that deadline. Readers can also consult KQED’s Obamacare Guide, written specifically for Californians.

By Emily BazarCHCF Center for Health Reporting

Q: Our 24-year-old daughter is employed full-time and her employer offers health insurance. Does she have to enroll in one of their plans or can she stay on ours until her 26th birthday?

A: Young adults and college students will have more insurance options in the new health care landscape than just about any other group, including both the Covered California marketplace and Medi-Cal, depending on their income.

Gwen from San Jose wants to know more about one option, a popular Obamacare provision that already allows parents to keep their young-adult children on their policies until their kids turn 26.

The good news, Gwen, is that your daughter can stay on your employer-sponsored plan until she’s 26, but … (And there is always a “but” … ) Continue reading

Medi-Cal Enrollment Surging Via Covered California

(David McNew/Getty Images)

(David McNew/Getty Images)

David Gorn, California Healthline

The Department of Health Care Services released enrollment numbers last week for Medi-Cal-eligible Californians who initially contacted the Covered California health benefit exchange.

The department said 143,608 people will likely receive Medi-Cal coverage as a result of contacting Covered California.

That’s about 40 percent of all applications completed through the exchange, said Anthony Cava, a spokesperson for DHCS.

“We are very pleased with this surge of interest and the momentum we are seeing in consumer awareness,” Cava said in a written statement. Continue reading

California Sends Incorrect Information to 246,000 Low-Income Patients

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By Anna Gorman, Kaiser Health News

California has mistakenly sent letters to 246,000 low-income residents, warning they may need to find new doctors next year under the state’s newly expanded Medicaid program.

The error frustrated counties and community health centers which have repeatedly assured patients they can keep their providers when the Affordable Care Act takes effect in 2014. The patients are part of the state’s “bridge to reform” program, which was designed to cover uninsured, poor Californians until they became eligible for Medi-Cal, the state’s version of Medicaid.

Bridge to reform launched in 2011 and more than 600,000 people across the state enrolled in county-based health coverage. Many people formed relationships with doctors and started seeking regular care. But county and clinic administrators said the incorrect information in the mailing this month has put the counties’ efforts in jeopardy.

The mix-up occurred as people are scrambling to figure out how the health law impacts them, and as private policy holders have been receiving letters canceling their insurance plans. Continue reading

For This Uninsured Man, Medicaid Looks Good

Brad Stevens used to think he didn’t need health insurance. (Sarah Varney/Kaiser Health News)

Brad Stevens used to think he didn’t need health insurance. (Sarah Varney/Kaiser Health News)

By Sarah Varney, for Kaiser Health News and NPR

Have you heard about the young invincibles? That’s the name given to young people who think nothing bad can happen to them.

Enrollment of healthy people like them in insurance under the Affordable Care Act is key to offsetting the costs of older, less healthy buyers.

Brad Stevens is 54-years-old and not so invincible anymore. He has been uninsured for most of his adult life — “ever since about 24 when I finished college,” he says. “Basically, I’ve always tried to take care of myself and be healthy and exercise and eat right and take vitamins and that type of thing.”

During the three decades Stevens has spent without health coverage, there have been numerous attempts to curb the ranks of the uninsured in the U.S. Now, the Affordable Care Act is changing the nation’s insurance market.

Stevens, who lives in Lakeport, on the west shore of northern California’s Clear Lake, has plenty of company. Twenty percent of California’s population is uninsured; some 5 million people could gain coverage under the health law.

The Kaiser Family Foundation surveyed 2,000 of California’s uninsured on the eve of the opening of health care exchanges across the country. Stevens took part in the survey, which aims to follow the same people over the next two years. (Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.)

Over the years, Stevens wasn’t interested in the debate over how best to provide health care to the uninsured. He didn’t view it as an issue for him. “I’m the epitome of health, and so I didn’t have much concern. My health care was working out every day, eating right and taking care of myself,” he says. Continue reading

3 Out of 4 Uninsured Californians Eligible, But Unaware of Obamacare Benefits

(Getty Images)

(Getty Images)

By Sarah Varney, Kaiser Health News

As uninsured Californians head into a new era of health coverage, they’re worried about costs and unaware of the help they’ll get from the government, a new survey finds.

The survey, by the Kaiser Family Foundation, found that three out of four Californians who earn modest incomes and could buy government-subsidized private coverage wrongly believe they’re not eligible for federal assistance or simply don’t know if they qualify.

In addition, many undocumented immigrants, who constitute about a fifth of the state’s uninsured population, erroneously believe they will be eligible for coverage. The law specifically bars them from getting coverage from the state’s new health insurance marketplace, which opens next Tuesday, for coverage beginning Jan.1, 2014.

“This has been, for so long, a political debate,” said Anthony Wright, executive director of Health Access, a Sacramento-based consumer advocacy group. “We’re just starting to move it into a practical reality. Now that the benefits are close at hand, there is a concerted effort to educate people about what their benefits are.” Continue reading

With Lax Oversight, Fraud Flourishes in California’s Drug Rehab Clinics

A receptionist at Pride Health Services in Inglewood, Calif., said there were no counseling sessions on April 3. But the clinic billed taxpayers about $1,600 for serving 60 clients that day, records show. (Photo/CNN)

A receptionist at Pride Health Services in Inglewood, Calif., said there were no counseling sessions on April 3. But the clinic billed taxpayers about $1,600 for serving 60 clients that day, records show. (Photo/CNN)

By Christina Jewett and Will EvansThe Center for Investigative Reporting

Addiction counselor Tamara Askew discovered something wrong soon after she started working at Pride Health Services, an Inglewood rehab clinic.

Askew grabbed a stack of files and began contacting patients to introduce herself. That was harder than she had figured.

Some were in jail, Askew said. Several never showed up. One was dead.

Her boss, she said, wanted to bill the government anyway, for counseling addicts she never saw.

“He basically said, ‘How do you think you’re going to get paid?’ ” Askew said.

They lure patients in from the street by handing out cash, cigarettes and snacks. They have patients sign in for days they aren’t there.
Pride Health Services specializes in billing for “ghost clients,” fabricating paperwork for patients who don’t actually come in, according to former employees and whistle-blower complaints.

It is part of a rehab racket – a pattern of fraud by rehabilitation clinics that collect government funding to help the poor and addicted, a yearlong investigation by The Center for Investigative Reporting and CNN has found.

Thousands of pages of government records and dozens of interviews with counselors, patients and regulators reveal a widespread scheme – concentrated in the Los Angeles region – to bilk the state’s Medicaid system. Continue reading