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Valley Counties Move Slowly Toward Health Reform

Jan 15, 2013

Dr. Rogelio Fernandez of the United Health Centers clinic in Parlier performs minor surgery on Yesenia Campuzano of Reedley. (file photo)
Credit Shellie Branco / Valley Public Radio

In less than one year, the federal health care law will take effect. When that happens, an estimated 1.4 million low-income, uninsured adults in California will become eligible for Medicaid. That’s a huge number of people who will suddenly be eligible for health benefits and better access to health care.

“Right now, Medicaid covers children, parents, seniors and people with disabilities, but it doesn’t cover adults without kids at home, even if they’re penniless,” explained Anthony Wright, executive director of Health Access, a statewide health care consumer advocacy coalition. “The Affordable Care Act plugs that huge hole in our safety net in 2014, and it has an option for states to do that expansion early.”

The option Wright mentioned is called the Low Income Health Program, and it’s considered a “bridge” to health reform. The program allows counties to get a jump start at enrolling poor people in insurance, and providing them with basic health benefits. It utilizes the dollars that counties already spend on indigent care, and is supported by matching funds from the federal government.

So far, 51 of 58 counties have implemented this program. But several San Joaquin Valley counties have dragged their feet.

“The Central Valley can be described as “ground zero” for the uninsured crisis nationally,” Wright said. “You have a very high uninsured rate – close to a quarter of adults are uninsured, and so there is a huge need for the expanded coverage in the Affordable Care Act.”

Despite the need, Wright is not surprised that some Valley counties have not implemented this program.

“It is expected, but ironic, that the counties that have taken the most advantage are the counties with developed safety nets – public hospitals, community clinics – and the ones that are lagging behind in taking advantage of the Low Income Health Program are those with less-developed safety nets,” he said.

Kern County was one of the first in the state to pilot a version of the program. San Joaquin County has implemented one, too. But Fresno County, the largest county in the region, was the first in the state to turn down the opportunity completely.

Tulare County aims to implement its version of the program in March, according to Jason Britt, Director of Human Services at the Tulare County Health and Human Services Agency.

“Tulare County is looking at implementing a Low Income Health Program, primarily because we feel like it’s a bridge to health care reform and it will assist us in getting our system and our community ready for Medicaid expansion to occur in 2014,” Britt explained.

Tulare County’s program is expected to serve an estimated 3,000 to 5,000 poor people who live at or below 75 percent of the federal poverty level. For an individual, that works out to an annual income of about $8,300. For a family of four, that’s a little over $17,000 a year.

County staff working in emergency rooms and federally qualified health centers will screen people, and determine if they are eligible for the program. If they are eligible, they will choose a primary care physician, connect to a network of specialists, and gain basic health benefits.

“The Low Income Health Program offers a core services that include medical equipment and supplies, emergency medical services which may also include transportation, inpatient hospital service, laboratory services, some mental health benefits that are authorized in this program, physical therapy, podiatry, prescription medicine, orthotics… so that’s really the core of the services that the LIHP offers,” Britt explained.

But Britt believes the greatest benefit of the program is that it will help people develop the habit of visiting a primary care physician, instead of the emergency room. That’s why he believes it’s worth implementing, even if lasts just for a couple of months.

“It gets our indigent population connected with a medical home,” he said. “Typically, this population that we’re targeting typically only seeks services when they are needed, and so getting them connected to a medical home, getting them connected with a primary care physician, getting them the preventative medicine that they need to be healthy and productive members of society, is really the benefit we see to this program.”

But Fresno County residents won’t gain these benefits until the health care law takes effect next January. That’s because the Fresno County Board of Supervisors voted against implementing the program in October 2011.

Their decision still frustrates Kevin Hamilton. He’s the deputy chief of programs for Clinica Sierra Vista. He says that if the program had been implemented, poor people would have already gained access to health care.

“They would have been provided with access to a medical home, so they’d have a primary care provider,” Hamilton said. “We could have already started seeing the reductions in emergency room visits for sore throats, headaches, colds, and the associated costs of those visits, like ambulance transportation, more missed work, and missed days of school for kids.”

Hamilton is concerned that without the support of the Low Income Health Program, Fresno County won’t be prepared to enroll newly eligible people into Medicaid beginning October 1st.

Sanja Kovacevic, the deputy director for the Fresno County Department of Social Services, says it might have been easier to prepare for the upcoming Medicaid expansion, if the county had created a Low Income Health Program.

“From the Social Services Department standpoint, if we did the Low Income Health Program, it would have taken a portion of the population, and already figured out the eligibility piece, and in some ways, that would have made our preparation for the Affordable Care Act easier, maybe,” she said. “That’s a big maybe, depending on how we did the eligibility piece.”

But she’s not looking back. The county faces a huge to-do list as the first day of Medicaid enrollment approaches.

“I think the biggest issue for us will just be the volume, and needing to really recognize that we’ll need more staff to deal with the increase,” she explained.

Wright, of Health Access, says Valley counties should seize the chance to ensure more people gain access to health insurance.

“Especially for Central Valley counties, which have such a high uninsured rate, this provides a new framework and new funds to address some longstanding issues with regard to health care, but it’s only if they take advantage of those opportunities. And so what’s needed is a commitment to seizing these opportunities moving forward.”

Support for coverage of health comes from the California HealthCare Foundation.