Healthcare Expansion Threatened by Budget Cutting
Staff Report
In our last issue, we reviewed the momentous changes that are occurring for low income and homeless people who do not qualify for Medi-Cal, and who formerly received services under the County Medically Indigent Service Program (CMISP).

Since last year, 10,000 to 14,000 low income people in Sacramento County, including homeless people with urgent medical needs, are being shifted to “Medi-Cal Managed Care Coverage” under Sacramento’s new Low Income Healthcare Program (LIHP). Care for these patients will be provided by private HMO providers like Blue Shield and Molina.

This transition is mandated under the new federal health care law, the Affordable Care Act (ACA), which is sometimes called “Obamacare”; an additional 1.1 million low income adults in California, starting in January 2014, will become eligible for Medi-Cal.

As we reported, two health care consumers – Jonah and Pamela – had different experiences in this transition. Pamela, who has an acute condition, reports that she has had her first appointment and feels satisfied that her appointments have been prompt and satisfactory. Jonah, who needs cancer surgery, was transferred to a private HMO and has seen months of delay and disruption in the continuity of care as he lost the doctors who were coordinating needed appointments, and lost the opportunity to receive desperately needed surgery from specialists. But recently he received a letter from a specialist and reports that he has an appointment.

This is good news. It is important to understand that LIHP health care recipients have rights they did not have when receiving services from CMISP, such as the right to appeal and file grievances. For information about these rights, call the health care hotline at the Legal Services of Northern California: 916-551-2100; toll free 888-354-4474.

Meanwhile, however, there are serious threats to low income and homeless health care.
On the State level, the administration of Governor Jerry Brown is attempting to implement a 10% cut in Medi-Cal reimbursement to doctors, clinics, hospitals, and pharmacies. This cut, which was supposed to go into effect in June, 2011, has been held up in the Courts. It will be devastating to low income and homeless individuals with urgent medical needs who are searching for a doctor who will accept Medi-Cal.

Already, two thirds of doctors in California do not accept Medi-Cal because the payments are so low. But the Obama administration is urging the Courts to let the cuts go forward.

No State or Federal official has explained how a million people will get care under the expanded Medi-Cal eligibility if they cannot find a doctor because of the low reimbursement rates.

Secondly, 4 to 5 million Californians will not be eligible for the expanded medical care under Medi-Cal, including undocumented residents and those who cannot afford insurance or qualify for Medi-Cal. They will continue to need services from the County Health Centers, community clinics, and public hospitals, where they exist. And the funding for these institutions is set to decrease even as they prepare to lose revenue as a result of the expansion of Medi-Cal and the shift to private HMO providers. The Brown administration is getting ready to strip 1.3 billion “re-alignment funds” from these “safety net” institutions administered by counties in California.

Clearly, we are facing an emergency. And the emergency is nowhere more shocking – and disgraceful – than at Skid Row in Los Angeles, where, as we go to press, public health officials are facing an outbreak of tuberculosis in the homeless population. Sixty of the seventy-eight cases of people infected with a unique strain of TB since 2007, have been homeless and lived on skid row.

According to health workers, 4,650 people in the area have been exposed - and, as homeless residents, they are especially vulnerable to this life threatening and painful disease because of their poverty and living conditions -- crowded into shelters, moving around to escape arrest on the streets, surviving without adequate food or sanitation, dealing with untreated mental illness and addiction. TB cases among this homeless population are increasing even as the Los Angeles County as a whole is seeing a decline in the number of infected patients. Yet the underlying health risks of being homeless are not being remedied by adequate housing and medical care - in fact, LA CAN, one of the most active organizations of homeless people in Los Angeles, has called for a meeting with the Health Department to protest its demonization of homeless people and fear-mongering, as it targets the homeless population as “the problem” rather than focusing on the intolerable conditions that threaten the very survival of residents struggling with extreme poverty.

It’s time to join up with the folks who are organizing for health care for all and to fight against the Brown administration’s war on health care for low income and homeless people. Let’s get an ambulance – lights flashing, siren screaming – and take it to the State Capitol and to Washington for our protest against the “managed death” of poverty!