Low Income Health Program Comes to SacramentoYou Must Know Your Medical Rights, And Fight For Them, If You Are Going to SurviveBy Cathleen Williams
Health care for low income and homeless people is undergoing massive upheaval. Sacramento County health programs like CMISP are being phased out, and low income people are being shifted to LIHP or Medi-Cal. Low income health care is being put completely into private hands. New systems are being set up to handle more low income people, but at the same time cuts in benefits and State payments to medical providers (doctors and hospitals) are placing the whole process in jeopardy.

What’s going on? It’s complicated and you need to know your rights to survive these massive, ongoing shifts. Unfortunately, it looks like the sicker you are, the more difficult it may be for you to get the urgent medical care you need in the new world of private care.

Our story begins with two people, Pamela and Jonah. Their experiences have been different over the past two years because their health care needs are different. Pamela has a debilitating condition (asthma). Jonah had cancer, and needs restorative surgery. We can learn from their experiences in dealing with the big changes that are going on. Future articles will report on their on-going struggles to find medical care and inform you about your rights.

As of December 2012, Pamela is being switched from the County Medically Indigent Services Program (CMISP) to a new program called “Bridge to Reform” or the Low Income Health Program (LIHP), which was set up by Sacramento County in response to Obama’s signing of the Affordable Care Act, also known as Obamacare.

It took Pamela months after she applied in October 2011 to be finally accepted into CMISP, which has extremely low income eligibility (for one person, income must be LESS than $600 per month) and requires that the applicant have an urgent, current medical need.

Medical access under CMISP is slow and hard. CMISP did not notify Pamela that she had been accepted. When she called to find out, three months had passed – then it took three months to get an appointment at the County Primary Care Center on Broadway. The appointment was then changed to a time that was impossible for her to make – and she had to make a new appointment. By the time she got an appointment a year had passed – and it was time for her to file a renewal eligibility application with CMISP. Pamela rushed from Primary Care to the CMISP eligibility office and barely managed to get approval. When she saw the doctor, she was not eligible for preventative care because she was being transitions to LIHP.

Now she’s starting over. After her appointment, she got a letter that she was being switched to a private insurer and health clinic, Molina Healthcare, and would have to start the whole process over at the new clinic. However, recently she called the Molina clinic and they scheduled her first appointment for one week later. She says she is pleased with their service, so far.

She’s one of 10,000-14,000 childless adults between 19-64 years of age whose income is EXTREMELY low who are being enrolled in LIHP by the County. The County pays half the cost; the federal government pays the other half, which explains why the County has participated in the program. Yet the need for medical care is far greater than LIHP will cover – only 8% of uninsured low income individuals statewide are projected to be enrolled in LIHP.

Pamela’s not eligible for Medi-Cal now, but in January 2014 her medical costs might be covered by Medi- Cal, along with an estimated one to two million other low income Californians whom the State might add. Under the expansion, Medi-Cal would cover people whose income is up to 138 percent of the federal poverty line, or about $15,400 annually for an individual. But the State must take action to expand the program and get the billions of federal funds that finance it. If the program goes through, Pamela will have to re-apply and establish her eligibility every year.

At this same time, the State has tried to cut Medi-Cal re-imbursement to doctors and hospitals by ten percent, a reduction that follows years of cuts in funding and benefits. The State will save over $300 million per year by making these reductions, which have been delayed by court decisions.

As quoted in the Sacramento Bee on December 12, 2012, Vanessa Cajina of the Western Center on Law and Poverty, which advocates for the poor, stated, “I think the question here is, when we expand it, is it actually going to serve the people who need it.”

California already has very low payment rates compared to other states: here, Medi-Cal only pays $24.00 for a fifteen minute visit; by comparison, Medicare, which subsidizes the care of seniors and some disabled people, pays $70.00 per visit. There seems to be little question that cutting payments will cause doctors, dentists and pharmacists to limit or reject patients. The State does not even keep track of the declining acceptance of Medi- Cal patients.

Right now, some Democratic lawmakers want the state to rescind the cuts approved last year. But Gov. Jerry Brown has not said whether California will commit to fully expanding its Medi-Cal program to take advantage of federal funding.

Unlike Pamela, Jonah’s experiences in getting medical care as a low income person started when he was hospitalized in 2009 for surgery of a cancerous tumor. Because of his critical condition, he qualified for SSI (Supplemental Security Income) as a disabled person, and became eligible for Medi-Cal. Jonah should have already been scheduled for follow-up surgery – but the difficulty in finding surgeons who accept Medi-Cal has been extreme, delaying the procedure for years.

Now Jonah’s being required, like Pamela, to enroll in private “managed care”. Even though he was waiting for surgery to be scheduled under Medi- Cal, and finally had appointments, he now has to start all over.

He’s been assigned to a Anthem Blue Cross and has yet to be referred to a specialist. In fact, for Jonah, being required to enroll in managed care has caused the very problems which low income health advocates warned against when the managed care option became compulsory – (1) lack of opportunity to make an informed choice about managed care plans; (2)loss of relationships with health providers; (3) disruption in treatment and care.

In the next issue, we will write about what rights Pamela and Jonah have under the system and how they can assert those rights as they continue to seek urgently needed care.

If you need personal help, try calling 916-551-2100 – the Health Rights Hotline (HRH) administered by the Legal Services of Northern California.

Right now, there is an urgent task: by yourself and with advocacy groups, urge your state representatives to restore the $660 million cuts made to Medi-Cal last year, which affect 7.7 million Californians now on Medi- Cal and the future of the Medi-Cal