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AC A THE CALIFORNIA WELLNESS FOUNDATION

WINTER 2013/2014

compelling health stories from california

Health Safety Net Providers Gear Up After Three Years of Preparation for Launch of the Patient Protection and Affordable Care Act, Community Health Centers Across California Focus on Outreach and Enrollment

California Colleges Are Pipeline for Health Workforce

Protecting the Rights of Low-Income Seniors

Demystifying the ACA for Small Businesses

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THE CALIFORNIA WELLNESS FOUNDATION

Magazine Credits:

compelling health stories from california

VICE PRESIDENT OF COMMUNICATIONS Magdalena Beltrán-del Olmo EDITOR Adriana Godoy Leiss CONTRIBUTING EDITORS Breanna M. Cardwell, Cecilia Laiché, David B. Littlefield STAFF WRITERS Breanna M. Cardwell, Adriana Godoy Leiss CONTRIBUTING WRITERS Christina Boufis, George White COPY EDITOR Roni Hooper DESIGNER Sauci Creative, Inc. PHOTOGRAPHY Robert Pacheco (pp. 4, 6, 8, 10, 12-13, 16); Michael Karibian (p. 14); Joshua Targownik (cover, pp. 2, 5); photo on p. 3 courtesy Cole Wilbur; photo on p. 11 courtesy Campaign for College Opportunity.

Executive Leadership:

As of November 1, 2013, TCWF is not accepting unsolicited letters of interest submitted to its Responsive Grantmaking Program, which is scheduled to conclude prior to the end of 2014. Updates about the Foundation’s future grants program will be provided on CalWellness.org. © 2013 The California Wellness Foundation. (818) 702-1900. Contents may not be reproduced without permission. Printed by Challenge Graphics on FSC-certified, 25% post-consumer waste recycled paper. 12/13

Health Reform: A New Era Begins

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One Nonprofit’s Boots-on-the-Ground Approach to Health Care Enrollment

Californians 6 Covering Before They Fall Through the Cracks

4 ON THE COVER: Health Safety Net Providers Gear Up Whether it’s through Covered California or expanded Medi-Cal, there are now more opportunities to become insured. The challenges for TCWF grantees are finding the newly eligible, explaining the complex steps in many languages and helping them to navigate the enrollment process.

INTERIM PRESIDENT AND CEO Cole Wilbur BOARD OF DIRECTORS Barbara C. Staggers, M.D., M.P.H., Chair Eugene Washington, M.D., Vice Chair David S. Barlow, M.B.A., C.P.A. M. Isabel Becerra, B.A. Elizabeth M. Gomez, M.S.W. Elisabeth Hallman, M.B.A., R.N.

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Works To 10 Grantee Clear Roadblocks to Higher Education

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How One National Organization Protects the Rights of California’s Most Vulnerable Senior Citizens

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Helping Small Businesses Navigate the Affordable Care Act

THE CALIFORNIA WELLNESS FOUNDATION is a private independent foundation, created in 1992, whose mission is to improve the health of the people of California by making grants for health promotion, wellness education and disease prevention. The Foundation’s goals are: to address the particular health needs of traditionally underserved populations, including low-income individuals, people of color, youth and residents of rural areas; to support and strengthen nonprofit organizations that seek to improve the health of underserved populations; to recognize and encourage leaders who are working to increase health and wellness within their communities; and to inform policymakers and opinion leaders about important wellness and health care issues.


NEARLY $46 MILLION IN GRANTS FOR ACA IMPLEMENTATION

on health

Since the Patient Protection and Affordable Care Act (ACA) was signed into law in March 2010, The California Wellness Foundation (TCWF) has made nearly $46 million in grants in three areas targeted to implementation: $29.7 million to sustain the health care safety net; $11.4 million to increase the health care workforce and its diversity; and $4.7 million to support advocacy and public policy efforts to inform underserved populations, policymakers and opinion leaders about ACA. A recent example is a grant to Field Research Corporation to conduct a survey of registered California voters to gauge their views about the new health care law. Findings from the 2013 TCWF/Field Health Policy Survey, now in its seventh year, are based on a survey of 1,687 California registered voters completed by telephone in June and July 2013 in seven languages and dialects — English, Spanish, Cantonese, Mandarin, Korean, Vietnamese and Tagalog. Voters’ awareness of their eligibility to Among the key findings is that less than half of low-income voters under the age of 65 who are eligible for free health care coverage under the expanded Medi-Cal program currently know of their eligibility. Visit CalWellness.org for more key survey findings.

receive free health care coverage under the expanded Medi-Cal program (among those under 65 whose income qualifies them for Medi-Cal who are not currently enrolled). Source 2013 TCWF/Field Health Policy Survey.

Health Reform: A New Era Begins By Cole Wilbur, Interim President and CEO

It is a historic time in California and the nation as millions of previously uninsured individuals and families are newly eligible to obtain health coverage under the provisions of the Affordable Care Act (ACA). The ACA is the biggest expansion of health care coverage since Medicare and Medicaid were established in the 1960s with October 1, 2013, marking the enrollment kick-off, and coverage taking effect January 1, 2014. Health experts project that millions more will have insurance through Covered California, the state’s health insurance marketplace, and Medi-Cal, which is being expanded to cover more than 1.4 million people who are near or below the poverty level. The California Wellness Foundation (TCWF) has made nearly $46 million in ACA-related grants to fund a variety of efforts — from advocacy to outreach — since the ACA was signed into law on March 23, 2010. This special issue of Grantee magazine highlights seven TCWF-funded

organizations as they work in their respective fields toward one goal: to ensure that as many Californians as possible can access quality, affordable and culturally competent health care. This new era of health coverage in California also reflects a time of transition for TCWF. I have been honored to serve as interim president and CEO at this crossroads in the Foundation’s history. TCWF’s Board of Directors is overseeing an executive search firm to identify the next president and CEO, and it is overseeing a strategic planning process to produce the next phase of the Foundation’s grantmaking program to be announced in 2014. As many of you have already heard, this planning necessitated a transition in our grantmaking. As of November 1, 2013, the Foundation is no longer accepting unsolicited letters of interest submitted to its Responsive Grantmaking Program, which is scheduled to conclude prior to the end of 2014. All these changes promise new opportunities for the Foundation to reflect, plan and unveil in 2014 the next chapter of its grantmaking program. However, there is one constant that remains: the Foundation’s commitment to underserved communities and pursuit of its mission to improve the health of the people of California. p3


Special ACA Edition This edition is focused on our grantees’ years of planning and preparation for implementation of the Affordable Care Act, which was signed into law on March 23, 2010. Now that the ACA era has begun, grantee organizations across the state have kicked their work into higher gear. Whether it’s through Covered California or expanded Medi-Cal, there are now more opportunities for Californians to become insured and obtain health care. Read on for feature stories that explore our grantees’ work as they find and enroll the newly eligible and hard-to-reach populations; pave the way for the next generation of health care providers; ensure that low-income seniors dually eligible for Medicare and Medi-Cal can get the health care they need; and help small businesses navigate coverage options for their employees. Please also check our website, CalWellness.org, in the months to come for more features and highlights of our grantees’ efforts.


cover story

One Nonprofit’s Boots-on-theGround Approach to Health Care Enrollment By Christina Boufis

It was 9 a.m., the last Saturday in September at Martin Luther King Jr. Park in South Los Angeles. Marqueece Harris-Dawson, president and CEO of Community Coalition for Substance Abuse Prevention & Treatment (CoCo), arrived to set up tables and chairs for a neighborhood festival and noticed a line of people already stretched around the block. “We had over 1,800 people in a little neighborhood park,” Harris-Dawson said. “They started lining up at 7 or 7:30 [a.m.].” The main draw? Not the food trucks, nor a famous musician. People had come in droves to learn about the Affordable Care Act and make an appointment with a certified enrollment counselor for Covered California, the new state health insurance marketplace that began enrollment on October 1, 2013. In September 2013, CoCo, a grassroots organization established in 1990 with a mission to transform the social and economic conditions of South Los Angeles, received a one-year, $600,000 grant from TCWF to conduct outreach and enrollment for residents eligible for coverage through expanded Medi-Cal and Covered California in Los Angeles County. CoCo is one organization within a cluster of grantees awarded a total of $3 million by TCWF targeted for ACA outreach and enrollment in Southern California. “The Foundation recognizes this is a critical time for health reform implementation in California — the entire country has eyes on our state,” said Cole Wilbur, interim president and CEO of TCWF. “Targeting Southern California was very strategic for this cluster of grants because of the great number of people who are newly eligible for coverage.” Southern California is home to nearly 2.4 million people who are eligible for expanded Medi-Cal (individuals at or below the poverty level) and Covered California. With a boots-on-the-ground approach that involves targeting hard-to-reach neighborhoods with the highest

density of people, CoCo is canvassing neighborhoods, focusing particularly on those who may be eligible yet unaware they qualify for federal subsidies. “Community Coalition is a unique organization that ordinarily focuses primarily on community organizing and civic engagement work,” said Sandra J. Martínez, TCWF director of public policy. “In this effort they have joined forces with a local clinic, a labor union and other community organizations, highlighting a different approach to enrollment to find and inform as many in the community as possible.” “We’ll go door-to-door, talk about the program and sign them up for an appointment [to enroll].” Harris-Dawson said. In addition, CoCo holds community enrollment events at churches, libraries and schools, and partners with local clinics, unions and youth organizations. “Partnership is key,” HarrisDawson said. To reach South Los Angeles residents whose primary language is not English, CoCo is expanding the creation of Spanish-language material and working with organizations that provide legal assistance to individuals who speak little or no English. “We want the Affordable Care Act to be successful and hope that as many people as possible benefit from this new opportunity,” Martínez said. “TCWF made these grants to nontraditional organizations who could reach folks who weren’t necessarily going to present themselves at a community health center.” So far, the ACA has not been a tough sell. At the September community festival, the initial reaction was one of disbelief, Harris-Dawson said. “People were asking, ‘Is it real? Am I really going to be able to get health care? Do I qualify?’ Because not having health insurance has become normalized for them,” he said. When asked what the reaction was from people when they learned that they were indeed eligible, often for far less than they imagined, and couldn’t be denied coverage, HarrisDawson responded: “Exuberance. “I just can’t emphasize enough the exuberance in the community.” p5


Covering Californians Before They Fall Through the Cracks With more health coverage opportunities on the horizon, TCWF grantees are canvassing neighborhoods, staging health fairs and helping their communities navigate the uncharted territory of the Affordable Care Act By George White and Adriana Godoy Leiss

For several weeks before and after the Oct. 1, 2013, open enrollment launch date for Covered California, concerned Californians have been searching for answers to questions related to major impending changes to medical coverage laws, including new regulations that could make insurance more affordable for some and provide a safety net for others who can pay little or nothing for the health care they need. Do I have to acquire private insurance? How much will it cost? How can I find a plan that’s affordable? Am I now eligible for Medi-Cal? If so, how do I qualify for that program? When do all of the changes take effect?

These are some of the questions many state residents are asking. Health centers across the state are preparing Californians for change. That change is the Patient Protection and Affordable Care Act, the landmark federal law passed in 2010 that will provide affordable health insurance to more Americans. Enrollment was launched on Oct. 1, 2013, and coverage under the law is scheduled to commence January 2014. The reforms, commonly called Obamacare, include provisions that: • prohibit health insurers from refusing coverage based on medical histories; • require health providers to establish minimum care standards and electronic medical records for patients; • require the uninsured to obtain health insurance or pay a financial penalty;


• call on states to establish private health insurance marketplaces where policies and rates can be compared; and • expand Medicaid — and affiliated state-based programs such as Medi-Cal — to include more low-income Americans by extending coverage to adults without dependents. Covered California, the health insurance marketplace in the Golden State, has been set up to help individuals compare health insurance plans and choose according to their health needs and budgets. For several months leading up to the launch, the state has been actively hiring and training certified health educators, enrollment counselors and licensed insurance agents. And through its Community Outreach Network, the state is making grants to health providers, nonprofit organizations, business and academic groups, and others to raise public awareness and understanding of Covered California.

We need people who can explain the options and help residents get the message. While the state of California’s campaign efforts are underway, TCWF grantees that serve low-income and uninsured Californians are also answering many questions and working diligently to increase awareness among their own patients and networks about the expanded coverage.

“Outreach is urgent because many Californians — those with and without access to the Internet among them — need more information on the impending changes,” said Sandra J. Martínez, director of public policy at TCWF. “We need people who can explain the options and help residents get the message,” she said. Health centers from across the state, including many funded by TCWF, are involved in outreach.

Spreading the Word in the South Bay of Los Angeles County The outreach team at South Bay Family Health Care (SBFHC) is staging health fair events and working with churches and neighborhood groups to inform the uninsured and lowincome residents in the South Bay and Harbor Gateway regions of Los Angeles County. SBFHC, a federally qualified health center with medical centers in Gardena, Inglewood, Redondo Beach and Carson, serves nearly 20,000 patients annually. About 84 percent of them live below the poverty level, and 36 percent have no medical insurance. SBFHC’s medical centers are certified as patient-centered medical homes (PCMH), a team-based model of care in which patients are engaged in direct relationships with providers who coordinate all aspects of health care to increase wellness and quality of life. There are several provisions in the ACA directed at the establishment of PCMHs. SBFHC is making progress despite challenges, notes John Merryman, senior director of marketing and public relations for SBFHC, which received a core operating support grant from

ELECTRONIC MEDICAL RECORDS By George White

Among the new requirements of the ACA is that all physicians and medical facilities provide each patient with an electronic medical record (EMR), a digital version of a paper chart that contains a patient’s medical history. In 2012, South Bay Family Health Care completed its transition from paper to electronic medical systems. The change has allowed the health center to more seamlessly share and transfer records of patients who often move. At San Diego American Indian Health Center (SDAIHC), the electronic database was installed two years ago to maintain and update patient records. “With digital records, medical staff can view and compare the treatment, nutrition and exercise regimes of patients with comparable diseases or health maladies,” said Douglas Flaker, SDAIHC’s chief administrative officer. Alliance for Rural Community Health’s (ARCH) administrative center managed the EMR installation between 2009 and 2012. Paula Cohen, chair of ARCH’s board of directors said the electronic system makes it easier to maintain, update and quickly find records for patients across the vast, lightly populated county. p7


The people most difficult to enroll are those [nonpatients] who are not currently sick.

South Bay Family Health Center staged four health fairs during 2013 National Health Care Week in August that offered health screenings and information about ACA enrollment.

TCWF in June 2013 to provide primary medical care to underserved residents. “Many of the people we’re trying to connect with change residences or telephone numbers regularly,” Merryman said. “It makes it difficult to reach them by mail or by phone.” In terms of mobile technology, Merryman said SBFHC is looking into developing mobile applications that will enable smart phone users — of which he says there are many in the service area — to access information. “While some may not have home computers, many have smart phones with Internet connections,” he said. SBFHC has also been working with the Los Angeles Department of Health Services to enroll thousands of qualified, uninsured residents into Healthy Way L.A., a no-cost county health insurance program. Under the ACA, these patients will automatically transition to Medi-Cal on January 1, 2014.

Enrolling Urban American Indians in San Diego With more than 52,000 people identifying as American Indian or Alaska Native, San Diego County has the second highest Native American population in California’s 58 counties. One in five earns income below the federal poverty level, and nearly 30 percent of adults are likely to be uninsured all or part of the year. While American Indians and Alaska Natives are exempt from the ACA’s individual mandate — also known as the shared responsibility payment — the federal government is encouraging enrollment because, it says, the law will address inequities, increase access to quality, affordable health care coverage, invest in prevention and wellness, and give individuals and families more control over their care. However, because of attitudes rooted in historical relationships with the federal government, San Diego American Indian Health Center (SDAIHC) faces outreach and education challenges, according to Douglas Flaker, the organization’s chief administrative officer.

Through the Indian Health Service (IHS), a federal agency within the U.S. Department of Health and Human Services, American Indians receive health services from tribal and urban Indian clinics free of charge, or at greatly reduced fees, as part of the U.S. government’s treaty obligations to American Indians. IHS mostly serves American Indians who live on federally recognized reservations and in rural communities. However, over the past five decades, many American Indians have left IHS’ service jurisdiction to move to urban areas, according to Flaker. “It’s a cultural, historical problem,” he said. “Many have no history of connecting with private medical insurers or federal programs beyond IHS.” As a result of this legacy, the vast majority do not have Medi-Cal or private medical coverage. SDAIHC is a federally designated Urban Indian Health Program, one of eight in California. It is also certified as a patient-centered medical home. In June 2013, the health center received a two-year, $150,000 core operating support grant from TCWF to provide primary medical care and dental services to underserved residents of San Diego. It provides health services to approximately 12,000 patient visitors per year — 60 percent of whom are Native American and 40 percent of whom include whites, African Americans and Latinos. SDAIHC recognizes that outreach to San Diego’s American Indians on ACA coverage options warrants a culturally appropriate and unique approach. “This is a population that suffers from historical trauma, mistrust of non-native health care systems and persistent bias of American Indian health disparities and status,” he said. “In short, there are distinct barriers that surround successful outreach to the American Indian population.” To address the challenges, Covered California has partnered with the California Consortium for Urban Indian Health (CCUIH), a TCWF grantee, and the California Rural Indian Health Board (CRIHB) to produce outreach materials and training curriculums. In addition to Native American-led outreach at community events, including powwows and


SDAIHC’s Community Kitchen (see sidebar), CCUIH and CRIHB are providing resources and trainings to American Indian clinic staff and patient benefit coordinators on ACA outreach and the unique American Indian protections and provisions within the law. The groups are also providing materials and videos, which SDAIHC is screening in clinic waiting rooms and common areas to engage patients in new coverage options.

Outreach in California’s Rural North Mendocino County, along California’s north coast, is a largely rural region with isolated, small communities spread across wide-ranging terrains. Providing health care to the underserved in the county, as well as parts of neighboring Lake and Sonoma counties, are eight community health centers — all members of the Ukiah-based consortium Alliance for Rural Community Health (ARCH). The collaborative was formed in 1998 to facilitate resource development, concentrate and strengthen advocacy efforts, and share resources. In June 2011, ARCH received a three-year, $255,000 grant from TCWF to strengthen infrastructure and sustain the provision of primary health care services at its member sites. Each ARCH health center is working toward becoming patientcentered medical homes. More than 62 percent of the county’s residents obtain health services at ARCH member health centers. ARCH estimates that 9 to 11 percent of its patients have no insurance, and 40 to 45 percent of those it serves are Medi-Cal recipients. There are about 4,000 county residents — those without dependents — who can qualify for Medi-Cal under the expansion that begins in January 2014, according to ARCH. ARCH member clinics are spread out across a vast, but lightly populated county where many residents are isolated. And with few public billboards and no locally owned television stations, informing people of their eligibility and options has been challenging. ARCH’s certified outreach educators and enrollment counselors are canvassing grocery stores, laundromats, libraries and public events to inform residents, and presenting information in English and Spanish. ARCH is also helping patients enroll via computers at its health centers, by telephone and by mail. “The people most difficult to enroll are those [nonpatients] who are not currently sick,” said Paula Cohen, chair of ARCH’s board of directors and executive director of Mendocino Coast Clinics, Inc., an ARCH member. “We’re dedicated to getting them interested enough to want to know more.”

A ROOM WITH A HEALTH CARE EDUCATION VIEW by George White On Aug. 19, Randy Edmonds, a Native American elder who receives dental care at the San Diego American Indian Health Center, joined 30 members of the center’s staff who were standing in a tight circle at a dedication for the creation of a special room at the facility. The staff had asked Edmonds to provide a blessing of the room because he understands the cultures of urban Native Americans. Also, Edmonds is an activist who helped launch and manage Indian employment training institutions in Los Angeles and San Diego. In addition, he is a health services advocate who supported the creation of the health center in 1979. The room is called the Community Kitchen and is — today, as originally envisioned — the forum for the center’s campaign to inform urban American Indians on how they can and should enroll in ACA programs. “In my blessing,” Edmonds said, “I talked about the history of the center and I called upon the Great Spirit to look out for the organization and all the people who work there.”

Featured grantees online @ • Community Coalition for Substance Abuse Prevention & Treatment www.cocosouthla.org • South Bay Family Health Care www.sbfhc.org • San Diego American Indian Health Center www.sdaihc.com • Alliance for Rural Community Health www.ruralcommunityhealth.org

Covered California (www.coveredca.com) is the health insurance marketplace in California. Medi-Cal eligibility changes can be found at www.medi-cal.ca.gov. p9


DIVERSITY IN THE HEALTH PROFESSIONS

Grantee Works To Clear Roadblocks to Higher Education By Breanna M. Cardwell

With coverage through the Affordable Care Act taking effect January 1, 2014, experts estimate that an additional 3 million to 4 million Californians will be eligible for health insurance through Covered California and expanded Medi-Cal. How will California’s health workforce care for this influx of new patients? Michele Siqueiros, executive director of Campaign for College Opportunity (Campaign), believes a key answer

she said. “This includes 70 percent of all imaging professionals, nearly all clinical lab scientists, and they are a training ground for our state’s nursing profession.” Created in 2003 with a mission to ensure that the next generation of students has the chance to attend college, the Campaign focuses on improving college access and success in higher education to train and strengthen a diverse health care labor force. In December 2012, the Campaign received a two-year, $100,000 grant from TCWF to inform policymakers and opinion leaders about higher education and health workforce needs. With the unprecedented and urgent need for educated,

lies within California’s public universities and community

culturally competent medical, dental and allied health

colleges. She says these systems are critical to improving

care providers, California’s public academic institutions

students’ success and producing a diverse health

are a vital pipeline. However, years of budget cuts to

workforce.

educational systems, increased tuition costs and a

“Community colleges serve more than 2.4 million

slow recovery from the Great Recession have created

students, have an incredibly diverse student body and

challenges for many of California’s youth pursuing higher

educate many of California’s health care workers,”

education, according to the Campaign.


grantee in focus

Great strides were made in 2010 with the passage of the Student Transfer Achievement Reform Act (SB 1440, Padilla), which sought to streamline the complex transfer system for students moving from California’s community colleges to California State Universities. However, implementation of the law, including marketing and outreach, is not yet widespread. Meanwhile, without easy transfer options, the lengthy time required to earn a degree is costly to the student and to the state, creating a bottleneck, as Siqueiros describes it, and trapping prospective health professionals at the college level instead of successfully moving them into careers in high demand. With TCWF funding, the Campaign generates research and reports outlining recommendations to help solve the lingering issues and uses data to inform the public, the news media and policymakers about college access and health workforce needs. Crystal D. Crawford, TCWF program director, says the Campaign understands that health care must be provided by a well-trained, qualified and culturally proficient workforce that mirrors the diversity of California’s population. “For California to successfully carry out the ACA and serve as a model for the rest of the nation, it takes organizations like the Campaign to spur immediate and lasting reform within our higher education and health care systems,” Crawford said. Siqueiros says that in order to meet workforce needs in a state that is growing, aging and becoming more diverse, it is important to pay attention to how California adequately funds its community colleges. Further, she notes that the system needs to significantly improve college completion rates and close performance gaps between students of color and their white peers. “Doing so will help ensure that more students can go to college and succeed in being prepared for health careers in a shorter period of time,” Siqueiros said.

In 2010, college student leaders gathered to ask California gubernatorial candidates to prioritize higher education at a Sacramento debate rally. Leading the effort were Alex Pader (holding megaphone), then-president of the Student Senate for California Community Colleges and Michele Siqueiros, president of Campaign, for College Opportunity (second from right).

EDUCATION AND TRAINING AVENUES THROUGH AFFORDABLE CARE ACT Beginning January 2014, millions of the newly insured will seek medical care in a primary care setting, placing an even greater strain on the primary care workforce. The following ACA provisions aim to address the educational pipeline for the primary care labor force, as outlined by the National Conference of State Legislatures.

1 Academic assistance and training programs: The Personal and Home Care Aide State Training Program and the Nursing Assistant and Home Health Aide Program are designed to create curriculums and training to increase participation in science-based training programs and undergraduate work.

2 Professional and postgraduate training programs: The ACA dedicates more than $200 million to training primary care

doctors, nurses and physician assistants, and expands the National Health Service Corps by $1.5 billion over five years nationwide.

3 Medical residency training in community health centers: This program offers payments to eligible health centers to cover the costs of residency training in primary care.

www.collegecampaign.org

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How One National Organization Protects the Rights of California’s Most Vulnerable Senior Citizens By Christina Boufis

HEALTHY AGING

Dual-eligible seniors, those eligible for both Medicare and Medi-Cal, are among the most medically frail in California.

Like nearly 1 million “dualeligibles” in California, Mary is a low-income older adult who gets her health care benefits through federal Medicare and state Medi-Cal programs. However, this is slated to change starting in April 2014 when one provision of the Affordable Care Act rolls out. Dual-eligible seniors like Mary will be part of a new, three-year demonstration project called Cal MediConnect under California’s Coordinated Care Initiative (CCI), which will integrate her Medicare and Medi-Cal benefits into one managed care system. Starting January 2014, dual-eligibles in eight California counties will receive notices in the mail asking them to choose among different managed health care plans. “Already it’s complicated,” said Amber Cutler, staff attorney at National Senior Citizens Law Center (NSCLC), which was established in 1972 to protect the rights of low-income older adults and persons with disabilities. “They have to decide what choice is best for them,” Cutler said. “If they do nothing, the state will make the choice for them.” Eligible seniors will be “passively” enrolled into Cal MediConnect, a new managed plan, which is an entire shift in the way that they receive their health care benefits, she said. Right now, most seniors receive Medicare and Medi-Cal benefits through fee-for-service, in which providers are paid directly for each service provided. But under the CCI, managed care plans are paid a lump sum for covered services via in-network providers. Will dual-eligible seniors lose their doctors who may not be part of the new managed care plan? “Possibly,” Cutler said. “There are some continuity of care protections that are in place, but those only last for so long.” In March 2013, NSCLC received a two-year, $120,000 grant from TCWF to provide consumer protection-focused outreach, education and advocacy under California’s demonstration project that will transition low-income seniors dually eligible for Medicare and Medi-Cal into Medi-Cal managed care plans. “Because there’s a cost saving element to the dualeligible demonstration project, people are concerned that money may be the main focus and not the quality and continuity of care,” said Jeffrey S. Kim,


They have to decide what choice is best for them. If they do nothing, the state will make the choice for them.

grantee in focus

TCWF program director. “NSCLC is going to be the consumer watchdog to help protect the rights of these seniors who are low-income and have high needs in terms of use of health care.” Dual-eligible seniors are among the most medically frail in California. Two-thirds have three or more chronic conditions; many have cognitive impairments; and nearly 50 percent are limited-English proficient. Cutler said that’s why one of NSCLC’s top priorities is to conduct extensive outreach and education about the CCI to as many advocates, service providers and community-based organizations that work with dual-eligibles as possible.

“We’re constantly working on moving further and further into those communities because they are the most vulnerable and least likely to get education and outreach regarding the [CCI] program,” she said. But while the notifications may confuse many dual-eligible seniors — they can opt out of managed care for Medicare, for instance, but not Medi-Cal — the theory behind CCI is also to improve access to care. “By coordinating care, the hope is you can keep people in the community longer, so they don’t have to go into nursing facilities or be hospitalized because of things that could have been prevented by coordinating their benefits,” Cutler said. NSCLC is working hard to make sure dual-eligibles like Mary understand all the moving parts of the new CCI so they can make informed choices without disruptions in crucial health care services.

NSCLC IS A RESOURCE FOR SENIOR ADVOCATES The California counties participating in tihe Coordinated Care Initiative are Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo and Santa Clara. Through webinars, onsite training sessions and technical assistance, NSCLC is working to educate on-the-ground advocates and community-based providers to ensure that seniors who are dually eligible for Medicare and Medi-Cal are equipped to navigate the new systems of care. A recent addition to its toolkit for advocates is the “Advocate’s Guide to California’s Coordinated Care Initiative,” which NSCLC published in September 2013 in collaboration with the Disabilities Rights Education Defense Fund. The guide can be found at: www.nsclc.org.

www.nsclc.org and http://dualsdemoadvocacy.org

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SPECIAL PROJECTS

Helping Small Businesses Navigate the Affordable Care Act By Christina Boufis

Family-owned Atlantic Tax Services in East Los Angeles could not afford to offer health insurance to its employees, like nearly 32 percent of small businesses in California with fewer than 50 workers. “The costs [of health care] have been going up at a staggering rate over the last ten years, and, in some cases, tripling for small business owners,” said John Arensmeyer, founder and CEO of Small Business Majority Foundation, Inc. (SBM). Among the self-employed in California, many of whom are low-income and people of color, nearly 35 percent don’t have health insurance, often because of pre-existing conditions, Arensmeyer said. Yet under the Affordable Care Act, government tax credits and health care exchanges can help small businesses offset the cost of health care for their employees. Self-employed individuals will no longer be denied coverage for preexisting conditions. Despite these policies, 51 percent of small business owners in California are unaware of the new ACA provisions, according to a recent SBM poll. Founded in 2005 and run by small-business owners, SBM focuses on solving the biggest problems facing small businesses. Engaging with other small-business owners and policymakers, SBM works to promote job growth and maximize cost savings in areas such as health care reform. In March 2013, SBM received a two-year, $250,000 core operating support grant from TCWF to sustain outreach and education efforts about the ACA for small business owners in California. “With the onset of health care reform, there is a lot of apprehension on the part of the business community,


SHOP), Arensmeyer said. “They’ll be able to simply pay one fee at a certain coverage level, and their employees will then have a choice of plans at that coverage level,” he said. Arensmeyer cites that preliminary costs of health insurance for small-business owners are much lower than expected. “No longer will someone be deterred from starting a business because they’re worried about their health coverage,” Arensmeyer said. TCWF’s grant to SBM has also enabled it to dramatically expand its reach across California, including targeting the 17 percent of Latino-owned businesses in the state to ensure that they receive information about the ACA. SBM’s online information about the ACA, healthcoverageguide.org, is available in Spanish and English. The grant has enabled SBM to hire a full-time bilingual staff member to do extensive outreach to the Latino community and through Spanish-language news SBM Is a Resource for Small Businesses media to help get the word out, explains Arensmeyer. On its website, Small Business Majority shares It was at one such SBM educational event in Los that the ACA saves small-business owners money Angeles that Vairon Perez, chief operating officer, and immediately through tax credits. Visitors are Andy Rodriguez, chief financial officer, of Atlantic Tax encouraged to see how much their business tax Services, a Latino-owned business, first heard about credit will be by accessing the tax credit calculator at how the ACA could benefit their company. www.smallbusinessmajority.org. “We didn’t know exactly what was involved,” Perez said. “We learned that we can actually pick up the cost [of health care] because of tax incentives,” a win-win for

grantee in focus

especially small businesses, that providing health insurance is going to cost more,” said Sandra J. Martinez, TCWF director of public policy. “The Small Business Majority is demystifying the Affordable Care Act and reframing the issue for business owners to see and understand how it will be beneficial and not detrimental for them.” To that end, SBM conducts extensive outreach and education about the new ACA provisions and has held more than 100 health care reform-related events in California during the past year, hosted educational webinars and worked hand in hand with business organizations to inform them about the new law. For instance, under the ACA, small-business owners with employees can go to a competitive marketplace where multiple insurance companies and plans are available (called Small Business Health Options or

www.smallbusinessmajority.org

SBM IS A RESOURCE FOR SMALL BUSINESSES On its website, Small Business Majority informs visitors that the ACA saves small-business owners money immediately through tax credits. Visitors are encouraged to see how much their business tax credit will be by accessing the tax credit calculator at www.smallbusinessmajority.org.

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