DOORS OPEN Community clinics like the Alliance Medical Center in Healdsburg are at the frontlines of the massive reorganization of healthcare and coverage.
Like many Californians, late last year "Michelle," a self-employed Santa Rosa resident (her name was changed to preserve her anonymity), found herself navigating the Covered California website in search of affordable health coverage.
After a frustrating, confusing and slow process filling in the required information, Michelle discovered, to her surprise, that she and her self-employed partner qualified for Medi-Cal, the state sponsored Medicaid program for low-income California residents, because of expanded income guidelines.
The news turned out to be a blessing and a curse.
"The Covered California site just sort of dropped me off," explains the 39-year-old mother of two. "They sent my paperwork to the state and then seemed to be expecting that the state would call me. I know from experience that that's just not going to happen, or it'll be months."
According to the California Department of Health Services, Medi-Cal currently provides services to more than 8 million residents. Under the expansion mandated by the Affordable Health Care Act, roughly 1.4 million more state residents have become eligible. In Sonoma County, Michelle is one of 18,000 people who once had private insurance but can now get coverage through Medi-Cal. An additional 18,000 previously uninsured county residents are now eligible as well.
So who qualifies? Whereas previously one had to be disabled, elderly, pregnant or living in extreme poverty, now all individuals and families at or below 138 percent of the federal poverty level can receive Medi-Cal benefits, according to the Partnership HealthPlan of California website. That translates to an income of $15,856 a year for a single adult and $32,499 for a family of four.
Using the new modified adjusted gross income calculator, an applicant's property and assets no longer determine eligibility, unless the applicant is over 65, disabled or living in a long-term care facility. As reporter Emily Bazar wrote in her "Ask Emily" Obamacare advice column at the Center for Health Reporting, this means that "coverage has been expanded to include 'people of all stripes,' from young adults and college students to single, older men."
The number of pending applications for Medi-Cal in Sonoma County is somewhere around 9,000, says Joy Thomas, communications and outreach manager for the Sonoma County Human Services Department. But until those are processed, it's hard to tell just how many qualify under the expanded guidelines. Either way, Sonoma County has set the ambitious goal of enrolling 75 percent, or 13,500, of the 18,000 previously uninsured people by the end of 2014.
Of course, the verdict is still out on how long those people will have to wait for their applications to see the light of day. Though the state claims that Medi-Cal is not only easier to qualify for but also comes with an improved, streamlined application process, Michelle says that after waiting a few weeks to hear back about her application, she called the state to find out what was going on. She was told that her family's information was in the system, but they didn't know how long it was going to be before coverage was sorted out.
In the meantime, an emergency medical condition forced the state to expedite Michelle's application, and she was assigned coverage from a community clinic by Partnership HealthPlan. Eight weeks later, her partner still doesn't have coverage.
Thomas acknowledges that there is a backlog, as Human Services deals with the deluge of applicants. "We know that there are many people who have applied for Medi-Cal in recent months who are still waiting for their applications to be processed," she says via email. "We've added a significant number of staff and expanded our service center, which is experiencing a record number of calls. We understand the urgency involved in getting people access to the healthcare they need."
It's a point that's reiterated by Kim Seamans, economic assistance division director for Sonoma County Human Services, who asks that people be patient as the department works through thousands of applications, the largest number ever processed at one time. Even with about 75 new staff members, the system is in overload, she says.
Still, the Economic Assistance Division is participating in continued outreach events, including upcoming Covered California education and enrollment events to reach out to the Spanish-speaking population, a group with sluggish application numbers thus far.
Seamans says the impact of expanded Medi-Cal provisions on the community should not be underestimated. "The [access to healthcare] is great for people who are eligible, because they'll be able to choose or be assigned a medical home," she explains. "They'll get regular treatment for chronic conditions that they couldn't get access to before. The hope is that the need for emergency care will be reduced."
Logistically, that medical home would be one of the many community clinics in Sonoma County. Established to serve the low-income and uninsured, these clinics are at the frontlines of a massive reorganization of healthcare and coverage. Alliance Medical Center, with locations in Healdsburg and Windsor, has been in expansion mode since early fall when enrollment through Covered California first began, says development director Tresa Thomas Massiongale. Though it has yet to see a tidal wave of new patients, Massiongale says there has definitely been an "increase
in folks accessing care here" and that they are seeing new people every day.
"Community health center nurses, dentists and doctors are working at a fever pace all of the time," she explains. What's more, the work doesn't stop once someone is enrolled in Medi-Cal. "The distinction is that there is a difference between healthcare and healthcare coverage," Massiongale says.
Purchasing or qualifying for healthcare—which provides access to the essential preventative care that can reduce costly health emergencies down the road—is just the first step. After that, the newly insured need to actually step through the doors of the clinic to access that care in a responsible, consistent manner, she explains.
Once the state and county gets Michelle's Medi-Cal coverage sorted out, she plans to petition for a return to Kaiser, where she has a primary doctor she likes and a medical home she trusts. And she's learning to quiet that voice in the back of her mind telling her she should feel shame for seeking help from the state.
"I had Medi-Cal when I was 20 and I got really bad care, but I'm smarter now," she explains. "I know that if I get Kaiser they'll treat me like any other Kaiser patient, so I don't have to go to the clinic. But there's definitely a stigma about it, and I feel it. I don't think I'm really a poor person. I'm hoping that this is just because more people are qualifying for Medi-Cal, there won't be such a stigma about it."