It has long been the ground zero of the uninsured crisis in America. As a result, Los Angeles can’t afford not to take advantage of every opportunity under the new Affordable Care Act to improve its health care system.
Appropriately, the county’s new health director, Dr. Mitch Katz, is moving forward aggressively, as reported by Anna Gorman of the Los Angeles Times today.
Through Low-Income Health Programs (LIHPs) like Healthy Way LA and other efforts in other counties, California is one of the few places nationally where there is an expansion of public coverage prior to 2014. As correctly described in the article, it’s a huge benefit to the county–and crucial as a way for the county to be ready for reform.
The article is worth reading in full, but’s here a few excerpts:
In one of the largest expansions of health coverage to the uninsured, Los Angeles County is enrolling hundreds of thousands of residents in a publicly funded treatment program and setting the stage for the national healthcare overhaul.
The county hopes to register as many as 550,000 patients and is assigning them to medical clinics for services at no cost to them. At the same time, the county is transforming its healthcare system to be less focused on acute care and more on primary care. The changes are expected to reduce costs, streamline care and attract patients.
Under President Obama’s controversial healthcare overhaul, millions more uninsured Californians will be eligible for Medicaid — the healthcare program for the poor — beginning in 2014. Even as the debate over the law continues in Washington, California is starting that expansion now and using federal dollars to do so. Altogether, the state expects to receive $2.3 billion to expand and modernize its Medicaid program, known as Medi-Cal, now available only to certain low-income residents.
In L.A. County, the stakes are high. In 2014, the newly insured county residents will be able to seek treatment wherever they want. To keep them with the county, health leaders recognize that they must make the system one of choice rather than of last resort. Otherwise, the only patients left will be illegal immigrants and others still ineligible for public coverage.
“Our survival depends on it,” said Mitchell Katz, director of the county Department of Health Services. Unless the healthcare system improves, he said, “if people have choice, they won’t choose us and the system will implode.”…
Health workers began signing patients up for a program called Healthy Way L.A. in July and so far have enrolled 24,000, many of whom are receiving services. County residents are eligible if they are between the ages of 19 and 64, citizens or permanent residents of five years and earn less than 133% of the federal poverty level (about $14,500 for an individual and $29,700 for a family of four).
Over the next two years, the county will pay half the cost for Healthy Way L.A. — or about $300 million — and the federal government will pay the other half. By 2014, when the patients become eligible for Medi-Cal, the federal government will pick up the entire tab, which will help bolster the financially strapped county’s health system. The county also expects to receive about $300 million more for other changes.
“It’s the county’s job to provide care for the uninsured,” Katz said. “If I have an opportunity to get half of that paid for by the federal government, I’d be a fool not to take it.”
Healthy Way L.A. and other programs throughout the state will ensure that there isn’t a flood of new patients or any delay in receiving federal dollars for their care in 2014, said Anthony Wright, executive director of the California advocacy group Health Access.
“We are taking this two years to get fully ramped up so we are ready on Day One,” Wright said. “The more Los Angeles [County] enrolls people in the next two years, the more folks will be on the federal rather than the county dime.”
In other words, the federal government is now providing matching dollars to the existing funds counties use to provide indigent care. And the more people get enrolled in these matched Low Income Health Programs, the more folks will be enrolled on Day One, January 1, 2014, into Medi-Cal coverage. So this isn’t a long-term financial cost to the county–those enrolled will be 100% federally funded in 2014 and beyond.
All California counties have applied for these Low-Income Health Plan dollars, with the recent exception of Fresno. Los Angeles is one of ten counties which previously had pilot coverage initiatives have already started enrolling; the other counties are expected to go forward early in 2012. Health and community organization will be watching and working with counties to make sure we fully take advantage of these opportunities.