In the next month, counties across California will be making decisions about the safety-net health services they will be providing to those who remain uninsured even after the coverage expansions under health reform. Health advocates are focusing on these decisions at county health departments and Boards of Supervisors to better ensure access for all California residents, regardless of income or immigration status.
While the Affordable Care Act provides access to affordable, quality coverage for millions of Californians, potentially over 3 million Californians will remain uninsured for a variety of reasons despite the law. Counties have traditionally been the provider of last resort for those who are uninsured and cannot access health care through other means.
Health Access California, the statewide health care consumer advocacy coalition, last month released a new report, entitled “California’s Uneven Safety Net: A Survey of County Health Care”, revealing the wide range of what counties do and don’t do to serve their uninsured residents, and putting a spotlight on decisions counties are facing in the next month, and in the next year.
The study provides new, comprehensive county-by-county data not available from any single government source. It also reveals that California’s safety net for the remaining uninsured is uneven—and could get more uneven depending on these county actions. Twelve counties run public hospital systems; others run clinics or contract out with private providers to provide indigent health services. Counties range widely in the income eligibility to be served by the public safety-net without cost, from as low a 67% of the poverty level, to some serving those at three times the poverty level and above.
Only ten (albeit populous) counties explicitly recognize and offer primary and preventative services to indigent immigrant residents who are not legally present–down from 13 counties prior to 2009. The report includes a dedicated section on the issue of care to undocumented immigrants, including a map on page 14 of the report which counties provide more than emergency services for this population. Even with immigration reform, pending legislation would restrict those on a more-than-a-decade-long “path to citizenship” from any federal financial help, leaving states and counties responsible for safety-net services.
With this report as a benchmark, Health Access and other community advocates are closely following the decisions that counties are making regarding the scope of their indigent care programs after the Affordable Care Act.
Counties have already taken major steps to refashion their safety-net, with the creation of Low-Income Health Programs now covering over 660,000 Californians in 53 counties. These represent about half of the Medi-Cal expansion population, which will be switched into full Medi-Cal coverage on January 1. Some counties may see savings or new revenues as a result of this reduction in the uninsured.
The state did take back some funding directed to county public health and safety-net programs ($300 million in year 2013-14), and counties need to officially decide by January 2014 which formula they will choose for this reallocation of health realignment dollars. But as counties decide on these funding formulas, they are likely to make preliminary decisions about their safety-net. In some cases, counties will be well served to reorient their current safety-net spending to other populations, including the undocumented.
The survey includes key recommendations, including support for robust efforts to enroll eligible populations into Covered California plans and Medi-Cal to reduce the number of remaining uninsured. The recommendations suggest actions for both the state and the counties to be able to cover this population. As part of the report’s recommendations, Health Access and its partners urge greater transparency, and use the opportunity of the rollout of the ACA to further expand coverage; county governments should hold off on any reductions in services until they get a year of what is available today.
Ultimately, consumer and health advocates make the case that California is stronger when everyone has access to care and coverage; that it is cheaper to have access to primary, preventive care than to treat illnesses after they develop; and that by ensuring that Californians have that access, counties can make sure that their residents are healthy and contributing economically to their communities.
The full report and supporting documents (including a county profile on each page) can be accessed by visiting www.health-access.org or directly by visiting:
CALL: The California Endowment is hosting an informational webinar TOMORROW on Wednesday, December 11 from 11AM to 12PM Pacific to brief partners on a recent report surveying county level approaches to addressing the Health Care Safety Net. The webinar will emphasize best practices for engaging in funding decisions that counties will make by the end of the year. Attendees will also have an opportunity to learn about recently developed resources by The California Endowment and other partners focusing on health programs and services eligibility for mixed immigration status families.
CALL on the County Level Safety Net and Partner Resources on Health Program Eligibility for Mixed Immigration Status Families
* December 11 – 11AM to 12PM (PDT)
* Via Web: https://cc.callinfo.com/r/1gy6xiwch0per&eom
* Via Telephone: Toll Free Dial In: 800-707-8704 Access Code: 9288665
ACA Enrollment: The report highlights the importance of reducing the number of uninsured Californians by aggressive outreach, education and enrollment. California actually is leading the nation in enrolling its residents in coverage, both in Medi-Cal and Covered California, especially picking up in November. More enrollment data will be released this week about the past week and month.
For those efforts, Health Access needs to know how Californians are experiencing the Affordable Care Act, especially the process of shopping for insurance in Covered California, and what surprises–good or bad–they are encountering. CLICK HERE TO SHARE YOUR STORY, or that of someone you know.