CIRS Blog about Rural California

By Paulina Rojas

SAN BERNARDINO, Calif., Weeping as she narrated her story, Lupé (not her real name) an undocumented immigrant living in the Inland Empire, said she began feeling helpless and scared when her young son began having convulsions a few years ago. Like her, he had no health insurance.

Luckily for her, the nearby SAC Health System (SACHS), a federally qualified health clinic that does not turn uninsured patients away, enrolled the boy as a patient. The medications the clinic provided kept the boy’s convulsions under check.

Last May, when California launched its Health for All Kids program, SACHS helped enroll Lupé’s son in full-scope Medi-Cal, California’s name for the government program for poor people known as Medicaid in the rest of the nation.

Designed to provide health insurance for undocumented children who were left out of the Affordable Care Act because of their immigration status, the Health for All Kids is largely (71 percent) funded by the state, with the rest paid out of federal funds for emergency coverage.

Lupé’s son is among an estimated 250,000 children in California who have so far benefited from the program, said Dr. Jason Lohr, a family medicine practitioner at SACHS.

Lohr was a panelist at a February 7 round table ethnic media briefing here co-sponsored by New America Media and SACHS. Some 51 stakeholders, advocacy groups and media participated.

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By Hannah Guzik

If the federal Affordable Care Act is repealed, as some Republican lawmakers and President-elect Donald Trump have proposed, nearly 5 million Californians could lose health coverage, according to a new report.

In the last two years, the health law has enabled about 3.7 million California adults to enroll in the state’s low-income health program, known as Medi-Cal, and 1.2 million residents to receive subsidies to help them pay for insurance through Covered California. Repealing the health law could have a “devastating impact” on these groups, according to the December report from the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research.

In recent days, Trump and some Republican legislators have said that they want to repeal the health law and replace it with something else. It’s unclear whether the replacement would still provide funding for health coverage to adults under Medi-Cal or provide subsidies to those who purchase insurance on the state’s exchange.

Under the ACA, the number of uninsured residents in the state has decreased by almost half, from 6.5 million in 2013 to 3.3 million in 2015, according to the report. Since the majority of the health law’s provisions took effect in 2014, California has seen the largest decline in the uninsured rate of any state nationwide.

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By Lynn Graebner

One third of California residents and half of the state’s children qualify for Denti-Cal, the state’s Medi-Cal dental program. So leaders in counties like Santa Cruz, where 82 percent of the dentists don’t take Denti-Cal, are seeking new ways to serve this long-suffering low-income population.

“Most California dentists want nothing to do with Denti-Cal,” stated an April report by the Little Hoover Commission, an independent state oversight agency. It hammered Denti-Cal — calling it a broken system that has alienated its partners in the dental profession. Less than half of Denti-Cal beneficiaries use their benefits because they simply can’t find a dentist who will see them.

That has left counties, community clinics, nonprofits and private dentists to cobble together programs and safety nets for thousands of residents. Some of those are showing promise and some counties plan to expand them by applying for part of the $740 million state and federal agencies have allocated for the new Dental Transformation Initiative. It is meant to incentivize more dentists to offer preventative dental care to children.

While the California Dental Association, counties and private dentists say this is an encouraging step, there’s a long way to go to reviving the dysfunctional system, they say.

Dientes Community Dental Care, a community dental clinic receiving federal funding through Santa Cruz County, decided to commission its own report: Increasing Access to Dental Services for Children and Adults on the Central Coast, released in April. It showed that of the 80,000 people on Medi-Cal in Santa Cruz County, only 31 percent of them were able to see a dentist in 2014. Thirty-one percent of children under age 11 in the County have never seen a dentist and seniors on Medicare have no dental benefits except for extreme needs.

“Insurance does not equal access,” said Laura Marcus, Dientes’ executive director.

Despite its expansions, Dientes has to reject about 20 calls daily for dental service. Gaye Hancock was among them. She lost her job during the economic downturn and is working again but now has Denti-Cal. She started calling Dientes two years ago and finally resorted to getting her teeth cleaned at the Cabrillo College Dental Hygiene Clinic by student hygienists. They found cavities and bone loss which have forced Hancock to chew on just one side of her mouth since 2014.

“I’m 63, I’m just fighting to keep my teeth healthy,” she said.

As a result of the Santa Cruz report, the Santa Cruz County Oral Health Access Steering Committee emerged, including Santa Cruz and Monterey County government, education and dental industry representatives among others. They plan to present strategies in December 2016.

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By Claudia Boyd-Barrett

It took a year for Elvira Gomez of El Monte to realize something was wrong with the therapy her son was supposed to be receiving at school.

Jose Antonio Suarez, then 5 years old, was scheduled to see a therapist once a week in his kindergarten class at a Los Angeles County elementary school. But in 2014, a year after the therapy started, Gomez had yet to see any improvements in her son’s hyperactive and aggressive behavior.

“I went to the school and asked, ‘How often is the therapist going (to the classroom)?’” recalled Gomez, a native Spanish speaker. She was shocked to find out that the therapist came only once or twice a month.

“I thought, I have to be more on top of this,” she said.

Gomez is one of thousands of parents across the state who have struggled to get their children adequate mental health services at school. She’s also part of a population that advocates believe is especially vulnerable to having their children’s special education and mental health needs neglected: parents with limited English skills.

Legally, school districts are supposed to provide students experiencing emotional and behavioral difficulties with mental health assessments and individualized services to help them benefit from their education. But a report earlier this year by leading advocacy organizations found half of all students with these difficulties get no mental health help at all.

Other students who do receive services, the researchers found, frequently don’t receive them enough or don’t receive the right kind of intervention to make a difference.

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By Lily Dayton 

As summer wanes and students head back to school, farmers on the Central Coast are draping fields with plastic, preparing for fall fumigations that will sterilize soils before the next growing season. And if previous years’ trends continue, more than 35,000 Monterey County schoolchildren will attend schools near fields treated with high levels of potentially dangerous pesticides—including chemicals that are known to harm the brain and nervous system, cause genetic mutations and disrupt hormonal regulation.

“I’m really worried about our students and how it affects their developing bodies and brains,” says Karin Wanless, an intervention teacher who works with kindergarten and first-grade students in the Pajaro Valley school district, which straddles agricultural areas in both Monterey and Santa Cruz Counties. Some schools within the district are surrounded by fields ranked highest in the state for pounds of pesticides applied, yet application regulations differ between the two counties.

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