CIRS Blog about Rural California

By Lynn Graebner

Counties all over California are cheering the state’s decision to expand Medi-Cal to more than 1.4 million low-income adults – and bracing for the $1.3 billion the state expects to take away from county health services over the next four years.

Counties should see savings on January 1, 2014, when Medi-Cal expands to include childless adults under the age of 65 with incomes less than 138 percent of the federal poverty level or $15,856 for an individual annually. The federal government will pay 100 percent of the costs for new enrollees from 2014-2016 and 90 percent in 2020 and beyond.

“On paper, you’d think there would be savings,” said David Luchini, Assistant Director of the Fresno County Department of Public Health. But the UCLA Center for Health Policy Research predicted in a Sept. 12, 2012 report that three to four million Californians would remain uninsured in 2019. Counties say it is way too early to count on savings from the ACA and to chop away at county health care safety nets.

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By Leslie Griffy

Agricultural businesses and the insurance companies that serve them are scrambling to prepare for the changes that health care reform will bring over the next few years.

Many smaller farmers struggle with the details of the Affordable Care Act, such as how to count seasonal farmworkers to determine who they must insure. Employers of more than 50 will face fines if they don’t insure eligible workers.

Meanwhile, three of California’s agricultural-focused health insurance providers required waivers from ACA rules to continue operation. Those waivers expire next year.

“There is a lot of confusion,” said Norm Groot, president of Monterey County Farm Bureau. “I think everyone is really put off with the amount of complexity, particularly for agriculture.”

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By Leah Bartos

With all Americans required to enroll in health insurance under the Affordable Care Act, will the existing safety net clinics become a thing of the past?

For generations, grassroots-style community clinics have worked to fill the coverage gap. Their mandate: to treat any patient who walks in the door, regardless of ability to pay.

But by January of next year, all those patients should have health insurance. In theory.

Despite the requirement  — and penalty fee for noncompliance — a projected 3 to 4 million Californians will remain uninsured through 2019, according to a UC Berkeley Labor Center study. Of the remaining uninsured, the report projects that nearly 40 percent still won’t be able to afford coverage, and that three-fourths will be U.S. citizens or lawfully present immigrants. More than half will include households with incomes at or below 200 percent of the federal poverty level.

For many, California’s safety net clinics will continue to be their best — or only — option for care.

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By Leslie Griffy
California Health Report

When students start school in the Salinas Valley town of Bradley, they bring with them with pens, paper and notebooks. The school district provides their water bottles.

That is because tap water in this south Monterey County school is undrinkable. It’s contaminated with dangerously high levels nitrates.

Bradley’s approximately 49 students, kindergarten through 8th grade, aren’t alone in their lack of tap water.

Officials at schools in San Lucas, a little less than a half hour north of Bradley, discovered about two years ago that the water from their taps isn’t safe. Filling the gap, first with county emergency funds and now with water provided by a bottled water company, was a juggling act at first.

“It was a bit of surprise and sudden scramble to think that ‘uh oh, we have to do something,’” said Principal Nicole Hester.

The Washington Union School District, off Highway 68 between Salinas and Monterey, is also without potable water.

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By Leah Bartos
California Health Report

In the coming year, millions of currently uninsured Californians will gain coverage under the federal Affordable Care Act — but that does not necessarily mean it will be any easier for them to see a doctor.

As the state prepares for the expected onslaught of newly insured patients, health-care professionals are warning there may not be enough doctors — particularly, those practicing primary care — to meet the increased demand. Some say that the problem will be even more amplified in rural California, which already suffers a physician shortage and dwindling workforce, as the majority of rural physicians nears retirement and recruitment of new doctors lags in replacing them.

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