CIRS Blog about Rural California

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By Hannah Guzik

If Washington, D.C. legislators approve cuts to government health care, California’s rural counties are among those who will suffer most, according to a new report.

Those who live in the state’s rural counties—which are largely in Northern California—are more likely than urban residents to be enrolled in the low-income health program called Medi-Cal, according to the report released June 6th from the Georgetown University Center for Children and Families and North Carolina Rural Health Research Program.

Medi-Cal covers 28 percent of adults and 54 percent of children in California’s rural counties, researchers found. Meanwhile, in the state’s metro areas, 21 percent of adults and 44 percent of children are enrolled in the health program.

Before the federal Affordable Care Act and state reforms opened the gates of Medi-Cal to most low-income adults and children, a quarter of the state’s rural residents under age 65 were uninsured. But by mid-2015, that uninsured rate had fallen to 11 percent.

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By Hannah Guzik

Amidst anxiety about potential federal funding cuts to health programs, California has one bright spot. The state’s new tobacco tax is expected to generate about $1.2 billion next fiscal year for the state’s low-income health program.

Now, California legislators and Gov. Jerry Brown are battling over how to spend the money.

Immigrant rights’ advocates are asking the state to use a portion of the Proposition 56 funding to expand health coverage to undocumented young adults.

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By Linda Childers

Seeing one of her sons struggle to breathe is an all too familiar sight for Natalie Sua of Fresno. Three of her six children have been diagnosed with asthma, a chronic disease in which the airways swell and produce extra mucus.

In the past, when one of the three, who are all boys, had a severe asthma attack, Sua would rush him to the emergency room. But, now, thanks to Fresno’s Asthma Impact Model, she has learned how to reduce asthma triggers in her home and largely keep her sons’ asthma under control.

“We used to visit the ER three to four times a year, or more, when one of the children had a bad asthma attack,” Sua said. “In the past year, we’ve only had to go once or twice.

Launched in 2013, the Asthma Impact Model, focuses on helping low-income families in the Central Valley better manage their children’s asthma, thus avoiding ER visits. The program was designed by the Central California Asthma Collaborative and Clinica Sierra Vista, a Fresno health clinic.

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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 Derek Walter

For Jen Smith, just feeding her family requires mind-bending effort — three times a day. That’s because her 8-year-old son Marty Smith is allergic to a host of foods, including those that contain or are cooked in peanut oil, soy or dairy.

He has a condition called eosinophilic esophagitiswhich is exacerbated by food allergies and causes his esophagus to become inflamed.

To get dinner on the table, Smith, a teacher in Clovis, must carefully examine all ingredients and find recipes that work with her son’s limited diet. She ends up spending hours each week on extra food prep for her son and hundreds of dollars annually on specialty foods that her son isn’t allergic to.

Coping with food allergies can be daunting for any family, but, due to the extra labor and grocery costs, they often hit low-income families hardest.

“When you buy packaged foods expect the price to double or triple,” said Smith, who carefully budgets food expenses to feed her family of five on a teacher’s salary. “If I’m baking something with chocolate chips, I have to use a specific brand that is far more expensive. But it’s the only choice, because everything else is made with soy.”

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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 Claudia Boyd-Barrett

Amid life’s everyday challenges and responsibilities, two worries weigh constantly on Jorge Zaleta’s mind.

The first is the health of his intellectually disabled son, Jorge Zaleta Jr., who at 15 years old needs around-the-clock supervision.

Second, Zaleta worries about his and his wife’s undocumented immigration status, which he fears could get them deported from the United States at any moment — leaving their son, who is an American citizen, to fend for himself.

“You’re always living under that uncertainty, that from one moment to the next, (while you’re) walking in the street or driving, you might get stopped,” said Zaleta, a Spanish speaker who immigrated to the United States 17 years ago and lives in Oakland. “We don’t have stability as a family to be able to give (our son) stability.”

Zaleta and his wife are among hundreds, if not thousands, of undocumented parents in California struggling to take care of U.S.-born children with special needs while at the same time living in fear of deportation. These parents face the same pressures any parent of a special needs child contends with: making sure their child gets the medical care, therapy, educational help and supervision they need, while balancing jobs and household responsibilities. But these families also grapple with the uncertainty of living in the shadows, and are barred from receiving the full range of government assistance that could help them care for their disabled children.

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By Hannah Guzik

Although more than half of California’s children are enrolled in the state’s low-income health program, the state does not report how many of them are born at a low birth weight, receive a developmental screening in their first three years of life or have a suicide-risk assessment if they have a major depressive disorder.

These are just a few of the indicators that the federal government uses to assess the quality of the Medi-Cal program, which will cost the state about $18 billion this year.

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This is the second in a series of stories about how health care reform is affecting newly insured Medi-Cal patients.

By Robin Urevich

The Affordable Care Act, with its promise of health care for most Americans, represents a welcome step forward for physicians who have cared for the uninsured.

Michael Core, a primary care doctor at The USC Eisner Clinic, treats some of the city’s poorest people in a spare no-frills office just south of downtown Los Angeles. Core says it’s great that his previously uninsured patients have access to a range of specialists that they never did before—at least on paper.

Many of them are part of the ACA’s huge expansion of the state’s Medi-Cal program. State officials say the increase in recipients—3 million new enrollees in 2014— hasn’t affected the quality of service they receive, but both patients and physicians report potentially dangerous long waits for specialty care.

Many of the newly insured are baffled by insurance and have trouble navigating the health care system. Core now spends much of his time deciphering his patients’ paperwork and helping them cut through insurance company red tape.

Many of the clinic’s patients come from the communities just south of LA’s central core, where incomes are low and many people live in crowded conditions. The area suffers a severe shortage of primary care doctors and dentists and is considered medically underserved by the federal Department of Health and Human Services.

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By Fran Kritz

President Obama’s executive action on immigration, announced in November, could potentially come with a much sweeter — and healthier — deal for undocumented immigrants in California than in the rest of the country.

While undocumented immigrants in the U.S. do not qualify for coverage under the Affordable Care Act, California law allows “certain lawfully present immigrants” to be covered by Medi-Cal, the state’s low-income health program. Immigration experts say they expect that provision to apply to the new Deferred Action for Parental Accountability program announced by the president, which allows undocumented people who have a child who is a U.S. citizen or lawful, permanent-resident to apply for a work permit and deportation protection if the applicant has been in the U.S. since Jan. 1, 2010.

Over four million people in the U.S. are likely to qualify for the program beginning in 2015, and over a million of those live in California, according to the National Immigration Law Center in Los Angeles. That means more than a million Californians could be newly eligible for Medi-Cal, if their incomes are low enough to qualify.

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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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