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Are Medical Credit Cards a Debt Trap?

Western Center attorney and policy advocate Jen Flory joined The Doctors for a segment on the topic of high interest medical credit cards. Some dental patients face years of debt due to high interest credit cards, many of which are promoted when patients are vulnerable and in pain.

Watch here

 

Western Center Statement On Supreme Court Public Charge Ruling

Today the Supreme Court chose to allow the Trump administration to enforce its cruel and inhumane Public Charge immigration rule, even though the underlying case has not yet been decided. The decision upsets historical legal precedent in which courts preserve the status quo while litigation is pending.

As we stated in our initial statement on the rule, and in our comments to the Department of Homeland Security, this ruling will have long term detrimental effects on the health of our nation. This rule change is a cruel action aimed at immigrant communities with the unrealistic intent to create a whiter, wealthier version of the United States that does not, has not, and will never exist. The administration’s continued attacks on our country’s already inefficient and unfair immigration system weakens our nation of immigrants.

We will explore all options to protect the wellbeing and safety of our clients and communities.

For more information:

Learn more about public charge at keepyourbenefitsCA.org (English) and tusbeneficiospublicos.org (Spanish). You can also text “benefits” (for English), “libre” (for Spanish), “福利” (for Chinese) or “lợiích” (for Vietnamese) to 650-376-8006.

Visit the Protecting Immigrant Families Campaign website for fact sheets, community flyers, and more public charge details: https://protectingimmigrantfamilies.org/community-education-resources/

Contact the Health Consumer Alliance if you are worried about how your access to health care may impact your family’s immigration status: https://healthconsumer.org/

Find a trustworthy immigration attorney for individual counseling at the organizations on this list: https://www.cdss.ca.gov/Benefits-Services/More-Services/Immigration-Services/Immigration-Services-Contractors

Medi-Cal Benefits Eliminated A Decade Ago, Such As Foot Care And Eyeglasses, Are Back

“Some health activists wonder why it took the state so long to restore the benefits. “A lot of these recession-related cuts came on the backs of the poor. Yet when the economic recovery came, we didn’t see their restoration,” said Linda Nguy, a policy advocate at the Western Center on Law and Poverty. “The low-income people who needed the medical services the most were the first to see them cut and the last to have them returned.”

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PRESS RELEASE: California plaintiffs win case against state for failing to provide federally-mandated In-Home Supportive Services

FOR IMMEDIATE RELEASE

State must reimburse or pay Medi-Cal recipients and conduct statewide outreach to thousands of Californians who may be eligible for in-home services

 

LOS ANGELES — Thousands of Medi-Cal beneficiaries with significant disabilities will now be able to access affordable Medi-Cal care at home, rather than going to a nursing facility. In-home care provides greater stability and health outcomes for individuals and families, and it is cost-effective for the state; but it can be prohibitively costly to pay for out-of-pocket. As a result, married people with disabilities often have to make a draconian choice: impoverish themselves and their spouses or go to a nursing facility.

“My wife and I live primarily on a fixed income of pensions and social security; we exhausted our life savings and retirement accounts paying for my care,” said plaintiff Patrick Kelley, a 68-year-old U.S. Army veteran living with spastic quadriparesis. “My wife’s ability to work was severely limited by her caregiving responsibilities to me. We spent almost all of her limited income paying for my in-home care.”

Thanks to the successful lawsuit against the state, married people with disabilities will now learn about their right to Medi-Cal eligibility so they can stay at home with their spouse, receive care, and be reimbursed through the state’s Medi-Cal program for In-Home Supportive Services (IHSS). The court ruling makes it clear that the state must fully implement a federal law, known as the expanded spousal impoverishment protection, which should have been implemented as part of the Affordable Care Act in 2014.

“This ruling will dramatically improve the quality of life for disabled Californians and their family caregivers and will prevent many Californians from falling into poverty due to the high cost of in-home care,” said Kim Selfon, IHSS Client Advocate at Bet Tzedek. “Caregivers selflessly care for their disabled spouses with courage and compassion, often to the detriment of their own finances and health. They and thousands of others will now have the support they need to continue caring for their loved ones at home.”

The two plaintiffs’ situations illustrate the diversity of the thousands of individuals that will be impacted by the outcome of this case.

“The judge’s decision is a boost to Welfare and Institutions Code section 10500, which says agencies must secure for every person the aid to which they are entitled. As California’s population ages, in-home care will become increasingly important to the future of the state,” said attorney Cori Racela of Western Center on Law & Poverty.

Plaintiff Matthew Reed is a 63-year-old man with multiple sclerosis, Bell’s Palsy, and vascular dementia from a stroke. Due to the severity of his disabilities and medical condition, Mr. Reed is eligible for Medi-Cal home services, and should have had access to care without out-of-pocket costs under spousal impoverishment protections. Instead, he was required to pay more than $1,500 per month for care, which he cannot afford.

“If the spousal impoverishment rule had been implemented as it should have, Matthew could have been found eligible for free Medi-Cal and IHSS,” said Matthew Reed’s wife, Vicki Reed. “That means my son or I could have earned IHSS wages, sparing us incalculable stress and anxiety and giving us better options for Matthew’s home care and more financial resources. I don’t want any other families to go through what we have gone through.”

The Affordable Care Act set a deadline to expand spousal impoverishment protections to home-based care starting January 1, 2014. However, the Department of Health Care Services (DHCS) failed to issue any guidance about the rule until July 2017, after Mr. Kelley and Mr. Reed brought this lawsuit.

The ruling in Patrick Kelley & Matthew Reed v. California Department of Health Care Services, et. al., was issued by a Los Angeles Superior Court judge on January 14, 2020. It concludes that DHCS must a) notify beneficiaries who could benefit from the rule, particularly those denied or discontinued from Medi-Cal because DHCS failed to implement the rule on time; b) create a process for people to be found eligible for IHSS retroactively to the date they applied for Medi-Cal; and c) allow impacted individuals to be paid for home services they were entitled to during the delay period.

“Choosing between remaining at home without needed services, impoverishing oneself and one’s spouse, or moving into a facility separate from loved ones is no choice at all,” said Claire Ramsey, Senior Staff Attorney at Justice in Aging. “This ruling means relief for many who have struggled to stay at home and in their community and receive the services they need.”

MEDIA CONTACTS:

For plaintiffs: Allison Lee: Bet Tzedek, alee[at]bettzedek.org

Courtney McKinney: Western Center on Law & Poverty, cmckinney[at]wclp.org

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About Bet Tzedek

Bet Tzedek is committed to providing free legal services to those that need them most. Bet Tzedek attorneys and advocates help people of all communities and generations secure life’s necessities. Wherever people are in crisis, Bet Tzedek’s core services and rapid response programs provide stability and hope. Founded in 1974, Bet Tzedek – Los Angeles’ House of Justice – helps over 50,000 people each year.

 

About Justice in Aging

Justice in Aging is a national organization that uses the power of law to fight senior poverty by securing access to affordable health care, economic security, and the courts for older adults with limited resources. Since 1972 we’ve focused our efforts primarily on fighting for people who have been marginalized and excluded from justice, such as women, people of color, LGBTQ individuals, and people with limited English proficiency.

About Disability Rights California

Disability Rights California (DRC) is the agency designated under federal law to protect and advocate for the rights of Californians with disabilities. The mission of DRC is to advance the rights, dignity, equal opportunities, and choices for all people with disabilities. www.disabilityrightsca.org.

About Western Center on Law & Poverty
Western Center on Law & Poverty fights for justice and system-wide change to secure housing, health care, racial justice and a strong safety net for low-income Californians. Western Center attains real-world, policy solutions for clients through litigation, legislative and policy advocacy, and technical assistance and legal support for the state’s legal aid programs. Western Center is California’s oldest and largest legal services support center.

Medi-Cal’s Very Big Decade

“Under the expansion, any adult who met the income guidelines could enroll, which represented a “radical shift” in the way the program operates, said Jen Flory, a policy advocate at the Western Center on Law & Poverty.

It transformed Medi-Cal “to more general low-income coverage,” she said.”

Medi-Cal’s Very Big Decade

Full Analysis of Governor Newsom’s proposed 2020-2021 state budget

For a PDF of this analysis, click here.

Last week, Governor Newsom unveiled his $222 billion 2020-21 budget proposal. Western Center’s summary of the proposal can be found here.

The state is in its 11th year of increasing tax revenue, and estimates a $5.6 billion budget surplus over existing obligations. The budget continues the practice of prioritizing saving state revenue for future years by increasing the Rainy Day fund to $18 billion and paying down state debts to reduce state payments in future years.

Governor Newsom is focused on addressing many long standing issues, particularly the homelessness and housing crisis. The budget proposes to allocate $1.4 billion to a variety of solutions, including $750 million in one-time funding to shore up board and care facilities, provide rental assistance to those at risk of or experiencing homelessness, and to fund adaptive re-use of existing structures to create additional housing that people experiencing homelessness can afford. The budget also includes substantial new funding for health care, including a proposal for the state to manufacture prescription medications and to expand health care to undocumented seniors.

The budget proposal does not include the third step of CalWORKs funding that would bring grants to 55 percent of the federal poverty level. Instead, the budget proposes a 3.1 percent increase for CalWORKs grants in October 2020. The budget also provides no increase in state funding for Supplemental Security Income (SSI/SSP) grants, keeping in place recession era cuts that have still not been restored.

Homelessness

The Governor’s budget proposes $750 million in one-time funds to be deposited in the new California Access to Housing and Services Fund, which the Governor recently created by executive order. The fund would be administered by the Department of Social Services, which would allocate dollars to “regional administrators” to be used to provide short- and long-term rental subsidies to people at risk of or experiencing homelessness, create additional housing units affordable to people with extremely low-incomes, and stabilize licensed board and care facilities around the state. How funds would be allocated and administered remains open to negotiation.

Housing

The budget proposes a one-time $500 million increase in the state Low-Income Housing Tax Credit program, which funds the production and rehabilitation of housing affordable primarily to households with incomes between 30% and 80% of area median income (AMI).

Financial Security

CalWORKs: CalWORKs has gone through a period of substantial investment. In 2019, the budget included funding for a 13 percent grant increase, expanded the earned income disregard to $500 a month, and stabilized CalWORKs child care for families. This budget is not as ambitious as prior years, though it does provide a 3.1 percent increase in grants beginning October 2020. This will increase grants for a family of three by about $25 a month. However, it was anticipated that CalWORKs grants would be raised to 55 percent of the federal poverty level to ensure no child lives in deep poverty. This budget proposal will not achieve that goal.

The budget does include funding to increase the CalWORKs child support pass through. Under current law, the first $50 of child support paid by the non-custodial parent goes to the CalWORKs family, but any amount over that is used to pay for the cost of welfare benefits to the state and federal government. Beginning January 2022, CalWORKs families with one child will keep the first $100 of child support, and families with two or more children will keep the first $200 of child support.

We are grateful the Governor heard parents and families in their call for a child support program that works for children. The increases to child support pass through and relief from government-owed, uncollectable debt proposed by the Governor look like a good start. We are eager to see the associated proposed trailer bill law changes so we have more details, and look forward to working with the Governor and legislature to achieve the goals of conforming with federal law and regulation, and ensuring the program works to benefit the children it purports to help.

Fines and Fees: The budget proposes to expand the traffic court ability to pay pilot program statewide. Currently, an eight county pilot program (operational in four counties) allows persons to adjudicate traffic tickets through an online portal and reduce fines by at least 50 percent for low income drivers. The budget would expand this pilot statewide over several years to all counties. The pilot has yet to be evaluated.

Additionally, the budget makes a $92 million investment in reducing criminal justice fees and their harmful, recidivistic impact on people with low-incomes and people of color, their families, and their communities. We are grateful to Budget Chair Mitchell for her leadership on this issue and look forward to working on details with her, the Governor, and other budget leaders.

SSI/SSP: The SSI/SSP caseload continues to decline, and as a result, state funding for the state supplemental program (SSP) is declining. In the 2020-21 budget the administration projects a 1.6 percent decline in SSP spending to $2.66 billion, down from $2.73 billion in the 2019-20 budget. This continues a trend of declining state spending for disabled and elderly adults. As recently as the 2016-17 budget, the state spent $2.87 billion. Rather than invest savings from caseload declines into grants, the savings are going into the General Fund for other purposes. SSI/SSP grants are critical for paying the cost of housing; this failure to invest in SSI grants will put more recipients at risk of homelessness.

Health care

Expands full-scope Medi-Cal to all income-eligible undocumented adults age 65+ (Health4AllSeniors): Building on the 2019 Budget, which made California the first in the nation to expand full-scope Medi-Cal to adults up to age 26 regardless of immigration status, the Governor’s recent proposal includes $80.5 million ($64.2 million General Fund) to expand full-scope Medi-Cal to all income-eligible undocumented adults age 65 and older. This would benefit about 27,000 older adults, to be implemented no sooner than January 1, 2021. Full implementation costs are projected to be approximately $350 million ($320 million General Fund) in 2022-23 and ongoing.

Delays 2019 Budget Act suspensions from December 31, 2021 to July 1, 2023: The 2019 Budget made important Medi-Cal investments that were to be suspended on December 31, 2021 and the proposal delays these suspensions by 18 months. This includes restoration of Medi-Cal benefits (optical, audiology, podiatry, speech therapy, and incontinence creams and washes), extension of Medi-Cal eligibility from 60 days to one year for post-partum women diagnosed with a mental health disorder, expansion of Medi-Cal screening for the overuse of opioids and illicit drugs, and Prop 56 supplemental payments to providers.

Funding for CalAIM (recently renamed to Medi-Cal Healthier California for All Initiative): The Governor’s proposal includes $695 million ($348 million General Fund) for CalAIM effective January 1, 2021 and ongoing. Despite the name change, the administration continues to advance policy changes released in October’s proposal. The proposal still terminates the Health Homes Program (HHP) despite loss of enhanced federal match rate and the Whole Person Care (WPC) program, and includes $225 million to implement the new statewide enhanced care management benefit through plans. Plans will have the option of providing housing transition services, currently provided under HHP and WPC, and other services In Lieu of Service. The Dental Transformation Initiative will end December 2020, but $112.5 million is proposed to continue and expand program elements including provider incentives for preventive services (expanded to adults); provider incentive payments for continuity of care (expanded to adults); caries risk assessment, and adding silver diamine fluoride as a covered service for children.

Termination of Dental Managed Care in Medi-Cal: The administration proposes transitioning Medi-Cal dental services from a managed care delivery system, currently mandatory in Sacramento and optional in Los Angeles, to a fee-for-service (FFS) system in January 2021. A net zero fiscal impact is estimated due to small administrative savings offset by higher dental utilization in FFS system. However, any transition will have to ensure existing consumer protections for enrollees in dental managed care, including network adequacy requirements, continuity of care protections, and a strong grievance and appeal process.

Medi-Cal Medication Assisted Treatment Benefit Changes: The administration proposes adding all FDA approved drugs (specifically buprenorphine and buprenorphine-naloxone combination) to treat opioid addiction as a Medi-Cal benefit. Currently, only methadone and naltrexone is covered for Medi-Cal enrollees needing Medication Assisted Treatment; adding two new drugs is estimated to cost $876,000.

Prescription Drug Cost Containment: The Governor proposes to continue last year’s Executive Order to carve-out the Medi-Cal managed care benefit from managed care to fee-for-service effective January 1, 2021 to include savings that are partially offset by creation of a new supplemental payment pool for non-hospital clinics for 340B pharmacy services. The Governor also proposes to establish the state’s own generic drug label to manufacture certain generic drugs, establish a single market for drug pricing within the state to combine purchasing power, and expand authority to negotiate with manufacturers internationally for Medi-Cal supplemental rebates.

Potential Public Option: With more details to come, the Health and Human Services Agency will develop options to strengthen enrollment, affordability, and choice through Covered California, including leveraging the network of existing public Medi-Cal managed care plans.

Office of Health Care Affordability: The administration proposes the establishment of the Office of Health Care Affordability in spring 2020 to increase price and quality transparency, and to reduce costs to generate savings to directly-impacted consumers.

Hearing Aids for Children: The budget proposes to create a state program to assist families with the cost of hearing aids and related services for children without health insurance coverage for households with incomes up to 600% FPL.

Behavioral Health: The administration proposes to establish the Behavioral Health Task Force Agency and strengthen enforcement of behavioral health parity laws. The Department of Managed Health Care’s enforcement will focus on timely access to treatment, network adequacy, benefit design and plan policies. The administration also supports updating the Mental Health Services Act to focus on people with mental illness experiencing homelessness, those involved in the criminal justice system, and for early youth intervention.

 

 

 

Western Center Reaction to Governor Newsom’s Proposed 2020-2021 Budget

First and foremost, Western Center is pleased that Governor Newsom’s proposed budget includes significant and innovative proposals to address the homelessness crisis in California, which will not only help the thousands of people currently experiencing homelessness, but will also prevent more people from losing their housing. We are also pleased to see the Governor take another major step toward providing health care for all by expanding Medi-Cal coverage to undocumented adults over age 65, and to see the extension of the tax ban on period products and diapers, which makes our tax code more equitable for women, girls and young families.

We were hoping to see additional investments for CalWORKs and SSI grants in this proposal, since they are both crucial for lifting Californians out of poverty. We will continue to advocate for those increases in the final budget agreement.

Below are our initial reactions to the proposed budget by issue area. We will release an in-depth analysis next week.

Housing

The proposed budget appropriately treats the state’s homelessness crisis as an emergency. The proposal devotes additional resources to help people at risk of homelessness remain stably housed and to increase both temporary shelter capacity and permanent housing options for people already experiencing homelessness. We are pleased to see the Governor’s sustained commitment to addressing homelessness and look forward to working in partnership with his administration and legislative leaders to further develop effective, sustainable solutions to the crisis that prioritize residents living in poverty.

We agree with the Governor that the state must ramp up efforts to address the state’s shortage of housing, which is primarily a shortage at lower income levels. We are eager to work with the Governor to ensure that policies and programs to speed housing production prioritize the creation of units for households with the lowest incomes who are priced out of the rental market in every county in the state, protect low-income communities and communities of color from displacement, and increase access to high opportunity areas for our clients.

Financial Security

The budget includes funding to increase the CalWORKs child support pass through (read about it here). Currently, the first $50 of child support paid by a non-custodial parent goes to the CalWORKs family, but any amount over that is kept by state and federal governments. In the Governor’s newly proposed budget, CalWORKs families with one child will keep the first $100 of child support, and families with two or more children will keep the first $200 of child support, beginning January 2022. It also includes funding to provide debt relief for child support owed to the government that is deemed uncollectable. We are grateful that the Governor has heard from parents and families in their call for a child support program that works for children, and we are eager to see proposed associated trailer bill law changes for details. We look forward to working with the Governor and legislature to achieve the goals of conforming with federal law and regulation, and ensuring the program works to benefit the children it purports to help.

The budget also includes the extension of the tax ban on period products and diapers, which will make our tax code more equitable, since taxes on period products and diapers are regressive to poor families and young people. We look forward to continuing work in the legislature to end unmet diaper need and period poverty in California.

Additionally, the budget makes a $92 million investment in reducing criminal justice fees and their harmful, recidivistic impact on people with low-incomes and people of color, their families, and their communities. We are grateful to Budget Chair Mitchell for her leadership on this issue and look forward to working on details with her, the Governor, and other budget leaders. We’re also happy to see that Californians with low incomes will soon be able to reduce the cost of their traffic fines and the overall impact of expensive traffic tickets, with this budget proposing to expand the traffic court ability-to-pay pilot program (currently operational in four counties) statewide over several years. The pilot has yet to be evaluated, so we look forward to details from the Judicial Council to see if the program’s reductions in fines and fees are adequate or need to reduced further.

Finally, to further enhance financial security for Californians, the Governor’s budget creates a new state version of the Consumer Financial Protection Bureau (CFPB). The proposed financial watchdog will hold banks and other financial firms accountable when they engage in unfair and abusive debt collection and banking practices. Medical, student loan, school lunch, and other forms of debt disproportionally burden people experiencing poverty; we expect this new agency to offer important protections for our clients.

Health Care

We applaud the Governor for continuing to move toward universal coverage by making California the first in the nation to expand full-scope Medi-Cal to all income-eligible seniors regardless of immigration status, taking a whole person approach to Medi-Cal, and cost containment with an eye toward quality and equity. We look forward to working with the administration and legislature to advance a budget that ensures equitable access to affordable, comprehensive, quality health care for poor Californians.

The Governor’s proposal also delays suspension of benefits and eligibility, by extending certain Medi-Cal benefits (optical, audiology, podiatry, speech therapy, and incontinence creams and washes), extending Medi-Cal eligibility from 60 days to one year for post-partum women diagnosed with a mental health disorder, and expanding Medi-Cal screening for the overuse of opioids and illicit drugs, all until July 2023.

 

Ballot measure would tighten up rules for dealing with bad street behavior

“The Western Center on Law & Poverty has said the arrest and rehab plan would “take California back into the dark ages of mass institutionalization of people with perceived or real mental illness. Such zero tolerance approaches only exacerbate racial and class disparities through an overly aggressive criminal justice system.”

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California curbs deferred-interest credit for veterinary care

“Few consumers understand that if they fail to pay the entire balance during the introductory period or if they make a late payment, they end up with an interest charge that can be larger than the remaining balance, according to state Sen. Holly J. Mitchell, who co-authored the law, and Jen Flory, a health policy advocate with Western Center on Law & Poverty.”

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