health Archives – Western Center on Law & Poverty

Patients in California County May See Refunds, Debt Relief From Charity Care Settlement

August 14, 2023August 15, 2023, By Molly Castle Work, Kaiser Health News

California’s largest public hospital plans to start notifying 43,000 former patients Monday that they may be eligible for refunds or billing corrections, part of what advocates called a major legal settlement that will help force the hospital to fulfill its charity care obligations.

Santa Clara Valley Medical Center, along with other units of county-owned Santa Clara Valley Healthcare, will also adopt procedures to ensure patients are informed of their eligibility for charity care, which nonprofit and public hospitals must provide.

“This is huge,” said Helen Tran, a senior attorney with Western Center on Law & Poverty, which joined another California-based legal group, the Consumer Law Center, in a lawsuit against the hospital. “It’s so important that the hospital is stepping up to take corrective action. That’s something we haven’t seen many hospitals do.”

Filed in 2019 and settled in June, the lawsuit alleged that Santa Clara Valley Medical Center billed patients and sent them to collections for charges they should not have been required to pay. Emily Hepner, one of the plaintiffs, was a full-time student, raising two children alone,and uninsured in 2014 when she needed urgent surgery, according to the lawsuit. The hospital never followed up after telling her she might be eligible for charity care and, nearly a year later, she received a $34,884 bill. The hospital later sued her for that amount plus attorney fees.

Western Center on Law and Poverty suggests California pauses Medi-Cal disenrollments that are due to procedural reasons

July 27, 2023, By Hannah Saunders, State of Reform

With Medi-Cal redeterminations underway following the end of the federal public health emergency, the Western Center on Law and Poverty (WCLP) is concerned about recently released data from the state, which shows that 225,231 individuals have been disenrolled from the program so far.

For the renewal period beginning in April, a total of 1,052,030 individuals underwent a renewal, of which 199,852 were terminated due to procedural reasons. Procedural reasons may include being unable to complete renewal packets, and the state not having up-to-date contact information for beneficiaries. David Kane, senior attorney at WCLP, spoke with State of Reform about his concerns with the high level of terminations.

WCLP has been working with California’s Department of Health Care Services for over three years to prepare for this redetermination process. WCLP meets with the agency twice per month and reports challenges they hear about from the community. The Center also advocates for policy changes that will make it easier for Californians to renew and maintain coverage.

The state says procedural errors occur when individuals fail to turn information in, but Kane said many are attempting to renew their Medi-Cal but run into roadblocks. Bumps occur when individuals attempt their annual renewal through the phone—which is critical for those who don’t have a physical address—need to conduct the renewal during their lunch break, or don’t receive paperwork in the language they speak. Phone wait times have also increased, with LA County having hold times of 45 minutes to one hour.

Tens of thousands lose Medical eligibility

July 25, 2023July 25, 2023, By Mariel Mallare Jimenez, KALW

About 225,000 Californians lost their free or low-cost health coverage as of July 1st in the first round of a Medi-Cal renewal process – which had been suspended since early in the COVID-19 pandemic.

The number makes up more than 20 percent of the 1 million or more people who were due to reapply for coverage in June.

Less than three percent of those who lost coverage lost it because their incomes now exceed program limits. Most lost it because they didn’t submit a renewal packet and could not have their incomes verified.

Staff attorney David Kane told CalMatters “I don’t think today’s preliminary numbers mean we can all sit back and think things are OK, these disenrollments are not inevitable.” He added that the lack of responses could be due to not receiving the packets or not getting the packets in their language.

Anthony Cava of the California Dept. of Public Health told KALW that it’s not too late for some residents to hold on to their Medi-Cal coverage. If you’ve lost your insurance, Cava advised Californians to: return packets to their county office; notify them if you’ve moved; and to return any yellow envelopes promptly.

The state will review eligibility for about 16 million people over the next year. Those who were dropped from Medi-Cal on July 1st have 90 days to re-apply for reinstatement.

225,000 Medi-Cal enrollees lost coverage in June; here’s how that compares with prior years

July 21, 2023July 25, 2023, By Cathie Anderson, Sacramento Bee

A three-year hiatus ended in June for more than 1 million California Medi-Cal enrollees. They once again had to prove they were eligible for the government-funded health care coverage, and roughly eight out of 10 got their paperwork in by the June 30 deadline, California Medicaid Director Jacey Cooper said Thursday.

That was about the same proportion of enrollees who successfully completed monthly re-enrollment in California before Congress enacted the Families First Coronavirus Response Act in the early days of the COVID-19 pandemic, requiring states to continue covering anyone who was approved for Medi-Cal or any other Medicaid program around the country.

Beginning in June and continuing through May of next year, Medi-Cal enrollees have to re-apply for coverage by the end of the month in which their eligibility dates fall.

Medi-Cal discontinued coverage for about 225,000 individuals, or roughly 21% of people whose coverage came up for renewal in June, Cooper said, but those who lost coverage have 90 days to provide the necessary documentation and restore their coverage retroactive to the cut-off date.

More than 220K people kicked off Medi-Cal in its first checkup since COVID

July 21, 2023July 25, 2023, By Ana Ibarra, CalMatters

About 225,0000 Californians lost their free or low-cost health coverage as of July 1, in the first round a Medi-Cal renewal process that had been suspended since early in the COVID-19 pandemic.

That’s approximately 21% of the over 1 million people who were due to reapply for coverage in June, according to preliminary numbers released by state health officials on Thursday.

Medi-Cal, the state’s health insurance program for low-income people, typically reviews enrollees’ eligibility every year. The state paused that process during the pandemic at the orders of the federal government, but resumed in the spring.

Less than 3% of the people who lost coverage no longer qualify for Medi-Cal because their household income now exceeds the program’s limits.

That means the majority of people were kicked off because they didn’t return a renewal packet and county Medi-Cal offices couldn’t verify an enrollee’s income. Cooper said the counties and state are trying to reach enrollees in multiple ways — email, mail and texts.

David Kane, a senior attorney with the Western Center on Law and Poverty, said it is concerning that tens of thousands of people could be without insurance even though they are eligible. They may have failed to respond for a number of reasons, such as not receiving the packet or not getting the packet in their language.

“I don’t think today’s preliminary numbers mean we can all sit back and think things are OK,” Kane said. “These disenrollments are not inevitable. The state, counties, advocates, and community groups together have the power to help more people keep their Medi-Cal.”

Over 34,000 L.A. County households lost Medi-Cal in July amid rollback of COVID rules

July 20, 2023July 25, 2023, By Emily Alpert Reyes, Los Angeles Times

More than 34,000 households in Los Angeles County have had their Medi-Cal coverage discontinued this month as California joins other states in beginning to cut off people from Medicaid programs who no longer meet income requirements or whose paperwork was not submitted in time.

The latest numbers were shared by L.A. County officials at a public meeting Wednesday. Health officials and legal advocates are closely eyeing such early figures to see how a major shift in health coverage is playing out in L.A. County and across California, amid concerns that people who legally qualify for Medicaid could end up losing it unnecessarily or suffering interruptions in their coverage.

Earlier in the pandemic, federal rules had allowed people to hang on to Medicaid coverage without turning in annual paperwork to prove they were still eligible. Now states have started ejecting people from their programs again after the federal government rolled back those pandemic rules.

California Steps up to Stop Big Tobacco From Maliciously Targeting Black Communities

July 18, 2023, By Abraham Zavala-Rodriguez, WCLP Outreach & Advocacy Associate

Every year, over 45,000 Black lives are lost in the United States to tobacco-induced illnesses like lung cancer, heart disease, and strokes. Tobacco corporations for decades have been intentional about their predatory targeting of Black communities. Black, Indigenous, and communities of color are already denied equitable access to social, political, and economic systems which produce inequitable and preventable negative health outcomes.

This is an industry rooted in racism, white supremacy, and nefarious capitalism. The colonialist and extractive production models used by tobacco producers had detrimental effects on Black, Brown, and Indigenous people at its origins. Today, Big Tobacco actively continues to disrupt community health initiatives meant to improve health outcomes for profit.

In 1964, after a report by the U.S. Surgeon General about the hazardous health impacts of smoking and subsequent federal laws limiting smoking and tobacco advertising, tobacco companies shifted their marketing to target Black communities across the country. Big Tobacco had lost their biggest youth demographic, as they were banned from advertising in colleges or from handing out loose cigarettes on campus to students under 21.

The industry thrives due to strategic co-optation of community leadership whenever it can. Tobacco industries deployed a multi-pronged effort to prey on Black communities by working with Black influencers, handing out free cigarettes through bellhops or barber shops, and funding political campaigns or supporting Black causes. Tobacco businesses have for years tried to create fake cultural affinities like the advertising campaigns for Kool Jazz Festivals with icons such as Dizzy Gillespie.

Tobacco companies went as far as appropriating #BlackLivesMatter, Juneteenth, and used Dr. Martin Luther King Jr. quotes in their product advertising a couple of years back. Their marketing has been a shallow and peformative public relations strategy to buy good will and actively undermine or discredit the systematic harm tobacco perpetuates.

In 2009 the U.S. Food and Drug Administration (FDA) banned flavored cigarettes, yet menthol cigarettes slipped by due to a split in the Congressional Black Caucus (CBC). A recent survey found that 85% of Black smokers preferred menthol cigarettes. Many in congressional leadership at the time received support and donations from tobacco companies.

States like California have been taking strong steps to disrupt Big Tobacco’s assault on Black communities. This past November, Californians voted to support Proposition 31 and uphold Senate Bill 793, authored by former Senator Jerry Hill. Once SB 793, a bill to ban the sale of flavored tobacco products and tobacco product flavor enhancers, was signed into law, Big Tobacco immediately jumped into action to delay the implementation of the law by referendum. California voters saw through this self serving and dangerous ploy and voted in favor of keeping the law, with 63.42% voting to do so. In California, flavored tobacco including menthol flavors remain banned. The industry immediately shifted to introduce new cooling non-menthol tastes.

In response, the African American Tobacco Control Leadership Council (AATCLC) and California Attorney General, Rob Bonta sent warning letters to RJ Reynolds and Imperial Tobacco Group Brands to stop these new products from harming Black communities.

AATCLC Co-Chair Dr. Phillip Gardiner proclaimed that this violated the state’s law prohibiting the sale of flavored tobacco, “we will not sit by as tobacco companies work to continue their assault on the health of Black people.”

Big Tobacco is just one example of an issue at the intersection of public health and racial justice. Thankfully, lawmakers, advocates, community groups, and voters came together to call out their predatory and harmful practices. When we come together, we can stop special interests and protect the health and well-being of Californians.

Analysis Of Governor Newsom’s 2023-2024 May Revision Budget

May 12, 2023May 15, 2023, By WCLP Policy Team

The Newsom Administration released its 2023-24 May Revision budget, projecting a $31.5 billion deficit. After years of a budget surplus, California is forecasting a downturn in funding due to a combination of capital gains losses and delayed tax filings due to natural disasters, but California remains strong. The May Revision reflects a $37.2 billion in total budgetary reserves and additional funds from the Managed Care Organization tax.

Governor Newsom maintains many of the Administration’s and legislature’s previous commitments and proposes no new trigger cuts. He also proposes no new corporate or personal taxes, despite calls from the Senate and advocates to increase taxes on wealthy corporations and the state’s highest earners.

We appreciate that the May Revision maintains past budget agreements including expansion of Medi-Cal to all regardless of immigration status, reforming the Medi-Cal share-of-cost, and on-time implementation of food assistance for Californians 55 years of age or older, regardless of immigration status.

As the fourth largest economy in the world, California has made great strides in addressing poverty and systemic inequities, but there is more work to be done. We look forward to working with the legislature and Administration to protect low-income Californians as the State enters more uncertain fiscal circumstances.

Below are our initial reactions to the proposed budget by issue area, with a focus on changes from the January budget proposal.

HEALTH CARE

Health4All: The May Revision maintains full funding to expand full-scope Medi-Cal eligibility to all income eligible adults ages 26-49 regardless of immigration status on January 1, 2024. The May Revision includes increases for previous expansions for adults 50 and older and ages 26-49 due updated managed care rates, higher share of state-only costs, higher caseloads, and higher acuity members.

Managed Care Organization (MCO) Tax: The May Revision proposes a bigger MCO tax with an earlier start date (April 2023 through end of 2026). This results in $19.4 billion in total funding, including $3.4 billion for 2023-24. $8.3 billion is proposed to offset General Fund and $11.1 billion is proposed to support Medi-Cal investments that improve access, quality, and equity over an 8- to10-year period. These investments include rate increases to at least 87.5% of Medicare for primary care, birthing care, and non-specialty mental health providers and the remainder will be put into a special fund reserve for future consideration.

Covered California Affordability Sweep: The May Revision maintains proposal to sweep Covered California reserve fund to General Fund totaling $333.4 million.

Distressed Hospital Loan Program: The May Revision includes up to $150 million one-time General Fund to provide interest-free cashflow loans to not-for-profit and public hospitals in significant financial distress or to governmental entities representing a closed hospital, for purposes of preventing the closure of, or facilitating the reopening of, those hospitals.

Home and Community-Based Services Spending Plan Extension: The May Revision includes a six-month extension until September 30, 2024 for specified programs such as the IHSS Career Pathways Program and the Senior Nutrition Infrastructure Program to fully spend allocated funding based on critical programmatic needs.

Doula Services Implementation Evaluation: To align with later implementation date, TBL is proposed to extend the timeline of the Doula Stakeholder Workgroup (from April 1, 2022 until December 31, 2023) and to extend the evaluation of the doula benefit implementation in the Medi-Cal program (from April 1, 2023 until June 30, 2025).

Medical Interpreter Pilot Program: Through TBL, the May Revision proposes to extend the expenditure authority of the Medical Interpreter Pilot Project for 12 months, from June 30, 2024 to June 30, 2025.

988 Update: The May Revision includes a one-time augmentation of $15 million for a total of $19 million, from the 988 State Suicide and Behavioral Health Crisis Services Fund for California’s 988 centers. This increase will support workforce expansion to handle increased answered call volume, extensions of service hours, and the availability of chat and text options for callers utilizing the 988 services.

BH-CONNECT Demonstration (formerly referred to as CalBH-CBC Demonstration): The May Revision includes an update to the BH-CONNECT Demonstration to include a new Workforce Initiative and includes $480 million in funding for each year of the five-year demonstration period ($2.4 billion total funding and no General Fund).

CalRX and Reproductive Health: The May Revision includes TBL and $2 million one-time General Fund reappropriation from the Capital Infrastructure Security Program and allows the use of these funds for reproductive health care if necessary.

Community Assistance, Recovery, and Empowerment (CARE) Act: The May Revision includes additional funding to support the implementation of the CARE Act. Compared to the Governor’s Budget, the annual increase is between $43 million and $54.5 million to account for refined county behavioral health department cost assumptions, additional one-time $15 million General Fund for Los Angeles County start-up funding. The May Revision also includes an additional $16.8 million in 2023-24, $29.8 million in 2024-25, and $32.9 million ongoing to double the number of hours per participant for legal services from 20 hours to 40 hours.

HOMELESSNESS

The May Revision preserves the full $3.7 billion in funding for homelessness programs, as committed in previous budgets, including $1 billion for the Homeless Housing, Assistance and Prevention grant program.

May Revision Adjustments:

Behavioral Health Bridge Housing Program: $500 million one-time Mental Health Services Fund in 2023-24 in lieu of General Fund. This investment eliminates the January Budget proposed delay of $250 million General Fund to 2024-25 and restores the $1.5 billion commitment funded in the 2022 Budget Act for the program.

HOUSING

While the May Revision reflects a steady commitment to Homelessness investments, the May Revision also culminated in a weakening of housing investments totaling $17.5 million in General Fund reductions and $345 million in deferrals related to housing programs. Funding for housing programs remains at approximately 88% of the allocations made in 2022-23 and proposed for 2023-24 ($2.85 billion). This outlook could change if there are sufficient General Fund dollars in January 2024. If that occurs, the Governor has committed to restoring $350 million of these reductions. Overall, the proposal includes $500 million continued annual investment in the state Low-Income Housing Tax Credit program, $225 million for the Multifamily Housing Program, and $100 million for the Portfolio Reinvestment Program. These programs have a proven track-record of addressing housing affordability and homelessness across California.

May Revision Adjustments:

Foreclosure Intervention Housing Prevention Program: Provides funds to various non-profit organizations to acquire foreclosed property and operate as affordable housing. Deferral of $345 million of the $500 million one-time General Fund over four fiscal years—for a revised allocation of: $50 million in 2023-24, $100 million in 2024-25, $100 million in 2025-26, and $95 million in 2026-27

Downtown Rebound Program: Funds adaptive reuse of commercial and industrial structures to residential housing. Reverts $17.5 million in unexpended funding that remained in this program after the Notice of Funding Availability.

In contrast, the Senate’s Budget Plan, which was released two weeks ago, both prevents funding cuts and delays, and builds on our progress by including ongoing investment in homelessness and resources for key housing production programs. Notably, that Plan provides $1 billion in ongoing funds to support the Homeless Housing Assistance, and Prevention Program, $1 billion towards the state Low-Income Housing Tax Credit Program, and an additional $300 million flexible allocation towards affordable housing programs.

Western Center is a proud member of a coalition of California’s leading affordable housing, homelessness, and housing justice advocacy organizations championing a comprehensive coalition investment strategy for affordable housing production, preservation, and tenant stability. While the May Revision falls short of our requests to meet the housing and homelessness crisis at scale, we look forward to continuing our budget advocacy and encourage the Governor and Legislative leadership to finalize a budget that includes ongoing, significant resources like those included in the Senate budget plan and our coordinated housing budget letter.

PUBLIC BENEFITS AND ACCESS TO JUSTICE

CalWORKs Grant Increase: The May Revision reflects a 3.6-percent increase ($111.2 million in 2023-24) to CalWORKs Maximum Aid Payment levels, effective October 1, 2023. These increased grant costs are funded through the Child Poverty and Family Supplemental Support Subaccount.

Supplemental Security Income/State Supplementary Payment (SSI/SSP): The May Revision continues to include an 8.6% increase in funding for the SSI/SSP and Cash Assistance for Immigrants (CAPI) program providing a $3.6 billion from the general fund. This allocation provides recipients with an increase in grant levels to $1,134 per month and $1,928 per month for couples.

California Food Assistance Program (CFAP) Expansion Update: The May Revision moves up the issuance of food benefits for older undocumented immigrants to start October 2025, instead of the January Proposal that delayed it until 2027, which we appreciate but we still need Food4All regardless of age and immigration status.

Summer Electronic Benefit Transfer (EBT) Program: The May Revision includes $47 million ($23.5 million General Fund) for outreach and automation costs to phase in a new federal Summer EBT program for children who qualify for free or reduced-price school meals beginning summer 2024.

Safety Net Reserve: The May Revision withdraws $450 million (half of $900 million) from the Safety Net Reserve. The reserve is intended to maintain existing Medi-Cal and CalWORKs program benefits and services when program cost may increase due to economic conditions, which may occur if recession occurs, so we argue it is prudent to not draw from Safety Net Reserve until those conditions are met.

Services for Survivors and Victims of Hate Crimes Augmentation: The May Revision includes an additional $10 million General Fund to support services for victims and survivors of hate crimes and their families and facilitate hate crime prevention measures in consultation with the Commission on Asian and Pacific Islander American Affairs.

For questions, contact:

Health:  Linda Nguy, Senior Policy Advocate – lnguy[at]wclp.org; Sandra Poole, Policy Advocate – spoole[at]wclp.org
Housing and Homelessness: Cynthia Castillo, Policy Advocate – ccastillo[at]wclp.org; Tina Rosales, Policy Advocate – trosales[at]wclp.org

Public Benefits/ Access to Justice: Christopher Sanchez, Policy Advocate – csanchez[at]wclp.org

Medi-Cal Enrollees: Here’s How to Verify Your Eligibility

May 5, 2023May 8, 2023, By Bernard J. Wolfson, California Healthline

Medi-Cal, the state’s version of the Medicaid health insurance program for low-income residents, has embarked on a 14-month effort to reexamine the eligibility of its nearly 15.8 million members. It is part of the massive “unwinding” being undertaken by all state Medicaid programs after three pandemic years during which their rolls swelled. States had agreed, in exchange for extra funding from the feds, not to boot anyone except in cases such as fraud, death, or a move out of state.

On April 1, Medicaid restarted the annual eligibility checks that had been the norm before the pandemic. It will be the biggest shake-up in U.S. health coverage since the Affordable Care Act, though it cuts the opposite way: Between 8 million and 24 million people will likely be bounced from Medicaid nationally, including an estimated 2 million to 3 million in California.

To minimize the number of enrollees dropped unnecessarily, California’s Department of Health Care Services, which runs Medi-Cal, has launched a $25 million advertising and outreach campaign that will send messages in 19 languages. The department is enlisting the assistance of nearly everyone who has contact with Medi-Cal enrollees: county offices, health plans, medical providers, advocacy groups, and volunteers. And it got $146 million in supplemental funding to help counties cope with the unprecedented number of renewal decisions.

‘A perfect storm’: Patients trying to hang on to Medi-Cal face long waits for help

April 25, 2023July 25, 2023, By Emily Alpert Reyes, Los Angeles Times

Canned music droned from the telephone as Jessica Sanchez waited, fidgeting and shifting her pregnant belly in her chair at the Santa Monica community health center.

It had been an hour since Sanchez and a Venice Family Clinic worker had dialed up a Los Angeles County agency for help. At a prenatal appointment, Sanchez, 33, had abruptly discovered that her health coverage had been cut off months earlier. The news rattled Sanchez, who was already in her third trimester.

Tag: health