Local patients and providers navigate the changing healthcare landscape
California's Healthy Families program was eliminated in Santa Cruz County on March 1, pushing thousands of children into Medi-Cal. Gov. Jerry Brown did away with the state's child healthcare plan—which served as the primary option for families who did not qualify for Medi-Cal, but could not afford private insurance—as part of a budget maneuver in 2012.
The change is one of the most visible markers that the Affordable Care and Patient Protection Act—commonly referred to as Obamacare—is actually changing the medical world.
The catch with this transition is that there is currently no mechanism in Medi-Cal to cover costs for dental, vision, or other services not seen in the business of medicine as central treatments.
Some local nonprofit healthcare providers are expanding their operations in preparation for 2014, when the most ground-shaking provisions of President Barack Obama’s healthcare reforms move into action. In California, the 6.7 million people currently uninsured will also be required to get insurance through Medi-Cal, Covered California (the new state medical exchange), or buy other private insurance, according to Covered California's website.
Dientes Community Dental Care, for example, is adding a children's wing to their existing Live Oak facility and opening a new location on Freedom Boulevard. They anticipate being able to treat about 1,000 people every year at their new location, as well as 2,000 more children at their expanded original office. This is being made possible, in part, by a $1.5 million grant from the federal government, but Dientes is currently in the process of raising the rest of the $3 million needed for the expansion. They are half way to their goal, working through long-time donors and foundations in the area.
They currently have a waiting list of three months for an appointment with the exception of emergencies that must be addressed immediately.
Executive Director Laura Marcus says that there is no clear information about whether newly insured people in Medi-Cal or Covered California's plans would have any coverage for dental care. Dientes bills on a sliding scale according to income for uninsured patients, but says the bare minimum expense of $800 or $1,000 for a root canal and crown could keep some patients from getting care that could affect their overall health and quality of life.
“The new [private insurance] exchange will offer medical benefits but no dental care,” Marcus says. “They are still developing the exchange, and the feds may require the state cover children for dental.”
Covered California posted a press release stressing its commitment to making affordable dental plans available through their network on Feb. 26, but that part of their plan will not roll out until after the start of 2014.
“Processing the enrollment of individuals in Qualified Health Plans [and] offering essential health benefits is the system’s core functionality and Covered California’s first priority,” reads the post.
They do, however, have numbers on who can enroll in the Medi-Cal expansion as well their plans. People earning less than 138 percent of poverty level will be eligible for Medi-Cal. Anyone above this income level can buy into the Covered California network of providers. Those making less than 400 percent of the federal poverty category will receive discounted premiums on a sliding scale.
But local parent Camile Smith-Ballon is not convinced that the new system is going to catch the thousands of families in Santa Cruz County who had been covered under Healthy Families.
“I just received very preliminary paperwork about the future of our coverage and it explained almost nothing about the details,” says Smith-Ballon.
She was directed to Dientes for dental care by the United Way in 2009, around the same time she was enrolled in Healthy Families. This was after a divorce and being laid off from her job, which left her with a Cobra insurance plan when her son came down with appendicitis. Cobra is a government plan created in 1985 to cover people between the loss of employer-based healthcare and purchase of other coverage. When his infection was treated that March, Smith-Ballon was left with $70,000 of a $120,000 bill for a 10-day hospital stay.
“In April I was put on Healthy Families and he went back to have his appendix removed a few months later when [the] swelling had gone down,” she says. “Between Healthy Families and help from Good Samaritan Hospital, I owed nothing.”
Even if families are able to switch to Medi-Cal, she is concerned that they won't receive the same care they have been getting from Healthy Families, such as dental care.
Despite apparent complications, Leslie Connor, executive director of the Santa Cruz Women's Health Center, says the transition is a positive one overall. Santa Cruz was selected for the first phase of eliminating Healthy Families because the state decided there was less chance of issues such as doctors dropping patients in response to the coverage shift, according to the California Department of Health Care Services.
“We are not a particularly rural county and providers are closer together,” says Connor. “In some areas, to find another doctor nearby when your coverage is changed can be very difficult.”
The Santa Cruz Women’s Health Center is also branching out as it looks toward 2014, when healthcare reform's provisions really start sinking their teeth into the many layers that make up the current scheme. The center won an annual $650,000 grant from the federal government in 2012 that will help them evolve with the changing landscape.
“We're going to be opening another clinic in Live Oak that will treat all ages and genders,” she says. By 2014 and 2015 they expect to be serving up to 10,000 people every year, up from about 5,200 currently.
Connor sympathizes with Californians who are alarmed with the murkiness of the healthcare reform details at the moment, but encourages patience.
“Our country has a very complicated healthcare system with a lot of run arounds and layers that allow companies to deny coverage,” she says. “Just because it's complicated doesn't mean it's wrong or that the government doesn't know what it's doing.”
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