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In Road to Medicaid Expansion, Only the Poorest Will Benefit in Sacramento

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(Sacramento, CA)
Wednesday, October 17, 2012

Midday on a Monday outside the Sacramento Primary Care Center, people stand around the building… smoking, talking on their cell phones, waiting.  Charles Hollingshead has been getting health care through the county for six years. When he started, it was easier to be seen. Now?

HOLLINGSHEAD: "It's bad. It's terrible. Take you three months between appointments. You can't just come in and be seen anymore, it's overcrowded."

Hollingshead is a musician who' struggled financially in recent years. He has a number of gastrointestinal problems. When he says he had problems with his foot this summer, he wanted to be seen right away. He couldn't get to the clinic, so he went to the emergency room. 

HOLLINGSHEAD: "And they tell you to see the county doctor to follow up.  They'll give you a form, [they] say 'In two or three days make an appointment.' They know... you're not going to follow up with a county primary doctor for about 3 months if you're lucky."

Emergency room care is far more expensive than a clinic visit. Sacramento County once had six clinics, now, it has one.

But the situation may improve for Hollingshead and as many as 14,000 Sacramentans who will be eligible for the county's Low Income Health Program (LIHP).

LIHP is part of the state's effort to get ready for Medi-Cal expansion. More than 550,000 Californians already have new coverage .Most will be moved into Medi-cal in 2014.

DAMIANO: "We're very excited about the opportunity to reconfigure services which we could not have been able to do without the Low income Health Program."

Sandy Damiano is a Deputy Director with Sacramento County Health and Human Services. She says with an infusion of millions of federal dollars, Sacramento County will contract with Molina Healthcare, which will provide access for the poor through at least 12 existing community clinics.

People who may be homeless, or have serious medical and financial problems will be guaranteed a doctor's visit within 30 days.

DAMIANO: "We're hoping that [LIHP] can really get them stabilized in terms of their medical conditions and also decrease the hospital emergency room use."

But only the poorest of the poor will benefit in Sacramento County - mostly childless adults with an individual income under $7500 dollars a year. Sacramento County is one of the last California counties to join the state initiative.

Alameda County began its program in the summer of 2011, and serves people at three times the income level covered in Sacramento. Alex Briscoe is Alameda County's Health Director.

BRISCOE: "Now, if you're getting seen in one of our primary care clinics and you go to the emergency room three times in the same month, we call that primary care home and say, 'Hey, what's up?' We never did that previously."

Other counties that are struggling to take advantage of the new federal funding - Merced and Tulare are expected to join LIHP next January.  Stanislaus County hasn't announced a start date, but plans to offer services to an even poorer population. Briscoe says that's bad news for people who need more preventive care now.

BRISCOE: "I'm deeply concerned that not every county is ready or able to take advantage of this opportunity and federal dollars will be left on the table that could have been brought to bear to mitigate the human suffering that is, frankly, everywhere."

Sandy Damiano with Sacramento County says recurrent budget cuts and a lack of infrastructure have made implementing the new health program a "huge undertaking." She and legal advocates, say they'd like the program to serve more people. Charles Hollingshead likes the idea of more clinics being available now.

HOLLINGSHEAD: "It would make it a lot eaiser. It would make it less of a headache for you, you'd have more piece of mind, you could be seen and get treated. Get what you needed."

Services are expected to begin in November. The program expires at the end of 2013, but benefits will continue when and if Medicaid expands in 2014.

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