As the Supreme Court tackles health reform, Kern County is seeing mixed results from a program designed to transition people to it.
Kern County was one of the first California counties to implement the Low Income Health Program, which provides healthcare to people previously ineligible for government programs who will qualify for public care in 2014. The idea is that getting people into the system now -- and out of the emergency room -- will ease the transition.
"That's why everyone is pushing for as much enrollment as they can get," said Jacey Cooper, program director for Kern County. "This program will prepare Kern County for health reform."
But far fewer than the number eligible are enrolling, and there's a high dropout rate among those who do. Still, the model has succeeded in providing primary care and reducing expensive emergency room visits, Cooper said.
Participants must be a U.S. citizen or legal resident for five years making 100 percent or less of the federal poverty line. For a single person that's $11,170 a year; for two it's $15,130.
UCLA's Center for Health Policy Research estimated about 24,000 people in Kern County could qualify. For now, the county's goal is to include about 10,000.
But enrollment has hovered around6,500 in any given month.
To spread awareness, the county is working with Clinica Sierra Vista, National Health Services and Children's Health Initiative of Kern County. There's no marketing or advertising budget, though Cooper said they do attend health fairs and give brochures to partners.
"If they're coming to us, we push strongly" for enrollment, said Cindy Stewart of Clinica Sierra Vista, who questioned whether there's enough awareness and outreach in the overall community. "If there is an opportunity to have the visit paid for, and not have the patient be responsible, we're going to find it."
The county is also struggling with low re-enrollment figures. In any given month, about half of the participants are new. That could have something to do with the county dropping the requirement from 200 to 100 percent of the federal poverty line in July, Cooper said.
Or it may have been too tough to wade through the annual re-enrollment forms. In January, the county reduced those forms from four to two pages.
Counties throughout the state have seen similar enrollment challenges, said Peter Long, president of the Blue Shield of California Foundation, which is helping with LIHP planning and implementation. The enrollment system with the programs is often lacking, especially when people move and it's hard to track them.
That's a challenge of government programs in general, though this is exacerbated with the partisan healthcare debate, added Dr. Robert K. Ross, president and CEO of The California Endowment.
"Either they don't know about it or what they hear is negative," Ross said. "It's creating a dual challenge and I assume county officials are going to have to do a more aggressive and assertive job of making sure eligible families are aware this exists."
Since last July, the county has spent about $24 million on LIHP, 50 percent of which the federal government reimburses. Getting those funds on time hasn't been easy though -- which was one of the reasons Kern Medical Center had to go to the Board of Supervisors seeking help on its cash flow problem, Cooper said.
The county has also fielded unexpected costs for out-of-network emergency room care. If one of the members goes somewhere other than KMC, the county must pay 30 percent of the Medi-Cal rate.
It's not a lot, Cooper acknowledged, but it adds up. Over the past six months, for example, the county has paid out $70,000 for its members' out-of-network ER visits. As more and more hospitals realize they can claim for these services, that financial burden is expected to climb even more.
Another unanticipated cost involved is becoming the payer of last resort for individuals with HIV or AIDS. Previously, a federal program covered those medical costs, but the LIHP must now shoulder half of that amount. In Kern County, just 200 people qualify, but the costs can be high, with . the average monthly medication cost per client about $1,500, the county said.
Officials say the program is having a positive overall impact, though.
From 2007-2011, the total emergency department cost per member dropped 47 percent from $459 to $243.
Cooper attributed that to patients seeking primary care instead of waiting until they're very sick and heading to the ER.
Linda Bowyer, 36, used to frequent the ER for her health needs. Now, Bowyer says the LIHP has become her lifeline.
Having medical care for her ovarian cysts, back pain and lingering complications from a C-section helped Bowyer, who was homeless, secure a job in the food services industry. There was plenty of red tape to get into the program, and it's occasionally tough to get in for a doctor's visit.
"But overall this has been a big blessing, and I wouldn't have been able to get back on my feet if I had not had it," she said.
Similarly, the plan helped Lisa Wiswell, 49, see multiple specialists for her health problems, which include multiple sclerosis, sleep apnea and the effects of several strokes. Wiswell, a bartender, hadn't had insurance for a decade.
LIHP's physical therapy services have helped Wisewell feel her right side. That perhaps led to the most gratifying result: being able to hold her granddaughter.
"I get to watch her now," she said. "I don't know what I would do without it."
Linda Bowyer at her home in Oildale. Administrator, KRVR.org firstname.lastname@example.org
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