crossing the void
DESCRIPTION
Crossing the Void. Understanding Contra Costa’s Newly Uninsured Patients. Kali Stanger, MD PGY1 December 28, 2009. Project Objectives. Describe health care access for undocumented immigrants in Contra Costa County, in light of BHC eligibility cuts enacted in June - PowerPoint PPT PresentationTRANSCRIPT
Crossing the VoidUnderstanding Contra Costa’s Newly Uninsured Patients
Kali Stanger, MDPGY1December 28, 2009
Project ObjectivesProject Objectives Describe health care access for undocumented immigrants
in Contra Costa County, in light of BHC eligibility cuts enacted in June
Understand current outpatient primary care resources available for uninsured patients in Contra Costa County
Identify and realize strategies for connecting undocumented patients to outpatient follow-up services upon hospital discharge
Explain basic differences between types of insurance coverage in Contra Costa County
Brainstorm methods for increasing communication between financial counselors and medical providers at CCRMC
Goals of this Goals of this PresentationPresentation
Provide a bit of information gleaned during my 2 weeks on Community Medicine
Share experiences, corrections, arguments, thoughts, ideas…..
Foster conversation
Case 1Case 1 37 yo Spanish-speaking man with shortness
of breath
Case 2Case 2 27 yo woman w/AML still in hospital after
being discharged by her primary team earlier in the morning…..
Who are the insured in Who are the insured in our county?our county?
State MediCal
Medicare
Basic Health Care
Veterans
Healthy Families
Who are the uninsured Who are the uninsured in our county?in our county?
Visitors to the county
Wealthy uninsured (assets too high to qualify for MediCal or BHC)
Undocumented (as of June 2009)
Pausing for some Pausing for some definitions….definitions….
Immigrant: foreign-born individual
Legal non-citizen
Naturalized citizens
Undocumented immigrants
Undocumented Undocumented Immigrants in the USImmigrants in the US
39 million immigrants in US make up 13% of our population 7 in 10 of these are naturalized citizens or legal non-citizens
46% of ALL immigrants are uninsured; 59% of undocumented immigrants are uninsured Non-citizens make-up 20% of total US uninsured pts Undocumented immigrants are prohibited from Medicaid and CHIP Non-citizens are also prohibited from Medicaid and CHIP for their 1st 5 years in the US
Pregnant women and children in this category = state dependent
In 2005, Medicaid began requiring proof of citizenship which led to a decrease in coverage, largely due to loss of coverage in US citizens This new requirement cost $28 million in administrative costs 6 states combined spent $8 million to identify total 8 undocumented immigrants
US immigrants are healthier than the general population (thought 2/2 self-selection of who is healthy enough to immigrate)
sdf
What happens now What happens now with undocumented with undocumented
pts?pts? County writes off costs accrued during
inpatient stays
30 day override available for specially identified pts requiring specialty care Pts requiring longer care must be approved by
CEO
RN for specialty care acts as check/balance
New administrative costs?
Undocumented KidsUndocumented Kids
Undocumented Clinic Undocumented Clinic AccessAccess
Specialty AccessSpecialty Access
Basic Health CareBasic Health Care County Residents with limited assets
Do not qualify for MediCal or MediCare
Needs to be renewed frequently (every 6 months) but can be immediately approved (as opposed to MediCal, needs 4-6 months)
AO, AN, AT, AZ
Requires: proof of source of support (ie quarterly statement, pay stub); list of assets; proof of residence (PG&E, water bill); ID; proof of US citizenship Invited refugees ok (political asylum not qualified) Permanent residents ok Work authorization not qualified (work, religious, or student visas)
MediCareMediCare Open enrollment period each year
Ages 65 and older; renal failure
MediCalMediCal Age under 21 or over 65 are not eligible
Eligible: adults responsible for a deprived minor child; disabled greater than 1 year; pregnant women
4-6 months to get approved
Financial Counselors Financial Counselors and CCRMCand CCRMC
Every inpatient has a financial folder – either pending, PO, or BHC
All PO or BHC patients are seen by FCs during hospitalization to attempt to qualify them for better coverage
FCs make notes in E2Search (SW/case mgrs have access)
What’s the problem with BHC? Not really insurance – doesn’t cover pts outside of the county
even in emergencies MediCal reimburses better No ambulance coverage
What’s next?What’s next?
In ConclusionIn Conclusion
Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tost to me,
I lift my lamp beside the golden door!