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Crossing the Void

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

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Crossing the Void

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  1. Crossing the Void Understanding Contra Costa’s Newly Uninsured Patients Kali Stanger, MD PGY1 December 28, 2009

  2. Project 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

  3. Goals of this Presentation • Provide a bit of information gleaned during my 2 weeks on Community Medicine • Share experiences, corrections, arguments, thoughts, ideas….. • Foster conversation

  4. Case 1 • 37 yo Spanish-speaking man with shortness of breath

  5. Case 2 • 27 yo woman w/AML still in hospital after being discharged by her primary team earlier in the morning…..

  6. Who are the insured in our county? • State MediCal • Medicare • Basic Health Care • Veterans • Healthy Families

  7. Who are the uninsured in our county? • Visitors to the county • Wealthy uninsured (assets too high to qualify for MediCal or BHC) • Undocumented (as of June 2009)

  8. Pausing for some definitions…. • Immigrant: foreign-born individual • Legal non-citizen • Naturalized citizens • Undocumented immigrants

  9. Undocumented Immigrants 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

  10. What happens now with undocumented 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?

  11. Undocumented Kids

  12. Undocumented Clinic Access

  13. Specialty Access

  14. Basic 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)

  15. MediCare • Open enrollment period each year • Ages 65 and older; renal failure

  16. MediCal • 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

  17. Financial Counselors and 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

  18. What’s next?

  19. In 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!

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