Medicaid bridge plan expands healthcare in West Marin

12/29/2011

Amid erratic economic forecasts, West Marin residents living at or below the federal poverty line can soon rely on at least one certainty. 
Path2Health, a new County Medical Services Program (CMSP) initiative funded by California’s Federal Medicaid “Bridge to Reform” waiver and set to launch at the beginning of January, will eliminate bureaucratic and cost-prohibitive hoops to extend free health care coverage to nearly 30,000 additional uninsured state residents in 34 counties, including those in Marin.

The program is designed as a primer to the expected federal Medicaid expansion in 2014 that will allow CMSP to provide about 65,000 more low-income Californians with free or low-cost healthcare.

The eligibility requirements for Path2Health allow people at or below the federal poverty line, $10,890 in annual income for an individual or $22,350 for a four-person household, to receive free care—without having to prove that their assets do not exceed a defined amount. CMSP estimates that this change alone will enable more than 6,000 additional people to receive care. 

“The people that its going to affect the most are the people that are not on it now because they have too much money in the bank,” said Angelo Sacheli, program manager for West Marin Health and Human Services Center. “In the past, someone comes in and they were over the resource limit and we tell them, ‘Sorry, you’re over the resource limit, you’re not eligible.’”

To qualify for CMSP care under the old guidelines, people living at or below 100 percent of the poverty threshold were required to pass an “asset test.” The person had to tender documentation that his or her total assets, including a current bank balance, did not exceed $2,000.

According to Sacheli, many poor people were forced to spend down their rainy day savings or sell property to be inducted. Shedding financial resources will no longer be necessary under the new guidelines.

“Now we just look at their monthly income,” he said. “And that gets them in the program. [You] don’t have to become destitute to come in and be eligible for CMSP healthcare.”

Another significant difference in the Path2Health program will allow people between 67 percent and 100 percent of the federal poverty line to be released from associated costs. Under the current guidelines, this population had to shoulder some of the medical payments with a $300 deductible during months when the service was utilized. CMSP expects to recruit as many as 5,608 needy people with the share-of-cost modification. 

“Your care is covered but you have to pay the first [portion] every month,” Rafael Gomez, executive director of West Marin’s Coastal Health Alliance, said of the old rules. “It is a barrier, so it is nice to have that barrier removed.”

According to the executive director of CMSP Governing Board, Lee Kemper, this change makes the program compatible with people interested in basic health services, not just in expensive catastrophic or chronic care.  He added that a revamped outreach strategy, including media blasts, a website, brochures, and presentations to medical associations, will educate people on the new rules and hopefully account for another 16,000 enrollees.

CMSP will also provide new important benefits, like access to 10 mental health sessions and two drug counseling sessions per year—services it has not had the financial resources to provide before now.

Gomez said while the Coastal Health Alliance often provides psychological services to those who cannot afford it, Path2Health will make that practice more financially tenable.

“Those services aren’t yet sustainable on their own,” he said. “For a program to do this, [it] recognizes a need. It puts us one step closer to [being sustainable] without outside funding.”
Gomez added that reforms like this lay the groundwork for universal healthcare.
“We should capture as many people that are in need, and I think healthcare reform is working in the right direction,” he said.

Kemper was more measured in his evaluation of what the program will mean after its set two-year length. He said the future of public healthcare for the uninsured rural poor in California largely depends on whether the federal expansion of Medicaid in 2014 survives potential Congressional and Supreme Court review. 

“There’s a lot that’s unknown and despite all that’s unknown, our board felt this [program] was the appropriate strategy,” he said. “Are we building to something? I hope so.”