Health Insurance and Coverage Options in

1
The Critical Role of Health Insurance as an Asset
Building Strategy

• Health Insurance and Coverage Options in
• Bay Area Counties

2
Current Environment

• Unprecedented instability
• Changing and challenging day-to-day
• Lots of anticipation (both hope and dread) about
  national health care reform
• Existence of coverage today doesnt mean that
  qualifying applicant can easily enroll and stay
  enrolled
• Program with given set of benefits doesnt ensure
  easy access or continuation of benefits
• Awareness lacking of economic impact on families

3
Insurance vs. Coverage vs. Access

• First lets dispel the biggest myth that
  insurance access
• Insurance is a legal term in California for
  risk-based products regulated by the Department
  of Insurance (DOI) and the Department of Managed
  Health Care (DMHC)
• Coverage generally refers to programs that
  provided limited coverage often to limited
  populations and are not generally regulated

4
Programs for Adults and Children A Messy and
Shifting Patchwork

• Medi-Cal
• Healthy Families
• Healthy Kids
• County Indigent Programs
• Other County Coverage Programs
• Categorical Programs
• Private Insurance
• COBRA

5
Insurance Programs for Children

• State policy
• Health programs for California children
• Childrens Health Initiatives
• CCHI the statewide organization
• What is happening in Bay Area counties

6
Adult Programs Both Insurance and Coverage in
Bay Area Counties

• COBRA and Federal Stimulus ARRA
• Medi-Cal
• County Indigent Programs
• County Medical Services Program (CMSP)
• Individual County Indigent Programs
• Coverage Initiative Programs in designated
  counties

7
Medi-Cal for Adults page 8

• Over 90 different categories of enrollment
• State administered program with federal matching
  dollars and requirements for participation
• Benefits have been comprehensive until recently
  with elimination of adult dental and other
  optional benefits
• Generally covers adults with incomes under 107
  FPL linked to children and seniors and people
  with disabilities who are at 133FPL
• PLUS applicants must fit one or more criteria
• Disabled
• 65 or older
• Pregnant (up to 200FPL)
• Skilled nursing facility

8
County Indigent Programs

• Section 17000 of the Welfare and Institutions
  Code (WI) mandates role of counties in provision
  of health care differences from county to county
• Single childless adults
• Undocumented individuals (county option)
• Bay Area counties are more similar than different

9
Bay Area Counties

• CMSP Program Solano, Sonoma, Marin, Napa
• Individual County Indigent Alameda, Contra
  Costa, San Francisco, San Mateo, Santa Clara
  all with public hospital systems
• Coverage Initiative Counties public hospital
  counties expansion of county indigent programs
  3 year federal waiver program anticipation of
  expansion and extension after August 2010

10
Individual County Descriptions - see appendix

• Alameda page 2
• Contra Costa page 3
• San Francisco page 4
• Santa Clara page 5
• San Mateo page 6
• Solano page 7
• Sonoma page 8
• Marin page 9
• Napa page 10

11
COBRA

• Consolidated Omnibus Budget Reconciliation Act
  enacted in 1985
• ARRA federal stimulus package recently
  expanded benefits and provided subsidies
• 18 month eligibility when workers leave jobs and
  want to continue coverage
• Costly option and often not used

12
Categorical Programs

• Family PACT
• Section 330 and FQHC look-alike Community Centers
  and Community Clinics
• Breast and Cervical Cancer and Prostate Cancer
  Screening and Treatment Programs
• IHSS Coverage for In-Home Supportive Services
  Workers through the local Public Authority

13
To get more involved

• Health access coalitions
• Childrens Health Initiatives and CCHI
• Community clinics and health centers and clinic
  associations
• PICO affiliates and other faith-based coalitions
• Health Access
• 100 Campaign

14
Future Possibilities

• National health care reform
• Expansion of state hospital waiver to expand
  Medi-Cal and Coverage Initiative
• Renewal of state health care reform efforts if
  national changes are not passed

15
For more information

• Bobbie Wunsch
• Pacific Health Consulting Group
• bwunsch_at_pachealth.org
• 415-459-7813
• www.pachealth.org