KUSP Topics in Health

Interviews with Sam Farr on the health care bills and their importance in the Monterey Bay area

Sam Far on hopes for a fix to low Medicare reimbursement in Monterey Bay area

Sam Farr discusses tradeoffs in the health care bills

Sam Farr reviews the State of the Union address and hopes for a health care overhaul

Farr – still hope for health overhaul

The Monterey Bay area’s representative to Congress says he thinks a good health bill will still make it into law, though he didn’t lay out a specific political path. And Sam Farr says that hope includes hope for his fix for the Medicare reimbursement designations for Santa Cruz, Monterey and San Benito counties. These three counties bear a rural designation for Medicare rates since the system was established in the 1960s. So despite costs for operating that are at parity, doctors get about 2/3 the reimbursement per patient visit that doctors get in neighboring Santa Clara County.

On the politics of the health care overhaul, Farr acknowledged the path would be difficult. But he noted that difficulty is the norm with significant legislation. Speaking after the President’s State of the Union Address, Farr alluded to Obama’s chastising of Congressional Republicans. Farr suggested that advocates for the health overhaul may find the traction they need by campaigning for the bill among the constituents of legislators that hold it up.

Immigration Reform and Public Health

Immigration reform is in the air once again – with President Obama saying the issue will be tackled next year. Join Health Dialogues as we look at what it’s like for undocumented and seasonal workers to get health care under the current system, and how immigration reform could change things.

Elderday, adult day health care breathe easier

California is one of only a few states that covers adult day health care programs for Medicaid recipients. Adult day health care centers provide daytime supervision for people with cognitive, physical and social impairments. They also administer a variety of prescribed therapies. Since May, supporters of adult day health care have been rallying—first against a cut of all Medi-Cal funding. More recently, they rallied against a proposal to cap the number of days Medi-Cal recipients would be able to attend these programs. From Elderday, an adult day health care program in Santa Cruz, Christopher Connelly has this story.

Elderday is the only adult day health care program in Santa Cruz County. The center has about 150 regular paritipants over the age 50 with a variety of physical, cognitive and social impairments. A typical day begins at 8 or 9 in the morning, when the participants are picked up from their homes by bus and driven to the facility.

Elderday does everything that any adult daycare center does, providing seniors a chance to socialize with each other and with staff members, a variety of activities to keep them sharp and meals and supervision while their families and caretakers work during the day. But what separates adult daycare programs from adult day health care centers is the range of therapeutic and health services that are offered at programs like elderday. They provide physical and occupational therapy, case management, mental health services, excercize, transportation, podiatry and nursing.

Sheri Anselmi is the director of Elderday. She says that in California, there are over 33,000 participants at around 330 adult day health care facilities. While most participants are seniors, the facilities can serve adults of any age.

Starting last spring, anselmi and other adult day health care supporters have been fighting to keep Medi-Cal funding intact. She says that the battle began in may, when Governor Schwarzenegger proposed to cut all Medi-Cal funding of adult day health care to help balance the budget. Although a total cut didn’t gain traction, the idea was revised. In July, lawmakers and the governor passed the budget revision package that would scale back the number of days Medi-Cal would pay for—from five to three days per week.

Anselmi says although it was not a total cut, the effect of the cap on her facility would have been severe.

A law suit was filed in august on behalf of three women who attend adult day programs paid for by Medi-Cal five days a week. They argued that the cuts violated the Americans with Disabilities Act and federal Medicaid law because it failed to provide alternative care and was therefore a cut in medically necessary services. They said that the cap would lead to institutionalization in nursing homes in most cases.

The case was heard on September 9^th in federal district court in Oakland.

On September 10^th, Judge Sandra Armstrong ordered an indefinite suspension of the cap, saying that scaling back services would cause irreparable and immanent harm to the people who rely on them, and that the state was obligated to provide alternative services that would prevent insititutionalization.

The Health Effects of State Budget Cuts

September 2009 Health Dialogues

www.HealthDialogues.org

As Congress considers a major overhaul of the U.S. health care system, Health Dialogues examines how the new state budget will affect health care closer to home. Will kids in low income families be able to get basic services? What about drug treatment programs mandated by Proposition 36? And how may where you live affect the care you’ll get?

The Value of Community Health Clinics

Many unemployed Californians and the working poor often turn to the nearly 800 community health centers throughout the state when they need medical attention. Host Scott Shafer visits the Russian River Health Center in Guerneville, in rural Sonoma County, to see how the state budget cuts have affected staff and patients.

Proposition 36 Coping With Significant Cuts

California’s landmark Proposition 36 was intended to send drug users into treatment, rather than prison. The current budget slashed Prop. 36 funding almost in half. That complicates things for the Superior Court in Santa Clara County, where Judge Stephen Manley oversees Proposition 36 cases. Guest: Honorable Judge Stephen Manley, Santa Clara County Superior Court judge.

Map of Rural Health Clinics

For more information, visit www.HealthDialogues.org

Health Dialogues Looks at Food Safety

Photo by Shuka Kalantari

Recent scares over tainted peanut butter and spinach exposed holes in our system of protecting the food supply. President Obama called for tougher food safety measures, and in May of this year launched a Food Safety Working Group to update the system of food safety in America.

Health Dialogues host Scott Shafer begins by interviewing two voices familiar with food safety at the federal level: Michael Taylor, the newly appointed Senior Advisor to the Commissioner at the Food and Drug Administration, and Dr. David Acheson, who, until the end of July, worked as Associate Commissioner for Foods at the Food and Drug Administration. The program also looks urban gardening safety and lead as well as the dangers of sport fishing.

Health Dialogues also visits two grocery stores in San Francisco’s Outer Mission with food inspector Sheldon Lew to see what the food inspection process looks like.  Lew talks about what red flags he looks for during food inspections.Visit www.HealthDialogues.org to watch an audio slideshow of the inspection.

Also, check out an audio slideshow of foods imported into the United States with FDA inspectors at the Los Angeles Port of San Pedro.

Severe cuts to children’s health coverage

After months of wrangling, California’s legislature finally approved a budget. The governor is expected to sign it next week. Among the many severe cuts in the budget is about a third of Health Families, a program that provides health insurance for children whose families can’t afford private insurance, but who don’t qualify for Medi-Cal. KUSP’s Robert Pollie has this report.

Health care overhaul

On Your Call right now Anthony Iton, director of the Alameda County Public Health Department: even with universal coverage there’s not enough primary care.

Are we ready for universal health coverage?

Are we ready for universal health coverage? On the next Your Call we discuss the status of the health care reform effort. President Obama’s Wednesday evening press conference is his attempt to reinvigorate a wavering Congress. But what happens if everyone gets a health insurance card? Are there enough primary care doctors? Would more healthcare mean better outcomes for patients? We’ll speak with Anthony Iton, director of the Alameda County Public Health Department, and take your calls. Send us an email at feedback@yourcallradio.org or join us live at 11 a.m. How do we get from better healthcare to better health? It’s Your Call with Rose Aguilar and you.

The State Budget and the Safety Net

Safety net nonprofits, the organizations that provide food, clothing, medicine, health and mental health care for central coast resident have caught a dual edged attack over the past couple years. Climbing unemployment, food and energy costs meant more clients for food and other direct assistance just as the state legislature halted nonessential checks last summer for a period of weeks. Many of these organizations contract with the state or with state programs through local governments. All indications are that this squeeze between increased demand and uncertain state funding has intensified in the proceeding 12 months.

In health and mental health care nonprofits, these challenges build complexity as the state chooses to opt out of programs with generous federal funding and release prisoners early from jails and prisons. In Santa Cruz and Monterey counties, patients receiving state subsidized addiction treatment
will see fewer effective options. In particular, residential rehabilitation may fall well out of reach. The potential loss of assisted day programs like Salud Para la Gente’s Elderday may leave families with few options for care for family members who need some nursing help during the day. As Sarah Clarenbach noted in her post on this blog, the loss of the state portion of adult dental care under Medicaid probably means people who need treatment for cavities will go without.

Each of these are cases that illustrate the strategic effort on the part of safety net nonprofits to provide subsidized services that help people with limited resources avoid devastating outcomes like imprisonment, hospitalization or placement in an assisted living facility. Outcomes that end up costing society more in moral terms and probably in fiscal terms.

April topic: cuts to Medi-Cal optionals – J.D. Hillard

According to the current state budget, cuts to Medi-Cal optionals would take place in June. State funding for psychological, podiatric, dental and other services for indigent patients would be eliminated. Recent reporting differs as to whether the federal stimulus may contain funds that will make up some of this funding.

How does the uncertainty around this funding affect staffing and services? What direct effects of a cut would you expect in your agency? How would patients experience these effects? Who are the patients who benefit from this funding – can you describe the conditions the need help with, the circumstances that lead them to need government assistance? When patients seek services that have been defunded what will they encounter? If defunding leads to emergency room visits, what outcomes are likely for patients and for hospital resources?

J.D. Hillard

Talk and Information Producer KUSP