SAN JOSE, California — Crisanta Alias, an immigrant from Sampaloc, Quezon Province in the Philippines, is 87 years old but considered to be very healthy for woman her age.
Alias was among the speakers at New America Media’s Ethnic Media news briefing about the State of California’s new Cal MediConnect in Santa Clara County held in San Jose recently.
Crisanta came to the United States in 1993, and has lived at Mabuhay Court, a government-subsidized housing program in San Jose, since 1998. She has lived there alone since her husband died, and has also outlived two of her sons who died in the Philippines. Crisanta occasionally visits two other adult children still living in Quezon Province.
A government-provided homecare aide helps her now when she needs someone to look after needs she can no longer take care of on her own. But the new program may help smooth out other aspects of her care.
Cal MediConnect, a pilot program that the State of California is testing in eight counties, aims to improve care for low-income seniors and people with disabilities, who are dually eligible for federal Medicare and state Medicaid benefits.
Called “dual eligibles” by health professionals, the pilot program will include almost a half-million people in California, about 37,000 of them in Santa Clara County.
Each person who signs up for Cal MediConnect will be assigned a care coordinator to help them better manage their Medicare and Medi-Cal benefits, which have long been confusing for patients, leaving costly gaps in care for the state.
Cal MediConnect also provides dual eligibles, for the first time, with vision care and non-emergency transportation, such as a taxi to a doctor’s office, up to 30 times a year.
Crisanta Alias has a busy schedule though, and even passes her time line dancing, which keeps her healthy.
“I am assigned at the front desk registration of the Merchant Community Center as a volunteer worker,” she said.
“My schedule varies, although at present I have Monday morning duty up to noon, whole-day Tuesday duty and Thursday 9:30 a.m. to 3 p.m. duty. On Wednesdays, I attend Chinese calligraphy session.”
She has had no major medical operations, no major surgeries nor serious illnesses in all the years she has spent in the United States, making her one of the healthiest 87-year-olds around. She experiences back pains every now and then but is otherwise worry-free.
If she were to sign up for Cal MediConnect, though, she would have to sign up with one of two approved health care plans for Santa Clara County: Anthem Blue Cross or Santa Clara Family Health Plan.
When beneficiaries like Crisanta receive their blue information envelopes about the new program from California’s Department of Health Services they can opt out of the program at any time. But if they say no to Cal MediConnect, they must still be in a managed care plan for the Medi-Cal part of their coverage.
Crisanta is currently covered for her Medicare and Medi-Cal through United American as her current medical provider. She disclosed that she does not have problems with her medical coverage with United American that she even recently received her renewal of coverage letter from them even if though the year is not yet over.
With her current health care plan, she chose a primary doctor who has an office near the place she stays for easier access, near enough she can practically just walk after a short bus ride going there.
When told that she must decide whether or not to join Cal MediConnect plan by the time it rolls out in Santa Clara country this January, Alias initially welcomed it.
“Having a medical coordinator will certainly be a big help, if ever I need to request medical assistance,” she said. Crisanta also noted that having some of the plan’s allowed non-emergency health care trips would be helpful.
And she likes the eyeglass provision of $100 every two years. “I may need to replace my old one soon,” she explained. “This will be a big help to me because of the added benefits and coordination.”
There is one important thing she wants to be sure about, though.
Crisanta wants to know whether, in joining the Cal MediConnect, she can still keep her primary doctor that she has been going to for many years and has full faith and trust in for all her medical needs.
Other Filipino dual eligibles in the area expressed reservations on having to change their doctors in case their current doctors do not belong to Cal MediConnect’s Santa Clara Family Health Plan or Anthem Blue Cross plans.
Filipinos are known to usually stick to the doctors they are familiar and very comfortable with and at times treat them more like family, especially those they have been with for so long.
How flexible then can Cal MediConnect be on this?
The program’s guidebook indicates there is no problem, if the beneficiary’s doctor is part of the Cal MediConnect plan’s provider network.
But if the doctor is not “in-network,” a prospective member like Crisanta may ask her doctor about joining the plan’s network of her choice while also informing her chosen plan that she wants to keep seeing her doctor.
If her doctor agrees, he or she can work only with their patient through the approved health plan for up to the first six months. After that period, the physician can only continue by joining the plan and agreeing to accept some of its other patients. Or the doctor’s patient has the right at any point to change to another plan or to opt out of Cal MediConnect.
If Crisanta were to remain in Cal MediConnect without her original doctor, she would have to start seeing other physicians in the plan’s network.
At the moment, Crisanta admitted that she has not yet decided on whether to join the new Cal MediConnect plan and is still studying the health plans available in her county and, more importantly, whether she can continue to keep her primary doctor
Another concern aired by some Filipino dual eligibles is that of the coordination between social workers, case managers and the plan’s care coordinator.
Ryan McDonald of Harbage Consulting, who also spoke in the San Jose briefing, explained that each person’s care will be done by a health care team.
He explained, “There will be a health risk assessment. The plan is going to look at all their needs, look at all the providers, look at all the services they may need and what they already have. They will put all that on file. Then the care coordinator is going to look at all the moving components in that file. The coordinator is going to be the glue that connects the beneficiary’s whole team including all the providers that are in that beneficiary’s life. They are going to be able to connect to them to share information with the providers.”
Depending on the need of the moment, McDonald also stated that beneficiaries will go either to their social worker, case manager or care coordinator.
“But you can always go to the care coordinator of the health plan. If you don’t know where to go then he will be able to connect you to the right services of the correct people,” McDonald advised
Because many dual eligibles have found the decisions they must make under Cal MediConnect to be confusing, Marcelo Espiritu, of Santa Clara County’s Health Insurance Counseling and Advocacy Programs (HICAP), acknowledged, “The decision to transition [into the new program] is the most difficult.”
Simpler to navigate
Espiritu, a Filipino American product analyst for HICAP through Sourcewise Community Resource Solutions, continued, “Once the person is in such a plan, then it proves to be a little simpler to navigate the existing system. But it is the decision and the choice that are difficult to the people.”
Espiritu emphasized, “You can call us to explain what you can and cannot get as benefits for the various plans available.” Espiritu added that HICAP is a nonprofit agency, is not representing any plans, and is a free service.
Open 8 a.m.–5 p.m., HICAP can work calls in Tagalog or other languages. Those leaving a phone message will hear back from HICAP within a day or two. The Santa Clara office number is (408) 350-3200 (press 2 for HICAP).
Espiritu added, “We could talk to you on the phone or you can make an appointment with a staff member or a volunteer and we can help you look at your options.”
For more information about Cal MediConnect, visit the website, www.calduals.org. To learn more about the approved Cal MediConnect providers in Santa Clara County contact the Anthem Blue Cross Provider Service Representative at 1-855-817-5786, or visit them online. [http://www.anthem.com/ca/home-providers.html]. At the Santa Clara Family Health Plan, contact their service representative at 408-376-2000, or see their website. [http://www.scfhp.com/for-providers]
Jun Nucum wrote this article for INQUIRER.net supported by a New America Media journalism fellowship sponsored by The SCAN Foundation.
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