MADERA, California – Growing up among the dusty agricultural fields of the Central Valley, Ruby Marentes-Cabrera can’t recall a time without breathlessness.
Diagnosed early with asthma as a child, the 9th grader has come to loathe the pistachio trees that surround her home as dust, pesticides, and other allergens blow up her regular orchard. trigger an asthma attack – even breaking into her home to do simple tasks like vacuuming can be dangerous.
Ruby, 14, said: “We live very close to the fields – I breathe in the dust and chemicals in it. “It got so bad that my back hurt, my head hurt, my lungs hurt. I was sick and really had trouble breathing.”
Ruby is among about 2 million low-income Californians who have health insurance from Medi-Cal, the state’s Medicaid program, and have been diagnosed with asthma, a chronic and expensive illness that plagues California. Pay the price. BillionS dollars per year in healthcare spending, missed work for parents and lost school days for kids.
This disease – exacerbated by air pollution and indoor threats such as harsh cleaning products, cockroach infestations, dust and mold – affects low-income communities hardest. Follow quoted data by state health officials.
Starting in January, California will embark on an ambitious experiment to control asthma in its most vulnerable patients. Medi-Cal will provide recipients like Ruby with unique home “treatments” that are not traditionally considered healthcare: remove mold, install air purifiers, and even change carpets, curtains and mattresses.
This new benefits on asthma just a small part of Governor Gavin Newsom’s cleanup $6 billion initiative to transform the largest Medicaid program in the country. Initiative, called CalAIM, which will target the state’s sickest and most expensive patients and include a host of new social services, including healthy meals delivered to your home; help with grocery shopping, laundry and money management; and security deposit for homeless people looking for housing.
Newsom’s goal is to reduce skyrocketing Medi-Cal spending — reaching $124 billion this fiscal year — by stopping costly care services like emergency room visits. But state health officials admit the new benefits of asthma may not actually save taxpayers money.
Benefits are also not evenly distributed: Because Medi-Cal managed care plans have great discretion in deciding what new services to offer and to whom, the initiative This will create a patchwork between yes and no. Of the 25 participating insurance companies, 11 will provide Home asthma services began in January in 36 of the state’s 58 counties. In those counties, some Medi-Cal recipients will be eligible; others won’t.
With just two weeks to go before the program launches, many insurers are trying to establish a network of nonprofits and private contractors dedicated to providing home asthma services and home repairs.
For example, in San Bernardino and Riverside counties, approximately 400 patients served by Inland Empire Health Plan – of the nearly 1.4 million Medi-Cal program members – will have access to asthma services. during the first year, largely because the insurer has identified only one organization equipped to handle the liability.
“If we don’t get it right, this dream can become a reality,” said Alexander Fajardo, executive director of the El Sol Neighborhood Education Center in San Bernardino, which is negotiating a contract with the insurance company. a nightmare.
Fajardo said El Sol is frantically preparing. Although his organization has experience in providing asthma education, it does not have expertise in medical billing, patient privacy regulations, and regulated care contracts. manage.
“This is new, so we still have to learn,” said Fajardo.
Jeanna Kendrick, senior director of care integration for Inland Empire Health Plan, calls the experimentation to develop new social services “probably the hardest thing we’ve ever done”. It pushes plans into untapped territory, she says, contracting with community organizations and teaching them how to handle medical bills, for example.
“We really need to get creative and have some room to mess around because this is completely new to all of us,” says Kendrick.
Jacey Cooper, California’s director of Medicaid, argued earlier this year that health plans would start small but add capacity over the initiative’s five years. The state is providing incentive payments to help with plans to roll out new services and has set aside $300 million for the first half of 2022 alone.
The Department of Health Care Services, which administers Medi-Cal, cannot say how many low-income Californians will receive the new home asthma services, because they are voluntary and therefore it is not possible to predict future costs. But Anthony Cava, the department spokesman, quoted data showed that more than 220,000 Medi-Cal recipients had poorly controlled asthma. The state pays $200 to $350 for an asthma-related emergency room visit and $2,000 to $4,000 a day for a typical inpatient admission, department officials said.
Agency officials could not confirm the benefit asthma would save money, saying the cost would be the same or less than the cost of traditional medical treatments.
Under the program, health insurance companies will send contractors into homes and apartments to assess hazards and educate patients about conditions that can trigger asthma attacks. Insurance executives say they will consider approving any service that could help asthma patients – from replacing tattered rugs to purchasing non-toxic cleaning products and sheets pillow dust – in scope $7,500 lifetime limit for each Medi-Cal recipient. Services will be available to both tenants and landlords.
“Not someone can say they just want a brand new $3,000 mattress,” said Dr. Takashi Wada, medical director of Inland Empire Health Plan. “But we think a lot of these asthma attacks are preventable, and by avoiding illness you also avoid unnecessary hospital and emergency department visits.”
Fresno and Madera counties have several worst air quality in the state. They also have the highest rates of childhood asthma-related ER visits in California, along with Imperial County on the Mexican border, according to State public health data for 2019.
Joel Ervice, deputy director of the Regional Asthma Management and Prevention Division, said Ruby and her family, who live in Madera, California, appear to be ideal candidates for asthma benefits due to state funding. Both Ruby and her sister Yesenia, 20, have asthma and were frequent emergency room visitors during their childhood.
But as in the Inland Empire, initially only a small fraction of Central Valley asthma patients received the new services. Ruby and family hope they will be one of the lucky ones but realize they may still have to rely on conventional treatments like an emergency inhaler – and the hospital if necessary.
“I’m taking a lot of medication right now – it would be great if my asthma goes into remission,” says Ruby. “I’m having a hard time running miles at school, so maybe running will be good for me and my health.”
CalViva Health, a large insurance company serving Central Valley patients, including the Marentes-Cabrera family, has so far identified a nonprofit to provide services and is negotiating with other organisations.
That organization, the Central California Asthma Collaborative, is expected to be able to serve up to 500 people across seven counties next year. Unlike other nonprofit groups that are still evaluating how the service will be delivered, the collaborators have identified private contractors to remove mold, install ventilation in the bathroom or kitchen, and provides other services, said co-director Kevin Hamilton.
CalViva Health CEO Jeffrey Nkansah says asthma is one of the leading causes of hospitalization for those who enroll with the insurance company.
“But right now, the conversations around identifying partners to provide these asthma remediation services are flowing very well,” Nkansah said. “We are still working hard to ensure that we can deliver those services by January 1.”
For Marentes-Cabreras, the relentless clouds of dust and other toxins from the orchards, combined with seasonal wildfire smoke, are the biggest problem. The particles enter their lungs and home, cover surfaces and freeze on the carpet they want to replace. But they have no money.
Currently, Sandra Cabrera uses non-toxic cleaning products and daughters Ruby and Yesenia monitor their lung capacity with an oximeter.
“I’m trying to control things in the house to keep them from getting sick, do a lot of cleaning and use different cleaning agents,” Cabrera said in Spanish. “We could use the help to do more, but that’s really hard.”