Community Health Centers gears up for expanded Medi-Cal program

jlavelle@thetribunenews.comJanuary 11, 2014 

Patients getting checkups, dental work, eye exams and various other services may not notice the sense of urgency at Community Health Centers of the Central Coast.

But the 36-year-old nonprofit is undergoing dramatic change.

As the main provider of primary care to people on Medi-Cal in San Luis Obispo and northern Santa Barbara counties, the nonprofit is scrambling to hire staff, expand programs and reconfigure its network of 26 clinics in order to care for the thousands of people expected to be added to the Medi-Cal rolls under an expansion of the program that began Jan. 1.

As part of the Affordable Care Act, or Obamacare, about 1 million more adult Californians were expected to be eligible for Medi-Cal this year, including as many as 19,000 San Luis Obispo County residents.

From the start, the Obama administration envisioned community clinics caring for the bulk of Medi-Cal patients (called Medicaid in other states) and in the last four years has doled out $5.2 billion to clinics nationwide to help them gear up — including $21.2 million to Community Health Centers of the Central Coast.

The goal is for clinics to serve as a “medical home” where low-income residents can see a doctor for minor illnesses or preventive care, instead of waiting until they get so sick they head to an emergency room.

Ron Castle, chief executive officer of Community Health Centers, said that ever since Congress passed the federal law in 2010, the nonprofit has been focused on this moment.

“This is a very exciting time,” he said. “We knew 2014 was going to be a very challenging year. But this is what a lot of us have been waiting for, when our residents would have access to affordable health insurance to get the care they need.”

Filling a coverage gap

A survey by the UCLA Center for Health Policy Research shows that about 19 percent of San Luis Obispo County residents ages 18-64 — or about 34,000 adults — had no health insurance in 2011-12, the most recent data available.

Under the Affordable Care Act, uninsured adults can buy policies through Covered California, many with the help of a federal subsidy. While the insurance mandate has taken center stage, a supporting actor is Medi-Cal, which has now been expanded to cover most adults with incomes below 133 percent of the federal poverty level. That’s $15,856 for an individual and $32,499 for a family of four.

County officials estimate that 12,000 to 19,000 county residents qualify for Medi-Cal under the new expansion, in addition to the 18,000 people — mostly children — who already get Medi-Cal in the county.

Tracy Schiro, assistant director of the county Department of Social Services, said that as of Monday, 3,200 people countywide have been approved or are awaiting approval for Medi-Cal under the expansion. Schiro said she expects those numbers to steadily grow.

“Hopefully, with expanded Medi-Cal people won’t have to choose between getting medical treatment and putting food on the table,” she said.

Making an impact

For Nathan Appel, a 41-year-old freelance photographer from Santa Maria, receiving his Medi-Cal card in the mail last week was exciting. Using it was monumental.

For the past year, Appel has paid out of pocket to see a psychiatrist at Community Health Centers in Nipomo and to buy medication for clinical depression and anxiety that led to several suicide attempts in the past. Struggling both with his health and his finances, Appel says that in the last few months, the treatment has changed his life.

"I can laugh now or sing along with the radio — normal-people things that I couldn’t do before,” he said.

But even with the reduced-fee psychiatric care at CHC and medication discounts, Appel sometimes had to skip appointments to save money.

Then on Monday, the Medi-Cal card arrived, and on Wednesday he went to Walmart to pick up his medication.

“I pulled out my wallet to pay for it and saw the bill was zero. I just had to sign for it,” he said, his voice laced with awe. Next week, he will see his psychiatrist for the first time since November and may even schedule his first physical in a decade.

“I’ve never had anything like this happen before,” he said, “where I didn’t have to worry about something as important as going to the doctor.”

One-stop shop

The most obvious sign that Community Health Centers has been mobilizing for 2014 can be found in Nipomo, where the nonprofit opened a 28,000-square-foot clinic last March. The handsome earth-toned building cost about $9 million, with $7.5 million coming from federal funds.

The spacious clinic is designed with efficiency in mind and is what Castle calls a “supercenter,” with extended hours and a full range of medical services including primary care for all ages, optometry, dentistry, chiropractic care, mental health, nutrition and laboratory services.

Castle wants to create six full-service supercenters, with fewer small clinics. Paso Robles, San Luis Obispo, Arroyo Grande, Nipomo, Santa Maria and Lompoc “are all on the road to being supercenters,” he said. “They will be true supercenters when they’re open from 8 a.m. to midnight, seven days a week. It might take us awhile to get there, but we will.”

CHC also is recruiting across the spectrum of health care — from primary care and specialty physicians to nurses and mental health professionals, said Dr. John Khan-Variba, a pediatrician and CHC’s medical director. So far, two physicians, 11 nurse practitioners and physician assistants, plus two psychiatric nurses have been hired.

Recruiting doctors has been the biggest roadblock to expansion, Khan-Variba said. “But we’re on our way to doing it,” he said.

Emphasis on outreach

CHC officials estimate that about 11,000 current patients who have been paying out of pocket now qualify for Medi-Cal. To get those patients enrolled and to help anyone else sign up, CHC used a $320,000 federal grant for outreach and enrollment staffing.

Six employees have been trained as Covered California certified enrollment counselors to help people sign up for insurance or Medi-Cal. An outreach team, partnering with the Prado Day Center in San Luis Obispo and the Five Cities Homeless Coalition, is working to enroll poor and homeless people in Medi-Cal.

Sally Smith is one of those 11,000 CHC patients who now qualifies for the expanded Medi-Cal program.

Smith, 60, lives in San Luis Obispo and worked as a nurse for 36 years before a shoulder injury in 2012 left her unable to do the heavy lifting required for her job. She has been unemployed since then and, like millions of people looking for work, without health insurance.

Now that she has Medi-Cal, Smith can get comprehensive medical care including the checkup she had at CHC’s San Luis Obispo clinic this week, complete with mammogram, blood work and pap screening.

“I’m really grateful,” Smith said. “I wouldn’t be able to put out the money now to get a well-woman exam, and it’s been a number of years since my last one. So for me, this is a blessing.”

Getting patients like Smith the appropriate care requires an efficient tracking system. Two federal grants totaling $2 million were used for a project, about 85 percent complete, to convert all patient files into electronic health records accessible from any of the 26 health centers, Castle said.

The Obama administration has required the conversions to electronic systems to streamline health care and lower costs by eliminating duplicate services if a patient goes to more than one clinic.

Right now, CHC officials seem most excited about a new central call center for patients to make appointments and, maybe more importantly, where CHC “navigators” call to remind patients due for a checkup or vaccinations, or to monitor chronic conditions such as diabetes and high blood pressure. The patient navigators also connect callers to CHC’s Covered California enrollment counselors.

“Patients typically call in when they’re not feeling well instead of when they need to come in,” said call center director Victoria Wood. “Now that we have electronic health records, we can look at the entire chart to see what they need, what they’re due for, what they can benefit from.”

And now, Wood said, “When patients call for an appointment we’re able to offer them help in getting insurance or Medi-Cal.”

The call center opened in July with eight navigators staffing the phone lines for three clinics. By April, 60 navigators are expected to be handling calls for all 26 clinics.

Poised for growth

The dramatic changes amount to a third incarnation for Community Health Centers, which Castle and Dr. James Dorr cofounded in 1978 to provide health care to farm workers out of an old four-bedroom house in Nipomo.

Starting with seven employees and a $100,000 annual budget, CHC had grown to 18 clinics by 2004, when it entered its second life. That year, the nonprofit took over responsibility for San Luis Obispo County’s four public health clinics.

“I’ll never forget it,” Castle said. “They handed us the keys at 6 p.m. on a Friday and we got the electricity turned on and everything switched over to open the following Monday.”

Today, CHC serves 90,000 patients a year, employs 570 people and operates on a $75 million annual budget. Those numbers are all expected to grow as CHC responds to changing health-care demands under the Affordable Care Act.

Khan-Variba, the medical director, echoed Castle’s comments that he’s been looking forward to the changes.

“When you’re on the front lines of health care, you see people who haven’t gotten medical care they need,” he said. “It’s heartbreaking to see that. We have the mechanism now to provide it. That’s a very positive step.”

 

COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST

CHC AT A GLANCE

Headquarters: Nipomo

Clinics: 26 throughout San Luis Obispo and northern Santa Barbara counties

Employees: 570, including 60 physicians, 10 dentists and one optometrist

Patients: 90,000 patients and 400,000 patient visits annually; 65 percent are in San Luis Obispo County

Annual budget: $75 million in revenue with 60 percent from Medi-Cal, 15 percent from Medicare, 25 percent from private insurance or out-of-pocket patient payments. Patient payments are on a sliding scale based on ability to pay.

Contacts: communityhealthcenters.org; 805-929-3211

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