Oaklanders lined up for RAM medical care, April 2011, http://www.zimbio.com/pictures/EJZaXcZ9lMk/Remote+Area+Medical+Provides+Fr
When ?Jeffrey? walked into Bay Area Legal Aid?s Oakland office in January, his life could not have been going worse.
The homeless, 26-year-old Oakland resident had a long history of mental illness and already had undergone three involuntary confinements in psychiatric hospitals this year. With no regular medical care and his mental conditions worsening, there was no end in sight to his downward spiral.
Like thousands of people living on Oakland?s streets, Jeffrey had crashed through the healthcare safety net. He was ineligible for Medi-Cal (California?s version of Medicaid) and had no health insurance.
?Basically, his healthcare consisted of going to the emergency room at Highland General Hospital when things got out of control,? said Abby Herzberg, the BayLegal attorney who saw him that day. ?Next to no care at all, that was the worst option for him and the most expensive for the County.?
But in 2010, Congress set the wheels in motion to assist Jeffrey and 16 million other poor Americans. By passing the Affordable Care Act - or ACA, the most sweeping healthcare reform in nearly 50 years - Congress committed about $940 billion over 10 years to expand Medicaid. While there is little about the ACA that is not controversial, no one disagrees that it is big. Once this portion of the ACA is implemented in 2014, all Americans under 133 percent of the federal poverty level will be eligible for Medicaid.
When Jeffrey first met Herzberg, the fine points of federal healthcare policy were the last things on his mind. All he knew was that he needed help and time was not on his side.
The ACA also provides money for states and counties to expand Medicaid eligibility even before 2014. For every dollar counties spend on these efforts, the federal government chips in a 50-cent match. Given the political uproar surrounding the ACA, many local governments have not taken advantage of this funding.
Alameda County, by contrast, has led the way in California and already has signed up more than 75 percent of its 56,000 eligible residents. Under the county?s indigent health program, now called HealthPAC, these enrollees are now benefitting from an expanded and increasingly more efficient array of healthcare services.
The HealthPAC program also has been a good investment for the county.
?By the end of the year, with the federal matching funds, we will have $50 million in new revenue,? Alex Briscoe, director of the Alameda County Healthcare Services Agency, said.
Oakland-based BayLegal, the Bay Area?s largest legal aid group, has a federal grant to take part in the sign-up effort. Along with other advocates statewide, BayLegal has been working to help local indigent populations take advantage of federal healthcare reform.
For Jeffrey, that has meant access to the care he needs. Herzberg took him immediately to TRUST Clinic, a new facility designed for the county?s mentally ill and homeless population. Jeffrey has had four subsequent visits there and also will have his primary healthcare needs met at Lifelong Medical Care.
?Taken together, this is a much better setup for him than going to the emergency room at Highland,? Herzberg said.
?BayLegal has brought in about 1,500 mentally ill consumers who have never had a medical home and now have a regular source of care,? Briscoe said. ?We?re happy about that. The mentally ill and homeless population is particularly hard to reach.?
Briscoe recalled going to a homeless shelter soon after the ACA was passed and announcing that everyone there will be covered so long as they bring in their birth certificates.
?The manager there told me, ?Alex, they can?t even find their shoes, much less their birth certificates,?? Briscoe said. ?So we got creative. We went and found birth records from the states from which a lot of the population comes, got those records and matched them to a significant number of the people.?
Because Alameda County was already running its own indigent healthcare program before the ACA was passed, the county had mechanisms in place to bring in the newly eligible Medi-Cal population, such as a simple web-based application process. Additionally, the Alameda County has established dozens of ?new points of entry,? including application centers in schools, community colleges and medical facilities.
The goal, Briscoe said, is to get every eligible resident enrolled: ?When that happens, then the dollars roll in to pay for the healthcare delivery system.?
To handle all of the new enrollees, clinics will need to be built, more doctors and nurses hired and new efficiencies put in place. Additionally, under federal requirements, each enrollee must be assigned to one of about 30 specific ?medical homes.?
By all estimates, none of this will be easy, but the work has already begun. The new TRUST Clinic is one example. So are new facilities being built to serve people afflicted with HIV/AIDS. The county also is making basic workflow changes to improve cycle times and serve patients as efficiently as possible.
?Doctors will no longer be taking blood pressure readings,? Briscoe said.?
All of this is a work in progress. The outcome of the county?s effort to take advantage of the ACA while continue offering care to people who still won?t qualify for Medi-Cal and do it all in the midst of a prolonged recession is anything but certain.
?We refuse to be imprisoned in scarcity,? Briscoe said. ?We?ll get this done.?
But for Jeffrey, who is finally receiving the medical attention he needs and will no longer have to depend on the emergency room for his primary healthcare, the effort has already been a success.
?Before he came into our office, his situation was nearly hopeless,? Herzberg said. ?Now at least he has a chance.???
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