Growing up in the dusty farmland of the Central Valley, Ruby Marentes-Cabrera can’t remember when it wasn’t difficult to breathe.
The ninth grade student was diagnosed with asthma in her early childhood and began to hate the pistachio trees around her home, because dust, pesticides, and other allergens blown away from the orchard often trigger asthma attacks—even infiltrating her home. Such simple housework, such as vacuuming, can be dangerous.
“We live close to the fields-I inhale dust and chemicals,” said 14-year-old Ruby, who described the use of emergency inhaler suction or nebulizer breathing therapy to relieve cough and wheezing. symptom. “It got so bad, my back pain, headache, lung pain. I was sick and it became very difficult to breathe.”
Ruby is one of approximately 2 million low-income Californians who have Medi-Cal health insurance under California’s Medicaid program and have been diagnosed with asthma, which is a chronic disease and expensive. California’s costs are high. Billionsecond USD per year In terms of health care expenditures, parents missed jobs and children missed school hours.
This disease-exacerbated by air pollution and indoor threats (such as irritating cleaning products, cockroach infestation, dust and mold)-hits low-income communities the hardest. In 2016, Medi-Cal patients accounted for half of the state’s emergency and emergency care visits related to asthma, even though they accounted for about one-third of the population, according to Referenced data Provided by state health officials.
Beginning in January, California will begin an ambitious experiment to control asthma in the most vulnerable patients. Medi-Cal will provide recipients such as Ruby with unconventional home “treatments” that are not traditionally considered medical care: removing mold, installing air purifiers, and even replacing carpets, blinds, and mattresses.
These New asthma benefits It’s just a small part of Governor Gavin Newsom’s cleanup. $6 billion plan Transform the largest Medicaid program in the country. initiative, Called CalAIM, Which will target the most severely ill and costly patients in the state, and will cover a range of new social services, including home-provided healthy meals; help grocery shopping, laundry, and money management; and help the homeless who are looking for housing The margin provided.
Newsom’s goal is to reduce the soaring Medi-Cal expenditure by preventing expensive care costs such as emergency room visits, which reached an astronomical figure of $124 billion this fiscal year. But state health officials admit that the new asthma benefits may not actually save taxpayers money.
Benefits will not be evenly distributed: because the Medi-Cal managed health insurance plan has huge powers to decide which new services to provide and to whom, the plan will create intricacies for the rich and the poor. Among the 25 participating insurance companies, 11 will provide 36 of the 58 counties in the state started providing family asthma services in January. In these counties, some Medi-Cal recipients will be eligible; others will not.
With only two weeks left before the plan starts, many insurance companies are scrambling to establish a network of non-profit organizations and private contractors that specialize in home asthma services and home repairs.
For example, in San Bernardino and Riverside counties, among the nearly 1.4 million Medi-Cal plan members, about 400 patients receiving Inland Empire Health Plan services will receive asthma services in the first year. This is because the insurance company has only identified an organization capable of handling responsibilities.
“If we don’t do it right, this dream may turn into a nightmare,” said Alexander Fajardo, executive director of the San Bernardino El Sol Community Education Center, who is negotiating a contract with an insurance company.
Fajardo said that El Sol was preparing frantically. Although his organization has experience in providing asthma education, it has no expertise in medical billing, patient privacy regulations, and managed care contracts.
“This is new, so we still need to learn,” Fajardo said.
Jeanna Kendrick, senior director of care integration for the Inland Empire Health Program, called this experiment in developing new social services “probably the most difficult thing we have ever done.” She said it pushed the plan into uncharted territory, for example, signing contracts with community organizations and teaching them how to handle medical bills.
“We do need to be creative and have some leeway, because this is new to all of us,” Kendrick said.
Jacey Cooper, director of California’s Medicaid program, argued earlier this year that the health plan will start on a small scale but will increase capacity within five years of the plan. The state is providing incentives to help plan the launch of new services, and set aside $300 million in the first half of 2022 alone.
The Department of Health Care Services, which administers Medi-Cal, cannot tell how many low-income Californians will receive new home asthma services because they are voluntary and therefore cannot predict future costs. But department spokesperson Anthony Cava (Anthony Cava) Reference data Shows that more than 220,000 Medi-Cal recipients have poor asthma control. Department officials say the state pays $200 to $350 for a typical asthma-related emergency room visit and $2,000 to $4,000 per day for a typical hospitalization.
Agency officials were unable to confirm whether asthma benefits would save money, saying the cost would be equal to or lower than the cost of traditional medical care.
According to the plan, health insurance companies will send contractors into houses and apartments to assess hazards and educate patients about the conditions that may trigger an asthma attack.Insurance company executives said they will consider approving any services that can help people with asthma — from replacing broken carpets to buying non-toxic cleaning products and pillow dust covers — in $7,500 lifetime cap For every Medi-Cal recipient. These services will be provided to renters and homeowners.
“It’s not that anyone can say that they just want a brand new mattress worth $3,000,” said Dr. Takashi Wada, chief medical officer of the Inland Empire Health Program. “But we do believe that many asthma attacks can be prevented. By avoiding illness, you can also avoid unnecessary hospital and emergency department visits.”
Fresno County and Madera County have some The worst air quality In the state. According to their data, they also have the highest rate of emergency room visits for children with asthma in California and Imperial County on the Mexican border. 2019 National Public Health Data.
Joel Ervice, deputy director of regional asthma management and prevention lobbying for new services, said Ruby and her family, who live in Madeira, California, appear to be ideal candidates for state-sponsored asthma benefits . Ruby and her 20-year-old sister Yesenia both suffer from asthma and used to go to the emergency room during childhood.
But like the Inland Empire, only a small percentage of Central Valley asthma patients will initially receive the new services. Ruby and her family hope they will be lucky, but realize that they may still need to rely on traditional treatment methods such as emergency inhalers—and go to the hospital if necessary.
“I am currently taking a lot of medications-it will be fine if my asthma gets better,” Ruby said. She hopes to be able to play outside at home and perform well in outdoor school activities. “It is difficult for me to run a mile at school, so being able to run is great for me and my health.”
CalViva Health is a large insurance company that provides services to patients in the Central Valley, including the Marentes-Cabrera family. So far, it has identified a non-profit organization to provide services and is negotiating with other organizations.
The organization, the Central California Asthma Cooperative, is expected to serve up to 500 people in seven counties next year. Unlike other non-profit organizations that are still evaluating how to provide services, the cooperative has identified private contractors to remove mold, install bathroom or kitchen ventilation, and provide other services, said co-director Kevin Hamilton.
CalViva Health CEO Jeffrey Nkansah (Jeffrey Nkansah) said that asthma is one of the main reasons for insurance company participants to be hospitalized.
“But now, these conversations around identifying partners to provide these asthma treatment services are unstable,” Nkansah said. “We are still working hard to ensure that we can provide these services on January 1.”
For Marentes-Cabreras, the ruthless cloud of dust and other toxins in the orchard, coupled with seasonal wildfire smoke, is the biggest problem. These particles infiltrate their lungs and their homes, covering the surface and clumping the carpet they want to replace. But they have no money.
Currently, Sandra Cabrera uses non-toxic cleaning products, and daughters Ruby and Yesenia use oxygen meters to track their lung capacity.
Cabrera said in Spanish: “I try to control the things in the house to prevent them from getting sick, clean often and use different detergents.” “We can use help to do more things, but it’s really difficult. “
Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.