Federal waiver allows coverage to eligible adults in San Benito,
34 rural counties in advance of 2014 reforms
Federal waiver allows coverage to eligible adults in San Benito, 34 rural counties in advance of 2014 reforms
Health coverage for low-income adults in San Benito County will be expanded Jan. 1 through a program called Path2Health.
“As a member county of the County Medical Services Program, we will be able to help additional low-income persons in the community that were previously not eligible for Medi-Cal or the prior CMSP program,” said Kathy Flores, the director of Health and Human Services Agency for the county. “It is part of health care reform and an expansion for low-income persons.”
The program provides no-cost health coverage to adults from 19 to 64 who reside in 34 rural counties in California, including San Benito. Flores said HHSA staff have attended webinars to learn about the eligibility requirements and are ready to take applications for the program that will launch locally on Jan. 3 since the offices are closed Jan. 1 and 2.
To qualify, residents have to be at or below 100 percent of the federal poverty level, or earn less than about $10,890 annually for a single person. To be eligible, residents must not qualify for Medi-Cal and meet federal citizenship and documentation requirements. The County Medical Services Program Governing Board announced the approval from the federal government to expand the coverage on Dec. 21. The coverage is possible through the state’s federal Medicaid “Bridge to Reform” waiver.
Flores said that low-income residents will be coming in for their annual renewal of Medi-Cal and the prior CMSP program.
“Those who don’t qualify for either will automatically be directed to Path2Health,” Flores said.
Residents can apply for the program in person at the Health Department or they can apply online at www.c4yourself.com.
“The federal waiver makes it possible to bring the benefits of federal health reform early to many of California’s rural communities,” said Lee Kemper, the executive director of the CMSP governing board, in a press release.
The program was implemented in 10 urban counties over the summer.
“Path2Health’s 34 counties represent regions with some of the highest levels of poverty and uninsurance in the state,” Kemper said. “Path2Health will provide many low-income adults in these counties with needed coverage. Others will benefit in 2014 when the federal Medicaid program is expanded by federal reform.”
Path2Health covers medically necessary health care services including primary care, emergency and hospital care, pharmacy services, and limited dental and vision care. It also covers a set number of mental health and substance abuse counseling visits.
Coverage is provided through Anthem Blue Cross for medical care and MedImpact Health Systems, Inc. for pharmacy benefits. Vision Service Plan and DentaQuest will provide vision and dental services. Some of the covered benefits include acute inpatient hospital care, adult day health care services, audiology services, emergency air and ground ambulance services, hearing aids, hospital outpatient services, medical supplies and more. The insurance does not cover family planning services, pregnancy-related services, long-term care facilities, chiropractic services, acupuncture services and some other services.
“We are excited about it,” Flores said. “As you know there are a number of persons who don’t qualify for Medi-Cal because of stringent eligibility. With the economy many people who lost their jobs lost their health insurance. It is a very positive situation that came about.”
CMSP currently serves 60,000 low-income adults each month. The Path2Health program will run as a two-year pilot program until the federal Accountable Care Act expands Medicaid for single low-income adults in 2014. It is anticipated that up to 30,000 adults will enroll in the program across the 34 counties.
The County Medical Services Program was established in 1983, when state law transferred the responsibility for providing health care services to medically indigent adults from the Medi-Cal program to counties. Smaller, mostly rural counties were allowed to contract back to the state. The program is funded through realignment revenue from motor vehicle license fees and sales tax with limited county general revenue.
For more information on Path2Health, visit mypath2health.org.
