San Joaquin Valley Families Hit Walls Pursuing New Medicaid Asthma Services
Medi-Cal Makeover

San Joaquin Valley Families Hit Walls Pursuing New Medicaid Asthma Services

Maria Rubio and her five kids have had asthma for years. Rubio ― pictured with four of her children, Andrea (from left), Esmeralda, Josue, and Lino — says their asthma has worsened since the family moved to the Central Valley. (Angela Hart / KHN)

On a warm Monday evening in the city of Madera, Maria Rubio’s youngest kids were playing a video game in the living room. The windows were closed and the blinds drawn to keep the heat out and the house cool.

Still, Rubio worried about what they can’t keep out, pointing to a corner in her bedroom where black clusters of mold were forming.

“That right there, it’s all just getting bigger,” she said in Spanish.

Rubio and her five kids have had asthma for years. Rubio and her oldest son were diagnosed first, almost 20 years ago. She said the doctors told her a number of things could trigger asthma, including dust mites, mold, cockroaches, pesticides, and air pollution.

The Rubio family is among roughly 2 million low-income Californians who have health insurance coverage through Medi-Cal, the state’s Medicaid program, and have been diagnosed with asthma. About 220,000 of them have poorly controlled asthma, according to state data.

A woman points to the corner of a ceiling.
Rubio points to clusters of black mold forming in the corner of her bedroom. (Madi Bolanos)

At the beginning of this year, the California Department of Health Care Services rolled out a program to help Medi-Cal recipients improve their health by eliminating asthma triggers in their homes. The program will offer select enrollees remediation services like removing mold, installing air purifiers, and even replacing carpeting, blinds, and mattresses.

The asthma efforts are part of CalAIM, an ambitious initiative to transform Medi-Cal and target the state’s sickest and most expensive patients. It is expected to cost at least $8.7 billion over five years.

But five months after the asthma program launched, families in the San Joaquin Valley are still struggling to get these services.

“The thing that bothers me the most is it’s more cumbersome for the patient,” said Kevin Hamilton, director of the Central California Asthma Collaborative, the organization coordinating with five Medi-Cal health plans to deliver these services in the San Joaquin Valley.

For example, the Rubio family would first need a referral from a source such as a medical provider. From there, their Medi-Cal health plan would have to approve the referral. Then the partnering community-based organization — in this case, the collaborative — would visit the home to determine what services are needed. The organization then would return the assessment to the health plan for one final approval before it could move forward with the services.

So how many Valley residents have Medi-Cal plans referred to the Central California Asthma Collaborative for services since the program launched Jan. 1?

Just one, according to Hamilton.

That’s out of the thousands of eligible Medi-Cal patients in Madera, Fresno, Tulare, Kings, and Kern counties, said Jacey Cooper, California Medicaid director. She acknowledged the program’s slow start but said that was expected.

“I think identifying individuals, training providers to make referrals for new services, education, and outreach to providers and beneficiaries, all of those things take a little bit of time to get nuanced and implemented,” she said.

Mold covers the wall underneath a kitchen sink.
Rubio, who rents her home in Madera, California, says mold in several rooms makes her children’s asthma worse.(Angela Hart / KHN)

Back in Madera, Maria Rubio examined the wood under the sink in her kitchen. It’s expanding due to humidity, which is another asthma trigger.

“I asked the landlord to change it, but they just put in another wood panel and painted over it,” she said.

She said she has tried to ask her landlord to fix these issues, but she’s usually met with no response or cheap fix-it solutions. And she said she’s scared to keep asking.

“I didn’t want to ask for anything more because we’ve been kicked out of our rental before, with nowhere to go,” she said.

A community health worker told her about the state’s new asthma services, she said, and she thinks they could be really helpful.

“I heard that there’s going to be assistance to help us live a little better in our home, so we don’t continue to suffer from these illnesses,” she said.

Her family could qualify for the program but would generally need to get a referral. Rubio is hesitant to go to the doctor because of bad experiences. It’s one more obstacle the state faces in helping families that need these services the most.

Two children run around a living room.
Lino and Esmeralda Fernandez-Rubio play in their living room where the old, tattered carpet causes them to regularly wheeze and cough. (Angela Hart / KHN)

California Healthline senior correspondent Angela Hart contributed to this report.

This story is part of the Central Valley News Collaborative, which is supported by the Central Valley Community Foundation with technology and training support from Microsoft Corp.