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Forum Examines Residually Uninsured

On Monday, UCLA health researchers convened a roundtable discussion about what’s being done to help the residually uninsured.

“The estimate is that 3.2 million to 4 million people will be uninsured in California in 2015,” said Dylan Roby, director of the health economics and evaluation research program at UCLA’s Center for Health Policy Research.

“We anticipate about 1.5 million of those are undocumented,” Roby said. “So that means a vast majority of the remaining uninsured should be eligible for coverage in some way.”

Reaching those uninsured can be difficult, but there are some projects around the state that offer some promise, Roby said.

One of those efforts, My Health LA, launched Oct. 1 and has already had significant success, said Tangerine Brigham, director of the Office of Managed Care at the Los Angeles County Department of Health Services.

“We started on Oct. 1, 2014, and by the 31st of October we had enrolled 40,000 people,” Brigham said. “We haven’t seen the full numbers for November yet, but it looks like November enrollment is keeping pace with the last month.”

One emphasis, Brigham said, was to make sure enrollment worked simply and eligibility determination happened in real time. That started with a strong online presence, she said.

“We tried to simplify the enrollment and eligibility system,” Brigham said. “You can do it online and you get real-time eligibility — that is, you can be enrolled that same day.”

Brigham said part of the goal is to identify heavy utilizers of services and empanel them into a medical home model so they get the care they need without constantly returning to clinics and hospitals.

“My Health LA is not insurance,” she said. “It’s to provide a medical system to address the residually uninsured.”

San Francisco has a similar model with the same online program to facilitate smoother enrollment and eligibility determination, said Alice Kurniadi, senior health program planner at the San Francisco Department of Public Health.

“Real-time web eligibility was an important component, so people can be enrolled on the same day,” Kurniadi said. With the Healthy San Francisco program in operation, a lot of the health care infrastructure was already in place to enable better care for the residually uninsured, she said.

In San Mateo County, the number of uninsured has been cut more than 50% over the past several years, officials said.

“We went from about 80,000 to about 30,000 uninsured in the county,” said Srija Srinivasan, director of strategic operations for the San Mateo County Health System.

The reduction is the result of a decades-long effort to reach the uninsured, she said. The current challenge is figuring out how to integrate mental health care with physical health care. So far, she said, they’ve had some success.

“We are seeing evidence that people are accessing the right care, Srinivasan said. “This gives us some optimism that we’re not only getting people into coverage, but also getting them into the right care.”

Roby said these success stories offer a little hope to other counties that have struggled to involve the hard-to-reach residually uninsured population in health programs. He also hopes the next version of California’s Medicaid waiver allows public health systems some flexibility around how money is used through payment reform.

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