The Affordable Care Act (ACA) presents a timely opportunity to initiate a coordinated campaign to expand access to health care and prevention in Riverside and San Bernardino Counties that coordinates with and leverages the impact of ACA-related efforts of the Eastern Coachella Valley Building Healthy Communities (ECVBHC) site. The campaign will focus on advancing the following goals to support a prevention-oriented health system and healthier communities: (1) strengthening the link between medical care and community health, (2) helping the newly enrolled and continuing uninsured to understand how to best use the health system and how to stay healthy, (3) improving personal behaviors, health workforce, public policies, and environmental conditions for better health outcomes, and (4) advancing a system for community-collaborative prevention and the practice of health equity.
ACA Implementation in the Inland Empire: According to Insure the Uninsured Project (ITUP), of the total 1.4 million state residents that enrolled in Covered California plans, the Inland Empire accounts for 8.8 percent. In Riverside County, 69,000 residents enrolled—surpassing initial base projections (40,000) by 172%. In San Bernardino Counties, 54,000 residents enrolled—surpassing initial base projections (36,000) by 150%. The majority of Inland Empire residents enrolled in the silver and bronze tiers. Among subsidy-eligible Inland Empire residents, over two-thirds (69.3%) selected silver, while a fifth (20.9%) selected bronze plans. The most popular plans selected by all Inland Empire enrollees were Blue Shield of California (31%), Health Net (29.8%), Anthem Blue Cross (17.5%), and Kaiser Permanente (15.4%), while 6.4 percent selected Molina Healthcare.
Statewide, 1.9 million Californians newly enrolled in Medi-Cal; the 2014-15 budget expects this to grow to 2.5 million. Formal county-level Medi-Cal enrollment data is not yet available from the State Department of Health Care Services (DHCS). Riverside County enrolled 34,211 into its LIHP and San Bernardino enrolled 38,796 into its LIHP, and these were transitioned into Medi-Cal managed care with the Inland Empire Health Plan effective January 1, 2014. Both counties were quite aggressive and successful in encouraging LIHP enrollment and there were no reported difficulties in the transition to Medi-Cal managed care.
The Uninsured: According to ITUP, there were 6.8 million uninsured in California over the course of the year before the ACA coverage expansions began. A recent report from the Commonwealth Fund found that California has already reduced its uninsured rate by 50%, but the sample sizes are small, and the more definitive CHIS survey for 2014 will not be available until 2016 at the earliest. Of the Inland Empire’s 3,735,000 residents (under the age of 65), 512,000 (13.7%) were not insured for the entire past year and 298,000 (8%) were uninsured for only part of the past year.
Estimates by UCLA/UC Berkeley of the remaining uninsured post-ACA do not provide a specific number for undocumented immigrants in the Inland Empire. The UCLA/UC Berkeley report estimates that California has 1 million uninsured undocumented immigrants, of which 310,000 live in the “Other Southern California” region (Orange, San Bernardino, San Diego, Riverside, and Imperial) – this projects to about 122,000 residents in the Inland Empire.
In 2012, 21.3% of the low income uninsured in the Inland Empire reported no usual source of care, which testifies to the importance of developing identifiable, reliable and effective health homes in the Inland Empire safety net. In any scenario, there are a lot of folks who still need coverage and a lot of newly enrolled folks who will need assistance in being renewed for coverage and use their benefits.
The purpose of the grant awarded to CCASBC is to build upon existing ECVBHC relationships to engage in the following activities:
- Inform and activate newly covered and other low-income populations to better understand, navigate and leverage the health system and coverage options, while reducing health risks;
- Assist the newly enrolled to maintain their coverage through the Asegúrate campaign;
- Activate local organizations and individuals in the statewide and local discussion of providing health care access and coverage to all Californians, including the undocumented, also known as Health4All;
- Enroll persons made eligible for Medi-Cal due to the President’s immigration Executive Order; and
- Engage youth groups and regional organizations in the Health Happens Here Campaign;
- Achieve a workforce that is diverse and community-responsive.