Thuy Phan/Nguoi Viet
IRVINE, Calif.— Health-care coverage in America is notoriously difficult to navigate ― even more so when you are a low-income senior citizen unfamiliar with all the programs, rules and changes. Add to that not understanding the language, and you can see why most people would rather not deal with making changes to the health plans they already have.
With that in mind, New America Media brought together several organizations ― including the Health Insurance Counseling and Advocacy Program (HICAP), the Council on Aging of Orange County and the Legal Aid Society of Orange County (LASOC) ― to educate ethnic media about the newest programs for seniors who are dually enrolled in MediCal and Medicare. The event, held last week at the Orange County Alzheimer’s Association in Irvine, gave representatives of Vietnamese, Hispanic and Korean news outlets a chance to join in on the discussion and learn more about a health-care coverage option for seniors.
The program, called OneCare Connect in Orange County and Cal MediConnect elsewhere in California, is a three-year pilot program being rolled out in eight counties throughout the state. It will affect roughly 450,000 seniors who are eligible for Medicare and Medi-Cal, California’s Medicaid program. California is one of about 20 states participating in pilot project through the Affordable Care Act. There is no cost to the member to be a part of this program.
“Having heard so many stories from the people, the difference that this pilot program could make, is making, and wants to make, I am profoundly honored to be a part of the communications effort to raise awareness about it,” said Sandy Close, executive director of New America Media.
Linda Walton, RN and program manager at the Health Insurance Counseling and Advocacy Program of Orange County, explains what her agency offers to seniors.
OneCare Connect aims to merge the benefits of both Medi-Cal and Medicare into one program. In Orange County, there are nearly 57,000 people who qualify for both, and are known as “duals.” As of Aug. 1, CalOptima began “passively” enrolling all members who qualify for this program.
“All of the seniors who had a birthday month in August, and they were eligible for the program, were passively enrolled,” said Javier Sanchez, CalOptima’s chief network officer. “So this passive enrollment process is going to take place over the next 12 months from August 2015 to July 2016.”
That means whether or not you’re on board, if you qualify, you’ll be automatically enrolled. According to Sanchez, people who are eligible are sent three notices through the mail ― in a blue envelope ― to let them know of their enrollment. These notices are in English, unless members indicate their primary language is Vietnamese or other. Opting out is an option, too.
However, Sanchez said this new plan will give seniors added benefits and streamline the services that each individual entity provides into one, making it easier to navigate. Members would no longer have to manage two separate insurance programs, which can be complicated, fragmented and inefficient.
“Seniors can have taxi rides to take them to the doctor’s office and also to pick up medical prescriptions,” Sanchez said. “They will also have vision services (annual eye exams and glasses) and then they also have a dental benefit that’s better than what they get today.”
Dr. Richard Helmer, the chief medical officer of CalOptima, said one of the main benefits of OneCare Connect is the health risk assessment that each person is given at the start of care.
“Based on the findings, we can assess what issues the patient is having,” Helmer said. “It could be medical ― an illness or an acute need that goes with that. It could be social services, problem with transportation. And we also do a questionnaire about their medications to make sure there aren’t any adverse affects of taking more than one at the same time.”
Dao Nguyen, 78, second to left, poses with members of CalOptima’s staff at the New America Media event held at the Orange County Alzheimer’s Association office in Irvine.
In addition, each enrollee will be assigned a personal care coordinator who will help participants make appointments, schedule transportation and answer any questions qualifying seniors may have.
While the benefits to being enrolled in this program include extra vision and dental benefits, transportation to and from doctor visits, many people have opted out — more than 45 percent in all. Of that number, roughly one quarter are of Vietnamese origin.
“Members who speak Vietnamese are opting out at a higher rate than the general population,” Sanchez said. “This is an area we’ve really gone out to make sure the seniors really understand what the program is about so they can use this information to make an informed decision to select the plan that is best for them.”
Dao Nguyen, 78, became a OneCare Connect member at the beginning of September and loves it for the personal care coordinator.
“I don’t speak much English, so having someone to explain things and help me has been a huge relief,” Nguyen said.
In Orange County, HICAP also is a resource for seniors to help understand the benefits and drawbacks of OneCare Connect. It is a free agency that provides counseling in several languages, including Vietnamese, Spanish, Farsi, Korean and English.
“We try to serve as an advocate for the clients,” said Linda Walton, RN and program manager of Orange County’s branch of HICAP. “We provide counseling services, help people apply for Medi-Cal and Medicare, and also have a call center for people to access if they need any help.”
Sanchez said this new program will cover dentures, which Medi-Cal doesn’t cover. So what’s the drawback?
“Part of the problem is that it’s a big change,” Sanchez said. “Right now they like what they have. We understand there’s been a lot of information in the media, telling these seniors that they were going to lose benefits, their freedom, and that they’ll have higher costs and co-payments. None of that is true. Their co-payments are not going to change. And if they don’t like the program, they have the freedom to opt out.”
Nguyen said she won’t be doing that anytime soon.
“There have been no complications or hardships for me to switch over,” Nguyen said. “It’s actually been really good for me. If you’re older and everyone in your family works and has their own lives, this program assigns you someone that can help you with getting what you need without having to put a burden on anyone. I really like it so far.”
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