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Health care: Mid-City CAN eNews

Building Healthy Communities: City Heights
December 2011
Health-care reform provides some benefits now, with more in 2014
Council of Community Clinics works toward prevention goal
Center for Health Education and Advocacy trains residents
The California Endowment marks BHC achievements, relationships
Mid-City CAN Coordinating Council joined by Pinces, Ali, Malinomar
Mid-City CAN members attend Equity Summit, grantee retreat
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Health-care reform provides some

benefits now, with more in 2014


The coming health-care reform bills will produce fundamental change in the U.S. health-care system says a Sacramento advocate.

"It is a pretty radical shift from the current world - from the world where you get charged based on how sick you are, to a world where you actually pay based on what you can afford - as a sliding scale based on income," said Anthony Wright , executive director of consumer-advocacy group Health Access California.

Medi-Cal currently provides health and long-term care for about 6.5 million of California's low-income children, their parents, elderly and the disabled. Nondisabled adults who aren't parents will be eligible for Medi-Cal in 2014, as one of the highest-profile consequences of health-care reform, also known as the Affordable Care Act. This will add about 2 million people to Medi-Cal in the state.

"There was this big hole in our safety net, and they were the responsibility of the counties," Wright said. "In their agreement with the federal government, the states actually got permission from the federal government to have counties put up match."

This agreement allowed for Low-Income Health Programs, which provide new federal money to California counties to expand coverage for the poor now.

The programs allow the state and federal government to evenly split the cost of caring for those who are at or below 133 percent of the federal poverty level until 2014, when the federal government assumes the entire cost.

"So it is a very exciting opportunity not just to sort of get a lot of people into coverage and be a bridge to health reform in 2014, but it also an exciting opportunity for the county to draw down more funds," Wright said. "It is [also a chance] for the hospitals and providers in an area to get more resources flowing through them for the local economy."

All counties in California except for Fresno have taken advantage of these programs to draw more federal funding.

San Diego County's pilot Low-Income Health Programs has enrolled close to 15,000.

However, the county's efforts are not without critics.

Hannah Gravette of the San Diego Organizing Project was quoted in The San Diego Union-Tribune as saying the county needs to do more outreach.

The county will not come to events, churches or other venues to sign people up or allow emergency rooms, clinics or community groups to sign patients up for the Low Income Health Program, according to the Nov. 27, 2011, article.

Health Access is working with groups like PICO, which SDOP is a member of, and Western Center on Law and Poverty to encourage counties to be as aggressive as possible to take advantage of these new funds, Wright said.

The second major part of health care reform that Health Access has been advocating for is health-care exchanges. The state's is called the California Health Benefit Exchange.

"The exchange is something that is going to be incredibly important, but those benefits will come in 2014," Wright said.

One of its five board members is Dr. Robert Ross of The California Endowment.

Its executive director is Peter V. Lee.

Starting in 2014, people whose income is 133 to 400 percent of the poverty level will have subsidies for their insurance premiums - that are a sliding scale from 2 to 9.5 percent of their income, Wright said.

"If their premium goes above that they can get a subsidy to basically make up the difference," he said.

These exchanges are designed to give individuals and small businesses the advantages that large corporations enjoy when negotiating with large insurers.

"Our task in the future is to create a new health insurance marketplace," he said. "One where, not only will we be in a world where folks will no longer be denied for preexisting conditions, but that individuals will no longer be all alone at the mercy of the big insurers."


Council of Community Clinics
works toward prevention goal

A major focus of the Council of Community Clinics is helping City Heights-based clinics move toward a preventative focus that is part of health-care reform law.


"Our goal there is to eliminate re-admissions and unneeded emergency room visits," said Steve O'Kane, Council of Community Clinics' Chief Executive Officer.


One model that is being used to achieve that would involve a team of people that partner with clinic patients to provide ongoing comprehensive care.


How would it be different than what the clinics do now?


One example would be "a care coordinator, saying 'Wait a minute, [this patient is] on three medications, he should be coming in now for his labs and his physical' and reaching out."


This concept is called a patient-centered medical home, and the idea is that the Medi-Cal system will realize greater efficiency - and save money - by treating symptoms before they become severe.


"That provides better over-all care and lessens emergency room admissions," he said.


The Council of Community Clinics partners in these pilot efforts include Planned Parenthood, San Diego Family Care, La Maestra Community Health Centers, UCSD Medical Center and Scripps Mercy Hospital.


The Council of Community Clinics is also working to make health-care accessible to diverse, low-income communities.


It has been participating in the Mid-City CAN Access to Health Care Momentum Team for a year and a half to work on access problems and do trainings, he said.


O'Kane gave one example of why cultural sensitivity is important by describing one of the City Heights member clinics, La Maestra.


Refugees who come to La Maestra for treatment often see someone who came to the U.S. from the same country as them, O'Kane said.


"At La Maestra, there are Somali speakers, Spanish speakers, speakers of different Asian dialects," he said. "You walk in and you are greeted by someone of your culture."


Center for Health Education

and Advocacy trains residents

Helping City Heights residents find their voice is part of the San Diego Consumer Center for Health Education and Advocacy's mission.


"We are in the midst of developing some trainings funded by [The California Endowment] on using the youth and some residents for policy and community lawyering," said Gregory Knoll, director of the San Diego Consumer Center for Health Education and Advocacy, which is a special project of the Legal Aid Society of San Diego.


This training will begin in City Heights and then expand to the 13 other Building Healthy Community sites, Knoll said.


The group conducts a Medical Legal Community Partnership in the Family Health Center's clinic in City Heights. This allows medical providers to get legal and policy clarification for patients in areas including housing, immigration, consumer protection and domestic violence. These problems often are beyond the scope of a medical provider's expertise, but may still be a major factor in a resident's health.


The group also works with the Access to Health Care Momentum Team and several other Mid-City CAN organized work groups.


"[For example, we] are working with Food Justice folks around legal questions about community gardens and on policy issues," he said.


The California Endowment marks BHC achievements, relationships

About eight City Heights residents and organizational representatives attended a two-day event hosted by The California Endowment to reflect on work in the 14 Building Healthy Community sites during the past year.


"Celebrating BHC Achievements and Relationships" was Nov. 29 and 30 in Los Angeles and a major focus was cross-pollination of ideas.


"People from City Heights got to share information with people from 13 places on larger state-wide strategies," said Steve Eldred, The California Endowment's program manager for City Heights. "One of our goals was just to let people talk amongst the sites."


Another aspect of the gathering was video and PowerPoint presentations about Building Healthy Communities' work in all the California sites.


"City Heights really focused on letting youth tell their story in their own voices," he said. For a link to the video, click here.


Fred Carson, Dad's Club project coordinator and School Attendance Momentum Team member enjoyed the camaraderie, both with other members from City Heights and those throughout the state.


"It was interesting for me to talk to people in similar areas," he said. "It was a good chance for collaboration and sharing ideas."


Sadad Ali, African Coalition Workforce executive director and newly elected Mid-City CAN Coordinating Council member, agreed.


"It was a very interesting two-day conference," he said. "It was very good. A lot of the different sites are working on creative things."

Sadad Ali, African Coalition Workforce executive director and newly elected Mid-City CAN Coordinating Council member, enjoyed hearing Dr.  Anthony Iton, speak at the BHC Celebration at the end of November.
Sadad Ali, African Coalition Workforce executive director and newly elected Mid-City CAN Coordinating Council member, enjoyed hearing Dr. Anthony Iton speak at the BHC Celebration at the end of November.
Mid-City CAN Coordinating Council joined by Pinces, Ali,
The Mid-City Community Advocacy Network elections determined three new members for the Coordinating Council, which is the network's governing body.

More than 100 members voted Dec. 13 at the City Heights Wellness Center.

Winners are:
  • Carolyn Pinces, community engagement associate manager at Planned Parenthood, co-chair of the Teen Sexual Health Momentum Team and a member of the School Attendance Momentum Team.
  • Sadad Ali , executive director of the African Coalition Workforce and member of the Peace Promotion Momentum Team
  • Ahmed Malinomar, property manager at Metro Villa Apartments Interfaith Housing and City Heights resident
Coordinating Council leadership consists of two co-chairs and a secretary. The overall Council is made up of 15 representatives elected from the general membership. A representative from the fiscal agent (SAY, San Diego) and the Community Liaison from the Central Region of San Diego County Health and Human Services Agency attend.
Co-chairs and council members are elected to three-year terms.
Mid-City CAN members attend Equity Summit, grantee retreat
  • Jeanette Neeley, City Heights resident and Coordinating Council Member, was one of about four Coordinating Council members to attend the Equity Summit 2011, the fourth national PolicyLink Summit, which brought together advocates, activists, policymakers and leaders from across the country from Nov. 8 to 11 in Detroit. Speakers included Geoffrey Canada, president and CEO of the Harlem Children's Zone in Harlem, N.Y., and Manuel Pastor, an advisory committee member for The California Endowment, as well as an author and professor. For Neeley, the network the conference created has already proved valuable. PolicyLink created equityblog.org, which she has stayed engaged with. "I have been on it asking for samples of other cities transportation surveys to create better access to disenfranchised areas," Neeley wrote in an email.
  • On Dec. 5, about 40 Building Healthy Community grantees gathered at Price Charities City Heights Center. Grantees updated the group on their projects and networked. To see photos of the event, click here.


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The Mid-City Community Advocacy Network's mission is to create a safe, productive,Quotation (Right)
and healthy community through collaboration, advocacy, and organizing.

Fiscal sponsor Mission Edge San Diego.