Forget controversial – the Affordable Care Act is just plain confusing. But that can be expected when federal, state and local governments come together in a collaborative effort.
One of the major changes tied to Obamacare is a significant expansion of the federal government's Medicaid program. And here are some answers to your questions.
Q: So what is the Medicaid expansion?
This is one of the law's landmark provisions. It will expand the eligibility requirements for Medicaid – the nation's public health insurance plan – which mainly serves the poor. That's going to give tens of millions of uninsured people across the country coverage. California's Medicaid program – which is called Medi-Cal – is expected to grow by about 1.4 million people.
Q: What about in L.A. County?
A good part of the Medi-Cal expansion will come from Los Angeles. According to Louise McCarthy, the president and CEO of the Community Clinic Association of L.A. County, about 550,000 county residents are expected to be eligible for Medi-Cal coverage under the Affordable Care Act starting on January 1, 2014.
Q: So it's just a waiting game for them?
Not at all. They can actually get free medical services right now. L.A. County has a program called Healthy Way L.A., which in 2010 was restructured as a sort of "bridge to Medi-Cal." Healthy Way L.A. is not health insurance, but it does give those people who will gain Medi-Cal insurance next year a head start, so to speak. It does that by giving them free access to services at county clinics and certain community health centers starting right now – as soon as they sign up.
Q: What kinds of services?
Those enrolled in Healthy Way L.A. get access to primary care, preventive care, specialty services, vaccines, mental health care, and even subsidized E.R. visits in certain cases. Those in the field of health care administration have called it "Medi-Cal Lite," which is still more than many people are getting.
Q: So how do you qualify for Healthy Way LA?
Residents of L.A. County who qualify for Healthy Way L.A. are the same ones who will be newly eligible for Medi-Cal next year. This is just their "bridge," so to speak. The requirements include:
- They have to be county residents.
- They have to be between 19 and 64 years old.
- They have to have been a U.S. citizen or a legal resident for at least 5 years.
- They can't be pregnant.
- They can't currently be eligible for Medi-Cal.
- They can't earn more than 133 percent of the federal poverty level.
Q: What happens from here with Healthy Way LA? What's the timeline?
Well, health providers want to get as many people enrolled in Healthy Way L.A. as possible, as soon as possible. The idea is for these people to quickly find themselves a "medical home" – if they hit the ground running now, and start receiving services and finding "their" doctor, by the time they get full-on Medi-Cal coverage they'll be able, in theory, to just keep doing what they're doing. There won't be any disruption of service, in other words.
Q: What happens on January 1st?
Healthy Way L.A. will in large part cease to exist, and it'll be replaced by Medi-Cal, says McCarthy, of the Community Clinic Association. The idea is for a seamless transition between Healthy Way L.A. and Medi-Cal – those patients are supposed to just roll over automatically. Health leaders are optimistic it'll happen, but the mechanics of that transition are still unclear.
Q: Does it seem like people know about this?
The numbers are pretty telling. There are 550,000 people eligible for Healthy Way L.A. in the county – but according to McCarthy, only 250,000 are enrolled. That leaves officials with less than four months to get those folks on board and into the program before Medi-Cal expands. Health advocates are getting ready to kick a major outreach campaign into high gear to let people know about all the options that Obamacare will bring them. For many people, Healthy Way L.A. will be part of that conversation.
Q: Is that bad if the Medi-Cal expansion goes into effect and those who are eligible haven't yet signed up for Healthy Way LA?
Not necessarily. It mostly means that those people have missed out on months of free medical services. But if you're eligible for the Medi-Cal expansion, you can still enroll starting on January 1, 2014. Healthy Way L.A. is just a way to get to the front of the line and start receiving services now.
Q: One more question: Are officials worried about people falling through the cracks?
Yes, especially when it comes to unauthorized immigrants. But there are resources for them as well. Healthy Way L.A. has two "forms": Matched and Unmatched. Those with Healthy Way LA Matched are the ones who will transition to Medi-Cal next year.
Unmatched is for the undocumented. The criteria are basically the same as they are for Healthy Way L.A. Matched. The difference is Unmatched beneficiaries cannot be U.S. citizens or legal residents. While the Matched program will cease to exist once the Medi-Cal expansion goes into effect, the Unmatched program is slated to continue providing coverage.