Bridge to Health Reform

Bridge to Better Health

By John Gonzales, CHCF Center for Health Reporting
Sierra County will pool resources with 33 other rural counties statewide to participate in the “Bridge to Health Reform,” a federally financed $10-billion expansion of public health coverage that will roll out no matter what becomes of the health reform law scheduled for full implementation in 2014.


The multi-partner agreement was made possible by the relatively obscure County Medical Services Program, a consortium of counties with populations below 300,000 that already provides medical care to 54,200 lower-income patients across rural California.


Toby Douglas, director of the California Department of Health Care Services, which will oversee the effort, said it “will provide significant additional health care funding aid for all counties, including those in rural areas who face some of the most difficult obstacles to providing essential health care.”


However, rural health providers are worried that the CMSP’s projected 37 percent growth in clients through the bridge to reform could overburden their already strained health systems.


Though the beneficiary increases look modest numerically, they represent a percentage increase in patients similar to the health reform expansions slated for urban areas. Cities don’t have to wrestle with the same shortages in primary care doctors, specialists, even the retention of qualified staff to enroll people in the program that rural areas do.


“It’s like having a tornado, tsunami and earthquake hit you all at the same time,” said Steve Barrow, policy director for the California State Rural Health Association, a Sacramento-based nonprofit organization that works to improve the health of rural Californians.


Barrow said his organization has lobbied for programs designed to train and recruit enrollment staff to rural areas from community colleges and universities. It has also supported programs that pay a doctor’s medical school bills in exchange for service in rural areas.


He serves on an implementation workgroup that makes suggestions to the state on how to update California’s telehealth systems. Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care.


Despite the challenges in implementation, the county health officials who comprise the CMSP board said cuts to rural health budgets gave them little choice but to cast their lot with the “Bridge to Reform.” State officials said the $10-billion in bridge money will come no matter what happens to the larger health reform law, known as the Patient Protection and Affordable Care Act.

Congressional Republicans have vowed to scuttle the law, and federal courts are reviewing its constitutionality.


“Our program has grown so much in the recession that it’s not sustainable at its current level,” said Marta McKenzie, Shasta County Health & Human Services Agency Director, who is also vice-chair of the CMSP board.


State officials successfully petitioned the federal government in November for the $10 billion in funds needed to build the bridge to reform. That money will be used to provide a 50-cent match for every dollar that county health agencies spend on the expanded health programs that make up the effort.


Twenty-five larger counties and the California Rural Indian Health Board have already applied to be part of the program, which is formally called the Low Income Health Program. The larger counties applied individually because they believe they have enough health expenditures to create a healthy cash flow with the matching funds.


However, the smaller rural counties with modest health budgets realized they had to band together and use the collective CMSP budget to front enough money to the federal government. To receive the federal match, the counties must submit certified public expenditures as proof that they spent money on health care services.


Under the rules of the program, free health coverage provided by the CMSP will be offered to people earning up to 100 percent of the federal poverty level, or $22,350 for a family of four. Significantly, enrollees will no longer have to pay a share of costs, akin to a deductible, that was commonly $300 a month.

Still, the small counties also worry that the process of receiving the federal funds could be so slow that it will make paying for the expansion of services a constant financial risk.


“We need to have a clear outline of all of these requirements because we want to do it right,” said Lee Kemper, executive director of the CMSP.


John Gonzales is a senior writer at the California HealthCare Foundation Center for Health Reporting.  The center is an independent news organization that reports on health issues of importance to Californians. It is based at the USC Annenberg School for Communication & Journalism and is funded by the nonpartisan California HealthCare Foundation. Researcher Sharareh Drury contributed to this report.

John M. Gonzales, Senior Writer

California HealthCare Foundation Center for Health Reporting

USC Annenberg School for Communication & Journalism

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