HEALTH REFORM IMPLEMENTATION IN CALIFORNIA: IMPACT ON BOYS AND YOUNG MEN OF COLOR (BMOC)

Transcription

1 CALIFORNIA PROGRAM ON ACCESS TO CARE UC BERKELEY SCHOOL OF PUBLIC HEALTH A PROGRAM OF UC OFFICE OF THE PRESIDENT HEALTH REFORM IMPLEMENTATION IN CALIFORNIA: IMPACT ON BOYS AND YOUNG MEN OF COLOR (BMOC) THURSDAY, FEBRUARY 28, :30 P.M. TO 3:30 P.M. CAPITOL BUILDING, ROOM 444 SACRAMENTO, CALIFORNIA AGENDA WELCOME AND INTRODUCTIONS 1:30 P.M. Gilbert Ojeda, Director, California Program on Access to Care (CPAC), UC Berkeley School of Public Health OPENING REMARKS 1:35 P.M. Steven Bradford, Assemblymember, 62 nd District Chair, Assembly Select Committee on the Status of Boys & Men of Color MODERATOR 1:40 P.M. Richard Figueroa, Director, Prevention and Health Care Reform, The California Endowment PRESENTATIONS Overview of the Alliance for Boys and Young Men of Color 1:45 P.M. The Role of the Alliance Rubén Lizardo, Deputy Director, PolicyLink 1:55 P.M. Health Advocacy Priorities Ellen Wu, MPH, Executive Director, California Pan-Ethnic Health Network 2:05 P.M. BMoC: Socio-demographics and Health Indicators Gilbert Ojeda, CPAC, UC Berkeley, School of Public Health Health Care Coverage 2:20 P.M. Healthy Families Transition to Medi-Cal Jamila Edwards, Northern California Director, Children s Defense Fund With the Support of Boys and Men of Color Initiative: The California Endowment & With the Assistance of the Office of Assemblymember Adrin Nazarian

2 2:35 P.M. Medi-Cal Expansion: Reaching Boys and Young Men of Color Ken Jacobs, Chair, Center for Labor Research and Education, UC Berkeley 2:50 P.M. Challenges to Outreach/Enrollment for Communities of Color Chad Silva JD, Policy Director, Latino Coalition for a Healthy California 3:05 P.M. Reactors Jorja Leap, PhD, Adjunct Associate Professor, Social Welfare, UCLA Luskin School of Public Affairs Opio Dupree, Chief of Staff, Assemblymember Steven Bradford 3:20 P.M. Questions and Comments 3:30 P.M. Adjourn With the Support of Boys and Men of Color Initiative: The California Endowment & With the Assistance of the Office of Assemblymember Adrin Nazarian

3 BMoC : Socio-demographics and Health Indicators GIL OJEDA, DIRECTOR CALIFORNIA PROGRAM ON ACCESS TO CARE UC BERKELEY SCHOOL OF PUBLIC HEALTH State Capitol Thursday, February 28, 2013

4 CALIFORNIA POPULATION BY RACE/ETHNICITY Total Population 37,826,160 Latino 14,501,606 White 14,953,617 African American 2,203,540 Asian 4,901,626 Native Hawaiian and other P.I. 133,976 2 or More (Not Latino) 967,413 Source: 2012 Census Dept. of Finance Projections

5 California Population by Race/Ethnicity Native Hawaiian/ Pacific Islander 0.4% Asian 12.9% 2 or More 2.6% African American 5.8% Latino 38.3% White 39.5% Source: 2012 Census Dept. of Finance Projections

6 2009 CALIFORNIA BMOC POPULATION BY RACE/ETHNICITY, AGES Latino African American American Indian/Alaskan Native 42.5 Asian

7 California s Latino and African American Populations Latinos are 38.3% (14.5 million) of the state's 37.8 million residents The Latino population is very young Latinos have a median age of 27.4, while the non-latino White population's median age is 44.8 Just over half (51.6%) of all children in California are Latino (18 and under) Over half of all children (50.4%) born in 2010 in California were to Latinas African Americans are 5.8% of California s population African American children comprise 5.7% of California's child population Source: 2010 US Census estimates and kidsdata.org

8 California Communities of Color Communities of Color include all non-white population. Communities of Color represented nearly 60% of California s population in Nevada County had the fewest non-white residents in relation to total population (10%), while Imperial County had the most (86%). Source: California Pan-Ethnic Health Network and 2009 California Health Interview Survey

9 Children & Youth Demographics Approximately 68.9% of California's children and youth (0-17) are from a community of color Just over half (51.2%) of all California s children and youth are male Interestingly the greatest numbers fall into two groups: Age group 6-10 are 27% of all male children, and Age group are 24% of all male children Source: 2010 US Census estimates and kidsdata.org

10 Median Household Income by Race/Ethnicity Source: 2010 Census and California Pan-Ethnic Health Network

11 Population Living Below the Federal Poverty Line by Race/Ethnicity Source: 2010 American Community Survey and California Pan-Ethnic Health Network

12 POVERTY LEVEL BY RACE, MALES, AGES % FPL and above % FPL % FPL 0-99% FPL % FPL 300% FPL and % FPL % FPL above Latino White African American Asian All Source: 2009 California Health Interview Survey

13 Source: U.S. Census Bureau, American Community Survey Public Use Microdata Sample (PUMS) Year, Steven Ruggles, J. Trent Alexander, Katie Genadek, Ronald Goeken, Matthew B. Schroeder, and Matthew Sobek, Integrated Public Use Microdata Series: Version 5.0 [Machine-readable database] (Minneapolis: University of Minnesota, 2010). Geographic Distribution of Disconnected* Males, Ages in California *Disconnected=being out of work, school and having no high school diploma

14 NO USUAL SOURCE OF CARE BY RACE, MALES, AGES Latino White African American Asian Native Hawaiian/ Pacific Islander All Source: 2009 California Health Interview Survey

15 California Enrollment in Select Coverage Programs by Race, Ages 0-18, 2008/2009 Source: California HealthCare Foundation, 2009

16 HEALTHY FAMILIES ENROLLED BY ETHNICITY Ethnicity Currently Enrolled % Latino 401, % White 79, % African American 15, % Asian 68, % Native Hawaiian/ Pacific Islander 11, % Native American 2, % Other Aggregated Ethnicities 278, % TOTAL 857, % Source: Managed Risk Medical Insurance Board, Nov. 2012

17 Ethnic Group/Age Category Medi-Cal Expansion, Covered California Individual Subsidy- Eligible, Healthy Families/Medi-Cal TLICHP, Uninsured Remaining, Latino 83, ,000 91, ,000 Asian-Pacific Islanders African American White/Non- Latino BMOC DATA (TABLE 1, 2014) 16,000 15,000 12,300 32,000 19,000 7,000 5,300 19,000 83,000 55,000 79,200 76,000 Other 5,000 4,000 2,100 7,000 Subtotal 206, , , ,000 Total, Low Estimate BMoC: 1,062,400 Source: Laurel Lucia, Ken Jacobs, UC Berkeley-UCLA CalSIM Model 1.7, May 12, Healthy Families

18 BMOC DATA (TABLE 2, 2015) Ethnic Group/Age Category Medi-Cal Expansion, Covered California Individual Subsidy- Eligible, Healthy Families/Medi- Cal TLICHP, Uninsured Remaining, Latino 89, ,000 91, ,000 Asian- Pacific Islander African American White/Non- Latino 17,000 14,000 12,300 28,000 21,000 11,000 5,300 20,000 86,000 57,000 79,200 65,000 Other 4,000 4,000 2,100 6,000 Subtotal 217, , , ,000 Total, Low Estimate BMoC: 1,030,400 Source: Laurel Lucia, Ken Jacobs, UC Berkeley-UCLA CalSIM Model 1.7, May 12, Healthy Families

19 PERCENTAGES OF OVERWEIGHT CALIFORNIAN MALES, AGES 0-18 BY RACE/ETHNICITY Latino 8.1 White 16.7 African American 10.6 Asian Note: "Overweight" includes the respondents who have a BMI in the highest 95 percentile with respect to their age and gender. Data on Asians and Two or More Races are statistically unstable Two or More All Not Overweight for Overweight for Age Source: 2009 California Health Interview Survey

20 ACKNOWLEDGEMENTS For assembling the data and addressing related information issues for this presentation, I thank Jackie Espana and Liza Topete. Thanks also to Perfecto Munoz, Chad Silva (LCHC) and Dr. Michael Rodriguez (UCLA) who also provided input and advice for this presentation. For additional information regarding this presentation and any information about the California Program on Access to Care, please go cpac.berkeley.edu or reach Liza Topete at topete.liza20@berkeley.edu or by calling (510)

21 THE ELIMINATION OF THE HEALTHY FAMILIES PROGRAM Jamila Iris Edwards Children s Defense Fund California February 2013

22 Children s Defense Fund The Children's Defense Fund s Leave No Child Behind mission is to ensure every child a Healthy Start, a Head Start, a Fair Start, a Safe Start and a Moral Start in life and successful passage to adulthood with the help of caring families and communities

23 Health of Children of Color African-American youth have diabetes death rates that are approximately twice as high as those for white youth Latino children are reported to have poorer health status than other children 1 in 3 South Asian and Native Hawaiian/Pacific Islander youth between have been diagnosed with asthma

24 The Value of Health Coverage Children with health insurance learn better. Children with health coverage get regular care that can help avoid costly hospitalizations. Children who stay continuously covered receive better, more appropriate care and are less expensive to treat.

25 Uninsured Children in California 2 out of 3 uninsured children are currently eligible for public health coverage programs Uninsured children are far more likely than those with health coverage to delay or not receive care, and as a result have worse health outcomes.

26 Disparities in Coverage 3 out of 5 uninsured African-American children in California are eligible for Medi-Cal or Healthy Families but are not enrolled 2/3 of California s uninsured children in 2009 are Latino 3 out of 5 uninsured Asian/Pacific Islander children in California are eligible for Medi-Cal or Healthy Families but are not enrolled

27 Sources of Children s Coverage, 2011 Medi-Cal or Healthy Families 38% Employerbased Coverage 49% Uninsured 10% Privately Purchased 7% Other Public Coverage 3% Source: Page 6 of California Health Care Almanac, Covering Kids: Children s Health Insurance in California, California HealthCare Foundation (November 2012).

28 Healthy Families v. Medi-Cal Medi-Cal provides health care services for the lowest-income Californians Serves 3.85 million children Healthy Families provides health coverage for low-income children whose families earn too much to qualify for Medi-Cal but can t afford private insurance Serves 875,000 children

29 Children of Color in Medi-Cal & Healthy Families Latino children make up about 75%of all children enrolled in Medi-Cal and Healthy Families Half of all African-American children in the state are enrolled in Medi-Cal or Healthy Families 1 in 5 Asian/Pacific Islander children in the state are enrolled in Medi-Cal or Healthy Families

30 The Elimination of Healthy Families August 2012: Legislature agrees to eliminate the Healthy Families Program and transition all 875,000 children into Medi-Cal December 2012: State receives federal approval January 2013: Transition begins of 197,241 children in certain counties

31 The Transition: Pros & Cons The Benefits Affordability Benefits Continuity of coverage Medi-Cal as an entitlement program The Disadvantages Reduced access to providers More cumbersome enrollment and retention procedures Loss of MRMIB Risks of transition

32 Ensuring a Responsible Transition Adequate provider networks for transitioning children and new applicants Clear systems and mechanisms to adequately monitor and address problems in children s access to care Coordinated and comprehensive outreach and communication with affected families and stakeholders

33 Thank you! Jamila Iris Edwards Children s Defense Fund California

34 Ken Jacobs UC Berkeley Center for Labor Research and Education February,

35 Developed by UC Berkeley Center for Labor Research and Education and UCLA Center for Health Policy Research with support from The California Endowment Enrollment estimates produced for Covered California Predicts the impact of the Affordable Care Act (ACA) on employer decisions to offer coverage and individual decisions to obtain coverage in California Uses public data sources mostly state-specific, including California Health Interview Survey

36 Adults under age 65 with income below 138% Federal Poverty Level (~$15,000 single individual, ~$32,000 for a family of four) More than 1.4 million eligible in Roughly 75% adults without children living at home 750, ,000 expected to enroll by 2019

37 Californians Newly Eligible for Medi-Cal, 2014 Other 50,000 3% All, Ages (1.42 million) Other 5,000 3% Young Men, Ages (206,000) White 470,000 33% Latino 690,000 49% White 83,000 40% Latino 83,000 40% African American 110,000 8% Asian 100,000 7% African American 19,000 9% Asian 16,000 8% Source: UC Berkeley-UCLA CalSIM model, version 1.8 (all) and version 1.7 (young men)

38 240, ,000 expected to enroll by % of those eligible are children, remainder are parents Most of increase will happen regardless of the Expansion due to mandatory provisions of ACA: minimum coverage requirement for individuals; simplified eligibility, enrollment & renewal processes; and improved awareness of coverage.

39 Share of Californians under Age 65 Previously Eligible for but Not Enrolled in Medi-Cal or Healthy Families who Take -Up, 2014 Demographic Group Base Scenario Enhanced Scenario People of Color 63% 75% Ages % 63% Ages % 11% Male 48% 45% Source: UC Berkeley-UCLA CalSIM model, version 1.8

40 Previous Medicaid expansions associated with reduced mortality Adults with Medicaid in Oregon were more likely to have regular place of care, usual doctor and use preventive care Sources: Sommers, Baicker and Epstein 2012; Baicker and Finkelstein 2011.

41 Uninsured Californians under age 65, ,010, ,000 1,180,000 23% 29% 3,110, , ,000 19% 25% Other (has an affordable coverage offer from Exchange or Employer) Eligible for Medi-Cal 830,000 21% 710,000 23% No offer of affordable coverage (>8% income) 1,070,000 1,030,000 27% 33% Not eligible due to immigration status Base Enhanced Source: UC Berkeley-UCLA CalSIM model, v1.8

42 Californians Predicted to Remain Uninsured, 2014 Latino Asian African American Other White Ages ,000 11,000 5,000 3,000 15,000 Ages ,000 21,000 14,000 4,000 61,000 Total 306,000 32,000 19,000 7,000 76,000 Source: UC Berkeley-UCLA CalSIM model, version 1.7

43 UC Berkeley Center for Labor Research and Education: Ken Jacobs UCLA Center for Health Policy Research Jerry Kominski Dylan Roby

44 CHALLENGES TO OUTREACH/ENROLLMENT FOR COMMUNITIES OF COLOR California Program on Access to Care Legislative Briefing Health Reform Implementation In California: Impact On Boys And Young Men Of Color (Bmoc) February 28, 2013 Chad M. Silva, JD Policy Director Latino Coalition for a Healthy California

45 Latino Coalition for a Healthy California (LCHC) Since 1992, the Latino Coalition for a Healthy California (LCHC) has been a major voice for improving and protecting the health of all Californians. As the leading voice on Latino health, we have assisted decision-makers throughout the state to develop policies, services and the social, economic, and environmental conditions that improve the health of Latinos.

46 Latino Coalition for a Healthy California (LCHC) Four Regional Networks Bay Area Central Valley Los Angeles San Diego

47 Latino Coalition for a Healthy California (LCHC) Serve as a conduit of information between community, regionally based organizations and statewide advocates and policy makers.

48 Demographics Total Population 37,253,956 Hispanic or Latino 14,013,719 White 14,956,253 African American 2,163,804 Asian 4,775,070 Native Hawaiian and other P.I. 128,577 Other 85,587 2 or More (Not Latino) 968,696

49 Demographics

50 Demographics California Enrollment in Insurance Programs by Race, Ages 0-18, 2008/2009

51 ACA Components Affecting BMoC Medi-Cal Expansion to Childless Adults. Covered California s Subsidy-Eligible Individual program Healthy Families in Transition to Medi-Cal Covered California s Small Business Health Options Program (SHOP) Let us not forget workforce

52 Education and Outreach Feedback from the Regional Partners Ensure cultural and linguistic competency of Assistors/navigators Need to use trusted non-profit organizations with years of experience/established trusted relations with the community versus government entities Have to ensure adequate funding of assistors/navigators Need diverse health workforce

53 Education and Outreach Funding Covered California Education and Outreach Grant Program Some issues with approach

54 Education and Outreach Funding The California Endowment has Committed Resources

55 Contact Information Chad M. Silva, JD Policy Director Latino Coalition for a Healthy California th Street Suite 550 Sacramento, CA (916)