Photo: San Jose’s Zonghu Wong Lee, 94, above, must decide whether to join a new California plan promising to coordinate her care, but she and others find the program confusing. (Richard Lee/World Journal)
In Chinese
SAN JOSE, Calif.--California’s state Medicaid program (called Medi-Cal) and federal Medicare are partnering to launch a three-year pilot project named Cal MediConnect to promote coordinated health care delivery to low-income seniors and people with disabilities, who are dually eligible for both programs.
Cal MediConnect aims to improve care coordination for these dual-eligible beneficiaries and provide high-quality care that can help people stay health and in their homes for as long as possible. By shifting services out of institutional settings and into home and community setting, the test project aims to create a more sustainable “person-centered” health care system also expected to reduce costs.
This project is take place in six counties--Los Angeles, Riverside, San Bernardino, San Diego, San Mateo and Santa Clara, and orange may be added later this year.
Confusion for Chinese Duals
Although Cal MediConnect aims to provide better service to dual-eligible beneficiaries, of “duals,” many Chinese beneficiaries have found the new confusing.
One of them is Zonghu Wong Lee, 94: “The new program is too complicated for me. I do not know how to register for it, and I really need help to go through the process.”
Lee, who immigrated from China 30 years ago, lives alone in a senior apartment in San Jose. Lee relies on her son and daughter to take care of her, including diving her to doctor’s appointment and the hospital when needed. Enrolling in Cal MediConnect is a new challenge.
Lee’s son, Chentai Wang, expressed appreciation for the new program, but he has also experienced frustration with it. “We tried our best to figure out what Cal MediConnect is. However, when we had questions and asked hospitals and physicians, most of they were not able to answer us. We do not have a clear instruction about how to enroll.”
“When I asked my mother’s physician if he is included in the network of the new program, he couldn’t answer,” said Wang. We made several phone calls back and forth with hospital, our doctors and insurance agencies. That made my mother really nervous. She doesn’t deserve this unnecessary stress.”
Wang also stressed that a senior like his mother and many other Chinese immigrants don’t have the capacity to respond complicated changes in their health care plans is out of their capabilities. He stated, “Age and language barriers are two main reasons to stop seniors from being moved into the new program. ”
Fu-Chun Liu, who takes care of her 97-year-old mother, faces similar issues. “Cal MediConnect is full of confusion. We still have no idea how to enroll in the new program. Our biggest concern is that our doctor is not included in the new network,” she said.
Liu continued, “We’re looking for a doctor in our health insurance plan’s network who works with seniors. We also hope to find a doctor who can speak our language. For immigrants like my mother, most of them prefer to see a Chinese doctor so they are comfortable talking about their medical issues. However, not many doctors in our network can speak Mandarin.”
In-Language Services
Ryan MacDonald, a deputy director at Harbage Consulting, said Cal MediConnect provides service for the state’s most vulnerable groups. He explained that enrollees will have access to a care coordinator and team, including doctors, nurses, social workers, nutritionists, physical therapists and other specialists who can best align services to meet someone’s needs.
MacDonald also said with Cal MediConnect, benefits and services work better together. The program also provides in-language services, including Chinese languages, to help dual eligible beneficiaries.
Peter Cheng, leader and doctor of the Guzik Center for the Advancement of Geriatrics and Palliative Care, observed that when seniors face healthcare problems, most prefer to consult with their friends to get solutions. Few tend to ask for help from health care agents, doctors or hospitals.
“If Cal Medi-Connect runs well, the new program will become known through word of mouth by seniors in a short time,” Cheng said.
Albert Lam, MD, of the Palo Alto Medical Foundation, said the goal of Cal MediConnect is to establish a coordinated and seamless system that will improve health care and help members stay longer in the comfort and security of their own homes and communities. Both members and health care providers in the program will experience a streamlined process: one benefit package, one responsible and an accountable health plan, he said.
Eligible beneficiaries are being sent three notices about enrolling 90, 60 and 30 days before their next birthday. Those who do not decide to sign up of decline the program are being automatically enrolled in Cal MediConnect.
Is Your Doctor In Plan’s Network?
Robert Ju, a Chinese healthcare insurance broker, noted that many Chinese patients would prefer to keep their existing primary or specialty care physician. Before enrolling in the new program, Ju suggested Chinese duals check to make sure their primary or specialty care physicians are included in the network of at least one of the approved Cal MediConnect health insurance plans in their county.
If a doctor is not included, Ju said, “An enrollee still has right to receive Medicare covered services from their existing primary or specialty care physician for six months to 12 months.”
Ju emphasized, “Eligible enrollees in a Cal MediConnect plan will eventually be required to receive all covered services from physicians and other providers who are part of the plan’s network. However, enrollees in a Cal MediConnect plan will also have continuity-of-care rights – the right to temporarily continue seeing a current physician for a limited period following enrollment, if the doctor is outside the Cal MediConnect network,” as long as the doctor agrees. Those physicians can continue treating the dual-eligible longer, if they eventually decide to sign on to the plan’s network permanently.
Richard Lee wrote this article in Chinese for World Journal in partnership with New America Media’s Dual Eligibles project, sponsored by SCAN Foundation.