San Gabriel Valley beneficiaries face language and cultural barriers in Cal MediConnect roll out

Individuals with dual eligibility for MediCal and Medicare in Los Angeles County have been given an opportunity to enroll in a coordinated health care effort since July 1. This summer saw the beginning of the state’s Cal MediConnect, an optional coordinated care initiative designed to provide low-income “Medi-Medi” or “dual eligible” beneficiaries with a number of improved health care options.

Cal MediConnect is a three-year pilot program California is testing in Los Angeles and up to seven other counties before implementing it for the estimated 1.1 million Medi-Medis statewide.

Some of these options include coordinating currently disjointed medical services into one system, providing vision and glasses care; non-emergency transportation, such as to a doctor’s office; and a care coordinator to help navigate the healthcare system.

But some people have seen challenges in the rollout of this health care reform, such as complaints of a lack of language and cultural sensitivity, causing confusion for Medi-Medi beneficiaries about the decisions they need to make.

The current form of communication (notices in the mail, some delivered in large blue envelopes) is not tailored to meet the needs of the senior Hispanic community, said one dual eligible beneficiary. Jorge Chuc, of El Monte, feels as though health care providers are not doing enough to communicate with their ethnic constituents about the new changes.

“There is a poor performance because they’re not sensitive to the culture. It’s important to know where these people are coming from,” Chuc stated, such as their often-lower educational levels and language barriers.He said mailing letters is not a realistic way to get people to make decisions about their health care. “The other scary part is when we get the envelope–what our community does, the Hispanic and senior community, we receive those and just trash it.”

Chuc advocates for affected individuals to participate, as Cal MediConnect will involve beneficiaries even if they do not make a decision. He noted, “If we don’t actually get involved in these changes, it’s still going to happen. We need to get involved.”

Eligible beneficiaries will be informed 90, 60, and 30 days before they are automatically enrolled in coordinated care, unless they choose not to participate. Beneficiaries have the option to enroll before the 90 days are up, opt out of enrollment or do nothing — which will result in them being automatically enrolled.

Qualified individuals may opt out of Cal MediConnect at any point, even after they first decide to sign up for it. As of July, 30 percent of those notified have opted out, according to Denny Chan, a staff attorney with the National Senior Citizens Law Center in Los Angeles. Some are choosing to stay in their existing federal Medicare program in order to keep their current doctors, who may not be part of the five approved Cal MediConnect health plans. But patients should first find out how the plans are working with patients to involve their physicians. 

If a dual eligible person opts out of the Medicare part of the program, they will still be required to sign up for one of the new state MediCal managed care plans. Opting out, though, will mean they will not have their care coordinated under the new program and will not receive other new benefits. 

Notices in the blue envelopes — the final mailings people are receiving — arrive 30 days before their deadline. Chuc has not decided whether he will take part in the coordinated efforts or not, but two other Pasadena residents have already made their decisions; one to opt out and one to enroll.

Pilgrim Tower East in Pasadena | Photo by Kyle Garcia

Dual eligible beneficiaries Man Fang Luo and Qun Tang Shang of Pilgrim Tower East, an affordable housing development for seniors in Pasadena, have made their decisions with the help of their doctors.

Luo will opt out of coordinated care but pick a MediCal plan, and Shang will participate in Cal MediConnect coordinated care.  They made this decision because “the doctor told [Shang] to enroll. [Luo] also got a recommendation from her doctor not to enroll,” said Nindai Hoo, social services coordinator at Pilgrim Tower East and interpreter for Luo and Shang during an interview.

Luo and Shang are Chinese immigrants, who primarily speak Mandarin, but also have limited-English proficiency. Shang laughed at the idea of making a decision on the matter without the help of a doctor.

Hoo translated for the residents: “They don’t have the ability to make the decision on their own.” Shang expressed his language needs by saying that although he lives in Pasadena, he goes to the Alhambra Hospital Medical Center in Alhambra where Mandarin interpreters provide aid.

Chan led a workshop last July in Alhambra presenting the Cal MediConnect changes. At the Allied Physicians Senior Wellness Center, he spoke in English and Cantonese and had a Mandarin interpreter to communicate with the multilingual audience.

Chan advocates for language and culturally sensitive outreach so that seniors from all communities can make an educated decision. “It’s about removing as many barriers as we can to allow people to participate so they can make meaningful and educated decisions about their health care,” said Chan. 

He and his colleagues have been leading workshops across Los Angeles County to provide seniors with information about new health care reform. Chan has seen difficulties in the way changes are being communicated and received. “It’s so important that when we talk about outreach and education we evaluate our strategies in a culturally competent context. Otherwise you’re going to have people sitting around tables talking about [the Coordinated Care Initiative] to no one even if it’s in language,” he said.

Chuc, Luo, and Shang all have hopes for the future of health care in California. Despite his skepticism, Chuc saw potential in the new system. “At least Cal MediConnect is saying, if I’m not mistaken, we’re going to have a group of people and this group of people is going to help make sure all of your needs are going to be met,” Chuc said.

Referring to the care coordinator, who will be assigned to help enrollees navigate the healthcare system, Chuc continued, “That makes you excited, say, ‘Oh, okay, orale–I’m not going to have any problems and all of these people are going to do that for me.’ Is that the case? I don’t know.”

Luo and Shang see the reform as an opportunity for more Mandarin-speaking doctors and services to be offered. “The Chinese and senior population here needs more Chinese-speaking doctors and they hope in the future that the government can provide seminars about health care reform,” Hoo translated for Shang.

Cal MediConnect is an effort to help low-income elders and people with disabilities streamline their healthcare under one system. Also, the state hopes to save money now lost due to such problems as unnecessary emergency room visits resulting from poorly coordinated care.

Medi-Medi beneficiaries can get free help in any language in understanding their choices and filling out the Cal MediConnect forms by calling the California Health Insurance Counseling and Advocacy Program (HICAP) in Los Angeles, cost-free at (800) 824-0780.

This article was produced with support from New America Media’s California Dual-Eligibles Fellowship program, sponsored by The SCAN Foundation.

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