In less than three months, thousands of California residents will begin enrolling in expanded health coverage as part of the Affordable Care Act. The law is complex and touches almost every part of the health care system. But what does it mean for residents of the San Joaquin Valley? Over the coming months, we’ll explore that question by visiting with patients, doctors, businesses and clinics in the community of Madera. It’s a city that’s home to more than 62,000 people, more than quarter of whom live below the poverty level.
We’ll start by examining how Madera County’s only federally qualified health center is gearing up for Obamacare. Camarena Health expects to treat 25,000 patients this year, and even more once the health law takes effect in January.
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It’s Wednesday afternoon, and the waiting room at Camarena Health in Madera is filled with families.
For years, the clinic has received federal funding to provide primary care and dental services for the poor and uninsured. But with the expansion of coverage that’s about to kick in under the new federal health law, big changes are on the way.
Paulo Soares, the CEO of Camarena Health, says preparing for the law has presented a number of challenges.
“I think a lot of it is just new, there is a lot of information being thrown at everyone at a very fast pace,” Soares says. “We’re really trying to figure out a lot of this as we move along.”
And his team is moving fast to get ready for the law with an expansion of its own. Soares estimates that around eight to nine thousand Madera County residents, who are currently uninsured, will become eligible for Medi-Cal in January.
“Many of those patients may already be patients of ours, but maybe not accessing care as regularly as they should,” he says.
"Many of those patients may already be patients of ours, but maybe not accessing care as regularly as they should" - Paulo Soares
Once they’re insured, those patients may visit the health center more regularly. For example, he says, diabetic patients may no longer wait until they’re very sick to seek care.
“Some of these folks who now have coverage are now willing to come in every couple months, and get some preventative care, and allow our medical personnel to manage those diabetes, to have our health education staff work with them, and keep them healthier and better manage their disease, rather than, ‘I can’t afford it, so I’m only going to show up when it’s really bad or too late,’” he says.
Dealing with the surge in patients is just the first challenge. Another is providing the space and staff to care for them.
Eight months ago, Camarena Health broke ground on a new, 16,000-square-foot medical and dental facility, thanks to a $4.8 million federal grant. It will join the clinic’s existing facilities in Madera, Chowchilla and Oakhurst. But there are fewer remedies to the San Joaquin Valley’s longstanding physician shortage.
“Part of the capacity-building is not only the physical space, the bricks and mortar, but once you build those buildings, you have to fill them with medical providers, physicians, mid-levels, as well as dentists, so we are actively recruiting for all those positions,” he explains.
Another challenge is helping patients navigate the new health insurance options. Soares hopes to receive a grant from the federal government to educate people about the law’s benefits.
“The outreach and education is a very critical piece, because Medicaid expansion is only going to really work if those who are eligible get enrolled and access those services,” he says. “If they’re eligible for this program, but they continue to walk around uninsured, it’s not very beneficial to them.”
"If they're eligible for this program, but they continue to walk around uninsured, it's not very beneficial to them" - Paulo Soares
Camarena is also striving to transform the way it provides care. It’s part of a national initiative known as the Patient Centered Medical Home.
Dr. John Forncrook, Camarena’s chief medical officer, explains that the goal is, “to really pull the pieces together, for instance, keeping track of your patients, getting care in other places, getting information back, following up on that information you get back, making sure that people don’t fall through the cracks.”
Camarena is applying for this accreditation for its Chowchilla facility first. The plan is to obtain it for its other facilities as well.
One more challenge is providing care to the undocumented. They can receive services, on a sliding fee scale, at the health center, but they’re generally not eligible for benefits of the health law. Without insurance, they may not be able to afford specialty services outside the health center.
“We will still do everything we can for the undocumented and/or the uninsured, but once they leave our four walls, and need more specialty care or hospitalization, that’s where unfortunately our coverage doesn’t reach,” Soares says.
Despite some growing pains, Soares says the new health law is good news for Madera.
“If eight to nine thousand more people can regularly receive health care and become healthier, it’s a win across the board,” he says.
