Sonoma County Medical Services Program (2008)
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Sonoma County Medical Services Program (2008) Sonoma County Medical Services Program (2008) Document Transcript

  • October 20, 2008 Prepared for Indigent Health Group Marion Deeds, Director of Economic Assistance, Human Services DepartmentLynn Scuri, Manager of Planning and Population Health, Department of Health Services Kim Seamans, Section Manager of Medi-Cal Eligibility, Human Services Department Prepared by Division of Planning, Research and Evaluation Marla Stuart, Director Tara Smith, Planner Analyst Graphics Assistance provided by the Division of Administration Lee Lewis, Systems and Program Analyst
  • PageSummary ......................................................................................................................................... 1Description of CMSP ...................................................................................................................... 2Purpose of Study ............................................................................................................................. 2Methodology ................................................................................................................................... 3Description of CMSP Recipients .................................................................................................... 4Tables and Graphs 1. Number of Enrollees by Month........................................................................................... 4 2. Aid Codes by Month ........................................................................................................... 5 3. CMSP Patterns of Enrollments ........................................................................................... 6 4. CMSP Recipient Demographics ....................................................................................... 10 5. Months on CMSP by Demographic .................................................................................. 11Conclusions ................................................................................................................................... 12Recommendations ......................................................................................................................... 12Endnotes ........................................................................................................................................ 13
  • The number of Sonoma County CMSP enrollees is increasing (page 4) 11,977 different Sonoma County residents received CMSP in the 20 months beginning December 2006 and continuing through July, 2008. This represents 4% of the adult population age 19-65. On average, 4,228 residents received CMSP each month January through July, 2008. Comparatively, approximately 54,000 Sonoma County residents received Medi-Cal in July, 2008. The number of residents receiving CMSP each month increased from 3,431 in December 2006 to 4,440 in July 2008 (a 29% increase). From 1999-2006, the Sonoma County population age 19-59 increased 4.33%. In 2008 (January through July), an average of 468 individuals each month are new CMSP enrollees (11% of all enrollees in the month). These individuals did not receive CMSP in the previous 12 months. NATIONAL COMPARISON: This growth in the Sonoma County CMSP caseload reflects the national trend of increasing numbers of individuals without health insurance. 18% of the US population does not have health insurance (46.5 million people). 12.9% of the US population did not have health insurance in 1987.37% of Sonoma County CMSP recipients are “churning” (page 7) 60% of CMSP recipients have predictable acute enrollment patterns 3% of CMSP recipients receive CMSP continually. 37% of CMSP recipients move on and off CMSP. This represents over 1,600 Sonoma County residents each month who do not have reliable and consistent medical coverage. NATIONAL COMPARISON: Senior citizens, Latino’s, and low-income individuals are most likely to lack medical insurance for extended periods of time.2The most common Sonoma County CMSP recipient is a white male younger than 60 (page 11) However, when compared to the Sonoma County population, Sonoma County CMSP recipients are disproportionately Hispanic males under age 29. NATIONAL COMPARISON: People of color are less likely to have health insurance.1 80% of uninsured people in the United States live in families with one or more full-time workers. 9ImpactHEALTH IMPACT: Uninsured Americans have higher rates of mortality, poor health outcomes, are lesslikely to receive preventive care, and are more likely to require inpatient care.3 The number of excessdeaths in 2000 among uninsured adults was estimated at 18,000.9ECONOMIC IMPACT: People without health insurance are often unable to pay for their medical care.The cost of uncompensated medical care was $41 billion in 2004. Federal, state and local governmentsreimburse health care providers for 85% of these costs.9Recommendations (page 13)CMSP regulations should promote continued medical coverage for eligible individuals to improve thehealth of Sonoma County and to reduce uncompensated medical care costs. Report on Sonoma County CMSP, M. Stuart, HSD PRE, October 20, 2008, page 1
  • In California, Medi-Cal (Medicaid) provides a array of programs to meet the health care of most low-incomeindividuals. Medi-Cal coverage is available for all children through age 20 and for those 65 and older. In somecases, the parents of a child are also eligible for Medi-Cal. Other Medi-Cal programs provide coverage for adultsin short-term nursing facilities, as well as those with specific medical needs such as dialysis, tuberculosistreatment, total intravenous nutrition, or breast or cervical cancer treatments.Established by California law in January 1983, the County Medical Services Program (CMSP) provides medicaland dental care for medically indigent adults between the ages of 21 through 64 who are not eligible for Medi-Cal, who have an income at or below 200% of the federal poverty level of $10,4004 and who have less than$2,000 in liquid assets. Applicants are approved for one of five aid categories. Most applicants are eligible forstandard CMSP coverage which is approved for six months and which covers all approved procedures ormedications. Some applicants, based on their income, must pay a share of cost and are only approved for threemonths. “Share of cost” is the amount that these applicants must pay or obligate before CMSP coverage will paythe medical provider. This is similar to a co-pay in private insurance. Other applicants are approved for restrictedbenefits. These are emergency services only and are approved for two months. Restricted benefits are providedto residents who lack documentation of satisfactory immigration status or citizenship. Finally, CMSP can also beapproved for an individual claiming disability while they complete the Medi-Cal disability application and forindividuals receiving Long Term Care to supplement the Medi-Cal coverage.CMSP is administered by the CMSP Governing Board comprised of county supervisors, administrators, healthofficials, and welfare directors. Benefits are administered by Anthem Blue Cross for medical, dental and visionand by Med-Impact for prescriptions. Thirty-four (34) small, rural counties currently participate in CMSPincluding Sonoma which is the second largest county with CMSP. These counties have a combined monthlycaseload of 40,000 people and an annual budget of approximately $238 million derived from motor vehiclelicense fees, sales tax and county general revenue.5In September 2007, the Sonoma County Human Services Department (HSD) and the Sonoma County HealthServices Department (DHS) convened the Indigent Health Group. The overall purpose of the group is to gainbetter knowledge of the medically indigent in Sonoma County and to develop recommendations to reduce theirobstacles to care. This study was designed to assist the Indigent Health Group’s activities by providing a betterunderstanding of the Sonoma County CMSP population. Specifically, this study explored the followingquestions. 1. What are the characteristics of Sonoma County CMSP recipients? 2. What is the pattern of enrollment for Sonoma County CMSP recipients?It is anticipated that this study will be useful to the following groups: HSD and DHS managers and executives for policy making. HSD and DHS staff for practice guidance. Sonoma County Administrator’s Office for information and policy development. CMSP Governing Board for policy development. Report on Sonoma County CMSP, M. Stuart, HSD PRE, May 30, 2008, page 2
  • Information about CMSP recipients was extracted from the California State Business Objects MEDS Database. Aquery was run for each of 20 months (December, 2006 through July, 2008). The following information wasextracted for each recipient. Name Primary language Case number Month of eligibility Date of birth Aid code Gender Amount of share of cost (if any) EthnicityOther information was of interest and attempts were made to include this information. However, this informationwas not, ultimately, available in a format that was reliable. Date and source all applications General Assistance (GA) status Date of all approvals Zip code Date of all denials Share of cost met Date of all discontinuations Earned and unearned incomeAll information was compiled in Excel, imported into the Statistical Package for the Social Sciences (SPSS), andrestructured to maximize analysis options. The following analyses were employed: Descriptive statistics describe information with numbers. Frequency, percent and mean are reported here. Inferential statistics quantify the level of uncertainty when using sample information to describe a whole population. This report uses independent sample t-test (t) to examine the difference between two means and chi-square (X2) to examine the difference between two percents. With both statistics, a p-value of less than .03 indicates that the difference identified in the sample is most likely evident in the whole population. A cohort of CMSP recipients was selected to examine CMSP enrollment patterns over time. To conduct this longitudinal analysis, a subset of one month of CMSP recipients was selected. 563 individuals received CMSP benefits in January, 2007 but not in December, 2006. These individuals were selected as the January 2007 Cohort because they appeared to be starting a new enrollment period and because information for 19 consecutive months was available for them. Observing these individuals for 19 consecutive months (January, 2007 through July, 2008) provides information about trends in CMSP enrollment and differences between demographic groups.The following pages describe Sonoma County CMSP recipients. Report on Sonoma County CMSP, M. Stuart, HSD PRE, October 20, 2008, page 3
  • The number of Sonoma County CMSP enrollees is increasing ______________________________TABLE 1: Number of Enrollees by Month Year # CMSP # New % New # with % with Month Enrollees Enrollees* Enrollees SOC+ SOC 2006 Dec 3,431 508 15% 2007 January 3,517 526 15% February 3,449 489 14% March 3,541 515 15% April 3,591 528 15% May 3,687 564 15% June 3,722 564 15% July 3,767 549 15% August 3,881 576 15% September 3,807 551 14% October 3,877 550 14% November 3,885 532 14% December 3,862 549 14% 2007 Average 3,716 541 15% 2008 January 3,961 552 14% 505 13% February 4,066 433 11% 482 12% March 4,173 415 10% 511 12% April 4,206 548 13% 544 13% May 4,300 425 10% 576 13% June 4,449 474 11% 602 14% July 4,440 426 10% 609 14% 2008 YTD Average 4,228 468 11% 547 13%* New enrollees are those in the month who were not enrolled in CMSP in the previous 12 months.+ Share of Cost (SOC) is an amount that must be obligated by the enrollee to the healthcare provider before CMSP coverage will pay the provider. This is similar to a co-pay in private insurance. Sonoma County Human Services Department Number of CMSP Enrollees 5,000 4,440 4,000 3,431 Number of CMSP Enrollees 3,000 2,000 1,000 0 May 07 Nov 07 May 08 Dec 06 Jan 07 Feb 07 Mar 07 Apr 07 Jun 07 Jul 07 Aug 07 Sep 07 Oct 07 Dec 07 Jan 08 Feb 08 Mar 08 Apr 08 Jun 08 Jul 08 Report on Sonoma County CMSP, M. Stuart, HSD PRE, October 20, 2008, page 4
  • TABLE 2: Aid Codes by Month (see definition for each aid code on following page) 88 89 8F 50 50 Disability Disability CMSP 84 85 Restricted Restricted Pending Pending Companion No Share of Cost Share of Cost (SOC) (no SOC) (no SOC)6 (SOC)6 (LTC) Month # % # % # % # % # % # % # % Dec 06 2,821 82.2 447 13.0 84 2.4 60 1.7 14 0.4 0 0.0 5 0.1 Jan 07 2,888 82.1 462 13.1 87 2.5 62 1.8 12 0.3 0 0.0 6 0.2 Feb 07 2,852 82.7 437 12.7 94 2.7 49 1.4 10 0.3 0 0.0 7 0.2 Mar 07 2,922 82.5 458 12.9 91 2.6 54 1.5 9 0.3 1 0.0 6 0.2 Apr 07 2,954 82.3 465 13.0 98 2.7 60 1.7 7 0.2 2 0.1 5 0.1 May 07 3,009 81.6 493 13.4 101 2.7 67 1.8 8 0.2 2 0.1 7 0.2 Jun 07 3,043 81.8 502 13.5 101 2.7 57 1.5 8 0.2 4 0.1 7 0.2 Jul 07 3,089 82.0 486 12.9 99 2.6 55 1.5 25 0.7 6 0.2 7 0.2 Aug 07 3,124 80.5 499 12.9 101 2.6 62 1.6 75 1.9 13 0.3 7 0.2 Sep 07 3,040 79.9 472 12.4 94 2.5 61 1.6 117 3.1 18 0.5 5 0.1 Oct 07 3,074 79.3 478 12.3 96 2.5 51 1.3 154 4.0 21 0.5 3 0.1 Nov 07 3,070 79.0 459 11.8 92 2.4 44 1.1 189 4.9 29 0.8 2 0.1 Dec 07 3,014 78.0 469 12.1 52 1.4 72 1.9 224 5.8 28 0.7 3 0.1 07 Average 3,007 81.0 473 12.8 92 2.5 58 1.6 70 1.8 10 0.3 5 0.2 Jan 08 3,146 79.4 413 10.4 66 1.8 78 3.8 227 5.7 26 0.3 8 0.1 Feb 08 3,259 80.2 400 9.8 62 1.5 81 2.0 239 5.8 22 0.1 3 0.0 Mar 08 3,329 79.8 435 10.4 56 1.3 65 1.6 264 6.3 22 0.5 2 0.0 Apr 08 3,351 79.7 471 11.2 66 1.6 52 1.2 244 5.8 21 0.5 1 0.0 May 08 3,405 79.2 503 11.7 61 1.4 54 1.3 258 6.0 19 0.4 0 0.0 Jun 08 3,510 78.9 518 11.6 73 1.6 64 1.4 264 5.9 20 0.4 0 0.0 Jul 08 3,449 77.7 503 11.3 85 1.5 77 1.7 296 6.7 29 0.7 1 0.0 08 YTD Average 3,350 79.3 463 10.9 67 1.5 67 1.9 256 6.0 23 0.4 2 0.0 Report on Sonoma County CMSP, M. Stuart, HSD PRE, October 20, 2008, page 5
  • Aid Code Definitions84 No share of cost (No SOC) – Individual does not incur any portion of the medical expense, as long as it is an approved procedure or medication.85 Share of Cost (SOC) - Individual must first pay or be obligated to pay a monthly amount before CMSP begins. The share of cost amount is basedon a person’s net nonexempt income minus their maintenance need.50 Restricted – Individual is entitled to emergency services only. Restricted benefits are provided to residents who lack documentation of satisfactoryimmigration status or citizenship.88 or 89 Disability Pending – An individual claiming disability is entitled to CMSP while they complete the Medi-Cal disability application, ifotherwise eligible.8F CMSP Companion (LTC) -Individual typically has both CMSP and Medi-Cal. The CMSP pays for any expense not related to Long Term Care;Medi-Cal covers the Long Term Care expense. (Long-Term Care is inpatient medical care which lasts for more than the month of admission and isexpected to last for at least one full calendar month after the month of admission.) Report on Sonoma County CMSP, M. Stuart, HSD PRE, October 20, 2008, page 6
  • 37% of Sonoma County CMSP recipients are “churning”__________________________________ CMSP eligibility is approved for two months (restricted), three months (share of cost) or six months (no share of cost). Patterns of enrollment were examined for the 563 individuals in the January 2007 cohort (recipients who received CMSP benefits in January 2007 but not in December 2006). Enrollment activity was tracked for 19 months for these recipients (January 2007 through July 2008). This cohort represents a sample of all CMSP recipients. The most common CMSP enrollment longevity is six months (see pattern 1 in Table 3.1). Approximately 25% of CMSP recipients experience this single enrollment episode. Approximately 60% of CMSP recipients appear to receive benefits for an acute episode of care (see patterns 1-8 in Table 3.1). Approximately 3% of CMSP recipients appear to receive benefits continuously (see pattern 9 in Table 3.1). The remaining 37% of CMSP recipients appear to be “churning.” They move on and off CMSP in unpredictable patterns of enrollment. These enrollment patterns are illustrated in the Table 3.2. TABLE 3.1: CMSP Patterns of Enrollment (cohort) = enrolled = not enrolled 2007 2008 Cum # of # % % J F M A M J J A S O N D J F M A M J J Months 1 142 25.22 25.22 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 6 2 62 11.01 36.23 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3 50 8.88 45.12 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 4 26 4.62 49.73 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 12 5 21 3.73 53.46 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 6 12 2.13 55.60 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 7 12 2.13 57.73 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 8 8 1.42 59.15 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 9 9 19 3.37 62.52 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 19 TABLE 3.2: CMSP Patterns of Enrollment (cohort) = enrolled = not enrolled Cum 2007 2008 # of # % % J F M A M J J A S O N D J F M A M J J Months10 19 3.37 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1811 7 1.24 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1812 5 0.89 68.03 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1813 5 0.89 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 1 1 1 1 1714 3 0.53 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 1 1715 2 0.36 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1716 2 0.36 1 1 1 1 1 1 0 1 1 1 1 1 1 0 1 1 1 1 1 1717 1 0.18 1 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1718 1 0.18 1 1 1 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1719 1 0.18 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 0 1720 1 0.18 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1721 1 0.18 71.05 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 17 Report on Sonoma County CMSP, M. Stuart, HSD PRE, May 30, 2008, page 7
  • TABLE 3.2 (continued): CMSP Patterns of Enrollment (cohort) = enrolled = not enrolled Cum 2007 2008 # of # % % J F M A M J J A S O N D J F M A M J J Months22 3 0.53 1 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 1 1623 3 0.53 1 1 1 1 1 1 0 1 1 1 1 1 1 0 0 1 1 1 1 1624 3 0.53 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1625 2 0.36 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1 1 1 1626 1 0.18 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1627 1 0.18 73.36 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1628 4 0.71 1 1 1 1 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1529 3 0.53 1 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1 1 1 1530 2 0.36 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 1531 1 0.18 1 1 1 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1532 1 0.18 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1533 1 0.18 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 0 0 0 1534 1 0.18 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1 1 1 0 1535 1 0.18 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 1 1 1 1536 1 0.18 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1 1 0 1537 1 0.18 76.20 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 0 0 0 1538 3 0.53 1 1 1 1 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1439 2 0.36 1 1 1 1 1 1 0 0 0 0 1 1 1 1 1 1 0 1 1 1440 1 0.18 1 1 1 0 0 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1441 1 0.18 1 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 0 1442 1 0.18 1 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 1 1 1443 1 0.18 1 1 1 1 1 1 0 1 1 1 1 1 1 0 0 0 0 1 1 1444 1 0.18 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 1 1 1 1 1445 1 0.18 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 1 1 1446 1 0.18 78.33 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 1447 3 0.53 1 1 1 1 1 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1348 2 0.36 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 1 1349 1 0.18 1 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 1 1350 1 0.18 1 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 0 0 1351 1 0.18 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 1 1 1 1 1352 1 0.18 1 1 1 1 1 1 1 1 1 0 0 0 0 0 1 1 1 0 1 1353 1 0.18 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 1 1 1354 1 0.18 80.28 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 1355 5 0.89 1 1 1 1 1 1 0 0 0 0 0 0 0 1 1 1 1 1 1 1256 5 0.89 1 1 1 1 1 1 0 0 0 0 0 0 1 1 1 1 1 1 0 1257 3 0.53 1 1 1 1 1 1 0 1 1 1 1 1 1 0 0 0 0 0 0 1258 2 0.36 1 1 1 1 1 1 0 0 0 0 0 1 1 1 1 1 1 0 0 1259 2 0.36 1 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 0 1260 2 0.36 1 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 0 0 1261 1 0.18 1 0 0 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 1262 1 0.18 1 1 1 0 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 1263 1 0.18 84.19 1 1 1 1 1 1 0 0 0 0 1 1 1 1 1 1 0 0 0 12 Report on Sonoma County CMSP, M. Stuart, HSD PRE, October 20, 2008, page 8
  • TABLE 3.2 (continued): CMSP Patterns of Enrollment (cohort) = enrolled = not enrolled Cum 2007 2008 # of # % % J F M A M J J A S O N D J F M A M J J Months64 5 0.89 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1165 3 0.53 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1166 2 0.36 1 1 1 1 1 1 0 1 1 1 1 1 0 0 0 0 0 0 0 1167 2 0.36 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1168 1 0.18 1 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 0 0 1169 1 0.18 1 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1170 1 0.18 1 1 1 1 0 0 0 0 0 0 0 1 1 1 1 1 0 1 1 1171 1 0.18 1 1 1 1 1 0 0 0 0 0 0 0 1 1 1 1 1 1 0 1172 1 0.18 1 1 1 1 1 1 0 0 0 0 0 0 0 1 1 1 1 1 0 1173 1 0.18 1 1 1 1 1 1 0 0 0 0 1 1 1 0 0 0 0 1 1 1174 1 0.18 87.57 1 1 1 1 1 1 0 0 0 0 1 1 1 1 1 0 0 0 0 1175 2 0.36 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1076 2 0.36 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1077 1 0.18 1 1 1 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1078 1 0.18 1 1 1 1 1 1 0 0 0 0 0 1 1 1 1 0 0 0 0 1079 1 0.18 88.81 1 1 1 1 1 1 0 1 1 1 1 0 0 0 0 0 0 0 0 1080 4 0.71 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 981 2 0.36 1 1 1 1 1 1 0 0 0 0 0 1 1 1 0 0 0 0 0 982 2 0.36 1 1 1 1 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 983 1 0.18 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 984 1 0.18 1 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 985 1 0.18 1 1 1 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 986 1 0.18 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 987 1 0.18 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 988 1 0.18 1 1 1 1 1 0 0 0 0 0 0 1 1 1 1 0 0 0 0 989 1 0.18 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 990 1 0.18 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 991 1 0.18 1 1 1 1 1 1 0 0 0 0 0 0 1 1 1 0 0 0 0 992 1 0.18 92.01 1 1 1 1 1 1 1 1 0 0 0 1 0 0 0 0 0 0 0 993 5 0.89 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 894 5 0.89 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 895 1 0.18 93.96 1 1 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 896 7 1.24 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 797 2 0.36 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 798 1 0.18 1 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 799 1 0.18 1 1 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 7100 1 0.18 96.09 1 1 1 1 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 7101 4 0.71 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 6102 2 0.36 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 6103 2 0.36 1 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 6104 1 0.18 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 6105 1 0.18 97.87 1 1 0 0 1 1 0 0 0 1 1 0 0 0 0 0 0 0 0 6 Report on Sonoma County CMSP, M. Stuart, HSD PRE, October 20, 2008, page 9
  • TABLE 3.2 (continued): CMSP Patterns of Enrollment (cohort) = enrolled = not enrolled Cum 2007 2008 # of # % % J F M A M J J A S O N D J F M A M J J Months106 1 0.18 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 5107 1 0.18 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 5108 1 0.18 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 5109 1 0.18 1 1 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 5110 1 0.18 98.76 1 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 5111 2 0.36 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4112 1 0.18 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 4113 1 0.18 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 4114 1 0.18 99.64 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 4115 1 0.18 99.82 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3116 1 0.18 100.00 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 Report on Sonoma County CMSP, M. Stuart, HSD PRE, October 20, 2008, page 10
  • The most common Sonoma County CMSP recipient is a white male younger than 60 ___________TABLE 4: CMSP Recipients Demographics (Compared to Sonoma County) CMSP Recipients 2006 Sonoma County Dec 06 – Mar 08 2006 Ages 21-65 Ages 21-65 n=11,977 n=286,1907 Statistic p Number Percent Number Percent Gender Female 4,879 40.8% 141,730 50% X2=404 .00 n=11,958 Male 7,079 59.2% 144,460 50% Ethnicity White 7,708 66.1% 205,249 77.5% X2=2,000 .00 n=11,654 Hispanic or Latino 2,615 22.4% 42,865 16.2% African American 551 4.7% 3,860 1.5% Asian 340 2.9% 8,892 3.4% Native American 307 2.6% 3,258 1.2% Pacific Islander 133 1.1% 566 0.2% Other or No Data 323 21,500 Age 21-29 140 24.9% 56,132 19.6% X2=35.57 .00 n=563 30-39 105 18.7% 73,692 25.7% (cohort only) 40-49 146 25.9% 80,113 28.0% 50-59 115 20.4% 59,554 20.8% 60-65 57 10.1% 16,699 5.8% Sonoma County Human Services Department CMSP Recipients Compared to Sonoma County Population (All enrollees Jan 2007-Jul 2008: n=11,977. Cohort: n=563.) 80%The most commonCMSP recipient is a 70% GenderWhite male under (n=11,958) CMSP Recipients Sonoma Countyage 60. 60%However, CMSP Percent of Population 50%recipients are morelikely than the 40%Sonoma County Age n=(563)population to be 30%Hispanic, or male, Ethnicityor under age 29. 20% (n=11,654) 10% 0% o e e an n an er er 9 9 9 9 5 te tin ia -2 -3 -4 -5 -6 al al hi nd th ic ic M As m 21 30 40 50 60 La W O er er la Fe Am Am Is or fic c an e ni ci iv pa Pa ric at is N Af H Report on Sonoma County CMSP, M. Stuart, HSD PRE, October 20, 2008, page 11
  • TABLE 5: Months on CMSP by Demographic (cohort, n=563, from January 2007 through July 2008) Average Number of Months in 19 months (Jan 07 – Jul 08) Demographic Sub-Groups with CMSP Enrollment Statistic p Age 21-29 (n=140) 4.42 F=10.92 .00 30-39 (n=105) 7.61 40-49 (n=146) 8.77 50-59 (n=115) 10.43 60-65 (n=57) 7.49 Ethnicity White (n=339) 8.79 F=10.55 .00 Hispanic or Latino (n=140) 5.69 African American (n=27) 9.48 Asian (n=20) 8.80 Native American (n=14) 12.21 Pacific Islander (n=11) 10.73 Primary Spanish (n=106) 5.13 F=25.15 .00 Language English (n=447) 8.83 Other (n=10) 11.50 Gender Female (n=238) 8.45 t=1.01 .31 Male (n=325) 7.98 Sonoma County Human Services Department Average Number of Months with CMSP Enrollment January 2007 through July 2008 Cohort n = 563 14 12 Average = 8.18 months Ethnicity 10 Age Language Average Months on CMSP Gender 8 6 4 2 0 er e 9 9 9 9 5 n sh n ish e o an er te al -2 -3 -4 -5 -6 ia ica al tin th hi nd i ic an gl M m As 21 30 40 50 60 La W O er er la En Fe Sp Am Am Is or ic c e an cif ni iv pa Pa r ic at is N Af H Report on Sonoma County CMSP, M. Stuart, HSD PRE, October 20, 2008, page 12
  • 1. With certification periods of two months (restricted), three months (share of cost), and six months (no share of cost) it appears difficult for recipients to maintain health coverage (based on patterns of enrollment), and presumably, to access preventive and chronic health care. CMSP appears to be utilized primarily by recipients as coverage for acute or emergency health needs.2. A very small percent of Sonoma County CMSP enrollees (12%) have a share of cost. The three-month certification period for recipients with a share of cost is not justified for such a small group. Increasing the share of cost certification period to six months would ease the burden for recipients, reduce workload (each CMSP re-application requires 59 minutes10), and presumably improve health outcomes.3. Within the Sonoma County medically indigent population, Hispanic, Spanish-speaking individuals have lower rates of coverage and coverage for shorter amounts of time. This may reflect the use of CMSP by undocumented residents of Sonoma County who are eligible for restricted CMSP.1. Collect and report this information on an ongoing, monthly basis (from MEDS) for use in policy development and practice management by the Human Services Department and the Department of Health Services.2. Add information about utilization of medical care to more fully understand the types of health care received by CMSP recipients and the impact of intermittent health coverage on health outcomes.3. Conduct additional study to determine the impact of CMSP enrollment patterns on health outcomes in Sonoma County.4. Continue to explore, and promote (as appropriate), a longer CMSP certification period to promote improved health. This may include testing, and if successful advocating for, self-recertification at six months and full recertification at 12 months.5. Explore methods to reduce churning (recipients going on and off CMSP). For instance, explore the feasibility of sending each recipient a reminder notice that their certification period will be ending in 15 (or 30) days and include instructions about how to renew the certification. Or, develop innovative strategies for utilizing the Certified Application Assisters (CAA) to assist with re-certification. Report on Sonoma County CMSP, M. Stuart, HSD PRE, May 30, 2008, page 13
  • 1 DeNaval-Walt, C., Proctor, B., and Smith, J. (2007). Income, Poverty and Health Insurance Coveragein the United States: 2006 (U.S. Census Bureau, Current Population Reports). Washington, DC, U.S. Government Printing Office, 60-233.2 Rhoades, J., Cohen, S. (2007, August). The Long-Term Uninsured in America, 2002-2005: Estimates for the U.S. Population Under Age 65. Rockville, MD, Agency for Healthcare Research and Quality.3 Lucey, P. (2001, January). An Access Program for Medially Indigent Individuals. Nursing Economics, 19.1, 12.4 2008 HHS Poverty Guidelines (2008, January 23). Federal Register, 783:15, 3971-3972.5 History of CMSP (2005). www.cmspcounties.org.6 According to Clo Hair, Economic Assistance Program Specialist, an effort has been made to more correctly use the “Disability Pending” aid code. First, a clerical worker was assigned to specifically work on referrals from the CMSP Governing Board. Second, reminders were made to staff at monthly technical meetings. And, third, programming was corrected in CalWIN to facilitate the use of the “Disability Pending” aid code.7 American Fact Finder (2006). US. Census Bureau. www.factfinder.census.gov.8 The disposition of the 21 individuals with only 1 month of CMSP eligibility is as follows: Disposition # of Recipients % of Recipients Converted to Medi-Cal 14 56% Over Income 5 20% Administrative Error 4 16% Client Request 2 8%9 The Uninsured: A Primer (2007, October). The Henry J. Kaiser Family Foundation.10 Himes, D. et al (2007, June). County Medical Services Program Work Measurement Study Initiative. Robert E. Nolan Company, Inc. Report on Sonoma County CMSP, M. Stuart, HSD PRE, May 30, 2008, page 14