The number of Sonoma County CMSP enrollees is increasing.
- 11,977 different residents received CMSP from December 2006 to July 2008, representing 4% of adults ages 19-65.
- The number of enrollees increased from 3,431 in December 2006 to 4,440 in July 2008, a 29% rise.
- On average, 468 individuals each month are new enrollees, representing 11% of all enrollees that month.
Managed Care within Health Care covers a variety of information from nursing homes, policies, Medical, Medicare, out of pocket, and partial payment, management, contracts, government, and the Social Security State Fund. Within this working paper I will discuss a few of these mechanisms that are applied and utilized within ‘Managed Care’ today. A system within a system that brings in 25% of the United States debt.
Managed Care within Health Care covers a variety of information from nursing homes, policies, Medical, Medicare, out of pocket, and partial payment, management, contracts, government, and the Social Security State Fund. Within this working paper I will discuss a few of these mechanisms that are applied and utilized within ‘Managed Care’ today. A system within a system that brings in 25% of the United States debt.
Past President Franklin Roosevelt and Lyndon B. Johnson enacted ACTS and legislation to help the United States Poor to ensure they has proper health care insurance. “The Social Security Act was passed by Congress as part of President Roosevelt’s Second New Deal agenda. In signing the Act into law on August 14, 1935, Roosevelt became the first president to advocate for and create legislation for the provision of governmental assistance for the elderly at the federal level” (CSU, 2015). Considering the new policies and new developments of the country to ensure that housing, food, and work was also available. Time was surely of the essence considering it was the turn of the century and the United States was implementing new changes and programs within the United States.
Past President Franklin Roosevelt and Lyndon B. Johnson enacted ACTS and legislation to help the United States Poor to ensure they has proper health care insurance. “The Social Security Act was passed by Congress as part of President Roosevelt’s Second New Deal agenda. In signing the Act into law on August 14, 1935, Roosevelt became the first president to advocate for and create legislation for the provision of governmental assistance for the elderly at the federal level” (CSU, 2015). Considering the new policies and new developments of the country to ensure that housing, food, and work was also available. Time was surely of the essence considering it was the turn of the century and the United States was implementing new changes and programs within the United States.
The U.S. created Medicare, a publically funded healthcare progra.docxteresehearn
The U.S. created Medicare, a publically funded healthcare program, to assist people sixty-five years of age and older in obtaining healthcare services.
Summarize the legislation that introduced Medicare and the funding source for the program.
Discuss some of the changes that have occurred in the Medicare program since its inception.
Describe the demographics of the population covered by Medicare and identify the number of people in the U.S. covered by Medicare.
Assess how changes in Medicare will affect the citizens and legal residents in the state of Maryland. Include specific demographic information on age, race, income, etc., for Maryland to justify your response.
Resources:
Centers for Medicare & Medicaid. (2015). CMS program history. Retrieved
from https://www.cms.gov/About-CMS/Agency-Information/History/index.html?redirect=/History/
Centers for Medicare & Medicaid. (2015). The Affordable Care Act &
Medicare. Retrieved from https://www.medicare.gov/about-us/affordable-care-act/affordable-care-act.html
Submission Details:
Assignment should be addressed in a 2- to 3-page document.
Cite all sources used in the work and provide references using APA format.
...
2013Medicaida PriMerThe Kaiser Commission on Me.docxaryan532920
2013
Medicaid
a PriMer
The Kaiser Commission on Medicaid and the Uninsured provides information
and analysis on health care coverage and access for the low-income population,
with a special focus on Medicaid’s role and coverage of the uninsured. Begun
in 1991 and based in the Kaiser Family Foundation’s Washington, DC office,
the Commission is the largest operating program of the Foundation. The
Commission’s work is conducted by Foundation staff under the guidance of a
bipartisan group of national leaders and experts in health care and public policy.
MEDICAID
A PRIMER
Key Information on the Nation’s
Health Coverage Program for Low-Income People
March 2013
v00 v00
TABLE OF CONTENTS
Introduction…….........................................................................................1
The Medicaid program is the largest health insurance program in the U.S., covering millions of
the poorest individuals and families in the nation. As such, Medicaid is also a key source of
health care financing. Medicaid covers many people with disabilities and complex needs, and
the program has been an important locus of innovation and improvement in health care delivery
and payment. The Affordable Care Act (ACA) expands Medicaid significantly beginning in 2014.
The expanded Medicaid program is integral to the broader framework the ACA creates to cover
the uninsured.
What is Medicaid?.....................................................................................3
Medicaid is the main publicly financed health coverage program for low-income Americans,
most of whom lack access to the private health insurance system. Medicaid is also the dominant
source of coverage for nursing home and community-based long-term services and supports.
The program provides core support for the health centers and safety-net hospitals that serve
low-income and uninsured people and provide essential community services like trauma care
and neonatal intensive care. States design and administer their own Medicaid programs within
broad federal guidelines.
Who Does Medicaid Cover?.......................................................................7
Medicaid covers more than 62 million people, or 1 in 5 Americans. It covers more 1 in 3 children
and some of their parents, and 40% of all births. It also covers millions of people with severe
disabilities, and provides extra assistance to poor Medicare beneficiaries. Historically, the
program has excluded most non-elderly adults, but the ACA expands Medicaid beginning in
2014, making it broadly a program for people under age 65 with income at or below 138% of the
federal poverty level. Each state will decide whether to adopt the Medicaid expansion.
What Does Medicaid Cover?....................................................................13
Medicaid covers a wide spectrum of services to meet its beneficiaries’ diverse needs. Medicaid
benefits for children are uniquely c ...
The Theme of Love in Sulaby The Theme Of Love In Sula The Th.docxarnoldmeredith47041
The Theme of Love in Sula
by The Theme Of Love In Sula The Theme Of Love In Sula
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The Theme of Love in Sulaby The Theme Of Love In Sula The Theme Of Love In SulaThe Theme of Love in SulaORIGINALITY REPORTPRIMARY SOURCES
Running head: IMPACT OF THE ACA ON HEALTH CARE
1
IMPACT OF THE ACA ON HEALTH CARE
4
Impact of the ACA on Health Care
Student’s Name
Institutional Affiliation
Impact of the ACA on the Health Care
Affordable Care Act (ACA) is one of the legislative laws that played an important role in redefining the health sector in the United States. The Act has been instrumental in ensuring medical coverage to enable citizens to acquire affordable health care services. The paper examines the impact of the ACA in healthcare as well as the effect that would be experienced if the law is repealed.
The main goal of ACA was to expand both the private and Medicaid coverage to ensure that it covers more than 50 million citizens that were uninsured before the law was enacted (Eguia et al., 2020). Before the law was enacted, the United States government-insured its citizens through programs such as the Medicaid and Children’s health insurance. However, through these programs, those without children and some low-income parents remained uninsured. Therefore, the law ensures that all citizens are insured regardless of age, gender as well as income eligibility.
The law also contained provisions that intended to increase the accessibility of health insurance. When the law was enacted, it ensured that the coverage of children is extended to cover up to individuals of age 26 (Eguia et al., 2020). Therefore, the law led ensured led to increasing of medical coverage among the target population. Upon the enactment of the law, the number of young adults that got covered increased from one million to three million.
The new Act also contained provisions that prohibited denying or charging higher premiums due to the health conditions of an individual (Eguia et al., 2020). It enabled individuals to get insurance regardless of their health conditions and created a website where individuals could view their premiums and plan effectively for their payments. Finally, the law also imposed penalties on those who default the amount of their coverage as well as employers who failed to cover their employees. That helped in ensuring that most of the citizens in the employment sectors got insured.
Impact of Repealing the ACA
Repealing the Affordable Care Act by the federal state had a significant impact on the health care that included both negative and positive effects. For instance, repeali.
State-Level Estimates for Tracking Health Reform Impact: Opportunities and Ch...
Sonoma County Medical Services Program (2008)
1. October 20, 2008
Prepared for Indigent Health Group
Marion Deeds, Director of Economic Assistance, Human Services Department
Lynn 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
2. Page
Summary ......................................................................................................................................... 1
Description of CMSP ...................................................................................................................... 2
Purpose of Study ............................................................................................................................. 2
Methodology ................................................................................................................................... 3
Description of CMSP Recipients .................................................................................................... 4
Tables 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 .................................................................................. 11
Conclusions ................................................................................................................................... 12
Recommendations ......................................................................................................................... 12
Endnotes ........................................................................................................................................ 13
3. 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.2
The 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. 9
Impact
HEALTH IMPACT: Uninsured Americans have higher rates of mortality, poor health outcomes, are less
likely to receive preventive care, and are more likely to require inpatient care.3 The number of excess
deaths in 2000 among uninsured adults was estimated at 18,000.9
ECONOMIC 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 governments
reimburse health care providers for 85% of these costs.9
Recommendations (page 13)
CMSP regulations should promote continued medical coverage for eligible individuals to improve the
health of Sonoma County and to reduce uncompensated medical care costs.
Report on Sonoma County CMSP, M. Stuart, HSD PRE, October 20, 2008, page 1
4. In California, Medi-Cal (Medicaid) provides a array of programs to meet the health care of most low-income
individuals. Medi-Cal coverage is available for all children through age 20 and for those 65 and older. In some
cases, the parents of a child are also eligible for Medi-Cal. Other Medi-Cal programs provide coverage for adults
in short-term nursing facilities, as well as those with specific medical needs such as dialysis, tuberculosis
treatment, total intravenous nutrition, or breast or cervical cancer treatments.
Established by California law in January 1983, the County Medical Services Program (CMSP) provides medical
and 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 for
standard CMSP coverage which is approved for six months and which covers all approved procedures or
medications. Some applicants, based on their income, must pay a share of cost and are only approved for three
months. “Share of cost” is the amount that these applicants must pay or obligate before CMSP coverage will pay
the medical provider. This is similar to a co-pay in private insurance. Other applicants are approved for restricted
benefits. These are emergency services only and are approved for two months. Restricted benefits are provided
to residents who lack documentation of satisfactory immigration status or citizenship. Finally, CMSP can also be
approved for an individual claiming disability while they complete the Medi-Cal disability application and for
individuals receiving Long Term Care to supplement the Medi-Cal coverage.
CMSP is administered by the CMSP Governing Board comprised of county supervisors, administrators, health
officials, and welfare directors. Benefits are administered by Anthem Blue Cross for medical, dental and vision
and by Med-Impact for prescriptions. Thirty-four (34) small, rural counties currently participate in CMSP
including Sonoma which is the second largest county with CMSP. These counties have a combined monthly
caseload of 40,000 people and an annual budget of approximately $238 million derived from motor vehicle
license fees, sales tax and county general revenue.5
In September 2007, the Sonoma County Human Services Department (HSD) and the Sonoma County Health
Services Department (DHS) convened the Indigent Health Group. The overall purpose of the group is to gain
better knowledge of the medically indigent in Sonoma County and to develop recommendations to reduce their
obstacles to care. This study was designed to assist the Indigent Health Group’s activities by providing a better
understanding of the Sonoma County CMSP population. Specifically, this study explored the following
questions.
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
5. Information about CMSP recipients was extracted from the California State Business Objects MEDS Database. A
query was run for each of 20 months (December, 2006 through July, 2008). The following information was
extracted for each recipient.
Name Primary language
Case number Month of eligibility
Date of birth Aid code
Gender Amount of share of cost (if any)
Ethnicity
Other information was of interest and attempts were made to include this information. However, this information
was 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 income
All information was compiled in Excel, imported into the Statistical Package for the Social Sciences (SPSS), and
restructured 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
6. 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
8. Aid Code Definitions
84 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 based
on 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 satisfactory
immigration status or citizenship.
88 or 89 Disability Pending – An individual claiming disability is entitled to CMSP while they complete the Medi-Cal disability application, if
otherwise 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 is
expected 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
9. 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 Months
10 19 3.37 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 18
11 7 1.24 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 18
12 5 0.89 68.03 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 18
13 5 0.89 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 1 1 1 1 17
14 3 0.53 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 1 17
15 2 0.36 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 17
16 2 0.36 1 1 1 1 1 1 0 1 1 1 1 1 1 0 1 1 1 1 1 17
17 1 0.18 1 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 17
18 1 0.18 1 1 1 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 17
19 1 0.18 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 0 17
20 1 0.18 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 17
21 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
13. 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 common
CMSP recipient is a 70%
Gender
White male under (n=11,958) CMSP Recipients
Sonoma County
age 60. 60%
However, CMSP
Percent of Population
50%
recipients are more
likely than the 40%
Sonoma County Age
n=(563)
population to be 30%
Hispanic, or male, Ethnicity
or under age 29. 20%
(n=11,654)
10%
0%
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9
9
9
9
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-6
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Report on Sonoma County CMSP, M. Stuart, HSD PRE, October 20, 2008, page 11
14. 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
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9
9
9
9
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Report on Sonoma County CMSP, M. Stuart, HSD PRE, October 20, 2008, page 12
15. 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
16. 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