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County , Federal and State Social Services - Keeping the impoverished poor since 1935

by Tim Rumford
A look at the state of County, State and federal health insurance. MediCruz, Medi-Cal, and Medicare as well as Social Security Disability.
socializedmedicine.jpg
Social Services – keeping the poor in poverty since 1935

by Tim Rumford

Social Services have existed in this Country since the 17th Century. They were designed from the same “Poor Laws” that were created from the very Country we fled from. Poor laws allowed social services to the destitute, but upper class citizens of each City could decide who was worthy and who wasn't.

Here in Santa Cruz we have are own county based health insurance providing healthcare for the poor, MediCruz. Although Medi-Cruz has many problems, it has to be said that it is not a requirement of the City nor the County to provide such services.

MediCruz is a County Health Service for the poor. It is designed to give healthcare to the homeless and the most poor in our community. It has been around for 20 years although budget problems have been an issue prior to 2005.

You can only apply only for Medi-Cruz if you are currently having a health crisis. In other words, you must already be sick or injured to even apply. It is designed for those without Medicare or Medi-Cal.

“Who can be covered? Generally, adults age 21 to 64, who are not eligible for the Medi-Cal program. Those who are not enrolled for Medi-Cal due to immigration issues or are only eligible for limited-scope Medi-Cal may also qualify for Medi-Cruz”

I believe the new County “2008 July Cuts” have eliminated access to Medi-Cruz for those with “immigration issues”

One of its purposes is to save money by stopping people from using the emergency room for non-emergencies. People with Medi-Cruz have a share-of-cost determined on a monthly basis using the Medi-Cal regulations. Additionally, you must re-apply for Medi-Cruz benefits every three months. Medi-Cruz also ends as soon as you are healthy. You must continue to fight for other benefits you may qualify for while using Medi-Cruz. You must prove your a resident of Santa Cruz to be eligible and you must of course be very poor. But new requirements may leave many people out all together when a ride to the hospital is so much easier, especially when your sick and without a house. While budget cuts to both County, State and Federal healthcare have been sweeping, a new hurdle now awaits those who need immediate help from Medi-Cruz.

Starting July 1, 2008 MediCruz applicants will have to show that they have filled their 2007 taxes in order to be eligible. They have 30 days from applying to prove they filed their 2007 income taxes to considered for eligibility.

This may seem like a reasonable request those that work hard and pay taxes. That is just how the people who drafted this idea hope you feel. However, Taxpayers will pay more as hospital emergency rooms become the De facto Healthcare Providers for the poor, while unpaid bills ruin the credit of the uninsured driving people deeper into poverty --the unpaid bills will be paid ultimately by the taxpayers. Additionally wait times and care at the emergency wards and hospitals will suffer greatly from the overflow. In the long haul, we will all pay.

I have a feeling few of the chronic homeless filed income taxes in 2007. Nor do I believe many made enough money to be required to file. Although many homeless do work and pay taxes, many in the depths of chronic homelessness have little to no income. Many people that use MediCruz fall into that category. Furthermore, MediCruz is the first stop for those who may have a communicable disease in Santa Cruz.

This additional layer of red tape is not designed to make poor pay their fair share. It is designed to stop a percentage of people from applying for MediCruz at all. The truth is the County is at odds with Dominican and Watsonville hospitals. Talks about reimbursement rates have all but stalled and broken down. Those of you that believe these services are a burden to your taxes realize you will pay more due to these new cuts in the future, not only in Santa Cruz, but nationwide. Healthcare for the poor is being gutted nationwide and the effects of the new cuts are already being felt.

Today July 2nd Watsonville a disabled man had his Oxygen and Nebulizer suddenly removed from his room in a nursing home, Medi-cal was no longer paying .

Medicare, Medi-cal and MediCruz and Medicaid have all been slashed this year nationwide effecting both patients doctors. The Medi-Cal budget has yet to be settled and the money is running out quickly.

Many medicines are no longer being covered by Medi-cal or Medicare prescription 'add on' or advantage plans. Reimbursement rates to doctors and pharmacies have been reduced by 10.6 percent for both Medicare and Medi-Cal. Massive changes in eligibility requirements coupled with sweeping cuts throughout all social services on a County, State and Federal level have just simultaneously come to pass.

Everyone will pay. Your children will pay. While re-designs of a failing systems could have prevented this, corporations that reap massive amounts of money from Bushes Medicare Advantage program keep well paid lobbyists busy fighting to keep things moving in their favor and senators and congressmen arguing. As always money comes before our nations humanity.

“Three weeks ago, the Senate could have followed the House and rescinded a punitive 10.6 percent cut in payments to doctors who treat Medicare patients. But Republicans, among them Florida's Mel Martinez, blocked action, preferring to protect private providers of Medicare Advantage plans.

The GOP's move came just after the Government Accountability Office reported that those plans made $1.14 billion more in profits in 2005 than projected and spent less on treating patients. On Wednesday, Republicans tried again. Fortunately, that effort failed, 69-30. (The missing voters? John McCain, Clinton and Obama)”

Despite popular belief, Social Services do not fall from trees. In order to receive a monthly check that is just enough to make sure you remain in poverty for the rest of your life, you must fight a long hard battle. You must be disabled and everyone is automatically denied the first time unless your blind or have lost a limb.

For those that are truly disabled , the average battle to obtain disability status is 2-3 years. SSI Supplemental Income is for those who are disabled but did not pay enough into Social Security. SSDI is Social Security Disability Income, and is for those who paid enough into Social Security to receive SSDI. Those with SSI receive Medi-Cal. Those with SSDI receive Medicare or both. Often the red tape and long battle is too much for those already struggling.

Distribution of wealth statistics are hard to quote without understanding the difference between “wealth” and “income” and the different ways statics are gathered.
The SSI and SSDI program are designed to keep you in poverty. The simple fear of loosing your medical benefits and small monthly check is enough to scare any disabled person from seeking a new job they may or may not be able to handle. No job training programs exists for the disabled through either Medicare or Medi-Cal.

Medi-cal , SSI, SSDI and Medicare all considers both wealth and income into factoring your income status. They don't not seem to understand the difference between wealth and income, or more likely, they understand it all too well. You cannot own many things, even simple things. You cannot save money over $2000.00 which by todays standards is not enough to pay first months rent and security deposit. You cannot own a car worth more than $2000.00. Things like a guitar count as assets. Yet out of pocket medical costs, like prescriptions not covered, co-pays, or even food or rent are not deductible from your income when applying or going through the yearly reviews for both SSDI, SSI, and Medi-Cal, Medicare and Medi-Cruz.

I ask you to keep in mind the following.
The United States is one of the richest countries in the world, and in 2000, the mean wealth was $143,727 per person.[9] In the United States at the end of 2001, 10% of the population owned 71% of the wealth, and the top 1% controlled 38%. On the other hand, the bottom 40% owned less than 1% of the nation's wealth.

We find massive amounts of money whenever a crisis occurs, fire, floor, war. Yet healthcare is not a crisis deemed worthy for every human being.

Medicare patients are facing there own issues. Lack of access to doctors and specialists is bad enough. Trying to navigate trough the many choices of “Add on HMOs” and other insurance plans that are attached to your Medicare is more than daunting. They cost money and each plan is different. This was Bushes big fix to our Healthcare system which did nothing but make countless insurance and drug companies very rich and the system more complex, less socialized and confusing to the average person. It did save a few middle income otherwise healthy seniors a very small savings.
The debate over importation of cheaper drugs from other countries heated up during the unveiling of Bushes Medicare Advantage Bill. Politicians listed below had their pockets lined for protecting corporate coffers over human decency.

“In the year leading up to the passage of the Medicare Prescription Drug Bill, the drug company PACs, employees, and their families gave more than $3 million in political contributions to these eleven elected officials, largely credited with negotiating the bill, and also responsible for inserting the provision that specifically barred importation of cheaper drugs to begin with.

How much did these industry lobbyists earn? Plenty! Bush $891,208; Senate Majority Leader Bill Frist (R-TN) $123,957; Sen Orrin Hatch (R-UT) $433,324; Sen John Breaux (D-LA) $59,150; Sen Max Baucus (D-MT) $145,372; Sen Charles Grassley (R-IA) $217,921; House Speaker Dennis Hastert (R-IL) $194,700; House Majority Leader Tom DeLay (R-TX) $78,250; Rep Billy Tauzin (R-LA) $211,249; Rep Nancy Johnson (R-CT) $336,908; and Rep Bill Thomas (R-CA) $322,514 “

Pfizer is one of the most profitable companies in the US and produces 14 drugs that are top sellers. In 2003, it spent $3.7 million on Washington lobbying and lead the industry's effort against importation. It has threatened to blacklist any Canadian pharmacies that sell drugs to Americans.

Social Services need to be designed to not only care for the health of the most destitute, disabled , elderly and poor but but to offer solutions such as job training and other programs that offer a way out to the many disabled and poor who feel enslaved by the very programs that are supposed to serve them. Programs that are designed to keep you in poverty and dependent on services with no alternative to escape the dependency without fear of loosing everything --- will always fail in the eyes of humanity.







I am interested in hearing from others who have been denied access to medicine, healthcare or denied or lost their coverage from any of the services listed. Please email me if you have encountered such problems.
Thanks
Tim Rumford
Add Your Comments

Comments (Hide Comments)
by lt
I had a friend who was unlucky enough to get meningitis from West Nile, and he had no insurance or bank account. In the hospital in the central valley, some accounting staff came in and granted him either the state or county destitute health insurance.
They had some waivers or plans available for cases like his for simplefying paperwork, basically. The truly destitute aren't going to pay, and then the hospitals would have to go through all sorts of maneuvers to finally balance their accounts by getting the federal government to pay or randomly raising rates on procedures for paying customers. Having an official destitution fund at least makes it straightforward and simple - they aren't yet at the point of pushing people back out the emergency room door or not paying the doctors. If they cut MediCruz, the same thing happens. The injured or sick people aren't just going to go away and die - they're going to be there in line for care.

Right now his complication is that despite the fact that whatever special insurance that was (MediCal?) paid his bill completely, the hospital is still seeking the same money from him due to a bookkeeping error and sent a collection agency. He confirmed that the bill was paid, but he can't get the collections agency to listen to that.
by Tim Rumford (thatoldbookstore [at] hotmail.com)
Thanks for the comment. I feel for your friend. I was left disabled from encephalitis which is very similar to Meningitis as well as a spinal injury. I lost everything do to a pre existing condition , loss of insurance and 140,000 in medical bills. Email me if your friend still needs help with that bill. Depending on what hospital the bill is at I may be able to help him straighten it out. These things can lead to a lifetime of poverty. People are just now receiving Medi-cal refusals with more to come when they finally get a budget passed. People who have medi-cal should double check that there yearly review was excepted so you don't find out when you go to the doctor or pharmacist. I agree with your comment. Thanks.

If anyone has been denied Medi-cal due to making too much money, please contact me. There are programs that they often wont even tell you about to help you keep it, depending on how much you make of course. Right now people making over 1,000 a month are getting denied.
Peace
Tim

I have in the last 2 days received two calls about people being told they lost their Medicare or Medi-cal and will be kicked out to the streets from two different care facilities, one is an 80 year old woman who is paralyzed. More info will be posted on these situations as the information arrives. Nursing homes and care facilities in this country for the poor are not great by ANY standard. The quality of care is poor at best for most. Yet for many, its all they have. If anyone is being threatened to be thrown out of a care or nursing home, or is being mistreated in any way they should call their local ombudsman. They have been extremely helpful in several situations that have crossed my path. They have helped people who would otherwise be left homeless from being kicked out of hospitals onto the street and have also stopped people from being kicked out or mistreated in long term nursing and care facilities. They are trained volunteers and exsist to fight for the rights of patients at such facilities. The National Number is 1-800-510-2020. Additionally CANHR is a great organization fighting for the rights of those in Nursing or Care facilities as advocates. They can be reached at http://www.canhr.org/ or -

California Advocates for Nursing Home Reform
650 Harrison Street, 2nd Floor
San Francisco, CA 94107

(415) 974-5171
(800) 474-1116

peace
Tim Rumford
by Sick and tired
I am disabled and have been for 11 years. My disability has never been in dispute. I have always had the combination of Medi-cal and Medicare. This has traditionally been for people like me who's SSDI is fairly low, 1,117.00 a month. Medi-cal simply paid for things Medicare did not, like dental care, which is nearly non existent even with Medi-Cal. It at least allowed me a cleaning once a year or a stainless steel cap in a pinch. After bushes prescription add on program for Medicare I was automatically (forced) enrolled in an HMO add on for prescriptions, Bravo. Again, anything this did not cover, Medi-cal did. Bravo paid for very little.

This year I filled out my Medi-cal review and turned in all the paperwork. I received a call saying everything was fine. Then the next day, I was told I made too much money as a single male to qualify for Medi-cal. I was told my Co-pays were not deductible from my income. The worker was nice and looked for anything to keep me enrolled. i was told I needed to purchase another HMO add on to my Medicare and that income would be deductible and i could keep this combination, the only way for me to have dental care through denti-cal. However, i cant afford the add on plan. I can't even afford to eat let alone buy another HMO I don't need to lower my income. I was then told there was a program where I can work... and earn up to 200.00 dollars a month and this income is deductible allowing me to keep my medi-cal. I enrolled in this program. I now have to work a few hours a month, which has only worsened my condition. On top of that, despite all this my Denti-Cal was denied separate from my Medi-cal. I have received three Medi-Cal Denial Notices and one that says I was approved under this work program. All dated the same date in the same envelope. I also am told I now have to pay each month to keep my medi-cal, even know as of this minute, i don't have it. I had to pay for my meds this month. I am trying to call Med-cal, but as you can imagine they are very busy...

If your not confused yet, try it from this end. Also realize, if i owned a home and died tomorrow, the state under Medi-cal can take that home. They have done this to others in 6 counties in Ca. recently. If you own a home and are on medi-cal, look into this.

So now as a disabled American i have to work, pay, loose my dental care, by two HMO's, and even with all of this, it seems as if i will loose my dental care and medi-cal anyway. If its not made for me who the hell is this program made for??? I worked. I paid into this system. I am not asking for much. Just simplifying this bullshit would save the state and feds oodles of money.

The insurance companies that supply these add on plans are racking in the money at the suffering of the poorest Americans.

by Tim Rumford
Dear Sick and tired,
Its seems we have similar issues with our disability insurance. Let me explain at least where your at and your options as I understand them. First off, when you enroll in the worker program, you can do anything, walk a dog , whatever. You can earn as much as your worker said, normally about 100-200 a month. This is deductible from your income as ridicules as that is. You have not lost your Medi-cal but your provider has changed. Central Coast Alliance is the Company that medi-cal farms out its insurance to. They become your insurance company when you have Medi-cal. but for you and I, we now have a different type of Medi-cal. Throw away your Central Coast alliance card and keep your blue and White card, a BIC card. Your State Medi-cal Card. That is now who pays for your Medi-cal, the state directly. Inform your doctors and your pharmacy immediately.

Problems. This form of Medi-cal does not cover as many medicines as Central Coast Alliance. Even with Bravo, you will likely run into meds not covered at times. You can get a list from the state. I will try and post the list or the number. You have also lost your dental-cal as far as I understand it. I am still waiting my own confirmation on that. We are now basically slaves to corporate add on plans designed to make money off the disabled and poor.

You can in December buy as you said yet another HMO add on to your Medicare that will lower your income to allow you to reapply... and get back on Central Coast Alliance and get your Dental care. The HMO needs to cost just enough to put you below 1,170.00 a month. But make sure it is at least 40% more as they adjust these numbers all the time and enrollment comes once a year in December. As ridicules as this all seems, this is healthcare for the elderly, disabled and poor in America.

Once you get that HMO, Medi-cal wont be paying for much anyway, thats the whole idea. But for those of us with Chronic problems, the HMO caps come quickly and thats when having your medi-cal with your Medicare is not only good its vital.

The opposite of being socialized, were being incorporated. Its less complicated for those who have only one form of aide, and not the combination of both. Others out there may not understand why you need both, but it goes beyond just dental care, but access to specialists, and having the right to see a doctor of your choice and being able to pay the 20% Medicare does not cover or pay for everything once you reach the cap of your HMO ad on. My general thought is try and get the HMO as much as i despise them and get off the direct state insurance. They are far more likely to find a reason to disqualify you next year, as they are much more stringent at looking at any money you may have gotten, even if it was 50.00 from your mom to eat during a rough month.

These are just my opinions of course and anyone else who knows more or has any other ideas, please, chime in. I hope dissenters will allow this conversation to keep to this tone of helping each other as this crisis is just beginning.

There is Good news " Overriding a presidential veto, federal lawmakers late Tuesday protected doctors from a 10.6 percent cut in Medicare reimbursement rates. The move will halt the reimbursement cuts in 2008 and gives doctors a 1.1 percent increase in Medicare reimbursement rates in 2009. The bill also increases bonuses paid to doctors in rural areas. "



by Thomas Leavitt
69-30 vote is 99 votes... are there two extra seats in the Senate, otherwise, how do you get 3 missing voters? Or did they miss the earlier vote, not the 69-30 vote?
by Thomas Leavitt
Great article, Tim. I'd bet there are quite a few middle class folks who still haven't filed their taxes from last year...
by Tim Rumford
Thomas,
Your right. The previous vote all three were absent. This time it was only McCain. Thanks for the clarification and comments!
Peace
Tim
by Tim Rumford
I also agree that yes, many middle class folks did not pay their taxes. I just heard from a mutual friend with no health insurance, denied medi-cruz, she does not know what to do, except maybe go the the ER.

Also, I wrote this article in early July and was thinking of an earlier vote, the first one. I realize the article is a bit jumbled. Its been hard to concentrate, but I think this is important. There have now been three votes, with this one being the one that successfully vetoed the president. At the time of the first vote, I was upset at their absence, despite the fact they may have been tired from their campaigning, all three were absent from the first vote where both the house and senate argued for five hours with both sides presenting different bills.

For this latest vote you are absolutely correct.

"In the end, it turned out, Kennedy's vote wasn't strictly necessary. Nine Republicans switched from no to yes, joining the nine who voted for the bill the first time. The final tally was a veto-proof 69-30, with only Republican John McCain noticeably absent."
by Tim Rumford
More corrections to Medi-cal
Although the recent defeat of Bushes veto by congress is a good step for Medicare patients, it did little to help those on Med-Cal or Medicaid.
I no longer want to go to work" said one pharmacy owner. Others have said they may shut down altogether."


Cuts will hurt patients, Medi-Cal told
detailed info - http://www.contracostatimes.com/ci_9927103
by Tim Rumford
e8-10879.pdf_600_.jpg
In writing this somewhat jumbled article on complicated issues. I was dealing with my own health disabilities which include light sensitivity caused seizures, which making writing very difficult when using a computer screen. So, I have been posting not only additional information but corrections.

Its untrue that no back to work program exists within the SSI and SSDI programs. However, this "Ticket To Work Program" has been deemed a failure by the SS administration itself. The reasons I have found it to be a failure is that 90% of the time you call a SS worker you get will be told NO PROGRAMS exists to help you return to work. There is a program that allows you to return to work, continue to get paid a fair percentage of your unfair monthly SSI or SSDI Payment for about a year. Prior to July there has been very little training that went along with this idea of putting the disabled to work Also the verbiage of the program is confusing to the average reader. Attached is the new "Ticket to Work" program details with the new updates for 2008. Although they state that many programs exist to train and even find work for the disabled. I have yet to find one SS worker to point me to such a program.

Other problematic aspects of this is that although this allows you to go back to work and even get two checks for a defined amount of time. This extra income would seem like a great opportunity to save up for housing, for some it may be. But the fear of being disqualified from other health insurance that comes along with SSDI and SSI , such as having the combination of both Medi-cal and Medi-Care are very real. I think the basic idea is great. But without knowledgeable staff that can help people get started without fear of loosing their health benifits, real training programs that truly exist beyond being simply referenced in a complicated document , is just another waste of money and another failure of the SS administration at truly trying to help people entrapped in poverty. Attached is the PDF file for those who feel they might be able to return to work part time or full time. It can be an opportunity to get out of this "keep you impoverished program". I would suggest people tread very carefully when entering this program. Know exactly how it will effect your health benefits. Especially for those who have costly disabilities and the combination of Medicare and Medi-cal.

I also discovered that Bushes stimulus tax rebates count as income when being reviewed for continued eligibility for Medi-cal or Medicare, pushing some people just over the limit and disqualifying them from the very health benifits that they rely on as disabled Americans. Stimulating them right into the further depths of poverty.

budgetletter.pdf_600_.jpg
Insurance companies cease payments to Physicians thanks to Governor Arnold Schwarzenegger.

See attached letter from insurance company Cent Cal, which has now sent letters to its physicians saying they are ceasing payments for Medi-Cal payments as this letter states from their website. This will include all hospitals here including SC Medical Foundation, Dominican and Watsonville Hospital. Because the state has yet to pass a budget and the cuts our Governor has already made, the poor are going to pay more then anyone for our economic crisis which keeps those with power and wealth very happy.

A good friend was refused Medi-cal this year because they made 4.00 too much... !!!! They went to apply for Medicruz and was denied there too. They did not want to ruin their credit by using the emergency room. Now they will have no choice. Nice job. This is just the beginning. Get ready for the flood.
$1,000 a minute.

That's the hit that San Joaquin Valley safety net health clinics started taking Thursday when Medi-Cal payments stopped because of the state's budget impasse. The cuts will mean a loss of $10 million a week in revenue to California's community clinics and health centers -- the offices that take care of the poor.

On day 24 without a state budget in place, Golden Valley Health Center's Chief Executive Officer Mike Sullivan spoke to a group in Modesto about how cutting Medi-Cal payments hurts the people least able to withstand a hit to their health.

"The legislators are putting their budget problems on the backs of the poor," Sullivan said.
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