The One Bay area health plan breaks the boundaries of health insurance. California could follow suit
This is the third in a three-part series on housing and health care. Listen to parts one and two here.
“Happiness comes to mind. I can only speak for myself. I am happy. I got my life back.
I meet Kojo Nsoah outside Home Sweet Home, an assisted living facility establishment in the town of Daly. He wears black, even his Raiders hat and mask match his outfit.
Nsoah is in his electric wheelchair ahead, waiting for a group van. He lives at Home Sweet Home, but likes to spend his days in an adult day care facility along the coast Half-moon bay.
The van stops at 8:30 am sharp. He climbs aboard, the driver straps him in and turns on his iPad to play games or watch horror movies for an hour on the road. It has been his routine for almost six years since he got off homelessness. This chapter in Nsoah’s story begins about 15 years ago in Washington DC. He had just finished his law studies and was working as a paralegal, studying for the bar.
“That’s when it happened. It looked like I had just lost my mind, ”he says.
He had what he describes as a psychotic breakup. He stopped going to work and started living in parks in Washington DC. One day he saw a picture of the Golden Gate Bridge and decided he was going to move to the Bay Area. Nsoah gathered enough money for a one-way bus ticket and went to San Francisco.
“I had been there for 10 years and woke up one morning – I was sleeping in the Chinese park up the hill – this is where I got the stroke.
He was 50 years old. An ambulance rushed him to hospital and he spent a year recovering in a nursing home in Daly City. Until, he says, they give him his medicine and put him in a wheelchair outside a shelter in downtown San Francisco.
“I had a rude awakening when they sent me to a homeless shelter. I wasn’t expecting it, ”he says.
So he says he’s become provocative. He didn’t want to live in a shelter. He didn’t have a good understanding of his stroke, but he knew he couldn’t take care of himself on the street or in a shelter. The stroke had paralyzed one side of his body. He was at the end of his rope.
“I walked to Market Street and stayed there for a few nights before stopping the police car and telling them I was feeling suicidal.”
They took him to a mental health ward at San Francisco General Hospital and he eventually ended up in the Daly City nursing home. It is a cycle that often continues for many people aging on the streets. – from the emergency room to the nursing home to the street to the emergency room. But during this to stay, he got lucky and landed a spot in a pilot program with San Mateo County Public Health Plan. The one that was designed, in part, to stop that endless revolving door.
The San Mateo Health Plan is unique among public health plans because they administer both Medi-Cal (the state program for low-income people) and Medicare (the federal program for the elderly).
Amy Scribner works with the health plan and says only six other counties in the state cover both plans in this way. This is because it means facing more demands from the state and more control from the federal government. It’s just more work. But, there is a big advantage.
“The idea was really to bring people from nursing homes back to the community with enveloping services and supports.. “
This started in 2014, Around the same time, Kojo Nsoah found himself for the second time in a retirement home in San Mateo County and didn’t really need to be there. And at the time, Amy Scribner saw a lot of people in the same situation – people with physical and mental limitations ending up in overcrowded nursing homes because they had nowhere to go. In addition, a large county nursing home was due to close and threatened to displace many people.
“One of the things that happens when someone goes to a skilled nursing facility that is on Medi-Cal, even if it’s short term, if they rent an apartment, their money ends up in the after 90 days to go to the retirement home. They cannot pay their rent. So a lot of people get evicted and end up in long term care because they lost their homes while they were there. And so they can’t go out because they’re homeless, right. Nobody wants to send someone from a retirement home to the street ”, she says.
So the plan decided to cover things that are not normally covered by Medi-Cal or Medicare. They can’t legally pay rent, but they can pay security deposits and people to help with things like section 8 bonds, for example.
“Here in San Mateo County, we have recognized it as something important to our members and to our community. And so we took on the burden, the financial burden of the program, ”says Amy Scribner.
In Kojo Nsoah’s case, he pays his rent with his social security check. Almost everything else at Home Sweet Home is covered by San Mateo’s health plan – a payment that is traditionally not covered by Medicare or Medi-Cal.
The plan also covers a case manager who connects him with other services to continue to live as independently as possible and keep him away from a nursing home. While this all sounds pretty expensive for the health plan, financially it ends up saving the state money in the long run. a independent assessor found that there is a savings of 30-35% by moving people from nursing homes and back in the community. But, Amy Scribner also thinks of it as an investment in the person.
“It’s not just a Medicare number. This is a person we are trying to serve.
This particular program only lasts until the end of this year. It was designed, in part, to demonstrate to California if it provides services in this manner could succeed. In January, it will be integrated into a new government initiative, called CalAIM.
The idea is to make Medi-Cal more responsive, more flexible towards people with these conditions who are outside the traditional medical world, says Sharon Rapport, policy advisor at the Supportive Housing Corporation.
She says there will be a a lot of changes in california. Something called instead of services is what could make a difference for people like Kojo Nsoah across the state. It basically does what the San Mateo health plan did, paying for things that are not traditionally covered by Medi-Cal, in an effort to keep someone out of a nursing home if they do. doesn’t need to be there – like paying for a wheelchair ramp at home or a grab bar in the shower. If someone is roaming, the plan could pay for a housing browser or a security deposit. If they end up in the hospital, it could pay for a respite home – a place they can recuperate so they don’t go back into homelessness.
“Instead, they go to another place that isn’t a hospital, but it’s a place where they can have a bed, maybe nursing, a case manager to help them find a accommodation when they leave, ”says Rapport. It’s the same as what refuge hotels offered to people homeless in the worst months of the pandemic.
Sharon Rapport says it’s a good start to recognizing the wide range of things that make a person healthy, but she wants the state to go further for people who are homeless. That much, instead of services are only optional, and plans can choose which services they want to cover or restrict eligibility. In addition, most insurance plans do not have clear data on which of their members are experiencing homelessness.
Kojo Nsoah will still benefit from the same services covered and paid for by his health plan. Although in other places the transitions may not be as smooth. Plans across the state are confirming the services they will cover through CalAIM, and homeless advocates are hoping housing will top the list.
Nsoah says having all this support around housing gives her the opportunity to think more about her health.
“It’s good. I mean. I’ve never lived in a place like this before. It’s great to have a nurse on staff. They have activities you can do or leave me alone. .
And when he comes to adult day care, he takes occupational therapy and physiotherapy. He rolls his chair around in a circle of other seniors, the teacher takes his legs off his wheelchair and hugs them together for extra support.
When it’s time to start, Nsoah and the rest of the class mimic the teacher as she moves her hands and feet in a circular motion, or taps her heels on the floor. He tells me it’s something that barely a decade ago he could never have imagined himself doing.
“I had a stroke. I think I was fine, but I wasn’t. You know, come to think of it, I wasn’t. I was not doing well at all.
Now that he has stable housing and his other basic needs covered, for the first time in years, he says he has finally been able to put his finger on how he feels.
Angela Johnston reported on this series while attending the USC Annenberg Center for Health JournalismCalifornia Stock Exchange 2021.