Community Health Alert/2006-09

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Revised 8/28/2006

Created by Korean Resource Center
Designed by Mina Park

The Community Health Alert is a periodic publication of the Health Access Project at the Korean Resource Center

Contents

Medi-Cal News

Citizenship Verification Rule - June 2006

Background
In Feb. 2006, the president signed a legislation called the Deficit Reduction Act (DRA), which will change many aspects of the Medi-Cal program. This new federal law will affect the application or annual redetermination process for United States citizens by requiring a show satisfactory evidence of their citizenship and identity with the appropriate documents. Originals of acceptable documents, such as birth certificates, U.S. passports, and U.S. certificates of naturalization, must be sent in with Medi-Cal applications or redetermination forms. Documentation of citizenship and identity is a one-time activity, and documents will not be collected again. U.S. Citizens applying for the first time must submit these documents in order to ensure that they will be eligible for full Medi-Cal benefits.
  • The new federal requirement is not applicable for those applying for Emergency/Pregnancy Medi-Cal.

FAQ

Q. If I am a permanent resident, how does this law affect me?
A. You are not subject to this law as a green card holder. Permanent residents already have to send in a copy of their green card when applying for Medi-Cal. This will not affect your benefit status or your eligibility for Medi-cal.
Q. I am a US citizen and receive Medicare or SSI benefits, how does this law affect my Medi-cal?
A. You would be exempt from this law because you already had to establish your citizenship when you enrolled in those programs.
Q. I am a naturalized citizen and receive no other benefits, how does this law affect my Medi-cal eligibility?
A. When you apply for Medi-cal for the first time or for renewal, you will be asked to provide certain documents to prove your citizenship status, such as US passport or certificates of naturalization.
However, if you do not have those documents, there is no reason to panic. Los Angeles County has decided not to implement the change until further notice, and the State is currently investigating alternative options to requiring hard copies. It is not recommended that citizens try to get these documents on their own at this time.

Even if the new rule gets implemented, you will be given a notice from the County and time to apply for required documents. If you do not understand this letter or do not agree with the information in this letter, contact the eligibility worker at the county social services agency and ask for language assistance. If your renewal application is denied, you have up to 10 days from receiving the written Notice of Action from the County to ask for a hearing.

Medicare News

Background
Medicare is the Federal health insurance program for eligible seniors over the age of 65 or eligible individuals with disabilities. Starting from January 2006, Medicare beneficiaries may enroll in Medicare Part D and choose a plan that offers the best coverage for their prescription drugs. If you have not yet chosen a plan before the May 15, 2006 deadline, you may enroll in Medicare Part D during the next open enrollment period.

Policy Update

Democratic legislators asked for a vote to be scheduled on a bill that would allow Medicare to negotiate directly with pharmaceutical companies for discounts on medications. Pharmaceutical companies this year will receive an additional $2 billion because of the provision in the Medicare law that prohibits the government from directly negotiating drug prices.

This bill would "assist low-income seniors and people with disabilities who are paying higher prices for prescription drugs under the Medicare Program than when they were covered by Medicaid." Elimination of the provision also would allow Medicare to address the "doughnut hole" in the prescription drug benefit, under which beneficiaries must pay 100% of total annual medication costs between $2,250 and $5,100.

For current beneficiaries 
If you have not yet enrolled in Medicare Part D, the next enrollment period is: from November 15 to December 31, 2006. For enrollment assistance, please contact Korean Resource Center.
For New beneficiaries
If you turned 65 after May, 2006 you have up to 7 months to choose and enroll into a plan - 3 months before the birthday, the month of your birthday and 3 months post.
For dual-eligibles
If you have both Medi-cal and Medicare, you have been automatically enrolled. If you are having problems receiving medications as prescribed, you can enroll into another plan once a month.

Medicare Only

If your pharmacist tells you that your Medicare drug plan won't cover a drug you think should be covered, or it will cover the drug but at a higher cost than what you are required to pay, you have the right to:

  • Request a decision called a "coverage determination" from your plan
  • Pay for the prescription and apply for reimbursement requesting a coverage determination
  • Request a coverage determination if your plan requires you to try another drug before it pays for the prescribed drug, or there is a limit on the quantity or dose of the drug and you disagree with the limit

If your prescribed drug is not covered by your current prescription drug plan, you can send a letter or a doctor’s note to the insurer of your prescription drug plan.

You, your doctor or family member can call your plan or write a letter requesting that the plan cover the prescription you need. Once the request is received, the plan has 72 hours (Standard) or 24 hours (Expedited) to notify you of its decision.

If you need more information regarding Part D program, please contact Korean Resource Center or pick up the booklet at the office.

Medicare Part B

The monthly premium for Medicare Part B will increase by 11.2% next year to at least $98.40 or higher, the current monthly premium is $88.50.

According to Centers for Medicare & Medicaid Services (CMS), overall Part B cost increased by 11% in 2005, including a 10% increase for physicians' services and an 11% increase for outpatient hospital services.


Healthy Kids News

In June, 2006 CA governor Arnold Schwarzenegger signed a $131 billion state budget but used the line-item veto to remove $23 million for county programs that would have gone toward providing health insurance for undocumented immigrant children. The one-time funding was intended to provide coverage by mid-2007 to 24,000 children who have been on waiting lists for Healthy Kids programs. Healthy Kids provides coverage for children from families of four with incomes of $50,000 to 60,000 a year who are uninsured and ineligible for Medi-Cal or Healthy Families, mostly for citizenship reasons. However, republican legislators refused to support a budget that would allow undocumented immigrant children to receive public health insurance benefits.

California voters will have the opportunity to ensure that all children have health insurance by voting for the tobacco tax measure on November's ballot. The November statewide ballot will include Proposition 86, which would increase the state tobacco tax to fund hospitals and emergency services, nurse education, children's health insurance and other health-related programs. The initiative will expand access to affordable, comprehensive health insurance to all children in California including undocumented immigrant children. 42.25% ($371 million) is to be used for children's health insurance, including an expansion of the Healthy Kids program. Children from households with incomes of up to 300% of the federal poverty level will be able to receive public health benefit from the current threshold of 250%. According to the recent CA Department of Health Services study, the passage of Proposition 86 will the lives of more than 180,000 of California's youth.

Contact us

If you are interested in helping to advocate for any of the aforementioned issues or becoming a volunteer at Korean Resource Center, please contact Caroline Lee at 323.937.3718 ext. 110.

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