Coaxing the Coachella Valley to Sign Up for Insurance

The Inland Empire is on track to meet the state’s goal of enrolling 76,069 people from the region into plans from the Covered California insurance exchange, according to figures just released.  Enrollment hit 39,474 during the first half of the sign-up period, which is 52% of the goal.

A big part of the effort in the Coachella Valley is a push by local hospitals to enroll the uninsured before the deadline of March 31st.

Efren Tenorio, 52, lost his health insurance when he got laid off a year and a half ago from his job as Transportation Director at a local school district.  Tenorio said, “I’ve got diabetes, high blood pressure, the residual effects of Bell’s palsy… I’ve got to get some type of coverage. With no income I’m eating up my savings for my house payments, car payments, etc.”

So Tenorio stopped by JFK Memorial Hospital in Indio recently to get help signing up for health insurance through the website   A trained navigator walked him through the process, and they discovered that Tenorio is eligible for Medi-Cal, the state’s health insurance program for the poor.  Under the Affordable Care Act (ACA), California expanded the maximum income requirements to cover more people.  A family can now make up to 138% of the federal poverty level and be eligible for Medi-Cal.  Families making between 138% and 400% of the federal poverty level can get subsidies that apply to the insurance coverage offered on the Covered California exchange.  A single person making up to $45,960 would qualify for a subsidy.

Local hospitals are making a big effort to help people like Tenorio sign up for insurance, in part because hospitals have traditionally had to absorb the cost of uninsured patients who can’t pay their bills.  Tenet Healthcare, which runs JFK and Desert Regional Medical Center, sponsored the workshop as part of a Tenet program called Path to Health.  About 35 people signed up, and 40 did so at a similar event in Palm Springs.  The hospitals also employ certified health counselors who take appointments on an ongoing basis and approach patients who come in without insurance.

Congressman Raul Ruiz, a former emergency room doctor himself, said “A lot more people are going to understand the Affordable Care Act, understand that they can qualify for subsidies, understand that they now have affordable health care assistance and now have assistance in enrollment and I’m a partner in that effort.”

Other groups are also working to implement the ACA in the Coachella Valley.  The Desert Healthcare District (DHD) and the California Endowment (via a program known as Building Healthy Communities) have contributed a total of $1.2 million to support the work of 26 navigators.

According to Kathy Greco of the DHD, The California Endowment was focused on the Medi-Cal expansion, but the DHD was concerned that the navigators should also be able to enroll people who make too much to qualify for Medi-Cal but need help paying for insurance on the Covered California Exchange.  The partnership then decided to train the Coachella Valley-based navigators to be able to enroll people in both Medi-Cal and the Covered California insurance products. “Many of the navigators also speak Spanish, which is a big plus in the heavily Hispanic Eastern Coachella Valley.

The DHD used census numbers to determine that 60,000 people in the Coachella Valley are currently uninsured and qualify for subsidies to help pay for insurance on the exchange.  The County of Riverside estimates that another 30,000 uninsured valley residents are eligible for Medi-Cal.

However, those numbers don’t take into account the large undocumented population in the area, who can’t sign up for Medi-Cal or CoveredCA.  Building Healthy Communities estimates that half of the uninsured in the Eastern Coachella Valley are undocumented.  UCLA’s California Health Interview Survey found that as of 2012, Riverside County as a whole is home to 282,000 undocumented residents.  This population can receive benefits under Riverside County’s Medically Indigent Services Program (M.I.S.P.), so the navigators are also trained to help with M.I.S.P.   The navigators are trained to reassure families who are afraid to apply.   The Immigration and Customs Enforcement agency (I.C.E.) has posted an open letter in English and Spanish on that says it will not use application information in any enforcement actions.

The navigators are based at multiple local agencies, including Borrego Health, Catholic Charities, Clinicas de Salud del Pueblo, Planned Parenthood, Find Food bank and a group called Health to Hope that works with the homeless.  A valley-wide sign-up day is in the planning stages.

Gary Honts, CEO of JFK Memorial, said the navigators help calm people’s concerns.  He said, “I think the obstacle to getting insured has been the fear of the unknown.  Not understanding what’s available, how it works, how to navigate through it.  Just the cumbersome process, having to spend an hour and a half on the internet trying to figure it out, but also the fear of having a pre-existing condition.  Do you qualify or not, how much is it going to cost? Do I qualify for a subsidy or not?  All of those questions kind of impede people to seek out and get the answer.”   Hortensia Federico, a Patient Advocate at JFK Hospital, added, “Once you provide your income information you’re eligible for the Affordable Care Act and the premiums are quite low.”

Tenorio said he was uneasy before he spoke with the navigator. “I had other questions on the requirements and I didn’t want to sign up for anything that I would regret later. I am so thankful to the state of California. I think they’ve gone the extra mile to provide the coverage for the citizens of this community.”

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