IN THE LOOP

If you are worried about the Trump Administration’s recent announcement that Medicaid recipients will be required to work, don’t be… at least not if you live in California.

The federal Centers for Medicaid and Medicare Services (CMS) released new guidance on January 11, allowing states to apply for waivers that would allow them to deny Medicaid benefits to people who are not working, volunteering, in school or otherwise participating in some form of “community engagement.”

California is unlikely to seek such a waiver, unless the political calculus in Sacramento changes radically (and that’s even more unlikely). Ten states meanwhile are currently filing waivers to add work requirements to their Medicaid programs and CMS has already approved the first such waiver from Kentucky.

“Community engagement” is conservative newspeak for requiring welfare beneficiaries to work for their benefits. The new guidance applies only to able-bodied Medicaid beneficiaries, not those who are disabled and unable to work.

Critics of the guidance argue that work requirements will lock eligible individuals out of Medicaid and reduce the Medicaid rolls. These critics also argue that many Medicaid beneficiaries have physical or mental limitations that prevent them from working, but don’t qualify them as disabled. A study last year in Health Affairs estimated that 11 million Americans would lose coverage if work requirements were in place in every state.

California’s expansion of Medicaid (Medi-Cal in California) under the Affordable Care Act (ACA) has been a boon to low-income individuals who previously did not qualify for coverage. This includes low-income single people living with or at risk of HIV who can now access care, treatment and PrEP through Medi-Cal. Cutting off health coverage does not make sense, especially to people who either cannot find work, are unable to work, or in some cases may have caregiving duties that make working, volunteering or going to school impossible.

Last week the Southern Poverty Law Center, the National Health Law Program, and the Kentucky Equal Justice Center filed a lawsuit against the U.S. Department of Health and Human Services (HHS) on behalf of 15 Medicaid recipients in Kentucky who say they would be in danger of losing health coverage once the changes take effect. You can support the effort here.

This won’t be the last of the legal challenges but, at least for now, you don’t need to worry if you’re living in deep blue California.

The two Democratic front-runners for California’s next Governor—Lieutenant Governor Gavin Newsom and former Los Angeles Mayor Antonio Villaraigosa—have clashed in recent weeks over a proposal to implement a single-payer healthcare system in the state. Newsom is a strong supporter of the proposal, while Villaraigosa has instead taken a more cautious approach to overhauling the state’s healthcare system. Other Democratic candidates, State Treasurer John Chiang and former State Superintendent of Public Instruction Delaine Eastin, have also taken opposing positions in the single-payer debate. Republican candidates John Cox and Travis Allen are strongly opposed to providing the government with more control over healthcare.

Last year, Senators Ricardo Lara (D-Bell Gardens) and Toni Atkins (D-San Diego) introduced Senate Bill 562, which would have created a single-payer healthcare system that provides medical, dental, vision, mental health and nursing home care for all California residents, including undocumented individuals. Assembly Speaker Anthony Rendon (D-Lakewood) shelved the measure saying that it failed to address several critical issues including financing, care delivery, cost controls and the realities of needed action by the Trump administration to make SB 562 a genuine piece of legislation.

Villaraigosa has also argued that the bill provides too few details about what coverage would look like under the new system and that it would require significant tax increases. A group of physicians and medical providers recently shared similar concerns claiming the bill would destabilize California’s economy and is based on flawed assumptions about how the state can use healthcare funds from the federal government.

Meanwhile, Newsom argues that a single-payer system would drive down the cost of healthcare and that financing of the program will be worked out as the legislative process moves forward. Supporters of the bill, including the California Nurses Association, also claim that a single-payer healthcare system would produce significant savings by slashing private insurance administrative waste and using the state’s bulk purchasing power to cut drug costs.

You can expect the debate over single-payer to only intensify as we approach the June primary election. Don’t forget to register to vote! You can register online here.

On World AIDS Day 2017, the Los Angeles County Department of Public Health’s Division of HIV & STD Programs (DHSP) launched its new Los Angeles County HIV/AIDS Strategy for 2020 and Beyond (LACHAS). The new strategy seeks to significantly reduce the number of new HIV infections in Los Angeles County each year and bring an end to the HIV epidemic once and for all. L.A. County has the second-largest HIV epidemic in the United States—nearly 61,000 people are living with HIV in the County and there are approximately 1,850 new diagnoses each year, most among gay men, African-Americans, Latinos, and transgender persons. The three goals of the LACHAS are:

• Reduce annual HIV infections to 500
• Increase the proportion of persons living with HIV who are diagnosed to at least 90%
• Increase the proportion of diagnosed people living with HIV who are virally suppressed to 90%

The Los Angeles County Commission on HIV, which serves as the local planning council for planning, allocation, coordination and delivery of HIV/AIDS services, has been tasked with oversight of the strategy. The Commission plans to set up work groups comprised of stakeholders and community members to assist and monitor implementation of the LACHAS. Work groups will be organized by the county’s 26 Health Districts, and members will help identify resources and actions to collaboratively work towards achieving goals. The Commission and corresponding work groups will also advise the Board of Supervisors on decisions that affect the strategy and engage with City officials and the Mayor to secure funding and partnerships that champion LACHAS goals. If you are interested in participating in one of these workgroups or attending Commission meetings to help end the HIV epidemic in L.A. County, visit their website here. For a full list of recommendations on how the community can engage in the strategy goals, and to sign up for updates, visit www.lacounty.hiv!

APLA Health provides services to more than 14,000 individuals in Los Angeles County, and we want to know their stories. Have you been receiving services from APLA Health for several years? Are you a new patient or client? Have you or a loved one been affected by HIV and AIDS? Has a staff member gone above and beyond what you were expecting?

We want to know the full story. What are we are doing well? How we can serve you better? Share your story here.