1. Health Care Self-Advocacy for People with Disabilities Disability and Employment Rights Advocacy Spring 2008

2. Health Care Rights All people have a right to minimal health care in California People with health insurance have additional rights People with disabilities have some additional access to health insurance others do not have Health care should be provided without discrimination, but the rules in the health care context are different

3. Access to minimal care in California The California Welfare and Institutions Code requires every California county to provide minimal health care to people with disabilities Generally, this means that counties must pay for medical treatment that is necessary to prevent death or disability Counties must also pay for health care that treats communicable diseases like Tuberculosis Care may be provided through hospitals, county clinics or private providers through county medically indigent programs

4. Why is access to minimal care important? People in need of emergency medical attention cannot be refused treatment Inability to pay is not a barrier to accessing emergency medical care Counties provide a health insurance program that usually covers more than minimal care, including care for chronic conditions County medically indigent programs may be the fastest way to get health insurance coverage, even if it’s not the best coverage

5. Health Insurance Private Health Insurance  Subject to underwriting rules – insurers can refuse to issue a policy for a person who they deem to be high risk  Cost regulated by the market  Provides 3 main benefits: Negotiated rates for care Full or partial payment for care, services, prescriptions Access to continued care

6. Types of Health Insurance Public Programs  Require that you meet eligibility requirements  Usually there are income and resource/asset limits  Not subject to underwriting – cannot refuse coverage or care because of health condition or disability  Provide extra “due process” protections

7. Major Public Programs Medicare Medi-Cal Healthy Families County Medically Indigent Programs Managed Risk Medical Insurance Program (MRMIP)

8. Medicare Medical Insurance  A – Hospital  B – Out-patient & preventive  “C” – Medicare Advantage  D – Prescription Drugs Eligibility  People 65 years old and older  People receiving Childhood Disability Benefits  People receiving Title II (SSDI) benefits for 25 months or more Covers medically necessary care within the scope of covered benefits

9. Medi-Cal California’s Medicaid Program Eligibility  Links through other public programs  People with disabilities  People older than 65  People with specific health conditions Coverage  Medically necessary care within the scope of services  More broad than Medicare Cost  Can be free or with a share of cost (monthly deductible), depending on income

10. Healthy Families Health insurance for families Eligibility  Children that do not qualify for Medi-Cal, but are under 19 and cannot afford other health insurance Cost  Families pay monthly premiums  Ordinary managed care costs like co-pays Coverage – Broad  Doctor’s visits, lab/xray, emergency care, DME, mental health, skilled nursing, physical therapy, maternity care

11. Patient Tip If you have a managed care plan through Medi-Cal or Healthy Families, you have 2 sets of protections  Managed care rules  Medi-Cal/Health Families rules Appeal Rights  Rights with the Department of Managed Health Care  Fair Hearing rights

12. County Medically Indigent Programs Eligibility  Coverage for otherwise uninsured adults  Must meet income and asset limits Coverage – services to protect “life and limb”  Less than Medi-Cal  More than imminent death  Standard is whether or not a reasonable person would believe it is an emergency

13. MRMIP What it is  Subsidized health insurance for people who do not qualify for Medi-Cal or Healthy Families and who have been refused insurance policies from private insurers because of medical conditions or disability Cost  Premiums and other ordinary managed care expenses

14. Patient Rights with Insurance Coverage Different laws apply depending on the type of coverage Private insurance and employer insurance are governed by California law Public programs each have their own program rules

15. When you are denied a service or treatment you need Insurer appeals processes Independent Medical Reviews Complaints/Grievances Fair Hearing Requests (only with public programs)

16. When your provider does not provide the treatment you need Second Opinions Medical or Dental Board complaints When you are treated differently because of your disability  Civil Rights Complaints (applies to hospitals, clinics, etc. that receive government funding)

17. When your privacy rights are violated Doctors can share information about your medical conditions for purposes of treatment and billing  Exceptions – psychotherapy notes, HIV/AIDS diagnosis, substance abuse Doctors and health plans cannot release health information to your employer except in limited situations If you believe your doctor or health plan violated your rights, you can make a complaint with:  The insurance company’s privacy officer  Department of Health and Human Services’ Office of Civil Rights

18. When you disagree with a statement in your medical records You have a right to review your medical records  Send a written request your doctor’s office to review Provider must respond within 30 days of request  You can be charged a reasonable amount for any copies You have a right to amend to your medical records if incomplete or incorrect  Addendum can be up to 250 words per item  Provider must add to records within 60 days of receipt

19. Medical Debt Tips for avoiding medical debt  Tell your doctor, hospital, or other provider about all of the insurance coverage you have  Show your insurance cards to the provider  Make sure the treatment you receive is covered by your health plan  Never use a credit card to pay a medical bill If you already have medical debt  Set up a payment plan  Apply debts to Medi-Cal share of cost

20. Resources for Help Private Insurance  HMO Help Center – (888) 466-2219  Department of Insurance (PPOs) – (800) 927-4357  Health Consumer Alliance (www.healthconsumer.org)www.healthconsumer.org Public Programs  Legal Aid (www.lsc.gov to find the program serving your area)www.lsc.gov  HMO Help Center - (888) 466-2219  Health Consumer Alliance (www.healthconsumer.org)www.healthconsumer.org  Fair Hearings

21. Sacramento County Department of Human Services General Information and Referral Line (916) 874-2072 Office Locations (not complete)  2700 Fulton Avenue, Sacramento, CA (916) 874-3800  1725 28 th Street, Sacramento, CA (916) 874-2072