California Health Advocates in Review…in Step with Medicare in California

Clare-SmithAs I consider my years of engagement in both the delivery of local HICAP services, and then later in my work with California Health Advocates, I am grateful for the wonderful opportunities I have been given to work on critical health care benefit issues with a group of dedicated, bright and passionate people.

California Health Advocates emerged in the late 1980’s from periodic informal roundtable meetings of the Health Insurance Counseling & Advocacy Program (HICAP) Program Managers, and evolved into a non-profit corporation with offices and staff located throughout California. The early days of California Health Advocates began with training- providing local regional training on Medicare and associated health plans, fraud and abuse, and long term care insurance. After talking about incorporation for several years, a core group of HICAP Managers moved forward with the process. With only days following the date of incorporation, the Administration on Aging awarded California Health Advocates with its first year of Senior Medicare Patrol funding. This award provided the organization’s foundation, making it possible for California Health Advocates to hire staff, begin building internal capacity and stabilize operations. The leadership at this time also revised and clearly stated California Health Advocates’ main mission of promoting the work of local HICAPs, and advocating on behalf of Medicare beneficiaries in California.

In these early years, the California HealthCare Foundation (CHCF) through their California Medicare Project awarded the state of California Department of Aging a generous grant which provided every HICAP office in the state with a desktop computer work station and Internet access. This unique gift accelerated the communication processes and networking opportunities for the HICAP programs when such interaction was most needed. The passage of the Balanced Budget Act of 1997 had resulted in numerous changes for Medicare patients, the most dramatic of which included the non-renewal of Medicare Health Maintenance organizations (HMOS) in several counties in California. The statewide and national media coverage of this time period was a catalyst in heightening the visibility of the local HICAP network of services, both in California and nationally.

Our timeline reflects the many changes which took place over the past ten years. Of great significance was the re-organization of the administration of the local HICAP network, due to the passage of AB 2800. The most worrisome of these re-organization changes was the reduction of state staff supporting the HICAPs. In addition, a plan to eliminate the dedicated 1-800 HICAP toll free line which linked Medicare beneficiaries and their families in California to free telephone help was under serious consideration by the state administration. At this same time, the Health Care Financing Administration (HCFA), now known as the Centers for Medicare and Medicaid Services (CMS), was on schedule to launch a huge national “Medicare+Choice” advertising campaign. California Health Advocates staff worked diligently to save HICAP’s 1-800 line so that access to Medicare information via the toll free line would remain intact in California.

Significant work memories over the past ten year also included adapting to dramatic administrative changes at the state level, providing increased education and assistance to the needs of Medicare beneficiaries covered by managed care plans, and later helping beneficiaries when many of the plans left thousands of them stranded with few coverage options. This was the advent of Medicare+Choice when no choices were offered.

Other challenges we experienced involved: eroding discharge planning services in hospitals accompanied by a sharp increase in restricting the delivery of Medicare home health benefits; chasing ambulance companies who had sent unsuspecting beneficiaries’ Medicare claims to collection agencies; and dealing with hostile insurance agents who were unhappy about losing a sale after a beneficiary had become better informed following a HICAP counseling session or educational forum… just to name a few.

During these years, the dedicated volunteer counselors sat at their tables in modest community centers and conference rooms, and with help from the ever-informed HICAP Program Managers and California Health Advocates trainers such as Betty Thurman, Bonnie Burns, Carol Jimenez, Julie Schoen and David Lipschutz, the volunteer corps dedicated themselves to learning the vast and complex changes in Medicare and serving their communities. This was a huge task given the complexity of changes in beneficiary rights and protections, benefits and coverage options (ranging anywhere from Medicare supplemental insurance to Medicare Select to preferred provider organizations to health maintenance organizations), and dizzying varieties of co-payments and out-of-pocket costs among plans, health care provider networks and geographic locations. HICAP volunteer counselors have been (and continue to be) dedicated and diligent in helping people understand these news concepts in plain English, or other languages such as Spanish, Chinese, Laotian, Farsi or Tagalog.

In 1999, CHA ‘launched’ its first web site and published a modest newsletter, thanks to the creative efforts of the dedicated Gene De Lorenzo, a HICAP Volunteer serving in Chico, Butte County and one of the ‘greatest’ of the greatest generation. Although California Health Advocates was a very small organization, it was in these early days that we were fortunate to foster productive working relationships with well-respected national agencies that were highly visible and effective advocates in Washington D.C. Some of these organizations include: the Medicare Rights Center, Consumer’s Union, National Senior Citizen’s Law Center and the Center for Medicare Advocacy. Carol Jimenez, Legal Counsel and Bonnie Burns, Training & Policy Specialist were critical in these efforts. With help from the California HealthCare Foundation, California Health Advocates was able to implement a thoughtful technology plan and in addition to strengthening CHA-HICAP web-based communications and resources, was sponsored by California Health Advocates and linked the public to local HICAP offices and easy-to understand information about insurance and Medicare.

Entering 2003, when state and federal budgets were being scrutinized, California Health Advocates was in the forefront to make sure that policymakers understood the relevance and necessity of the local counseling programs, and provided clear evidence of the need for local consumer assistance and guidance. By 2005, the HICAP state office was back in action with more HICAP staff and increased communication with the local programs. While California Health Advocates continued to work closely with the state HICAP office during this time, the organization also moved forward in Medicare advocacy on behalf of Californians. We are grateful for the partnership and support of the California HealthCare Foundation, and for the support of The California Endowment and The California Wellness Foundation. This period was a crucial time for California Health Advocates – the opportunity to represent the needs Medicare beneficiaries in California was never more necessary…the Medicare Modernization Act of 2003 was in full swing!

While the need for affordable prescription drug coverage was clear, no one envisioned the complex Frankensteinian structure and convoluted processes that formed Medicare Part D (the ‘part’ of Medicare that really isn’t) as the solution. The monster ‘D’ introduced new prescription drug plans that entered our consciousness through an exceedingly difficult to decipher program offering “Medicare-approved” drug discount cards, and then lurched forward, forcing the most vulnerable of Medicare beneficiaries from a familiar public benefit (Medi-Cal) into insurance plans. Today Medicare Part D is currently offered to beneficiaries in the form of 56 (not counting acronyms) prescription drug plans associated with various companies aggressively selling their products in California. The ridiculous number of prescription drug plans, associated benefit designs and enrollment rules has layered even greater responsibilities on the HICAP network. This increased responsibility is especially difficult considering that many beneficiaries are not able to either: A) access a computer; or B) negotiate plan coverage without individualized and educated guidance.

Over the past ten years, and especially leading up to Medicare Part D, California Health Advocates continues to work closely with the local HICAPs and many other community–based agencies and organizations to bring the experience of Californians to inform policy development in Sacramento and Washington D.C. The prodigious amount of work accomplished by California Health Advocates and its small staff is remarkable, and the impact of our collective work is significant. While we are not likely to see the changes we care about take place immediately, such as increased general Medicare beneficiary protections (including those specific to Part D, e.g., negotiating for lower drug prices, eliminating the ‘donut hole’), standardizing plan options, establishing effective government oversight and monitoring of the plans, and most notably the desire to see Part D incorporated as a full-fledged part of the Medicare entitlement program as opposed to a privatized branch. Take heart -the tireless efforts of a small network of people working together over the next ten years will successfully contribute to steering Medicare in the best direction and course for beneficiaries in the future.

Clare Smith

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.