Crazy California Idea: Help People Stay Healthy, Even If That Isn't Always 'Medicine'
Little babby using a nebulizer. Photo by Nenad Stojkovic, Creative Commons license 2.0

Starting in January, the nation-state of California is rolling out a new experiment in providing healthcare to its low-income citizens covered by Medi-Cal, the state's version of Medicaid. In addition to covering what we usually think of as healthcare — doctor/hospital visits, nursing services, pharmacy benefits — a new $6 billion initiative from the state's Department of Health Care Services (DHCS) called "CalAIM" ("California Advancing and Innovating Medi-Cal") will begin taking a "population health approach that prioritizes prevention and whole person care."

The idea is to work a wide variety of social services into what's covered by Medi-Cal, such as helping people without homes find and stay in housing. And since chronic severe illnesses like asthma are among the biggest drivers of healthcare costs, the state will also start providing services to folks with severe asthma, with the aim of limiting some of the nasties that can trigger asthma attacks that require pricey Emergency Room visits and hospitalization. As California Healthline reports, that could include home services like "removing mold, installing air purifiers and even replacing carpeting, blinds and mattresses."

Yes, that's pretty freaking brilliant. It's like California is turning into some kind of European social democracy or something!


Medi-Cal covers more than 13 million low-income Californians, about two million of whom have been diagnosed with asthma. The chronic disease costs the state billions of dollars per year, and is a burden for families when parents miss work and kids can't go to school. So hey, controlling asthma via non-medical interventions could significantly improve people's health and potentially save money for the state.

The disease — exacerbated by air pollution and indoor threats like harsh cleaning products, cockroach infestations, dust and mold — hits low-income communities the hardest. Medi-Cal patients accounted for half the state’s asthma-related emergency and urgent care visits in 2016, even though they represented about one-third of the population, according to data cited by state health officials.

In creating CalAIM, Gov. Gavin Newsom hopes to reduce healthcare costs by preventing ER visits, but California Healthline reports that the costs of rolling out new asthma benefits may not save the state a lot of money.

Agency officials couldn’t confirm the asthma benefits will save money, saying the costs will be equal to or less than the costs of traditional medical treatments.

We're no geologists, but we'd assume some savings might also start showing up as people get healthier and need fewer expensive medical treatments. But hell, we're the sort of commies who'd argue that even if the benefits only break even in budgetary terms, they're well worth it for all that "quality of life" stuff like better health, not wheezing or needing an inhaler as much, and people not missing work or school.

The story also notes that as CalAIM gets underway, the benefits won't be available to everyone, because 1) it's new! and 2) since the benefits are only an option and not a requirement for the private insurers that run Medi-Cal's participating managed care plans, not all will have the benefits:

Of the 25 participating insurance companies, 11 will offer in-home asthma services starting in January in 36 of the state’s 58 counties. Within those counties, some Medi-Cal recipients will qualify; others will not.

Also too, insurers are still working to "establish networks of nonprofit organizations and private contractors that specialize in delivering in-home asthma services and home repairs" in time to have them ready for the rollout in less than two weeks. Those providers may also need to be taught how to do medical billing, one of the arcane dark arts that comes along with a for-profit healthcare system oh Jebus do NOT get me started.

Still, California Medicaid Director Jaycee Cooper said earlier this year that while the program will start small, it should grow in capacity over its first five years.

It's not clear yet how many people will actually receive the new asthma assistance, but there's definitely a huge potential need for them:

Anthony Cava, a department spokesperson, cited data showing that more than 220,000 Medi-Cal recipients have poorly controlled asthma. The state pays $200 to $350 for a typical asthma-related emergency room visit, and $2,000 to $4,000 a day for a typical inpatient hospitalization, department officials said.

Now, the benefits will still be regulated; CalAIM's new "In lieu of" services, which provide non-medical help like the asthma assistance or first-month's rent, have a $7,500 lifetime cap per person.

“It’s not that somebody can just say they just want a brand-new $3,000 mattress,” said Dr. Takashi Wada, chief medical officer for the Inland Empire Health Plan. “But we do think a lot of these asthma attacks are preventable, and by avoiding illness, you’re also avoiding unnecessary hospital and emergency department visits.”

The California Healthline story focuses on a 14-year-old kiddo in the Central Valley, Ruby Marentes-Cabrera, who often has asthma attacks triggered by just plain living in an agricultural area.

Diagnosed with asthma early in childhood, the ninth grader has come to detest the pistachio trees that surround her home because the dust, pesticides and other allergens that blow off the orchards often trigger an asthma attack — even infiltrating her home so that simple chores like vacuuming can be dangerous.

“We live so close to the fields — I breathe the dust and chemicals in. [...] It gets so bad that my back hurts, my head hurts, my lungs hurt. I get sick and it gets really hard to breathe."

Her older sister, who's 20, also has asthma, and if the family qualifies for the new benefits, they could get help with things like replacing their home's carpet, which regularly gets coated with dust from nearby orchards and fields, and recently, from wildfire smoke. Or perhaps air filters, or better dust-proofing for the house.

Yes please I would like my tax dollars to go to things like this, and I see that even though I didn't plan it, all my stories today have had this theme: Government really can be the tool to promote the general welfare, by using things like the enhanced child tax credit to give kids a better start in life, replacing lead pipes around the country to prevent children from being harmed by freaking neurotoxins in their drinking water, or just making sure a 14-year-old can run in her PE class without the risk of going to the hospital. And every single one of these investments will pay off in healthier, more productive taxpayers in the future.

If that's "socialism," then color me deep red.

[California Healthline / Kaiser Health News / LAT / Photo by Nenad Stojkovic, Creative Commons license 2.0]

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Doktor Zoom

Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.

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