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REGION: Health aides say strict rules mean few qualify for diabetes treatment
By EDWARD SIFUENTES - Staff Writer | ∞
North County health officials say restrictive guidelines are barring needy residents from participating in a program that provides treatment to poor people with diabetes and high blood pressure.
Narrow citizenship, age and income requirements are keeping thousands of patients from qualifying for the county's Coverage Initiative program, they say.
And those low enrollments are putting the program at risk of losing its funding ---- a three-year, $13 million grant.
The program has managed to enroll only 147 people as of May 13, according to the county's Health & Human Services Agency, which runs the program.
That is far short of its goal ---- 3,260 people. The county ranked last in enrollment out of the 10 counties that have received similar grants in California.
North County health officials said the low participation rate is largely due to tough admission requirements, which are a combination of federal, state and local rules.
"When the program was announced, we were very excited about it," said Dorothy Lujan, programs director at the Vista Community Clinic in Vista. "We thought, 'Wow. We're going to get all these people covered.' "
But those hopes were dashed when they looked at how many of their patients would not meet the program's criteria.
A problem
County officials said they are working to boost enrollment. A top official at the state Department of Health Care Services, which is overseeing the grant, said he is watching closely to make sure the county meets its goal.
If North County clinics are an indication, that goal may be difficult to achieve under current guidelines. Two of the three largest community clinics in the region have been able to enlist only 74 people in the first seven months of the program.
The third clinic declined to participate in the program, citing the cumbersome application process.
The Vista Community Clinic is one of about 20 clinics and hospitals throughout the county that participate in the program.
Lujan said the Vista clinic's staff started assessing its patients to see how many would be able to qualify for the program. The clinic saw 48,000 patients in 2006 at its five sites in Vista and Oceanside.
Out of all its patients, 2,500 were identified as having diabetes, Lujan said. Of those, about 500 made it through an initial screening process. And of those 500 patients, the clinic was able to complete applications for 46 patients. Twenty-eight of those applications were approved by the county for enrollment, clinic officials said.
Similarly, the Neighborhood Healthcare clinic in Escondido identified 1,000 of its patients as diabetics. Of those patients, the clinic was able to enroll 42 people, said Tracy Ream, the clinic's executive director.
Neighborhood Healthcare is a nonprofit organization that serves about 65,000 patients each year through its network of 10 clinics in North County, East County and Southwest Riverside County.
Losing out
Stan Rosenstein, chief deputy director for the state Department of Health Care Services, said the county is at risk of losing the grant because it's far from reaching its enrollment target.
"So far, they've had very limited enrollment, and what it needs to do is enroll more people in the county," Rosenstein said.
If the county fails to enlist more patients, the state may shift San Diego County's share of the funds to other counties, Rosenstein said. Otherwise, the state would have to return the unused portion to the federal government, he said.
Rosenstein declined to say when the state would make the decision on whether to shift the funds.
San Diego County was one of 10 counties in the state chosen to receive money from the three-year, $180 million federal grant. By comparison, Los Angeles and Orange counties have enrolled 7,994 and 6,997 patients, respectively.
Holly Crawford, a spokeswoman for the county's Health & Human Services Agency, said the reason for the low enrollment numbers may be due to federal requirements that are beyond its control, such as citizenship requirements and proof that patients are ineligible for other state health programs.
Crawford said the county is reviewing its own criteria to make the program more accessible. She said the county is looking at broadening the income guidelines, expanding the program to cover other diseases and streamlining the application process.
"The model is not identifying the number of patients we had anticipated, and we are working with our partners to make the necessary changes," Crawford said.
Strict admission guidelines
One of the problems may be in the clinics' patient demographics, officials said. They are predominantly Latino immigrant families. Though they have among the highest rates of diabetes, most don't qualify for the program.
A 2006 Centers for Disease Control and Prevention study reported that about 10.8 percent of U.S.-born residents of Latino descent are diabetic, compared with 6.1 percent in the entire native-born U.S. population overall.
Latino immigrants' risk of diabetes increases the longer they've been in the country, according to the report.
Despite their high risk of diabetes, much of this population is barred from the program because of immigration status, income and other factors.
To qualify, applicants must be U.S. citizens, ages 21 to 64. Illegal immigrants cannot participate, and legal immigrants must have lived in the country for five years or more, according to the program's guidelines.
Another barrier is the program's strict income requirements, Ream said. About 98 percent of her clinic's patients earn less than the federal poverty level, according to the clinic's Web site.
The Coverage Initiative program requires that patients earn no more than 200 percent of the federal poverty level, or $1,734 a month for a single adult, but not less than 135 percent of the federal poverty level, or $1,171 a month.
For many of the Escondido clinic's patients, "it's not that they earn too much, it's that they earn too little," Ream said.
Many applicants also are eliminated from the pool because they have children. That's because their children may be eligible for Medi-Cal, the state's health insurance for the poor. Those patients must apply for Medi-Cal first and then provide proof they were turned down, a process that can take 45 days, clinic officials said.
A different route
North County Health Services, a community clinic based in San Marcos, chose not to participate in the program because it anticipated many of these problems, said Irma Cota, the clinic's chief executive officer.
"I'm about health care and providing access to health care without having to be in a position to make decisions about those eligibility criteria," Cota said.
The 35-year-old nonprofit clinic provided care to 58,000 patients last year, including 29,000 children.
Another disadvantage in the program is built into the county's health care system for the poor.
Instead of having a network of county-run hospitals and clinics, San Diego County contracts services out to community clinics. That means that there is no centralized database that health officials can tap into to cull information about diabetics.
Ream said the county and its partner clinics and hospitals had to create a new program to accommodate the Coverage Initiative, and it will take time to work out the problems.
"Most counties decided to take their existing programs and expanded them," Ream said. "We went another route and created a slightly different program."
Contact staff writer Edward Sifuentes at (760) 740-3511 or esifuentes@nctimes.com.
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Reardon wrote on May 17, 2008 9:07 PM:I fully understand Ms. Cota's interest in delivering healthcare absent those pesky rules. She can, of course, by putting her personal money up -- then she can set the rules. If she wants to use taxpayer money, only then is she encumbered by rules. Go for it, Ms. Cota -- write your own checks and be rid of our rules and our money. (Can you say "ingrate?")
MJ wrote on May 17, 2008 10:41 PM:My guess is that the fundamental problem is "immigration status" .... heaven forbid, a welfare program that actually requires one to be a citizen or a long term legal resident ... how novel!
To Reardon wrote on May 18, 2008 6:52 AM:Bingo, dude! You hit the nail on the head. You must have fallen out of your chair laughing (or crying) like I did at the complaint of "narrow citizenship" as one explanation for the "failure" of this program. Oh, and what a shame that taxpayer funds would have to be returned because the rules are "out of the control" of local health officials. Ohhhh...the horror.
Zephon wrote on May 18, 2008 7:55 AM:Society can either decide to try to help people with diabetes and hypertension now or pay later.
Later will mean possible stroke, daily care to do all activities - even the most basic to support life in many cases with hypertension. For diabetes, frequently amputation of distal digits such as toes then feet or more, blindness and a host of other problems that will cost us far more in the end.
Prevention will actually save us more in dollars than not providing in early for those that suffer illness - for those of you that only want to count dollars, which I do understand.
Furthermore, some may want to be altruistic and benevolent and consider that taking care of those that suffer from an illness is a hallmark trait of an advanced society; that it is a basic definition of humanity, and allows us to set an example of American society, to be world leaders, for countries and people in others nations that we so frequently criticize for not being like us, that our way of life is indeed a model they can learn from.
Reardon wrote on May 18, 2008 8:55 AM:No country on this earth gives more money to foreign countries for the benefit of THEIR people -- in THEIR countries. This "donation" is involuntary on taxpayer's part -- and would never be approved by a vote of the people!
Even less voluntary is the taxpayer's support of the illegally entering people of Mexico, Central and South America -- many countries use the US as a safety valve to send their poor, uneducated and unhealthy.
Of course, these other nations do not have the nerve to send their social service needy directly – we might send them back – so they advise, and facilitate a covert entry into the US. If their plane loads, shiploads and trainloads came directly through ports of entry only the most squishy liberals would support their retention and taxpayer support.
Basta!
Ms. Cota is free to volunteer her efforts in neighboring countries, without any interference from taxpayers. Many organizations will facilitate her generosity.
Reardon wrote on May 18, 2008 9:02 AM:Zephon: You probably have an extra bedroom in your home -- please legally adopt a family in medical need, pay their bills, place them on your insurance, pay the $11,000/child per year in their education, and either get them legal licenses to drive or drive them yourself.
Do not ask taxpayers to do that which you are not willing to do, first!
That is called "Leadership," and is a quality sorely lacking in our country. Leadership is saying, "Follow me!"
Others will. Show your dedication to your ideal! (Ms. Cota, please take note.)
Ridiculous wrote on May 18, 2008 9:26 AM:Have to be legal and live her for 5 years. Legal is a good qualification...5 years residency is absurd. Disease waits for no timeline. People need to be treated now. It's simple and fairly cheap to stop further serious diabetes related health problems from happening. Change the residency time rule.
Zephon wrote on May 18, 2008 9:26 AM:Reardon...
I have put up many a homeless person that I find in my community in my house for those in need (this includes victims of spousal abuse as well) ... many times. I have helped over a dozen people in the last 5 years. Providing them food, clothes and shelter. It is really not that hard of a thing to do unless you are a selfish materialistic person that seems to be more normal this day and age. Are you one of those people?
I also provide counseling in support of mental illness including substance use disorders.
I also frequently help these people understand how to change their diet to help hypertension (ie: DASH diet) and prevent stroke.
Diabetics I meet get education on how to recognize the signs and symptoms of hyper/hypoglycemia and the need to monitor blood sugar and coordinate physical exercise.
So yes... I practice what I preach. And if one of my extra bedrooms is not available I often open up my garage for space for them to sleep. All I really ask of these people is that they must do things to help better their lives. Sitting around doing nothing and accepting my handouts is not acceptable. Find a job, get a bank account and start saving money. I will loan them a bicycle or take them in my car for longer trips they need.
I usually give them a few weeks up to 6 months to get back on their feet.
Just yesterday a person came by in need of money for the train. I gave him $25 without any expectations on my part. After all it is just money. Helping others is far beyond money - it is about being a good citizen and helping to make the world a better place for all of us.
To Reardon wrote on May 18, 2008 9:49 AM:Yes, it's really cheap to treat infirmities of non-citizens...a plane ticket home.
Reardon wrote on May 18, 2008 10:11 AM:Zeohon: The subject is illegal immigrants getting American taxpayer help, involuntarily.
Please report your adopting one such family to take the illegal burden off the taxpayers. Your good deeds are admirable, but off-subject and not germane.
I award you a Gold Star. Now back to the subject of illegal immigrants not qualifying for taxpayer support.
Do you support illegal immigration?
Help everyone. wrote on May 18, 2008 10:11 AM:If they need medical care, and they are not a citizen, perhaps we can create a service that will provide a ride home so that they can receive medical care in their home country. I agree that if we don't treat them now we will have to treat them later for advanced illness, and it is only humane to be sure that they do get care. If we help them get back to their home country they will be able to get the care that they might otherwise not get in this country. I think that the Border Patrol has funding for this service. If patients are in need of medical care, and they are not citizens, do them a favor and ask the Boarder Patrol to help get them home so that they can receive the care that they need. If another country needs our help meeting the needs of its people, as an above poster stated, we are very willing to help.
Reardon wrote on May 18, 2008 11:49 AM:Milton Friedman said “"It's just obvious you can't have free immigration and a welfare state."
The logic of that is indisputable, but logic is not the strong point of illegal immigrant supporters.
It is obvious that the voting citizenry is not about to give up the welfare state – it is supported by the Democrats and not opposed by the Republicans – so an Open Border must be closed to keep the poor from this Hemisphere from inundating the entire nation’s educational, medical and legal system.
That is demonstratably the problem locally, and is rapidly overcoming the remainder of the nation.
Involuntary charity is not charity.
MJ wrote on May 18, 2008 12:02 PM:Reardon and Help Everyone are raising the kind of discussion that we need to have in this country -- "looking the other way" will lead to elements of anarchy and promote fraud. One of the fundamental problems we are faced with is the Mexican government (or lack thereof). We boarder on a country that is effectively controlled by organized crime, and has been for a long time. In my view, it is as much a threat to our well being and security as the middle eastern countries we are trying to reform. The problem has gotten to the point that solving it will not be pretty and may take a generation (or two). Mexico has the resources to be a very prosperous nation that can employ and take care of its own -- most of whom I believe would stay home if that were the case. So, step one: declare war (either overt or covert) on the criminals infesting Mexico who spill their venom into this country -- using our potent abilities, identify their lairs and launch cruise missiles to destroy them. These punks have no idea what they are up against. Let them see what playing in the big leagues is all about.
Zephon wrote on May 18, 2008 1:25 PM:This article is not about illegal immigration.
It's first line says:
"North County health officials say restrictive guidelines are barring needy residents from participating in a program that provides treatment to poor people with diabetes and high blood pressure"
It is about prevention and helping those that cannot afford treatment, mostly just simple education on lifestyle habits.
I had posted more earlier but the NCTimes censors appear to have taken away this part of my freedoms of speech.
Vista Granny wrote on May 18, 2008 1:56 PM:What kind of "charity" rules out people who don't make enough money? It sounds as if they want the really poor just to die or go away. Great!
Reardon wrote on May 18, 2008 2:06 PM:Zephon: The First Amendment applies ONLY to Congress – “CONGRESS SHALL MAKE NO LAW…” – neither of us has any rights on this Blog, it is wholly owned and regulated as the NCTimes wishes. I once had to resubmit a post seven times to get it published. If at first you don’t succeed, try, try again. Then quit – no use being a damn fool about it.
If you think you have “freedom of speech” outside the Constitutional prohibition to Congress, go tell your boss he/she is a jerk and see if there are no repercussions!
(Even the US Supreme Court has ‘interpreted” the word “NO” to mean “some” – by laws against pornography, slander, “fighting words,” “hate speech” and shouting “fire” in a theatre. Not that some of these should not be “regulated” but that is why we have the power to amend the constitution – instead we simply redefine the simple, and usually understandable word, “NO.” We have also redefined “General Welfare” and “Interstate Commerce” and will soon redefine yellow to be red.)
Roberto wrote on May 18, 2008 2:48 PM:Good point "Help everyone" I still don't get the part of not making enoug income to qualify either
Reardon wrote on May 18, 2008 2:55 PM:Gosh, Vista Granny, but what is described in the article is not “charity.” Charity is voluntary, but whomever gives the money gets to set the rules. You may, of course give your own money without rules.
I almost hate to mention that arcane document, the Constitution, but a few years after its ratification, Congress was to vote a measly $15,000 to some destitute people, and James Madison (whom I also hate to mention without reference because of the current state of California public education), wrote: "I cannot undertake to lay my finger on that article of the Constitution which granted a right to Congress of expending, on objects of benevolence, the money of their constituents." While Madison could not find that article, every Congress since has found it in spades!
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