Low-Income Koreans Confused on New California Care Plan

Low-Income Koreans Confused on New California Care Plan

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SAN JOSE--Young Soon Kim, 75, of San Jose received a worrisome notice late last year informing her that she would be disenrolled from her current Medicare Part D prescription drug plan on Jan, 1.

Confused, Kim contacted her insurance provider and learned that the pharmacy she uses for her medications is not a part of a new health insurance plan the state had enrolled her in under California’s new Cal MediConnect pilot program.

Like thousands of other low-income seniors and people with disabilities, Kim had ignored blue enveloped from the state about the new plan and not understood that unless she filled out the forms and made her own decisions, the state would chose a new plan for her.

“It doesn’t seem like a big deal finding a new pharmacy, but as an older person, changing pharmacies does present obstacles,” said Kim.

Integrating Two Health Programs

Kim resides in one of two San Francisco Bay Area counties--San Mateo and Santa Clara--that are offering the new program aimed at enhancing healthcare access for so-called “dual-eligibles.” They are low-income seniors and people with disabilities, who are eligible for both Medi-Cal (California’s Medicaid program) and federal Medicare.

Cal MediConnect is a three-year pilot program aimed at integrating the separate services under the two programs. Confusion patients have experienced in trying to navigate between them often left people frustrated and falling through the healthcare cracks.

The state Department of Health Services has launched the test program over the past year in six counties across California, and it may add another in the coming months. California eventually plans to expand the program to all 58 counties, reaching about 1 million people.

Alameda County was originally among the Bay Area counties set to launch the pilot-program, but was recently dropped. That isn’t necessarily bad news for Korean dual-eligibles there, however, as many around the state describe Cal MediConnect as too confusing to understand.

Many dual-eligibles have used their right to say no to the program because they find they may lose their doctor or hospital, which may not be part of one of the participating Cal MediConnect health insurance plan in their area.

For many Korean seniors, having access to a Korean-speaking physician is important, and finding one that is part of the Cal MediConnect network can be challenging.

That was the case for Sunnyvale resident Han Sul Cho, who stuck with his older plan because his doctor wasn’t part of the new network. (The state is allowing time for doctors not initially in a plan to continue treating the patient temporarily and possibly joining later.)

Those who do opt out of Cal MediConnect, though, forfeit its new benefits.
On top of existing Medicare and Medi-Cal service, the program has added vision care and nonemergency transportation, such as taxi service to a doctor’s office. Cal MediConnect also includes language-interpretation assistance.

The care coordinator’s job is to see that Cal MediConnect patients have a smooth transition between Medicare’s hospital and physician treatment and Medi-Cal’s health and social programs, including case management; adult day health care, enabling family members to go to work after dropping a family elder at a care center; and in-home supportive services, including assistance with things like taking a bath, getting dressed, cooking food and taking medicine.

Notices in Blue Envelopes

Eligible residents in counties where Cal MediConnect has taken effect were required to respond to notices mailed to them in special blue envelopes.

Many Korean seniors ignored the notices, however, not realizing that if they failed to actively opt out of the program, they would be automatically enrolled. As what happened to Kim, that sometimes resulted in dramatic changes to their healthcare plans.

The changes have caused frustration, particularly for those who struggle with language barriers or have difficulty reading the legal fine print. But given the complexities of the program, even those who get assistance from friends or relatives often say they don’t understand the changes. The confusion has meant that many have not filled the proper forms.

Dual-eligible beneficiaries have the right to decline the coordinated care program initially or to opts out later. But even if they do so, they still have to sign up for the new Medi-Cal managed care (HMO) part of the program. Beneficiaries can keep their existing federal Medicare part, but will have to be in managed care under Medi-Cal.

Such confusion among Koreans and other immigrant communities points to the need for greater outreach efforts by the state, advocates say.

Young Dae Sung, 69, and his wife live in Santa Clara. They received several letters about the Cal MediConnect plan, but did not respond as both were happy with their current Medicare and Medi-Cal plans. They later received notices along with new health insurance cards indicating they had been enrolled in Cal MediConnect.

Determined to make sense of the changes, the couple dug around, reaching out to friends and exploring what little Korean-language information is available.

“We’ve contacted Korean community agencies to get information,” Sung said. “We want to learn more about the new plans to see if they work for us.”

Cal MediConnect beneficiaries gain access to a care coordinator who will help manage their care. The new program aims at improving the treatment of patients by integrating services into one program, lowering the state’s costs while also providing more preventative treatment.

For more information on Cal MediConnect, please contact the

An important free information service about Cal MediConnect is available with access in Korean and other languages. The Health Insurance Counseling and Advocacy Program (HICAP) program can assist dual-eligibles in understanding their choices and filling out the needed forms.
The HICAP office in Santa Clara County is at (408) 350-3200. In San Mateo call (650) 627-9350. Or visit Cal MediConnect website, www.calduals.org/korean.

This article is adapted from a five-part series that Kwanghee Lee wrote for The Korea Times, supported by a New America Media journalism fellowship, sponsored by The SCAN Foundation. Click here to read the full series in Korean. Aruna Lee translated and editing the article, with additional editing by Peter Schurmann.