http://www.rssboard.org/rss-specification 720 https://escholarship.org/uc/ucla_healthpolicy/rss Recent eScholarship items from UCLA Center for Health Policy Research Fri, 15 May 2026 08:16:33 +0000 https://escholarship.org/uc/item/8cs8s8sh One in Three Young Children in California Consumed One or More Sugary Beverages a Day in 2013-14 https://escholarship.org/uc/item/8cs8s8sh Tue, 3 Jul 2018 00:00:00 +0000 Lai, Venetia https://escholarship.org/uc/item/2rv1n81j Six Facts About Undocumented Californians (California Health Care Foundation) https://escholarship.org/uc/item/2rv1n81j Tue, 3 Jul 2018 00:00:00 +0000 Lai, Venetia https://escholarship.org/uc/item/1d003851 Breast Cancer Treatment and Continuity of Care in California: Policy Solutions to Help Patients Maintain Consistent Care https://escholarship.org/uc/item/1d003851 Tue, 3 Jul 2018 00:00:00 +0000 Lai, Venetia https://escholarship.org/uc/item/0qv8c582 Sugary Beverage Consumption Among California Children and Adolescents https://escholarship.org/uc/item/0qv8c582 Tue, 3 Jul 2018 00:00:00 +0000 Lai, Venetia https://escholarship.org/uc/item/9hv9s6d1 <p>This report provides the first look at demographics, health, and health care access among transgender adults in California who participated in the 2015-2016 California Health Interview Survey (CHIS). In California, about 92,000 (0.35 percent) adults ages 18 to 70 are transgender. Transgender adults are similar to cisgender1 adults in many ways but experience disparities in mental health, disability status, and health care access. Compared to cisgender adults, transgender adults are more than three times more likely to have ever thought about suicide, nearly six times more likely to have ever attempted suicide, nearly four times more likely to have experienced serious psychological distress, and more than three times more likely to have emotions that interfere with their relationships, social life, ability to do chores, and work performance. In regard to health care access, transgender adults are nearly three times more likely than cisgender adults to delay getting medicine... https://escholarship.org/uc/item/9hv9s6d1 Thu, 28 Jun 2018 00:00:00 +0000 Herman, Jody L Wilson, Bianca DM Becker, Tara https://escholarship.org/uc/item/9hd1h8wm Characteristics and Mental Health of Gender Nonconforming Adolescents in California https://escholarship.org/uc/item/9hd1h8wm Thu, 28 Jun 2018 00:00:00 +0000 Lai, Venetia https://escholarship.org/uc/item/9g31q9hd Mental Health Services for Older Adults: Creating a System That Tells the Story https://escholarship.org/uc/item/9g31q9hd Thu, 28 Jun 2018 00:00:00 +0000 Lai, Venetia https://escholarship.org/uc/item/8614w510 Latino Immigrants Have Higher Rates of Health Insurance in States with Inclusive Policies https://escholarship.org/uc/item/8614w510 Thu, 28 Jun 2018 00:00:00 +0000 Lai, Venetia https://escholarship.org/uc/item/5fg1p4x0 MHSA and Older Adult Study Policy Recommendations https://escholarship.org/uc/item/5fg1p4x0 Thu, 28 Jun 2018 00:00:00 +0000 Lai, Venetia https://escholarship.org/uc/item/4vr849vr Patient Navigators and Breast Cancer Care: Policy Solutions to Help Survivors Access California’s Complex System of Care https://escholarship.org/uc/item/4vr849vr Thu, 28 Jun 2018 00:00:00 +0000 Lai, Venetia https://escholarship.org/uc/item/4c220148 Breast Cancer Treatment and Continuity of Care in California: Policy Solutions to Help Patients Maintain Consistent Care https://escholarship.org/uc/item/4c220148 Thu, 28 Jun 2018 00:00:00 +0000 Lai, Venetia https://escholarship.org/uc/item/467247r9 What has CHIS done in 2017? https://escholarship.org/uc/item/467247r9 Thu, 28 Jun 2018 00:00:00 +0000 Lai, Venetia https://escholarship.org/uc/item/232982k6 California's Public Mental Health Services: How Are Older Adults Being Served? https://escholarship.org/uc/item/232982k6 Thu, 28 Jun 2018 00:00:00 +0000 Lai, Venetia https://escholarship.org/uc/item/1fr7775g Older Californians and the Mental Health Services Act: Is an Older Adult System of Care Supported? https://escholarship.org/uc/item/1fr7775g Thu, 28 Jun 2018 00:00:00 +0000 Lai, Venetia https://escholarship.org/uc/item/0pz2z0gm Servicios públicos de salud mental en California: ¿Cómo están siendo atendidos las personas de tercera edad? https://escholarship.org/uc/item/0pz2z0gm Thu, 28 Jun 2018 00:00:00 +0000 Lai, Venetia https://escholarship.org/uc/item/02j782mm Breast Cancer and Low-Income Californians: Policy Solutions to Address Barriers to Care https://escholarship.org/uc/item/02j782mm Thu, 28 Jun 2018 00:00:00 +0000 Lai, Venetia https://escholarship.org/uc/item/2pb0434b <p>Los Angeles County has the state’s lowest rate of consumer enrollment in Cal MediConnect, a program that is responsible for the delivery and coordination of medical, behavioral health, and long-term services and support benefits for individuals who are dually eligible for Medicare and Medi-Cal. This policy brief examines the factors that influence consumer decisions and may contribute to low enrollment rates. Influential factors include consumer knowledge of health care options, perception of choice, and disruption of existing care. Differences in decision making by age, complexity of health care needs, race/ethnicity, immigration status, and primary language are also noted. Policy recommendations include engaging consumers in the planning and dissemination of information about their health care options, optimizing consumer choice and implementing the least disruptive pathway to enrollment, and recognizing and responding to the great diversity of dual-eligible consumers in... https://escholarship.org/uc/item/2pb0434b Tue, 12 Jun 2018 00:00:00 +0000 McBride, Kate Reynoso, Ana Alunan, Tiffany Gutierrez, Brenda Bacong, Adrien Moon, Marge Bacigalupo, Anastasia Benjamin, A E Wallace, Steven P. Kietzman, Kathryn G https://escholarship.org/uc/item/65w66833 <p>Federally Qualified Health Centers--commonly referred to as Community Health Centers (CHCs)--serve as critical safety net providers for those who are uninsured or who may become uninsured. This policy brief reports the findings from the Remaining Uninsured Access to Community Health Centers (REACH) research project, which sought to identify the impact of the Affordable Care Act (ACA) on the ability of CHCs to serve the remaining uninsured. We examined strategies undertaken by CHCs in four states to reinforce the local safety net through partnerships, improvements to the local health system, and advocacy. With the uncertainties about whether Medicaid expansion will be continued or will be handed over to the states with limited oversight, partnerships both among CHCs and between CHCs and others in the health care system and beyond may become even more important.</p> https://escholarship.org/uc/item/65w66833 Thu, 10 May 2018 00:00:00 +0000 Young, Maria-Elena Wallace, Steven P Bonilla, Amy Pourat, Nadereh Rodriguez, Michael https://escholarship.org/uc/item/3fk9k43k Podiatric Services Could Reduce Costs of Treating Diabetes Complications in California by up to $97 Million https://escholarship.org/uc/item/3fk9k43k Thu, 10 May 2018 00:00:00 +0000 Labovitz, Jonathan Kominski, Gerald F Godwin, James https://escholarship.org/uc/item/2r64d6bx <p>Using data from the California Health Interview Survey (CHIS) for the years 2011-2014, this report presents findings on families with children ages 0-5 years. It breaks down differences between urban, suburban, and rural families, and it highlights the characteristics of families who speak a language other than English in the home. As more than half of families with young children in California speak a language other than English in the home, the characteristics of dual language households are highlighted. In 1998, California passed the California Children and Families Act to improve development for children from the prenatal stage to five years of age. One goal of this ongoing commitment is to expand our understanding of the social and physical environments that can impact a child’s well-being and school readiness.</p> https://escholarship.org/uc/item/2r64d6bx Thu, 10 May 2018 00:00:00 +0000 Holtby, Sue Lordi, Nicole Park, Royce Ponce, Ninez https://escholarship.org/uc/item/25z526tz Parks After Dark Evaluation Brief https://escholarship.org/uc/item/25z526tz Thu, 10 May 2018 00:00:00 +0000 Pourat, Nadereh Martinez, Ana E Haley, Leigh Ann Rasmussen, Petra Chen, Xiao https://escholarship.org/uc/item/52t797dr <p>California has 12 county-owned and operated hospital systems and 5 University of California hospitals designated as public hospitals. These organizations deliver the majority of inpatient care and a significant amount of outpatient care to Medicaid patients in the state. In 2010, California was the first state in the nation to implement a five-year Delivery System Reform Incentive Payment (DSRIP) program under the Section §1115 Medicaid "Bridge to Reform" waiver to improve the capacity of these hospitals to deliver high quality and more efficient care. The California DSRIP was the first program in a continuing national initiative to reform the Medicaid delivery system while remaining budget neutral. An extensive evaluation revealed major advances in infrastructure development, delivery of health care, and patient outcomes during the program. The results highlight the importance of joint federal and state investments in bolstering the capacity of safety net providers to deliver... https://escholarship.org/uc/item/52t797dr Tue, 8 May 2018 00:00:00 +0000 Pourat, Nederah https://escholarship.org/uc/item/4tv6v7fx <p>Using data from the California Health Interview Survey (CHIS) for the years 2011-2014, this report presents findings on families with children ages 0-5 years. It breaks down differences between urban, suburban, and rural families, and it highlights the characteristics of families who speak a language other than English in the home. As more than half of families with young children in California speak a language other than English in the home, the characteristics of dual language households are highlighted. In 1998, California passed the California Children and Families Act to improve development for children from the prenatal stage to five years of age. One goal of this ongoing commitment is to expand our understanding of the social and physical environments that can impact a child’s well-being and school readiness.</p> https://escholarship.org/uc/item/4tv6v7fx Tue, 8 May 2018 00:00:00 +0000 Holtby, Sue Lordi, Nicole Park, Royce Ponce, Ninez https://escholarship.org/uc/item/4f75k8d1 Podiatric Services Could Reduce Costs of Treating Diabetes Complications in California by up to $97 Million https://escholarship.org/uc/item/4f75k8d1 Tue, 8 May 2018 00:00:00 +0000 Labovitz, Jonathan Kominski, Gerald F. Godwin, James https://escholarship.org/uc/item/8t1795v3 <p>Federally Qualified Health Centers--commonly referred to as Community Health Centers (CHCs)--serve as a safety net for people who did not gain health insurance under the Affordable Care Act (ACA), including those immigrants not eligible for Medicaid or health insurance exchange coverage. ACA-driven changes in health insurance coverage, funding, and related policy have created new challenges for these safety net organizations. This policy brief reports the findings from analyses of the U.S. HRSA Uniform Data System and interviews conducted in 2014-16 with the leadership of 31 CHCs. The CHCs were located in communities with high concentrations of immigrants and uninsured residents, in states that either expanded Medicaid (California and New York) or that chose not to expand it (Georgia and Texas). The study found that most CHCs now see more patients, including significant numbers without insurance. The ACA has brought new resources to CHCs but has also reinforced challenges,... https://escholarship.org/uc/item/8t1795v3 Thu, 3 May 2018 00:00:00 +0000 Wallace, Steven P Young, Marie-Elena Rodriguez, Michael A https://escholarship.org/uc/item/7zh6661d ACA Repeal in California: Who Stands to Lose? https://escholarship.org/uc/item/7zh6661d Thu, 3 May 2018 00:00:00 +0000 Dietz, Miranda Lucia, Laurel Komiski, Gerald F Jacobs, Ken https://escholarship.org/uc/item/79m365bd <p>Changing the Medicaid program is a top priority for the Republican party. Common themes from GOP proposals include converting Medicaid from a jointly financed entitlement benefit to a form of capped federal financing. While proponents of this reform argue that it would provide greater flexibility and a more predictable budget for state governments, serious consequences would likely result for Medicaid enrollees and state governments. Under all three scenarios promoted by Republicans--block grants, capped allotments, and per capita caps—most states would face increased costs. For all three scenarios, the capped nature of the funding guarantees that the real value of funds would decrease in future years relative to what would be expected from growth under the current program. Although the federal government would undoubtedly realize savings from all three scenarios, the impact might lead states to reduce benefits and services, create waiting lists, impose cost-sharing on a traditionally... https://escholarship.org/uc/item/79m365bd Thu, 3 May 2018 00:00:00 +0000 Mager-Mardeusz, Haleigh Lenz, Cosima Kominski, Gerald F https://escholarship.org/uc/item/767156b6 <p>Although the American Health Care Act (AHCA) was recently defeated, the policies in the bill represented a mix of ideas long favored by conservatives. If enacted, this repeal-and-replace bill would have had devastating consequences for most of the 5 million Californians currently receiving direct benefits from the Affordable Care Act (ACA), including more than 1 million who receive subsidies through Covered California and almost 4 million who have enrolled in the Medi-Cal expansion. Although the bill failed to garner enough votes for passage, it is likely that efforts to chip away at the ACA will continue and that some of the ideas contained within the AHCA will be revisited. This policy brief summarizes some of the most significant reversals that would have occurred under the Republican plan in the individual and small group insurance markets.</p> https://escholarship.org/uc/item/767156b6 Thu, 3 May 2018 00:00:00 +0000 Rasmussen, Petra W https://escholarship.org/uc/item/6xz2j1jk Growth in Medi-Cal in 2015 Fueled Unprecedented Drop in California’s Uninsured Rate https://escholarship.org/uc/item/6xz2j1jk Thu, 3 May 2018 00:00:00 +0000 Charles, Shana Alex Becker, Tara https://escholarship.org/uc/item/5mh35238 <p>In California, personal health care expenditures are estimated to total more than $367 billion in 2016. Approximately 71 percent of these expenditures will be paid for with public funds (i.e., taxpayer dollars). This estimated contribution of public funds to health care expenditures is much higher than estimates that include only major health insurance programs such as Medicare and Medicaid. Several additional public funding sources also contribute to health care expenditures in the state, including government spending for public employee health benefits, tax subsidies for employer-sponsored insurance and the Affordable Care Act (ACA) insurance exchange, and county health care expenditures. As health care reform continues to take effect, it will be important to monitor the public versus private contributions to state health care expenditures to ensure that funds are being distributed both efficiently and equitably.</p> https://escholarship.org/uc/item/5mh35238 Thu, 3 May 2018 00:00:00 +0000 Sorensen, Andrea Nonzee, Narissa J Kominski, Gerald F https://escholarship.org/uc/item/2nz781sk <p>Despite the high rate of untreated tooth decay, many young children in California under six years of age have never been to a dentist. Numerous and complex barriers to access to oral health care for young children exist, and a multifaceted approach is required to improve receipt of preventive and treatment services that could improve the oral health of this population. This policy brief describes the UCLA-First 5 LA 21st Century Dental Homes Project, which was designed to improve oral health care for young children in 12 Federally Qualified Health Center (FQHC) clinic sites with co-located dental and primary care services and its accessibility in their service areas throughout Los Angeles County. The project funded infrastructure and staffing, provided technical assistance to improve operations, trained clinical personnel to provide oral health care to young children, implemented a quality improvement learning collaborative, trained parents and child care providers in oral... https://escholarship.org/uc/item/2nz781sk Thu, 3 May 2018 00:00:00 +0000 Crall, James J Illum, Jackie Martinez, Ana Pourat, Nadereh https://escholarship.org/uc/item/8sv4w4m4 Undocumented Immigrants and Health Care Reform https://escholarship.org/uc/item/8sv4w4m4 Tue, 20 Sep 2016 00:00:00 +0000 Wallace, Steven P. Torres, Jacqueline Sadegh-Nobari, Tabashir Pourat, Nadereh Brown, Richard E. https://escholarship.org/uc/item/8jb9z82x <p>The home care industry is growing rapidly and coincides with increases in the growth of the elderly population, who are more frequently chronically ill and disabled and need assistance. This policy brief provides a profile of the home care industry and patients/consumers of these services in California, assessing available data on licensure and certification as a mechanism for promoting safety and quality of care. The findings indicate a dearth of information on the characteristics and care delivery of home care agencies and individual providers of nonmedical home care. The findings also illustrate that licensure and certification of home health agencies may enhance the capacity for improvements in quality of care. Establishing licensure and basic safety standards for home care agencies is a reasonable public health policy for reducing the potential for adverse consequences among the growing aging and disabled populations.</p> https://escholarship.org/uc/item/8jb9z82x Tue, 20 Sep 2016 00:00:00 +0000 Pourat, Nadereh https://escholarship.org/uc/item/7pm2s4k3 Overweight and Obesity among Children by California Cities - 2010 https://escholarship.org/uc/item/7pm2s4k3 Tue, 20 Sep 2016 00:00:00 +0000 Babey, Susan H. Wolstein, Joelle Diamant, Allison L. Bloom, Amanda Goldstein, Harold https://escholarship.org/uc/item/6999g2sz The home care industry is growing rapidly and coincides with increases in the growth of the elderly population, who are more frequently chronically ill and disabled and need assistance. This policy brief provides a profile of the home care industry and patients/consumers of these services in California, assessing available data on licensure and certification as a mechanism for promoting safety and quality of care. The findings indicate a dearth of information on the characteristics and care delivery of home care agencies and individual providers of nonmedical home care. The findings also illustrate that licensure and certification of home health agencies may enhance the capacity for improvements in quality of care. Establishing licensure and basic safety standards for home care agencies is a reasonable public health policy for reducing the potential for adverse consequences among the growing aging and disabled populations. https://escholarship.org/uc/item/6999g2sz Tue, 20 Sep 2016 00:00:00 +0000 Pourat, Nadereh https://escholarship.org/uc/item/5jb2t0g8 The rapid growth of the home care industry coincides with increases in the proportion of the population over 65 years of age and more likely to need assistance with basic daily activities due to illness or disability. This report provides a profile of the home care industry and the patients/consumers of such services in California, assessing available data on licensure and certification as mechanisms for promoting safety and quality of care. The results indicate that little information is available on the characteristics and care delivery of home care agencies and individual providers of nonmedical home care. The results also illustrate that licensure and certification of home health agencies are associated with higher structural quality‐of-care measures. Establishing licensure and basic safety standards for home care agencies is a reasonable public health policy to reduce the potential for adverse consequences for the growing aging and disabled populations. https://escholarship.org/uc/item/5jb2t0g8 Tue, 20 Sep 2016 00:00:00 +0000 Pourat, Nadereh https://escholarship.org/uc/item/5803k71h Interim Evaluation Report on California’s Low Income Health Program (LIHP) https://escholarship.org/uc/item/5803k71h Tue, 20 Sep 2016 00:00:00 +0000 Kominski, Gerald F. Pourat, Nadereh Roby, Dylan H. Cabezas, Livier Chen, Xiao Hadler, Max Milev, Dimiter https://escholarship.org/uc/item/31n7075x In late 2015, California passed the End of Life Option Act (AB 15), which allows residents at the terminal stage of an illness to request a prescription for medications meant to hasten death. As California seeks to implement the law in June 2016, findings from other states that practice aid in dying (AID) may guide implementation. This policy brief provides an overview of the use of AID, outlines outstanding questions about practice and ethics, and recommends steps for improving California’s implementation of AB 15. Specifically, the implementation of AB 15 would be improved by adjusting surveillance data-collection requirements and encouraging additional research investment, using the legalization of AID to improve knowledge of and practices for end-of-life care generally, and creating ongoing educational opportunities for providers and the general public. https://escholarship.org/uc/item/31n7075x Tue, 20 Sep 2016 00:00:00 +0000 Cain, Cindy L https://escholarship.org/uc/item/8ds5h7k3 <p>While many in the United States will gain health insurance coverage as a result of the Affordable Care Act, undocumented immigrants are one group that will not see much benefit from the law. That's because the approximately 11 million undocumented immigrants residing in the United States — most often young, working adults in good health — are excluded from participation in the new insurance marketplaces and state Medicaid expansions.</p><p>Focusing on the state with the largest number of undocumented residents ― California ― this report from the UCLA Center for Health Policy Research and The Commonwealth Fund examines the health status and health care use of undocumented immigrants and suggests policy alternatives that could improve their access to needed health care.</p> https://escholarship.org/uc/item/8ds5h7k3 Fri, 6 Sep 2013 00:00:00 +0000 Wallace, Steven P Torres, Jacqueline Sadegh-Nobari, Tabashir Pourat, Nadereh https://escholarship.org/uc/item/1053p5q2 The economic recession that began in California in 2008 did not affect all counties equally. Using data from several years of the California Health Interview Survey, this policy brief examines the differences between 2007 and 2009 for the populations who were uninsured "for all or part of the prior year." During this time period, counties with high unemployment and lower household income saw the highest growth in the uninsured population, due to a large drop in job-based coverage and only a small increase in public coverage. Compared to the uninsured population in California in 2007, Californians who were uninsured for all or part of 2009 were older, more likely to be U.S.-born citizens, had lower household incomes, and were more likely to be unemployed and looking for work. https://escholarship.org/uc/item/1053p5q2 Mon, 5 Aug 2013 00:00:00 +0000 Lavarreda, Shana Alex Snyder, Sophie Brown, E. Richard https://escholarship.org/uc/item/1nx0z8pv Grandparents over the age of 65 who are raising grandchildren are a small but extremely vulnerable population in California. These older adults usually become the primary caregivers of their grandchildren after an unexpected event. They are further faced with the financial challenge of having an additional dependent without additional income. This policy brief documents that the actual income needed to support a basic standard of living for older adults with grandchildren in California is about twice the Federal Poverty Level (FPL), depending on the county. Using 200% FPL as an approximate measure, about two-fifths of older grandparents who are responsible for their grandchildren in the state do not have enough income to make ends meet. The Elder Economic Security Standard™ Index (Elder Index) for California calculates that the costs of housing, food, and the older adults' health care account for more than two-thirds of total household expenses for grandparents and the grandchildren... https://escholarship.org/uc/item/1nx0z8pv Thu, 20 Jun 2013 00:00:00 +0000 Padilla-Frausto, D. Imelda Wallace, Steven P. https://escholarship.org/uc/item/4q1005d6 Health care workers at safety net facilities can recount endless anecdotes of adverse consequences arising from poor access to health care experienced by marginalized populations in California: The missed preventive care, infrequent screenings, and low use of unaffordable chronic disease medications that result in unnecessary illness, avoidable hospitalizations, late-stage diagnoses, and premature mortality. Each story is tragic, but such anecdotes have not convinced skeptics who in the past have questioned the degree to which expanded health care access has significant concrete benefits. A careful reading of the research literature on this topic, however, leaves no doubt of the critical importance of safety net care. This brief summarizes the evidence on the health benefits of expanded access, with particular attention to the newest studies from recent coverage expansions in Massachusetts, Oregon, and parts of California. https://escholarship.org/uc/item/4q1005d6 Mon, 3 Jun 2013 00:00:00 +0000 Dow, William H. Roby, Dylan H., ` Kominski, Gerald Jacobs, Ken https://escholarship.org/uc/item/2776586t <p>The success of health care reform implementation in 2014 partly depends on more efficient delivery of care to the millions of California residents eligible to gain insurance. Emerging evidence supports the effectiveness of the patient-centered medical home (PCMH) as a potential model of care delivery, which improves health outcomes and reduces costs. Among other principles, PCMH entails receipt of care from a personal doctor, who coordinates the patient’s care and develops an individualized treatment plan for the patient. These principles are particularly essential in delivery of care to those with chronic conditions who require more intensive care management.</p><p>Using the 2009 California Health Interview Survey (CHIS 2009), this policy brief indicates that patients who reported meeting these fundamental PCMH principles were more likely to have visited the doctor and to have received flu shots, and they also had better communication with providers than those who did not... https://escholarship.org/uc/item/2776586t Mon, 3 Jun 2013 00:00:00 +0000 Pourat, Nadereh Lavarreda, Shana Alex Snyder, Sophie https://escholarship.org/uc/item/068757nd In 2014, over 500,000 California residents will transition from the Low Income Health Program to health coverage provided by Medi-Cal or subsidized health plans offered in Covered California. This policy note focuses on the transition plans for the 27,000 higher income enrollees that will be eligible for sizeable federal subsidies in the state-based health insurance exchange, Covered California. A successful transition with high rates of participation relies on collaboration between the Department of Health Care Services, the local Low Income Health Programs (LIHPs) and Covered California. Enrollees will be moving into a complex system of premium payment, plan choice, subsidies and cost-sharing reductions and their engagement in the transition is necessary to result in enrollment in health plans by January 1, 2014. Recommendations to promote success include: applying administrative LIHP and DHCS data to ease the enrollment process in Covered California, collaborating in communication... https://escholarship.org/uc/item/068757nd Mon, 3 Jun 2013 00:00:00 +0000 Lytle, Elizabeth C. Roby, Dylan H. Lucia, Laurel Cabezas, Livier Pourat, Nadereh https://escholarship.org/uc/item/10h7g4rz <p>This policy note explores disparities in access to pediatric subspecialty care in California by insurance coverage, geographic location, race/ethnicity, and language. Using the available literature and interviews with stakeholders, it identifies barriers to access, which include a potential shortage of trained pediatric subspecialists, gaps in care delivery, low reimbursement rates and payment levels, and lack of care integration. Innovative care delivery models for improving the capacity of pediatric subspecialty care, including expanded use of technology, team models of care, and standard care processes, are also examined.</p><p>Among the recommendations proposed to ensure adequate access to pediatric subspecialty care: increase the number of pediatricians specializing in pediatric subspecialties; address payment and reimbursement issues that impede the access of children with special health care needs (CSHCN) to pediatric subspecialty care; increase the capacity of pediatric... https://escholarship.org/uc/item/10h7g4rz Mon, 20 May 2013 00:00:00 +0000 Gans, Daphna Battistelli, Molly Ramirez, Mark Cabezas, Livier Pourat, Nadereh https://escholarship.org/uc/item/6s27k46v In 2014, over 500,000 California residents will transition from the Low Income Health Program to health coverage provided by Medi-Cal or subsidized health plans offered in Covered California. This policy note focuses on the transition plans for the 27,000 higher income enrollees that will be eligible for sizeable federal subsidies in the state-based health insurance exchange, Covered California. A successful transition with high rates of participation relies on collaboration between the Department of Health Care Services, the local Low Income Health Programs (LIHPs) and Covered California. Enrollees will be moving into a complex system of premium payment, plan choice, subsidies and cost-sharing reductions and their engagement in the transition is necessary to result in enrollment in health plans by January 1, 2014. Recommendations to promote success include: applying administrative LIHP and DHCS data to ease the enrollment process in Covered California, collaborating in communication... https://escholarship.org/uc/item/6s27k46v Wed, 17 Apr 2013 00:00:00 +0000 Lytle, Elizabeth C Roby, Dylan H Lucia, Laurel Jacobs, Ken Cabezas, Livier Pourat, Naderah https://escholarship.org/uc/item/6004s4tc In 2014, over 500,000 California residents will transition from the Low Income Health Program (LIHP) to new health coverage provided by Medi-Cal or subsidized health plans offered in Covered California. This Policy Note focuses on the transition of more than 470,000 lower-income LIHP enrollees into a state-operated Medi-Cal program. If a county-based approach is adopted, expanding the existing local LIHPs, adjustments to the plan will be needed. The LIHPs continue to grow; one-third of those potentially eligible for the Affordable Care Act’s optional Medi-Cal expansion have already been enrolled in the LIHP. The Department of Health Care Services has made considerable efforts to involve stakeholders in the planning process for the transition. Including providers, consumer advocates, and other stakeholder groups will enhance the transition to Medi-Cal, regardless of the implementation approach. Further recommendations include: engaging in automatic Medi-Cal eligibility determination... https://escholarship.org/uc/item/6004s4tc Wed, 17 Apr 2013 00:00:00 +0000 Lytle, Elizabeth C Roby, Dylan H Lucia, Laurel Jacobs, Ken Cabezas, Livier Pourat, Naderah https://escholarship.org/uc/item/5xp775t6 In California, 2.15 million adolescents (62.9 percent) do not engage in at least 60 minutes of physical activity five or more days per week. This policy brief uses data from the 2009 California Health Interview Survey to find that adolescents who visited a park in the past month and those who live in a park service area are more likely to meet this goal. Lower-income California adolescents are less likely to visit local parks and more likely to believe local parks are unsafe. Actions by state and local policymakers to increase park access and attractiveness, especially to underserved populations, may be an effective way to promote physical activity among California's adolescents. https://escholarship.org/uc/item/5xp775t6 Thu, 28 Mar 2013 00:00:00 +0000 Babey, Susan H Wolstein, Joelle Krumholz, Samuel Robertson, Breece Diamant, Allison L https://escholarship.org/uc/item/0v766096 HMO enrollees with limited English proficiency, and particularly those in fair to poor health, face communication barriers despite language assistance regulations. More than 1.3 million California HMO enrollees ages 18 to 64 do not speak English well enough to communicate with medical providers and may experience reduced access to high-quality health care if they do not receive appropriate language assistance services. Based on analysis of the 2007 and 2009 California Health Interview Surveys (CHIS), commercial HMO enrollees with limited English proficiency (LEP) in poorer health are more likely to have difficulty understanding their doctors, placing this already vulnerable population at even greater risk. The analysis also uses CHIS to examine the potential impact of health plan monitoring starting in 2009 (due to a 2003 amendment to the Knox-Keene Health Care Services Act) requiring health plans to provide free qualified interpretation and translation services to HMO enrollees.... https://escholarship.org/uc/item/0v766096 Thu, 28 Feb 2013 00:00:00 +0000 Hadler, Max W. Chen, Xiao Gonzalez, Erik Roby, Dylan H. https://escholarship.org/uc/item/1pt6t9h3 <p>In early 2013, the California Legislature will consider bills implementing a key provision of the Affordable Care Act (ACA) which required states to expand Medicaid eligibility to low-income adults under age 65, including those without children living at home. This Expansion was  effectively made optional for states by a 2012 Supreme Court decision and has not yet been formally enacted in California. In this report, the authors find that the Medi-Cal Expansion offers California the opportunity to significantly increase health insurance coverage at minimal cost to the state budget.</p><p>Using the California Simulation of Insurance Markets (CalSIM) model, the authors predict that more than 1.4 million low-income adults will be newly eligible for Medi-Cal under the Expansion beginning in 2014. Other mandatory provisions of the ACA will lead to increased enrollment among Californians who are already eligible for Medi-Cal but not enrolled. This increase in coverage will have far-reaching... https://escholarship.org/uc/item/1pt6t9h3 Thu, 31 Jan 2013 00:00:00 +0000 Lucia, Laurel Jacobs, Ken Watson, Greg Dietz, Miranda Roby, Dylan H. https://escholarship.org/uc/item/55d2v5gp In 2009, nearly 2.4 million adults in California reported having seriously thought about suicide during their lifetimes. Among these adults, more than half a million had thought seriously about suicide sometime during the past year. Members of sexual minorities were almost three times as likely as all adults in California to have had suicidal thoughts during the past year. This policy brief, based on data from the 2009 California Health Interview Survey (CHIS), presents a comprehensive overview of risk factors associated with suicidal thoughts among adults ages 18 and older and highlights differences in suicidal ideation among demographic groups and geographic regions in California. https://escholarship.org/uc/item/55d2v5gp Wed, 2 Jan 2013 00:00:00 +0000 Grant, David Caldwell, Julia Padilla-Frausto, Imelda Adin, May Aguilar-Gaxiola, Sergio https://escholarship.org/uc/item/8763m2x0 <p>Half a million uninsured adults in California who need mental health treatment could gain access to those services through health care reform, according to this Center study. </p><p>In addition to providing new or improved health insurance coverage to as many as 4.6 million Californians, the Patient Protection and Affordable Care Act of 2010 will also implement the Mental Health Parity and Addiction Equity Act of 2008, the publication notes. </p><p>Mental health services will be part of the essential benefits package, which is a set of health care services that must be covered by certain plans. These include insurance policies that will be offered through Medi-Cal and the California Health Benefit Exchange. </p><p>An estimated 1.6 million California adults reported symptoms that were consistent with severe psychological distress and experienced difficulty with their day-to-day functioning, according to the Center's 2009 California Health Interview Survey. About a third of those... https://escholarship.org/uc/item/8763m2x0 Wed, 28 Nov 2012 00:00:00 +0000 Padilla-Frausto, D. Imelda Grant, David Lavarreda, Shana Alex Adin, May https://escholarship.org/uc/item/2sx1f4vs <p>This policy note represents the first time that data has been made available to describe Chronic Obstructive Pulmonary Disease (COPD) prevalence, COPD health care utilization and outcomes, and characteristics of adults with COPD in the state of California, as well as the regions of Southern California and Los Angeles County. The analysis finds that COPD remains a significant health burden, affecting approximately 1.1 million or 4% of California adults. Among them, more than half live in Southern California, and nearly one-fifth of California adults with COPD reside in Los Angeles County. California's COPD profile is complex, as many Californians are under age 45, female, and have never smoked. Not all Californians with COPD are receiving appropriate care, evidenced by the finding that nearly one-third of those with diagnosed COPD were not given a breathing test (i.e. spirometry), the only approved method for diagnosing COPD. More Californians with COPD report poor overall health,... https://escholarship.org/uc/item/2sx1f4vs Wed, 28 Nov 2012 00:00:00 +0000 Meng, Ying-Ying Pickett, Melissa C. Induni, Marta Ryan-Ibarra, Suzanne https://escholarship.org/uc/item/5rz2d8zk The distribution of health insurance in California changed dramatically after two years of high unemployment, from 2009 to 2011. According to data from the annual California Health Interview Survey, just under half of all nonelderly Californians in 2011 were insured through their own or a family member's job-based coverage. Nearly seven million children and adults were uninsured for all or part of the prior year, and almost four million of those had no insurance at all for the entire year or longer. The Medi-Cal and Healthy Families programs picked up much of the slack for private insurance, covering one in five nonelderly Californians. https://escholarship.org/uc/item/5rz2d8zk Wed, 31 Oct 2012 00:00:00 +0000 Lavarreda, Shana Alex Snyder, Sophie https://escholarship.org/uc/item/0kt5k1v4 More than 400,000 Californians had ever enrolled in California’s Low Income Health Program (LIHP) as of March 2012. These LIHP enrollees, who would otherwise be underinsured or uninsured, now have access to services through their county’s safety net facilities and contracted providers. This policy note highlights innovative and successful strategies for outreach, enrollment, and redetermination and retention, as well as the challenges faced by LIHPs.  https://escholarship.org/uc/item/0kt5k1v4 Wed, 31 Oct 2012 00:00:00 +0000 Meng, Ying-Ying, DrPH Cabezas, Livier, MPAf Roby, Dylan H., PhD Pourat, Naderah, PhD Kominski, Gerald F., PhD https://escholarship.org/uc/item/7244h6wq SUMMARY: This policy brief examines the Partners for Children (PFC) program—California’s public pediatric community-based palliative care benefit to children living with life-threatening conditions and their families. Preliminary analysis of administrative and survey data indicates that participation in the PFC program improves quality of life for the child and family. In addition, participation in the program resulted in a one-third reduction in the average number of days spent in the hospital. Shifting care from a hospital setting to in-home community-based care resulted in cost savings of $1,677 per child per month on average—an 11% decrease in spending on a traditionally high-cost population. As the three-year pilot program draws to an end, policymakers are considering the advisability of extending the program beyond the 11 counties that now participate. This policy brief provides recommendations that policymakers, families and advocates should consider to ensure sustainability... https://escholarship.org/uc/item/7244h6wq Tue, 11 Sep 2012 00:00:00 +0000 Gans, Daphna Kominski, Gerald F Roby, Dylan H Diamant, Allison L Chen, Xiao Lin, Wenjiao Hohe, Nina https://escholarship.org/uc/item/5407m7mh Food insecurity has increased significantly among low-income Californians over the last decade. According to data from the 2009 California Health Interview Survey, 3.8 million adults in households with incomes at or below 200% of the Federal Poverty Level (FPL) could not afford enough food at least once in the previous year. Low-income households with children and Spanish-speaking households suffered from the worst levels of food insecurity. Expanding nutrition assistance programs, such as the Supplemental Nutrition Assistance Program, could help reduce high rates of food insecurity among the low-income population https://escholarship.org/uc/item/5407m7mh Mon, 9 Jul 2012 00:00:00 +0000 Chaparro, M. Pia Langellier, Brent Birnbach, Kerry Sharp, Kerry Harrison, Gail https://escholarship.org/uc/item/98x9t1wb In 2009, an estimated six million caregivers in California provided care to a family member or friend with a long-term illness or disability. Of these caregivers, a significant number —450,000 persons—were paid for the care they provided. Nearly two-thirds of these paid caregivers, or 290,000, aided a family member or friend receiving Medi-Cal (paid Medi-Cal caregivers).Many of these paid Medi-Cal caregivers more than likely worked for California’s In-Home Supportive Services (IHSS) program. Despite being compensated, paid caregivers—and paid Medi-Cal caregivers in particular—fared much worse on a number of economic security indicators. https://escholarship.org/uc/item/98x9t1wb Mon, 18 Jun 2012 00:00:00 +0000 Hoffman, Geoffrey J Wallace, Steven P https://escholarship.org/uc/item/48p8229h <p>The Affordable Care Act (ACA) will significantly expand access to affordable health coverage in California starting in 2014. Californians with the lowest incomes will have access to coverage under the expansion of Medi-Cal, while millions of low- and middle-income families will be eligible for subsidies through the California Health Benefit Exchange (the Exchange). Demand for health insurance in the state will also increase as a result of the minimum coverage requirement.</p><p>The level of enrollment in the new and expanded programs and the resulting share of Californians who gain coverage under the ACA will depend on a range of factors, including the ease of enrollment and retention, outreach strategies, and language accessibility. </p><p>We used the California Simulation of Insurance Markets (CalSIM) model, version 1.7, to predict changes in health coverage in California under the ACA using two  scenarios: one based on typical responses by individuals and employers to expanded... https://escholarship.org/uc/item/48p8229h Mon, 18 Jun 2012 00:00:00 +0000 Jacobs, Ken Watson, Greg Kominski, Gerald F Roby, Dylan H Graham-Squire, Dave Kinane, Christina M Gans, Daphna Needleman, Jack https://escholarship.org/uc/item/1dv9s3w9 This policy brief highlights results from a survey of a broad sample of the California legislature on their data and information needs, as well as their familiarity and use of various economic measures. It finds that legislative staff most often use the Federal Poverty Level (FPL) when they are making recommendations about policy and evaluating programs for low-income populations. Yet the FPL does not meet most of the criteria for economic data that legislative staff say they want. Specifically, the FPL does not measure local conditions, it is not based on current costs,and it does not take into account all types of expenses faced by low-income families. Other measures of economic security more accurately meet legislative staffs’ stated data and information needs, including the Elder and Family Economic Security Indices, the U.S Census Supplemental Poverty Measure and Relative Poverty Measures. Improving awareness and usability of these other measures of economic security can... https://escholarship.org/uc/item/1dv9s3w9 Mon, 18 Jun 2012 00:00:00 +0000 Padilla-Frausto, D. Imelda Wallace, Steven P https://escholarship.org/uc/item/0wm191k7 This fact sheet describes a range of behavioral health issues that affect American Indian and Alaska Native populations in disproportionate numbers relative to the general population. Using data from the 2009 California Health Interview Survey (CHIS), the authors provide statistics on psychological distress, depression, suicide ideation, physical or sexual violence, binge drinking and use of alcohol or drugs and smoking status. They also report on the need for behavioral treatments, the type of behavioral health provider used most often by native populations, as well as the need for culturally appropriate treatments.  https://escholarship.org/uc/item/0wm191k7 Fri, 23 Mar 2012 00:00:00 +0000 Johnson, Carrie L Dickerson, Daniel L Satter, Delight E Wallace, Steven P https://escholarship.org/uc/item/8063q8fx <p>As we draw closer to 2014 and the full implementation of the Patient Protection and Affordable Care Act (ACA), we continue to increase our understanding of its full potential and its implications. In California, about 6.7 million nonelderly adults will be eligible for coverage under the law, through either Medi-Cal or tax credits to purchase insurance through California’s new Health Benefit Exchange.</p><p>This policy brief, developed with support from the California Pan-Ethnic Health Network (CPEHN), highlights findings from the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research’s California Simulation of Insurance Markets (CalSIM) model. The CalSIM model </p><p>estimates the effects of specific provisions of the ACA on family and employer decisions about insurance coverage in California. </p><p>People of color and those who speak English less than very well (Limited English Proficient, or LEP) could benefit greatly from implementation... https://escholarship.org/uc/item/8063q8fx Fri, 9 Mar 2012 00:00:00 +0000 Gans, Daphna Kinane, Kristina M Watson, Greg Roby, Dylan H Needleman, Jack Graham-Squire, Dave Kominski, Gerald F Jacobs, Ken Dexter, David Wu, Ellen https://escholarship.org/uc/item/41000267 <p>The fundamental purpose of "Mexico-United States Migration: Health issues" is to present a general overview of the conditions faced by Mexican residents in the United States concerning their health care. Good health constitutes an essential asset for the integral development of an immigrant's capacities for performing labor and for social participation. Enjoying good health not only benefits the immigrants themselves and their descendents, both Mexican and American, but also has larger social and economic implications for both the receiving communities and the places of origin. The health of immigrants, particularly the poorest and most mobile among them, is therefore a concern requiring attention from both Mexico and the United States in the form of programs and strategies with a binational perspective. The Ministry of Health and the National Population Council (Consejo Nacional de Población-CONAPO) of the Government of Mexico, and the University of California through the... https://escholarship.org/uc/item/41000267 Wed, 29 Feb 2012 00:00:00 +0000 Zuniga, Elena Wallace, Steven P. Berumen, Salvador Castaneda, Xotichl al., et https://escholarship.org/uc/item/4q03g1w7 The Affordable Care Act (ACA) requirement that almost all Americans purchase some type of health insurance coverage has been controversial. This policy note examines the potential implications of eliminating the minimum coverage requirement (MCR), or "individual mandate." Based on analyses using the California Simulation of  Insurance Markets (CalSIM) model, the authors find that the ACA will reduce California’s eligible uninsured population from 4.63 to 2.72 million by 2019; a reduction of 1.91 million or 41% of the eligible uninsured. In contrast, without the MCR, the ACA will reduce the state’s eligible uninsured population from 4.63 to 3.76 million; a reduction of only 870,000 or 19% of the  eligible uninsured. Comparing the number of newly insured with and without the MCR shows that the number of newly insured will be 1.04 million lower in 2019 without the MCR. In addition, eliminating the MCR is likely to accelerate premium growth due to adverse selection. If this occurs,... https://escholarship.org/uc/item/4q03g1w7 Wed, 25 Jan 2012 00:00:00 +0000 Kominski, Gerald F Roby, Dylan H Jacobs, Ken Watson, Greg Graham-Squire, Dave Kinane, Christina M Gans, Daphna Needleman, Jack https://escholarship.org/uc/item/8wr3t0zc In California, more than one-third (38%) of fifth-, seventh-, and ninth-grade public school students were overweight or obese in 2010. This number represents a 1.1 percent decrease in the statewide prevalence of overweight and obesity from 2005, suggesting that the 30-year trend of increasing childhood obesity rates may be leveling off. However, overweight and obesity continue to be of major concern in the state, with more than half of California counties experiencing increases in rates of overweight and obesity among youth between 2005 and 2010. Public policy options that promote healthy eating and physical activity will continue to be critical to reducing overweight and obesity among California’s youth.  https://escholarship.org/uc/item/8wr3t0zc Thu, 15 Dec 2011 00:00:00 +0000 Babey, Susan H Wolstein, Joelle Diamant, Allison L Bloom, Amanda Goldstein, Harold https://escholarship.org/uc/item/2sp4f15v This policy brief presents findings from a yearlong study that closely followed a small but typical set of older Californians with disabilities who depend on fragile arrangements of paid public programs and unpaid help to live safely and independently at home. Many of these older adults have physical and mental health needs that can rise or fall with little warning; most are struggling with increasing disability as they age. In spite of these challenges, most display resilience and fortitude, and all share a common determination to maintain their independence at almost any cost. Declines in health status and other personal circumstances among aging Californians have been exacerbated by recent reductions in public support, and will be made even worse by significant additional cuts that are pending. Policy recommendations include consolidating long-term care programs and enhancing support for caregivers. https://escholarship.org/uc/item/2sp4f15v Thu, 15 Dec 2011 00:00:00 +0000 Kietzman, Kathryn G Durazo, Eva M Torres, Jacqueline M Soon Choi, Anne Wallace, Steven P https://escholarship.org/uc/item/1bv483kw This report provides a comprehensive overview of the mental health needs, status, use of mental health services, and comorbidities of adults in California. It looks at key indicators associated with mental health needs, such as gender, socioeconomic and insurance status, and other health conditions. Using data from the 2007 California Health Interview Survey (CHIS 2007), this report finds that approximately 8.3% of adults residing in California, or 2.2 million people, reported having mental health needs. Within this group, striking disparities emerged that may help health providers and others effectively target programs and services to those most in need. https://escholarship.org/uc/item/1bv483kw Thu, 15 Dec 2011 00:00:00 +0000 Grant, David Padilla-Frausto, Imelda Aydin, May Streja, Leanne Aguilar-Gaxiola, Sergio Caldwell, Julia https://escholarship.org/uc/item/0vg2m7vg <p>Despite the steady decline of smoking rates in California, over 200,000 children under age 12 live in homes where smoking is allowed, and another 742,000 live with an adult or adolescent smoker. Significant differences in children’s exposure to tobacco smoke and risk of exposure are found by race/ethnicity, geographic regions within the state and by poverty level. African-American children were found to have a significantly higher rate of exposure than other racial and ethnic groups, while children in the Northern/ Sierra and San Joaquin Valley regions were at the highest risk of exposure to secondhand smoke. Children living in lower-income households were also at higher risk. These findings can aid strategies to decrease children’s exposure to tobacco smoke in the home through targeted public health messages and outreach to those enrolled in public programs.</p> https://escholarship.org/uc/item/0vg2m7vg Fri, 4 Nov 2011 00:00:00 +0000 Holtby, Sue Zahnd, Elaine Grant, David Park, Royce https://escholarship.org/uc/item/0sb8d6gd <p>This policy brief profiles California's informal caregivers—adults who provide care to a family member or friend coping with an illness or disability. Although caregivers appear to be as healthy as noncaregivers of the same age, they report higher levels of psychological distress and engagement in poor health-related behaviors, such as smoking. Middle-aged caregivers may be at greatest risk for poor health outcomes such as high blood pressure, diabetes and heart disease. Few caregivers are paid for their work or use state services that might help alleviate both financial and psychological burdens. Caregivers should foresee difficult times ahead, given recent state budget cuts to programs that support caregivers, and older and disabled adults.</p> https://escholarship.org/uc/item/0sb8d6gd Fri, 30 Sep 2011 00:00:00 +0000 Hoffman, Geoffrey J Mendez-Luck, Carolyn A https://escholarship.org/uc/item/7w11g8v3 <p>This policy brief presents findings on the linkages between intimate partner violence (IPV), emotional health and substance use among adults ages 18-65 in California. Among the 3.5 million Californians who have ever been victimized by IPV as adults, over half a millionreport serious psychological distress (SPD) in the past year. Almost half of all adult IPV victims indicate that their partner was under the influence of alcohol or other drugs during the most recent incident. Two-fifths of adult IPV victims report past-year binge drinking and 7% report daily or weekly binge drinking. One in three IPV victims expressed a need for mental health, alcohol or other drug (AOD) services and almost one-fourth used mental health or AOD services during the past year. These disturbing findings can aid strategies to identify, intervene with and assist IPV victims who experience emotional and/or substance use problems.</p> https://escholarship.org/uc/item/7w11g8v3 Wed, 31 Aug 2011 00:00:00 +0000 Zahnd, Elaine Aydin, May Grant, David Holtby, Sue https://escholarship.org/uc/item/5w17p523 <p>SUMMARY: In California, more than 2 million adolescents (58%) drink soda or other sugar-sweetened beverages every day, and more than 1.6 million adolescents (46%) eat fast food at least twice a week. Adolescents who live and go to school in areas with more fast food restaurants and convenience stores than healthier food outlets such as grocery stores are more likely to consume soda and fast food than teens who live and go to school in areas with healthier food environments. State and local policy efforts to improve the retail food environment may be effective in improving adolescents’ dietary behaviors.</p> https://escholarship.org/uc/item/5w17p523 Tue, 16 Aug 2011 00:00:00 +0000 Babey, Susan H Wolstein, Joelle Diamant, Allison L https://escholarship.org/uc/item/3mp0f3n3 <p>The Patient Protection and Affordable Care Act of 2010 (ACA) restricts its health insurance expansions in ways that exclude many uninsured children in California who are immigrants or have immigrant parents. These exclusions directly limit coverage options for noncitizen children. And immigrant parents, potentially misinterpreting eligibility requirements for these new programs, may not enroll their citizen children. Using the 2007 California Health Interview Survey (CHIS 2007), this policy brief estimates that of the 1.08 million children in California who were uninsured all or part of the year, between 180,000 to 220,000 will be excluded from the health care reform expansions due to the combined direct and potential indirect effects of these exclusions. This "left-out" group comprises between 17% and 20% of all uninsured children in California. In light of these exclusions, California’s community clinics and public hospitals could continue to serve a significant number of... https://escholarship.org/uc/item/3mp0f3n3 Wed, 20 Jul 2011 00:00:00 +0000 Ponce, Ninez Lavarreda, Shana A Cabezas, Livier https://escholarship.org/uc/item/0ds8j0w9 <p>Despite living in the countryside where open space is plentiful and there is often significant agricultural production, rural older adults have higher rates of overweight/obesity, physical inactivity and food insecurity than older adults living in suburban areas. All three conditions are risk factors for heart disease, diabetes and repeated falls. This policy brief examines the health of rural elders and, by contrast, their urban counterparts, and finds that both groups lmost one in five California adults age 65 and over (18.2% or about 710,000 seniors) lived in a rural area in 2007. A rural area is defined as a nonmetropolitan area with fewer than 950 persons per square mile.1 The low population density of rural areas creates special challenges for addressing the health needs of rural seniors. Using data from the 2007 California Health Interview Survey (CHIS 2007), the social characteristics, health risks and health conditions of older adults living in rural areas are examined... https://escholarship.org/uc/item/0ds8j0w9 Tue, 14 Jun 2011 00:00:00 +0000 Durazo, Eva Jones, Melissa Wallace, Steven Van Arsdale, Jessica Aydin, May Stewart, Connie https://escholarship.org/uc/item/8hn72960 <p>In California, more than 1.3 million adolescents (38%) do not participate in physical education (PE) at school, and this rate increases dramatically with age, from just 5% at age 12 to 77% at age 17. In addition, only 19% of teens meet current physical activity recommendations. Participation in PE at schoolis associated with more overall physical activity. Policies that promote more opportunities for physical activity, including those that help schools meet or exceed current PE requirements, can contribute to greater levels of physical activity for adolescents.</p> https://escholarship.org/uc/item/8hn72960 Thu, 2 Jun 2011 00:00:00 +0000 Diamant, Allison L. Babey, Susan H. Wolstein, Joelle https://escholarship.org/uc/item/1n197590 <p>About 2.13 million nonelderly Californians who were uninsured for all or part of 2009 are newly-eligible for Medi-Cal under the Patient Protection and Affordable Care Act (ACA) of 2010.1 Analysis of the 2009 California Health Interview Survey indicates that this newly-eligible population is often single, working-age and employed. Their rates of most chronic conditions are similar to those currentlyenrolled in Medi-Cal, but they have less access to care. The characteristics of the population of the newly-eligible for Medi-Cal under ACA are likely to change by 2014 when the major provisions of the law are fully implemented. However, coverage of this newly-eligible lowincome population is likely to improve their access to health services.</p> https://escholarship.org/uc/item/1n197590 Thu, 26 May 2011 00:00:00 +0000 Pourat, Nadereh Martinez, Ana E. Kominski, Gerald F. https://escholarship.org/uc/item/5g9103dq <p>About 1.71 million nonelderly Californians were uninsured for all or part of 2009 and are estimated to be eligible to participate and receive subsidies in the new California Health Benefit Exchange marketplace under the Patient Protection and Affordable Care Act (ACA) of 2010. Another 737,000 are currently insured with individual policies and will also be eligible for participation in the Exchange based on their employment, income and citizenship status. This policy brief examines the characteristics of these Exchange-eligible with subsidies groups, based on 2009 California Health Interview Survey data. Among the findings, these Exchange-eligible populations alifornia has established the California Health Benefit Exchange in compliance with the Patient Protection and Affordable Care Act (ACA) of 2010. Premium and cost-sharing subsidies are offered to eligible individuals under 65 who earn between 133% and 400% of the federal poverty level (FPL) and those with lower incomes... https://escholarship.org/uc/item/5g9103dq Tue, 17 May 2011 00:00:00 +0000 Pourat, Nadereh Kinane, Christina Kominski, Gerald F. https://escholarship.org/uc/item/11b5v6c7 <p>About 2.13 million nonelderly Californians who were uninsured for all or part of 2009 are newly-eligible for Medi-Cal under the Patient Protection and Affordable Care Act (ACA) of 2010.1 Analysis of the 2009 California Health Interview Survey indicates that this newly-eligible population is often single, working-age and employed. Their rates of most chronic conditions are similar to those currentlyenrolled in Medi-Cal, but they have less access to care. The characteristics of the population of the newly-eligible for Medi-Cal under ACA are likely to change by 2014 when the major provisions of the law are fully implemented. However, coverage of this newly-eligible lowincome population is likely to improve their access to health services.</p> https://escholarship.org/uc/item/11b5v6c7 Tue, 17 May 2011 00:00:00 +0000 Pourat, Nadereh Martinez, Ana E. Kominski, Gerald F. https://escholarship.org/uc/item/9gv99494 <p>Research on the health of lesbian, gay and bisexual (LGB) adults generally overlooks the chronic conditions that are the most common health concerns of older adults. This brief presents unique population-level data on aging LGB adults (ages 50-70) documenting that they have higher rates of several serious chronic physical and mental health conditions compared to similar heterosexual adults. Although access to care appears similar for aging LGB and heterosexual adults, aging LGB adults generally have higher levels of mental health services use and lesbian/bisexual women report greater delays in getting needed care. These data indicate a need for general health care and aging services to develop programs targeted to the specific needs of aging LGB adults, and for LGB-specific programs to increase attention to the chronic conditions that are common among all older adults.</p> https://escholarship.org/uc/item/9gv99494 Tue, 5 Apr 2011 00:00:00 +0000 Wallace, Steven P. Cochran, Susan D. Durazo, Eva M. Ford, Chandra L. https://escholarship.org/uc/item/3mg9h1pj <p>Almost 4.7 million nonelderly adults and children of the seven million Californians who were uninsured for all or part of 2009 will be eligible for insurance as a result of last year’s health care reform legislation, according to new data from the 2009 California Health Interview Survey (CHIS 2009). Eligible Californians will obtain coverage either through Medi-Cal or through subsidies to purchase private health insurance in the new California Health Benefit Exchange (CHBE) starting in 2014. The CHBE will also be open to 1.2 million uninsured persons who do not qualify for subsidized premiums due to their income exceeding eligibility levels, but who will benefit from the new marketplace created through the Patient Protection and Affordable Care Act (PPACA). Just over one million uninsured persons do not qualify to participate in either the CHBE or in the Medi-Cal expansion due to their citizenship status. With seven million uninsured residents of California in 2009, the new... https://escholarship.org/uc/item/3mg9h1pj Thu, 17 Feb 2011 00:00:00 +0000 Lavarreda, Shana Alex Cabezas, Livier https://escholarship.org/uc/item/10z2x41s <p>Low-income older Californians with disabilities depend on a variety of public programs to remain in their own homes. This policy note provides the first findings from a project that is following a group of seniors who depend on a fragile arrangement of paid and unpaid help to maintain their independence. The analysis finds that the disability needs of these older adults are often unstable, with both their physical and mental health status sometimes changing day to day. Public services are a crucial component of these individuals’ support networks, even if they sometimes fall short of addressing all their complex needs. Many of these disabled older adults have nowhere else to turn for assistance should their public services be cut. Interviews reveal that these people are typically in poor physical and psychological condition and are just managing to live safely in their homes. At the same time, they share a common goal of staying at home and maintaining their independence.</p> https://escholarship.org/uc/item/10z2x41s Tue, 1 Feb 2011 00:00:00 +0000 Kietzman, Kathryn Wallace, Steven P. Durazo, Eva Torres, Jacqueline Choi, Anne Soon Benjamin, A. E. Medez-Luck, Carolyn https://escholarship.org/uc/item/9pw681gq <p>Although asthma occurs among Californians at all socio-economic levels, it disproportionately affects low-income Californians, who miss more days of work and school, are more likely to have frequent asthma symptoms, and are more likely to go to the emergency department or be hospitalized for asthma care. In this report, the burden of asthma on low-income Californians is examined by geography, race/ethnicity, age and access to care, among other factors. The authors suggest that disparities in asthma prevalence and care are likely due to a number of factors including inadequate access to health insurance coverage, lack of continuity and quality of health care, and an increased likelihood of exposure to asthma triggers and they point to policy and environmental changes that will likely help address these disparities, including adequate health care coverage, quality health care for low-income Californians with asthma, and asthma-friendly environments.</p> https://escholarship.org/uc/item/9pw681gq Tue, 4 Jan 2011 00:00:00 +0000 Wolstein, Joelle Meng, Ying-Ying Babey, Susan H. https://escholarship.org/uc/item/96v856cx <p>This report provides a pre-reform snapshot of health status and utilization characteristics of Californians who were either enrolled in commercial or public managed care plans or who were uninsured in 2007. Using the most recently available data from the 2007 California Health Interview Survey (CHIS), this report provides a detailed profile of demographic characteristics, disease conditions, health status, health care use, and barriers to care among California residents. Among the findings are a high need for certain types of health care, such as mental health services, as well as a growing reliance on high-deductible health plans, especially among the low-income and self-employed.</p> https://escholarship.org/uc/item/96v856cx Thu, 28 Oct 2010 00:00:00 +0000 Roby, Dylan H. Nicholson, Gina Kominski, Gerald F. https://escholarship.org/uc/item/7pg2j9nb <p>is report examines both the health and economic costs of commercial tobacco use and secondhand smoke inhalation in the American Indian and Alaska Native communities in California. The authors estimate the cost of smoking — in health care and lost productivity — totals nearly 800 million dollars a year. It provides detailed breakdowns of productivity losses, as well as costs per individual and by specific health condition, of commercial tobacco use. The authors also describe complicating factors, such as confusion over the role of traditional tobacco use or “sacred smoking,” and offers practical guidance and resources to tribes and American Indian communities seeking to implement tobacco-control and prevention activities in culturally-appropriate ways.</p> https://escholarship.org/uc/item/7pg2j9nb Thu, 21 Oct 2010 00:00:00 +0000 Satter, Delight E. Roby, Dylan H. Smith, Lauren M. Wallace, Steven P. https://escholarship.org/uc/item/99x9x37c <p>This policy brief uses 2009 data to calculate the Elder Economic Security Standard™ Index (Elder Index), a measure of the basic cost of living for seniors in all 58 California counties. It shows that both singles and couples age 65 or older who rent need more than twice the amount established by the Federal Poverty Level (FPL) Guideline to meet basic living expenses. The gap is greater for elders who own their home and are paying a mortgage than for renters. The gap between basic expenses and the FPL is smaller for owners without a mortgage, but still exists.</p><p>Housing and health care are the primary drivers of the high costs. This policy brief documents that the Elder Index provides a better measure of income adequacy than the Federal Poverty Level guideline (FPL) for older adults because it accounts for those costs at the county level. It also details the growing number of public and nonprofit organizations using the Elder Index for planning and programs that improve... https://escholarship.org/uc/item/99x9x37c Thu, 16 Sep 2010 00:00:00 +0000 Wallace, Steven P. Padilla-Frausto, Imelda D. Smith, Susan E. https://escholarship.org/uc/item/8dz107b3 <p>The prevalence of both diabetes and obesity has grown significantly in California. Six million adults are obese and an additional 9.3 million are overweight. Obesity is a significant risk factor for diabetes; more than two million adults have been diagnosed with diabetes in California. Obesity and diabetes disproportionately affect people of color, the poor and those with the least education in California. Policy and environmental changes that promote and encourage physical activity and healthy eating will likely prove most effective in combating obesity and related conditions.</p> https://escholarship.org/uc/item/8dz107b3 Tue, 7 Sep 2010 00:00:00 +0000 Diamant, Allison L. Babey, Susan H. Wolstein, Joelle Jones, Malia https://escholarship.org/uc/item/2wt1593p <p>This fact sheet presents county-by-county estimates of the number of California residents who have lost health insurance during the economic downturn. The authors find that the number of Californians without health insurance grew in all counties and that 37 counties — from Imperial to Kern to Shasta — had uninsured rates above the statewide average of 24.3%.</p><p>Loss of health insurance was concentrated in Southern California (Imperial, Riverside, San Bernardino counties), the San Joaquin Valley (all counties), and the Northern/ Sierra areas (all but Sutter and Humbolt), all of which had 2009 uninsured rates that were above the statewide average (24%).</p><p>The losses were due to sharp increases in local unemployment and corresponding drops in both household income and job-based coverage.</p> https://escholarship.org/uc/item/2wt1593p Tue, 7 Sep 2010 00:00:00 +0000 Lavarreda, Shana Chia, Jenny Y Cabezas, Livier Roby, Dylan H. https://escholarship.org/uc/item/33n5h7m3 <p>This policy brief, based on data from the 2005 California Health Interview Survey (CHIS 2005), presents a comprehensive overview of mental health status and service use in California, and highlights differences by age, gender, race/ethnicity, income and insurance status. The authors find that nearly one in five adults in California, about 4.9 million persons, said they needed help for a mental or emotional health problem. Approximately one in 25, or over one million Californians, reported symptoms associated with serious psychological distress (SPD).1 Of those adults with either perceived need or SPD, only one in three reported visiting a mental health professional for treatment.</p><p>Mental health status was also closely linked to income and was pervasive regardless of race/ethnicity. Although mental health services can be effective, there were significant barriers to access to care, including fear of stigma as well as lack of insurance.</p> https://escholarship.org/uc/item/33n5h7m3 Fri, 20 Aug 2010 00:00:00 +0000 Grant, David Kravitz-Wirtz, Nicole Aguilar-Gaxiola, Sergio Sribney, William M. Aydin, May Brown, Richard E. https://escholarship.org/uc/item/1108k4mc <p>This report examines the health risks, health status and health services use of the American Indian/Alaska Native (AIAN) elders in California, home to one of the nation's largest populations of AIAN elderly. Specifically, this report uses the California Health Interview Survey (CHIS) to provide omnibus data on a range of issues, including demographics, obesity, alcohol and tobacco use, as well as cancer screening, mental health, health insurance and more. Assessing and understanding the disease burden among California AIAN elders will enable service providers, health advocates and policymakers to set priorities and allocate resources that will benefit the health and well being of this vulnerable population. Although national health status data exist on the AIAN population as a whole, there is a severe lack of state-level and sub-state level data focused on the health of AIAN elders. This report presents the first comprehensive population-level health data on California's Native... https://escholarship.org/uc/item/1108k4mc Fri, 20 Aug 2010 00:00:00 +0000 Satter, Delight E. Wallace, Steve P. Garcia, Andrea N. Smith, Lauren M. https://escholarship.org/uc/item/1k89r44j <p>examining subgroups of women at higher risk of being without coverage and looking at family incomes of uninsured women and at uninsured rates across counties. The information in the brief is based on data from the 2007 California Health Interview Survey (CHIS 2007).</p> https://escholarship.org/uc/item/1k89r44j Fri, 25 Jun 2010 00:00:00 +0000 Wyn, Roberta Peckham, Erin https://escholarship.org/uc/item/1kr1x82g <p>This policy brief examines the growing rate of repeated falls among senior citizens, comparing data from the 2003 and 2007 California Health Interview Survey (CHIS). The authors found that over half million older Californians (565,000) fell more than once in 2007—about 100,00 more seniors with repeated falls than in 2003.</p><p>National guidelines by the American Geriatrics Society (AGS) and a recent synthesis of the scientific literature recommend reducing the risk of falling by older adults with a history of falls through an evaluation by a health professional with counseling on how to reduce falls, a review of medications, home modifications, exercise or physical therapy, and using a cane or walker if needed. However, the authors of this brief found that fewer than half of seniors with multiple falls engaged in the six recommended preventive activities in the previous year.</p><p>Falls are the leading cause of injury among older adults. Over 1,400 California seniors died... https://escholarship.org/uc/item/1kr1x82g Thu, 13 May 2010 00:00:00 +0000 Wallace, Steven Pourat,, Nadereh Durazo, Eva Leos, Rosana https://escholarship.org/uc/item/4nb2h5bg <p>Nearly 1 in 6 adults in California, about 3.7 million persons, report experiencing physical intimate partner violence (IPV) as adults, according to the authors of this policy brief. Using data from the 2007 California Health Interview Survey, the authors found that over one million Californians were forced to have sex by an intimate partner during adulthood and17.2% of adults-—nearly four million Californians-—report being a victim of physical and/or sexual IPV as an adult. The brief also looks at patterns of reported IPV during adulthood by race ethnicity as well as gender and sexual orientation.</p> https://escholarship.org/uc/item/4nb2h5bg Tue, 4 May 2010 00:00:00 +0000 Zahnd, Elaine Grant, David Aydin, May Jawad Chia, Jenny Y. Padilla-Frausto, Imelda D. https://escholarship.org/uc/item/9rq520vm <p>policy brief examines the likely effects of the sweeping 2009 cuts to California's safety-net programs for low-income and disabled seniors. Specifically, it examines reductions in programs that help disabled seniors remain safely at home, including the Supplemental Security Income, In-Home Supportive Services, Adult Day Health Care and other programs. Among the findings: researchers found that up to half a million seniors will have their incomes reduced by the cuts and tens of thousands will lose some or all of their in-home supportive services. The research is based on program data, published research and interviews with key informants in the health and government services sectors.</p> https://escholarship.org/uc/item/9rq520vm Thu, 1 Apr 2010 00:00:00 +0000 Wallace, Steven P. Benjamin, A. E. Villa, Valentine M. Pourat, Nadereh https://escholarship.org/uc/item/67j4r0m1 <p>This policy brief uses data from the 2007 California Health Interview Survey (CHIS) to examine delays in fulfilling prescribed medication, delays in obtaining needed medical care, visits to emergency rooms and the presence of a usual source of care among insured African Americans in public and commercial HMOs. Specifically, it examines the assertion that individuals enrolled in health maintenance organizations (HMO) should be less likely to rely on emergency room and ambulatory care sensitive hospitalizations given the focus of HMOs on centralized care through use of a primary care provider. However, in this policy brief, researchers found that African-American HMO enrollees in California are more likely to delay obtaining needed medications and use the emergency room than other racial/ethnic groups in comparable HMO plans. The authors recommend a reexamination of use patterns and access barriers among African-American HMO enrollees. This policy brief is supported by a grant... https://escholarship.org/uc/item/67j4r0m1 Thu, 1 Apr 2010 00:00:00 +0000 Roby, Dylan H. Nicholson, Gina Kominski, Gerald F. https://escholarship.org/uc/item/3m28j57b <p>This policy brief examines a range of health issues and trends among California's approximately three million women ages 50-64, an age group that often faces new and accelerated chronic health conditions. The authors found that women ages 50-64 are more prone than younger women to a wide range of health conditions, including asthma, diabetes and heart disease. Nearly four in ten women in this age group will be diagnosed with high blood pressure in their lifetime while nearly six in ten are either obese or overweight -– in both cases a proportion higher than for younger women. Using data from the 2007 California Health Interview Survey, the authors also found that one-quarter of women who had never married and 21 percent of divorced, separated, or widowed women were uninsured -– percentages that are more than twice the rates of married women.</p> https://escholarship.org/uc/item/3m28j57b Thu, 1 Apr 2010 00:00:00 +0000 Wyn, Roberta Peckham, Erin https://escholarship.org/uc/item/1fj3h5cj <p>This study reports geographic variations in consumption of sugar-sweetened beverages among children, adolescents, and adults and examines the correlation between soda consumption and obesity. Among the findings: researchers found that adults who drink a soda or more per day are 27 percent more likely to be overweight than those who do not drink sodas, regardless of income or ethnicity. Among children, the study found that 40 percent of young children (2-11 years of age) are drinking at least one soda or sugar-sweetened beverage every day. Adolescents (12-17) represent the biggest consumers, with 62 percent(over 2 million youths) drinking one or more sodas every day – the equivalent of consuming 39 pounds of sugar each year in soda and other sugar-sweetened beverages.</p><p>Data was drawn from the 2005 California Health Interview Survey (CHIS), which interviewed more than 43,000 adults and 4,000 adolescents from every county in the state.</p> https://escholarship.org/uc/item/1fj3h5cj Thu, 1 Apr 2010 00:00:00 +0000 Babey, Susan H. Jones, Malia Yu, Hongjian Goldstein, Harold https://escholarship.org/uc/item/1b99x1qw <p>This policy brief examines the health disparities that low income nonelderly adult women in California encounter across a wide range of measures. Specifically, the authors examine health status and functioning, health risks, gaps in access to health care and health services, insurance trends and other topics of concern. The research finds that even though they are a younger population than women with higher incomes, low-income women have worse general health status and functioning. And mid-life, low-income women have a higher prevalence of three of the four chronic health conditions examined—diabetes, high blood pressure and heart disease. Prevention practices, the expansion of insurance coverage and the waiver of out-of-pocket expenses and premiums are among the policy recommendations.</p> https://escholarship.org/uc/item/1b99x1qw Thu, 1 Apr 2010 00:00:00 +0000 Peckham, Erin Wyn, Roberta https://escholarship.org/uc/item/14g1w8s7 <p>Specifically, the authors found that of the 7,240,000 school age children ages 5-17 in California, an estimated 504,000 missed at least one day of school due to a dental problem in the past year. The majority of these children report one missed day of school due to a dental problem, while the remaining 40 percent report missing two or more days. In total, California children report missing an estimated 874,000 school days due to dental problems.</p><p>The ability to afford needed dental care is the key difference between those children who miss school due to a dental problem and those who do not. The authors note that frequent absences may have significant negative societal and economic consequences and suggest that policymakers consider addressing gaps in coverage and access, as well as school-based dental care, among other recommendations.</p> https://escholarship.org/uc/item/14g1w8s7 Thu, 1 Apr 2010 00:00:00 +0000 Pourat, Nadereh Nicholson, Gina https://escholarship.org/uc/item/1112k1nc <p>Nearly two million Californians lost their health insurance during 2008 and 2009 – years characterized by a deep recession and mass layoffs – bringing the total number of uninsured in the state to more than 8 million, according to this policy brief that draws upon both 2009 and adjusted 2007 data.</p><p>The number of uninsured represents a 28 percent increase since 2007, when 6.4 million Californians lacked insurance, according to the authors, who also estimate that nearly one-quarter of all adult Californians currently lack health insurance.</p><p>The estimates are based upon 2009 enrollee data from health insurance companies and the public health insurance programs offered by the state of California. Those counts were then used to update 2007 California Health Interview Survey health insurance rates, adjusting for 2009 population growth and changes in insurance status.</p> https://escholarship.org/uc/item/1112k1nc Thu, 1 Apr 2010 00:00:00 +0000 Lavarreda, Shana Alex Brown, Richard E. Cabezas, Livier Roby, Dylan https://escholarship.org/uc/item/1025f7qr <p>Organized provider networks have been developed as a method of achieving efficiencies in the delivery of health care, and to reduce problems such as limited access to specialty and tertiary care, fragmentation and duplication of services, low-quality care and poor patient outcomes. This policy brief examines the experience of ten California counties participating in the Health Care Coverage Initiative (HCCI), a demonstration project to expand coverage to low-income and indigent residents, in overcoming these barriers and creating provider networks based on existing safety-net systems. These interim findings should provide valuable information for future efforts to develop effective networks based on safety-net providers. Specifically, the brief examines the structure of the networks built, how they were implemented, the types of services and reimbursements offered, the health information technologies employed in the effort, as well as plans to further enhance the networks in... https://escholarship.org/uc/item/1025f7qr Thu, 1 Apr 2010 00:00:00 +0000 Roby, Dylan Reifman, Corey Davis, Anna Diamant, Allison L. Meng, Ying-Ying Kominski, Gerald F. Kelley, Zina Pourat, Nadereh https://escholarship.org/uc/item/78k2v1z9 <p>This comprehensive, biennial report provides an overview of insurance trends throughout the state and looks specifically at coverage of California's working adults, elderly as well as children's coverage. It also examines the consequences of lacking insurance and provides policy recommendations. Based on data from the California Health Interview Survey (CHIS) that was collected during a period of economic growth — 2007 — the report provides a clear picture of the adequacy of health insurance arrangements at a time of seemingly high capacity. The authors found that health insurance coverage system stagnated even as the economy expanded. Using the data from several CHIS survey cycles, the report shows little change in employment-based coverage and a drop in employment-based coverage for children between 2001 and 2007. The report also found that nearly one in 13 Californians had some kind of medical debt and that those with debt were twice as likely as those without debt to... https://escholarship.org/uc/item/78k2v1z9 Thu, 18 Mar 2010 00:00:00 +0000 Brown, Richard E. Kronick, Richard Kincheloe, Jennifer R. Lavarreda, Shana Alex Peckham, Erin