{"id":66781,"date":"2024-08-19T10:33:24","date_gmt":"2024-08-19T17:33:24","guid":{"rendered":"https:\/\/lapost.us\/?p=66781"},"modified":"2024-08-19T10:33:24","modified_gmt":"2024-08-19T17:33:24","slug":"medi-cal-expansion-breathes-new-life-into-las-street-medicine-providers","status":"publish","type":"post","link":"https:\/\/lapost.us\/?p=66781","title":{"rendered":"Medi-Cal Expansion Breathes New Life Into LA\u2019s Street Medicine Providers"},"content":{"rendered":"
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By<\/span>Peter Schurmann<\/a><\/div>\n<\/div>\n<\/div>\n
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Recent changes to how Medi-Cal pays for both clinical and non-clinical services have been a game changer for street medicine providers in Los Angeles.<\/p>\n<\/div>\n<\/div>\n

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Brian Zunner-Keating at Casa Milagrosa, a day center for LA’s unhoused. Zunner-Keating heads a street medicine team, part of UCLA\u2019s Health and Homeless Care Collaborative. (Credit: Peter Schurmann)<\/figcaption><\/figure>\n<\/div>\n<\/div>\n
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LOS ANGELES \u2013 It\u2019s a warm Tuesday as a line forms outside Casa Milagrosa, a day center for the unhoused on the edge of Korea Town. Among the crowd is Wilki Tom, a 68-year-old Los Angeles native who for the past two years has received regular medical checks here.<\/p>\n

For Tom and many others, these \u201cstreet medicine\u201d services are a lifeline, and thanks to recent changes to Medi-Cal they are now financially viable over the long term.<\/p>\n

\u201cThe nurses know me here. It\u2019s been the same regular doctor for most of the year,\u201d says Tom, who compares that to past experiences with his primary care physicians who \u201crotate in and out,\u201d often mixing up his first and last name.<\/p>\n

\u201cIt\u2019s 3 to 4 months before I can see my primary,\u201d he notes. \u201cI waited three years to get eye surgery. I had cataract surgery. It\u2019s like, a new doctor comes in\u2026 this is the third primary physician I\u2019ve had in two years, and the new one doesn\u2019t know what the previous one was doing.\u201d<\/p>\n

He adds, \u201cThe folks here know my name. They see me every week. They\u2019re consciously aware of my situation.\u201d And that, in turn, has forced him to take better care of himself. \u201cIt keeps you on your toes,\u201d he says. \u201cYou have expectations for yourself.\u201d<\/p>\n

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Wilki Tom, 68, is a regular at Casa Milagrosa, a day center for LA\u2019s unhoused or unstably housed population. (Credit: Peter Schurmann)<\/figcaption><\/figure>\n<\/div>\n

That level of connection between provider and patient is a key hallmark of the street medicine model, which seeks to take health care out of the hospital and bring it to where the people are who need it most. In this case, the more than 75,000 individuals across LA County who are without shelter or unstably housed, according to the\u00a02024 Greater Los Angeles Homeless Count<\/a>.<\/p>\n

For many of these people, having regular and reliable access to health care has been as elusive as finding affordable housing.<\/p>\n

That may be starting to shift, however, following a series of important changes at the Department of Health Care Services (DHCS) \u2013 which oversees Medi-Cal \u2013 that now allow street medicine providers to bill directly for the services they render outside a hospital setting, which is most of the time.<\/p>\n

Brian Zunner-Keating with UCLA\u2019s Health and Homeless Care Collaborative says this is \u201csomething that is unheard of historically.\u201d<\/p>\n

Street medicine providers have traditionally relied on philanthropy, an unstable and unpredictable funding model. Any medical services, moreover, needed to be delivered within a licensed health care facility to be billed to Medi-Cal. The new DHCS guidelines have upended that old paradigm, allowing groups like Zunner-Keating\u2019s to continue with and even expand their work.<\/p>\n

\u201cWe are really grateful to have that sustainable way to continue our program,\u201d he notes of the recent changes.<\/p>\n

UCLA manages five teams across much of LA County, from the San Fernando Valley to the downtown metro area, South LA and the city\u2019s West Side. According to DHCS, there are around 25 such programs statewide.<\/p>\n

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Casa Milagrosa Program Manager Veronica Garcia accepts a gift from one of the center\u2019s guests, Joseph. The center, which opened just over two years ago, serves on average around 180 people per day. (Credit: Peter Schurmann)<\/figcaption><\/figure>\n<\/div>\n

Zunner-Keating\u2019s team, which visits Casa Milagrosa once a week, currently includes a physician, a nurse and a community health worker, with plans in place to add two part-time social workers and two part-time psychiatrists.<\/p>\n

That expansion of mental health services, as well as housing navigation and a range of other supports, form part of what\u2019s known as Enhanced Care Management (ECM), a new Medi-Cal benefit that covers a range of care, both clinical and non-clinical.<\/p>\n

For staff at Casa Milagrosa, a communal sanctuary for some of LA\u2019s most downtrodden, it means they\u2019re now able to bill Medi-Cal for these services. \u201cIt has definitely impacted our guests,\u201d says Program Manager Veronica Garcia.<\/p>\n

One of those guests is Anthony, a regular at Casa Milagrosa. Born in the Bay Area, he\u2019s spent most of his adult life in Los Angeles.<\/p>\n

\u201cThe city took my car because I hadn\u2019t renewed registration,\u201d he says. \u201cI tried to get it back, but the bank wanted me to make all the back payments and payments to the tow yard. I didn\u2019t have the money, so I had to let it go. So basically, I have nothing.\u201d<\/p>\n

Working with case managers at Casa Milagrosa, Anthony was able to secure a new ID, which he needed to open a bank account. \u201cI\u2019ve been slowly rebuilding my life, such as it was. And I thought it was important to get that foundation.\u201d<\/p>\n

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Anthony is a regular at Casa Milagrosa, where he says staff have helped him regain his ID and open a new bank account, services that Casa Milagrosa can now bill to Medi-Cal. (Credit: Peter Schurmann)<\/figcaption><\/figure>\n<\/div>\n

Under the new DHCS guidelines, Casa Milgrosa can now be paid through Medi-Cal for these services.<\/p>\n

\u201cI really saw a need to merge some of that social support with the medical care,\u201d says Iliana Ramirez, who runs ECM services as part of Zunner-Keating\u2019s team and spent years as a social worker focused on housing in her prior role. \u201cA lot of the folks, even after they were housed, still had a lot of health problems. Still had a lot of fear of being connected to a medical team.\u201d<\/p>\n

She says the newly expanded services have \u201callowed for providers to take the time to spend with a patient\u201d and that being able to \u201cconnect with them as a human goes a long way.\u201d<\/p>\n

Outside, Tom gets his blood pressure taken, the rapport he shares with his provider evident as they exchange pleasantries. \u201cIt feels great,\u201d he says. \u201cEven if there is nothing wrong, I will stop to say good morning and hi.\u201d<\/p>\n

Zunner-Keating echoes Ramirez. \u201cWe\u2019re able to go that extra mile,\u201d adding that with the Medi-Cal expansion has come a \u201cboom in street medicine teams, which we are so excited about because the need is so vast in LA County. And it has been unmet for years.\u201d<\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

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