The California Health Report is an independent, non-profit journalism project supported with initial funding from the California Endowment. The site’s mission is to inform Californians about public health and community health issues, to engage readers in an ongoing conversation about matters ranging from health care policy to land-use, transportation, environment, criminal justice and economic policy, and to show how all of these things are connected.

By Ron Shinkman

 

After nearly a decade of cuts and incomplete coverage, Californians enrolled in the state’s low-income dental program have full coverage this year.

 

But whether there will actually be enough dentists willing to accept the low-reimbursement rates and red tape often attached to the Denti-Cal program remains to be seen.

 

Denti-Cal provides dental services to roughly 14 million children and adults statewide. But coverage for the 7 million adults enrolled was hobbled for years following the 2007 economic recession.

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Dewey Welker has lots of dreadful memories.

 

With great clarity, down to the way his father turned up his shirt sleeves that day and the deep gray of his father’s jeans, he can describe every moment of being abandoned outside a liquor store at age 4.

 

He remembers stealing his first pair of shoes at age 7 and, a little later, beating up another boy to rob him of his scooter.

 

Marijuana came at 9, cigarettes at 12. His best friend introduced him to methamphetamine at 15.

 

That boy would later shoot himself.

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ChrisAnna Mink

 

“All five children get lunch at school,” mother Maria Chavez said through a Spanish interpreter. School lunches help the Chavez’, whose names have been changed, make ends meet.

 

Arturo Chavez, 7, is my clinic patient in South Los Angeles. He has developmental issues, notably a speech delay. But with help from medication and therapy, he is catching up to his first-grade peers. He is an engaging little boy who loves to tell stories, even with his speech difficulties.

 

Arturo has four siblings, ages 4 to 17, and all are in school. Maria Chavez, their mother, is unable to work, in part because of Arturo’s frequent appointments. The children’s father’s monthly income as a restaurant cook is less than $4,000.

 

“At the end of the month, it’s difficult,” Maria Chavez said. “So we go to food banks or our church for food.”

 

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New state rules about the application of  pesticides on farms near rural schools and daycare facilities take effect Jan 1., following years of campaigning by groups advocating for teachers, the environment and public health. Yet these advocates argue that the rules still don’t do enough to protect school children and school staff from potentially dangerous chemicals.  

 

The new rules adopted by the California Department of Pesticide Regulation (DPR) prohibit spraying pesticides within a quarter mile of schools and daycare facilities on weekdays between 6 a.m. and 6 p.m. 

 

Advocates argue that the buffer zone of a quarter of a mile doesn’t do enough to protect the estimated 5,500 students, teachers and daycare workers who spend their weekdays at the farm-side facilities.

 

“At the end of the day is this where we want to be? No. We wanted the buffer at one mile. But, are these new regulations better and more consistent than before? Yes, they are,” said Paul Weller, a spokesman for Pesticide Reform. 

 

DPR’s long-awaited rules apply to fumigation, aerial, ground air-blast, sprinkler and dust application of pesticides on fields. These application methods may cause pesticide drift, when potentially harmful chemical become airborne and drift from farms into the surrounding communities.

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Much has been written about the disproportionately high incidence of health problems such as diabetes and obesity among African Americans and Latinos when compared to non-Hispanic whites. But health disparities among smaller minority groups such as American Indians and Pacific Islanders have received far less attention.

new report out of University of California Riverside aims to change that. Led by Andrew Subica, an assistant professor of social medicine, population and public health, the study examines seven years worth of data on health trends among American Indians and Alaskan natives, native Hawaiians and other Pacific Islanders and multiracial adults living in California.

The findings paint a startling picture of ill health among these small and historically neglected populations. Not only do their rates of diabetes and obesity surpass those of non-Hispanic white people, but many are just as or even more likely to suffer from these diseases than African Americans and Latinos.

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By Linda Childers

Olivia Basurto was concerned when her nine-year-old son Samuel came home from school with a rash on his arms. After trying to treat the pink bumps with over-the-counter creams, and having no success, Basurto called to make an appointment with a dermatologist.

She quickly learned that in her small rural town of Pixley (population 3,310), in the Central Valley, physician specialists are a rare commodity. The nearest specialist was either in Porterville or Fresno, located almost an hour away, and they had a three-month wait.

But then, the Pixley Medical Clinic, a rural health clinic that provides family practice medicine to residents of Pixley and the surrounding cities, asked Basurto if she would be open to a telemedicine appointment with a dermatologist. The doctor, a retired dermatologist volunteer with The MAVEN Project, could assess her son’s rash and offer medical advice.

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By Alyssa Morones

Maria Castro * has worked in Kern County’s fields for 14 years, since her family moved to Delano, Calif., from Mexico when she was 16 years old. She started working as a grape harvester two days after her arrival.

She soon noticed a weird scent on her clothes that wouldn’t come off, even after washing. Her brother-in-law told her it was sulfur that growers applied to fields to help the grapes grow faster.

“They never really tell us the names of the pesticides,” said Castro, “or their dangers.”

But Castro learned first-hand about the health issues that come with exposure to pesticides.

She’s noticed that soon after chemical applications on or near where she’s working, she feels nauseous and dizzy. Sometimes she vomits. She said she’s seen co-workers faint.

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By Ron Shinkman

Amidst great uncertainty about federal health policy, Covered California announced Tuesday that insurance premiums on the state-run exchange will rise on average 12.5 percent next year, an increase that is slightly lower than in 2017. The agency reiterated that it has a containment plan should the Trump administration cease to provide cost-sharing subsidies for lower-income exchange enrollees.

All 11 insurers currently offering coverage on the state’ exchange will return in 2018, although Anthem Blue Cross will withdraw from Southern California.

The premium hike for 2018 is down from the 13.2 percent average increase for this year, but still much higher than the low single-digit rate hikes announced for 2015 and 2016.

Covered California Executive Director Peter V. Lee noted that if consumers shop around for different plans in each tier of coverage, they could keep their rate increases down to 3.3 percent.

“For consumers, no increase is a good increase, but Covered California did a good job in these uncertain times,” said Betsy Imholz, director of special projects for Consumers Union in San Francisco.

Imholz credited the exchange for taking a tough negotiating stance with the health insurers and ensuring that competition remains in place in most of the state. According to Lee, 82 percent of Covered California’s enrollees will have three or more health plans to choose from.    

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By Claudia Boyd-Barrett

The future is hot.

As climate change heats up the globe, Californians can expect to face longer and more extreme heat waves like the ones sweeping through parts of the state this summer, experts warn.

Seniors, who are more prone to heat stress than younger adults, will be among those most affected by rising temperatures. With the over-65 population projected to expand rapidly in the coming decades, the accompanying hotter weather could place an enormous burden on emergency and health care infrastructure.

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By Hannah Guzik

If Washington, D.C. legislators approve cuts to government health care, California’s rural counties are among those who will suffer most, according to a new report.

Those who live in the state’s rural counties—which are largely in Northern California—are more likely than urban residents to be enrolled in the low-income health program called Medi-Cal, according to the report released June 6th from the Georgetown University Center for Children and Families and North Carolina Rural Health Research Program.

Medi-Cal covers 28 percent of adults and 54 percent of children in California’s rural counties, researchers found. Meanwhile, in the state’s metro areas, 21 percent of adults and 44 percent of children are enrolled in the health program.

Before the federal Affordable Care Act and state reforms opened the gates of Medi-Cal to most low-income adults and children, a quarter of the state’s rural residents under age 65 were uninsured. But by mid-2015, that uninsured rate had fallen to 11 percent.

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By Hannah Guzik

Amidst anxiety about potential federal funding cuts to health programs, California has one bright spot. The state’s new tobacco tax is expected to generate about $1.2 billion next fiscal year for the state’s low-income health program.

Now, California legislators and Gov. Jerry Brown are battling over how to spend the money.

Immigrant rights’ advocates are asking the state to use a portion of the Proposition 56 funding to expand health coverage to undocumented young adults.

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By Lisa Renner

For Steve, a senior in rural Stanislaus County, problem-solving therapy helped him conquer mild depression.

“The first step in improving is finding the problems,” said the 63-year-old Oakdale resident, who requested that his last name not be used because he doesn’t want to be stigmatized for having depression. “Once you find and define them, then you can work on how to overcome them.”

Steve is one of about 80 seniors who have participated in a study to determine the effectiveness of problem-solving therapy in reducing depression in rural seniors who live in the Central California counties of Stanislaus, Tuolumne and Calaveras.

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By Lisa Renner 

Richmond resident Jervice Youngblood is grateful that she receives government-subsidized child care for her 2-year-old daughter while she works as a transit driver.

“I do not have too many family members I can depend on to watch my daughter,” she said. Without the subsidy, “I wouldn’t be able to go to work and make money and it would be hard to pay my bills.”

Youngblood is among the few qualifying low-income parents who use child-care subsidies for children 2 and younger. According to a report released in March by policy group Children Nowonly 9 percent of eligible infants and toddlers have state-subsidized child care.

Eligibility for these subsidies is based on state income eligibility guidelines, set at 70 percent of the state median income — or $46,896 for a family of four, said Stacy Lee, managing director of early childhood project integration for Children Now.

Those who work in the child-care field say the chief reasons the subsidies are underused are a severe shortage of child-care spots for that age group, insufficient hours offered by day care providers and reluctance on the part of parents to leave children that young in day care.

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By Derek Walter

On a recent Tuesday morning, a bustling health care clinic is filled with the sounds you’d expect to hear from children who need to see the doctor. Coughing, sneezing and sighs from an upset stomach fill the air.

But this isn’t a doctor’s office or emergency room. Instead it’s at Gaston Middle School in Fresno. While the enhanced services are a welcome addition for students, faculty and staff members who are trying to keep everyone well, there’s another purpose that it serves — helping kids stay in school or make a more rapid return.

The clinic, which is run by health provider company Clinica Sierra Vista, isn’t just a larger school nurse’s office. It’s a full-blown clinic, which features primary-care services, pediatric care and immunizations. The school district said during a board meeting last year that the free clinics would be paid for by health providers and federal subsidies.

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By Linda Childers

Seeing one of her sons struggle to breathe is an all too familiar sight for Natalie Sua of Fresno. Three of her six children have been diagnosed with asthma, a chronic disease in which the airways swell and produce extra mucus.

In the past, when one of the three, who are all boys, had a severe asthma attack, Sua would rush him to the emergency room. But, now, thanks to Fresno’s Asthma Impact Model, she has learned how to reduce asthma triggers in her home and largely keep her sons’ asthma under control.

“We used to visit the ER three to four times a year, or more, when one of the children had a bad asthma attack,” Sua said. “In the past year, we’ve only had to go once or twice.

Launched in 2013, the Asthma Impact Model, focuses on helping low-income families in the Central Valley better manage their children’s asthma, thus avoiding ER visits. The program was designed by the Central California Asthma Collaborative and Clinica Sierra Vista, a Fresno health clinic.

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By Derek Walter

For Jen Smith, just feeding her family requires mind-bending effort — three times a day. That’s because her 8-year-old son Marty Smith is allergic to a host of foods, including those that contain or are cooked in peanut oil, soy or dairy.

He has a condition called eosinophilic esophagitiswhich is exacerbated by food allergies and causes his esophagus to become inflamed.

To get dinner on the table, Smith, a teacher in Clovis, must carefully examine all ingredients and find recipes that work with her son’s limited diet. She ends up spending hours each week on extra food prep for her son and hundreds of dollars annually on specialty foods that her son isn’t allergic to.

Coping with food allergies can be daunting for any family, but, due to the extra labor and grocery costs, they often hit low-income families hardest.

“When you buy packaged foods expect the price to double or triple,” said Smith, who carefully budgets food expenses to feed her family of five on a teacher’s salary. “If I’m baking something with chocolate chips, I have to use a specific brand that is far more expensive. But it’s the only choice, because everything else is made with soy.”

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By Hannah Guzik

If the federal Affordable Care Act is repealed, as some Republican lawmakers and President-elect Donald Trump have proposed, nearly 5 million Californians could lose health coverage, according to a new report.

In the last two years, the health law has enabled about 3.7 million California adults to enroll in the state’s low-income health program, known as Medi-Cal, and 1.2 million residents to receive subsidies to help them pay for insurance through Covered California. Repealing the health law could have a “devastating impact” on these groups, according to the December report from the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research.

In recent days, Trump and some Republican legislators have said that they want to repeal the health law and replace it with something else. It’s unclear whether the replacement would still provide funding for health coverage to adults under Medi-Cal or provide subsidies to those who purchase insurance on the state’s exchange.

Under the ACA, the number of uninsured residents in the state has decreased by almost half, from 6.5 million in 2013 to 3.3 million in 2015, according to the report. Since the majority of the health law’s provisions took effect in 2014, California has seen the largest decline in the uninsured rate of any state nationwide.

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By Claudia Boyd-Barrett

Amid life’s everyday challenges and responsibilities, two worries weigh constantly on Jorge Zaleta’s mind.

The first is the health of his intellectually disabled son, Jorge Zaleta Jr., who at 15 years old needs around-the-clock supervision.

Second, Zaleta worries about his and his wife’s undocumented immigration status, which he fears could get them deported from the United States at any moment — leaving their son, who is an American citizen, to fend for himself.

“You’re always living under that uncertainty, that from one moment to the next, (while you’re) walking in the street or driving, you might get stopped,” said Zaleta, a Spanish speaker who immigrated to the United States 17 years ago and lives in Oakland. “We don’t have stability as a family to be able to give (our son) stability.”

Zaleta and his wife are among hundreds, if not thousands, of undocumented parents in California struggling to take care of U.S.-born children with special needs while at the same time living in fear of deportation. These parents face the same pressures any parent of a special needs child contends with: making sure their child gets the medical care, therapy, educational help and supervision they need, while balancing jobs and household responsibilities. But these families also grapple with the uncertainty of living in the shadows, and are barred from receiving the full range of government assistance that could help them care for their disabled children.

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By Lynn Graebner

One third of California residents and half of the state’s children qualify for Denti-Cal, the state’s Medi-Cal dental program. So leaders in counties like Santa Cruz, where 82 percent of the dentists don’t take Denti-Cal, are seeking new ways to serve this long-suffering low-income population.

“Most California dentists want nothing to do with Denti-Cal,” stated an April report by the Little Hoover Commission, an independent state oversight agency. It hammered Denti-Cal — calling it a broken system that has alienated its partners in the dental profession. Less than half of Denti-Cal beneficiaries use their benefits because they simply can’t find a dentist who will see them.

That has left counties, community clinics, nonprofits and private dentists to cobble together programs and safety nets for thousands of residents. Some of those are showing promise and some counties plan to expand them by applying for part of the $740 million state and federal agencies have allocated for the new Dental Transformation Initiative. It is meant to incentivize more dentists to offer preventative dental care to children.

While the California Dental Association, counties and private dentists say this is an encouraging step, there’s a long way to go to reviving the dysfunctional system, they say.

Dientes Community Dental Care, a community dental clinic receiving federal funding through Santa Cruz County, decided to commission its own report: Increasing Access to Dental Services for Children and Adults on the Central Coast, released in April. It showed that of the 80,000 people on Medi-Cal in Santa Cruz County, only 31 percent of them were able to see a dentist in 2014. Thirty-one percent of children under age 11 in the County have never seen a dentist and seniors on Medicare have no dental benefits except for extreme needs.

“Insurance does not equal access,” said Laura Marcus, Dientes’ executive director.

Despite its expansions, Dientes has to reject about 20 calls daily for dental service. Gaye Hancock was among them. She lost her job during the economic downturn and is working again but now has Denti-Cal. She started calling Dientes two years ago and finally resorted to getting her teeth cleaned at the Cabrillo College Dental Hygiene Clinic by student hygienists. They found cavities and bone loss which have forced Hancock to chew on just one side of her mouth since 2014.

“I’m 63, I’m just fighting to keep my teeth healthy,” she said.

As a result of the Santa Cruz report, the Santa Cruz County Oral Health Access Steering Committee emerged, including Santa Cruz and Monterey County government, education and dental industry representatives among others. They plan to present strategies in December 2016.

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By Claudia Boyd-Barrett

It took a year for Elvira Gomez of El Monte to realize something was wrong with the therapy her son was supposed to be receiving at school.

Jose Antonio Suarez, then 5 years old, was scheduled to see a therapist once a week in his kindergarten class at a Los Angeles County elementary school. But in 2014, a year after the therapy started, Gomez had yet to see any improvements in her son’s hyperactive and aggressive behavior.

“I went to the school and asked, ‘How often is the therapist going (to the classroom)?’” recalled Gomez, a native Spanish speaker. She was shocked to find out that the therapist came only once or twice a month.

“I thought, I have to be more on top of this,” she said.

Gomez is one of thousands of parents across the state who have struggled to get their children adequate mental health services at school. She’s also part of a population that advocates believe is especially vulnerable to having their children’s special education and mental health needs neglected: parents with limited English skills.

Legally, school districts are supposed to provide students experiencing emotional and behavioral difficulties with mental health assessments and individualized services to help them benefit from their education. But a report earlier this year by leading advocacy organizations found half of all students with these difficulties get no mental health help at all.

Other students who do receive services, the researchers found, frequently don’t receive them enough or don’t receive the right kind of intervention to make a difference.

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