Transcript Accessing Healthcare Services

Accessing
Healthcare Services
153
Accessing Services
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Finding services
Understanding eligibility
What to do if you’re turned down
Where to get more information
Who can help me
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Finding Services
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HMO or Medi-Cal Managed Care
Choose from a list of provider
 Primary care provider refers to
specialists
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Finding Services
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Fee for service Medi-Cal,
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No list
• Call providers to see if they take Medi-Cal.
• Large teaching hospitals such as
• Childrens Hospital Los Angeles,
• UCLA and
• County USC
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Finding Services
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Private insurance
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list of preferred providers
Private Pay
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clinic with sliding fee scale.
• free clinics in Los Angeles
• clinics operated by the Health
Department.
• county hospitals like
• County USC or
• Harbor UCLA
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Finding Services
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CCS
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Nurse Case Manager helps find
the special care center
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Eligibility
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“Can I qualify or use this program”
Can be based on
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Age
Family income
Residence (where you live)
Residence status (are you a citizen, are
you documented or undocumented)
Disability
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Eligibility
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Entitlement
 If you meet the eligibility
requirements, they have to
take you.
• They cannot say that they ran out of
room or money.
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What To Do if You’re Turned
Down
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Every program has an Appeal
Process.
Learn
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the appeal process
what the program covers
how the appeal process works.
Easier to learn when there isn’t a
problem.
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Where to Get More
Information
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Information about healthcare
for people with disabilities
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Protection and Advocacy, Inc.
The Health Consumer Center
of Los Angeles
Where to Get More
Information
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You can get information
about community resources
and specific care centers
through:
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Living Independently in Los
Angeles (LILA)
LA 211
Who Can Help Me?
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Health Consumer Center of
Los Angeles
Protection and Advocacy Inc.
National Healthlaw Program
Are Health Care Services
Accessible?
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Care that you can use and is
helpful to you.
More than just wheelchair ramps
or elevators.
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Accessibility
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Financial
• Affordable?
• Is there a system that
pays for this care?
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Cultural
• Does the system/provider
respect and understand
your
• beliefs
• preferences
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Are Health Care Services
Accessible?

Geographic
• Location
• Available
transportation
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Are Health Care Services
Accessible?
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Environmental/
structural
• Structural
barriers
• noise or other
uncomfortable
things
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Are Health Care Services
Accessible?
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Linguistic
• Communicate?
• Written
information?
Adapted from: Los Angeles
Medical Home
Project for Children with
Special Needs
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Coordinating care across
systems
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Care from several different
systems
Each system know about the
others
Care coordinator, can help with
this
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Coordinating care across
systems
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Tips for coordinating care
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List of the different systems (with
contact name, address and phone
number)
• everyone on the list receive copies of
records
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Ask your service coordinator to help
keep track of the different systems
Get copies of all records and keep
them in a notebook or file.
Adapted from: Los Angeles Medical Home
Project for Children with Special Needs
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Knocking on the right door
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People are turned down for
services when they ask the
wrong system or provider.
Go to the right source for
assistance.
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Knocking on the right door
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Healthcare systems are
responsible for things that
are medically necessary
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necessary for your health and
usually means that something isn’t
experimental.
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Knocking on the right door
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Services needed to live in the
community or succeed in
school aren’t considered
medically necessary
• Regional Center
• Special Education
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Self-advocacy skills
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An Advocate is someone
who acts on behalf of
themselves or others to
bring about change
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Self-advocacy skills
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A self-advocate
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Is assertive, this includes
• Objecting to things you don’t agree
with
• asking questions
• giving your opinion.
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If you don’t share information
and feelings, things will stay the
same instead of getting better.
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Getting and giving
information
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Need good information to make good
decisions
• Ask questions
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Need good information to make good
recommendations
• Provide information and feedback
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Getting and giving
information
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Getting more information
• Second opinions
• Going to another doctor for their opinion
• This is considered good care
• Many insurance companies want you to
get a second opinion before getting a
treatment like surgery
• Not insulting to doctors
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Tips for giving and getting
information
Prepare a thorough history
 Keep a list of questions that
you can add to as concerns
arise
 Bring a written list of questions
with you
 write down or ask permission
to tape the answers
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Tips for giving and getting
information
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Not everyone will feel
comfortable asking questions.
• Bring someone with you who has
credentials or can provide support
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Your Self-advocacy Tips
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Healthcare Team Partner
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You are an important member
of the healthcare team
• You make decisions and carry out
recommendations
• It is important to understand your
role and the roles of the other
members of the team.
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Understanding How You
Might be Perceived
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Providers have an expectation that
people will act in certain ways
• like middle-class white people
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Different cultures have different
behavior standards that might be
misinterpreted
Understanding this can help you
get better care
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Understanding How You
Might be Perceived
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Common
misinterpretations
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Lack of eye contact
• Disinterested
• May have autistic tendencies
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Not asking questions
• Satisfied with care
• No questions
• Disinterested
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Saying yes to a plan and
not following through
• Noncompliant
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Self-advocacy skills
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Maintaining records
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Track progress.
Makes it easy to share
information
Advocate more effectively
Paper trail
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Self-advocacy skills
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Keep a notebook or file
Get it in writing, give it in
writing, know where it is.
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Working with a Care
Coordinator
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Helps keep track of all of the
different systems and services
• Regional center – service coordinator
• CCS- nurse case manager
• Medi-Cal – case worker
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Working with a Care
Coordinator
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Share information
Ask questions and for help
Let her/him know if there
are any problems
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Developing Resources
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Gather information on:
• Diagnosis
• Treatment options
• Things they can do to
get better or feel more
comfortable
• Systems of care
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Sources of Information

books and other
literature
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non profit health
organizations (e.g.,
United Cerebral Palsy
or the American
Cancer Society)
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Family Resource
Centers
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Sources of Information
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the Consumer
Health
Information
Program (CHIPS)
support groups
other parents
the Internet
Resources
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Keep a list or notebook with
resources you use or hear
about.
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brochures
Recommendations
Resource lists
Etc.
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Transition from Pediatric to
Adult Services
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There are many
differences between
pediatric and adult
services.
• There are more
programs serving
children and
• The programs offer
more support
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Transition from Pediatric to
Adult Services
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Depending on the program, the
transition may happen at
different ages
• SSI – 18 years of age
• CCS – 21 years of age
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Important to learn how each
service transitions and the adult
services that are available.
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Age of Majority
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When youth turn 18 they
become adults in the eye of
the law
• They must consent for care or
services
• Unless they are conserved.
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Becoming Independent Adults
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Different cultures view
becoming independent
differently
Children need to learn skills
• begins before age 18.
• Help your child identify their
• goals
• preferences and dislikes
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Self-advocacy skills
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Participate in
• Taking care of their health
• planning meetings and
appointments
• record keeping
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Learn
• About their health
• How to get information
• What to do if there is a
problem.
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When Someone Says No:
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Bureaucratic Systems are often
operate by making people go
away
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Many people will go away if they
are told “no”
If people appeal the decision, very
often the answer changes to “yes”
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When Someone Says No:
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Appealing may be the
only way of getting a
“yes” answer
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When someone says no:
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Learn our child’s
medical (or service)
system when
things are going
well.
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Learn to appeal
decisions
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When someone says no:
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Make sure you are
asking for something
that the service system
provides.
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The system may not
be the best source for
that information
Use a trusted source
for information about
services and rights.
When someone says no:
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You can get legal help if you
were turned down and it is
something you are entitled to.
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If you decide not to go back to
that provider or use that
system, let them know why.
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Going for healthcare is
sometimes like going to
another culture.
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You may not understand:
• Provider’s way of doing things
• the language (jargon or acronyms)
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You may not know
• what is okay to ask
• what to do if you need more
information.
• what to do if you disagree with what
the provider recommends.
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Learn the culture of
healthcare systems
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Learn about office procedures,
Ask your provider to explain
medical jargon or acronyms
Ask questions
Ask for copies of test results
and to put recommendations in
writing.
Adapted from: Los Angeles Medical Home
Project for Children with Special Needs
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Does the healthcare system
know how to serve you?
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Getting good healthcare includes
getting healthcare in a way that feels
comfortable.
Different cultures may have different
ways of
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looking at health, disabilities and illness,
communicating,
making decisions
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Does the healthcare system
know how to serve you?
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It is important that your provider
understands about how your
culture is a part of your
healthcare preferences.
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Things that you can do make it
easier to get comfortable care
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Look for providers who are culturally
and disability competent.
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Bi- cultural and/or bi- lingual staff
Competent/collaborative in your area of
disability
Other patients from your culture
Respects your culture
• But doesn’t stereotype
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Share information with your provider
about your culture and what is
comfortable for your family.
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Overcoming Language barriers
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Getting information in your
language of comfort is your
right. It helps you
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understand what is being
presented,
make good decisions,
follow-through with the plan.
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Overcoming language barriers
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Using children or friends to
translate is not appropriate.
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May translate incorrectly.
Sometimes children will be asked
to translate information that they
are too young to hear.
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Overcoming Language barriers
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Important to get accurate
translations
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Look for providers with bilingual and bi-cultural staff
Ask about staff training in
cultural competence
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Overcoming Language barriers
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Ask about language
capacity.
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Do they use medically
trained interpreters
Are there written
materials that are in
your preferred language
Other forms of
information
• Audiotapes
• Videotapes
• Pictures
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Overcoming Language
Barriers
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Ask for help with
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Coordinating appointments
calling agencies
Ask your provider to use
resources like language
translating services
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Overcoming Language
Barriers
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Use community resources like
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Opening Doors
Cultural community based agencies
Adapted from: Los Angeles Medical Home
Project for Children with Special Needs
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How to Preserve Healthcare
Benefits
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Special Needs Trusts
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Must have SSI
A way to provide financial support
to a person with a disability
without threatening their SSI
eligibility
Different than other types of trusts
• must be set up by a lawyer who is
experienced in setting up special
needs trusts
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How to Preserve Healthcare
Benefits

Transition to work programs
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Taking a job might interfere with
their benefits like SSI and MediCal.
• Programs like the 250% Working
Disabled Medi-Cal Program allow
you to keep your Medi-Cal until
covered by employer.
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How to Preserve Healthcare
Benefits
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Consolidated Omnibus Budget
Reconciliation Act (COBRA)
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When you leave a job that provides
health insurance
You can pay out of pocket, up to 110%
of premium cost, to continue the
insurance for up to 18 months
• In some cases up to 36 months for
dependent children.
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How to Preserve Healthcare
Benefits

Cal-COBRA
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Special program
in California
• Companies with
2- 19 employees
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Summary
Introduction to Healthcare Systems
 Common Information
 Children’s Systems of Care
 Adult Systems of Care
 Accessing Healthcare
 How to Give a Presentation

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How to Reach Me –
Fran Goldfarb
323 671-3831
[email protected]
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