Dr. Bob’s Travelogue 9- “Roots”

Part 9 – Roots

From what I know of my genealogy, I am a true American mongrel – a little bit of everything.  At least, everything northern European, with a little other thrown in.  But Nancy and her family are evidence of pure-bloods, and it became obvious on our most recent two trips.  First, we traveled to Turku, Finland, to hook up with Dawn and Anthony, where he was attending a conference. 

Finland was a joyous and somewhat surreal experience.  Joyous in hanging with our daughter and son-in-law (seeing her come across the main square at the university was one of those pure moments I’ll carry forever).  Surreal in that I was clearly in the land of Nancy’s gene pool.  (For those of you who don’t know, Nancy is 100% Finnish, all four grandparents having immigrated to the US). 

Everywhere I looked, it was chock full of close family resemblances.  The very first day, Dawn, Ant and I were walking behind Nancy on the street, remarking “There’s her long-lost sister.  There’s another.  And another…”

During a medieval street festival, Nan herself spotted the doppelganger of her brother, John.  Here are their pics.  See for yourself.


Finn

Finn


Nancy's brother

Nancy’s brother

This Finn gentleman was one of a group performing medieval “music” on animal horns.  Think: a kindergarten kazoo band.  It was impossible to hit any actual notes on those things, and the six-part harmony between them was something beyond description.  Yet they persisted.  And it was somehow incredibly entertaining.  Who says the Finns have no sense of humor?

Speaking of breaking ethnic stereotypes, we found the Finns to be incredibly friendly and welcoming, albeit a quiet people, and nearly all we met spoke at least some English.  And their country is incredibly beautiful.  Cafes strewn the length of the river as it ran through the city, historic buildings to include a castle with an amazing tour.  Bucolic forests, rivers and mountains.  And just to fit my night owl personality, even though we were in the southern part of the country, 24 hours of daylight while we were there.

It all left a warm, safe feeling in me as we left for Italy to meet several of Nan’s family for a week-long retreat at Lake Como, in the far north of that country.

Upon our very arrival at the airport, one could tell it was a different place.  Children playfully rode atop rolling suitcases which they aimed smack into travelers, squealing with delight when they could really catch one by surprise.  Moms were right there, ignoring them, perhaps cherishing a moment of peace for themselves.  As we waited at the car rental counter, one man went berserk and laid into the staff for some perceived slight, at a volume and with an exuberance that would make the author of the most stereotypical, bad Hollywood screenplay about Italians blush.

Clearly Toto, we weren’t in Kansas anymore.  Or in Finland.

We had to wait a few hours for an available rental car, so we decided to eat lunch at the airport.  I helpfully pointed to a restaurant listed on an airport map, on the far top level, away from all others, hoping to escape the madding crowd.

As we headed for the escalator, we found ourselves behind a group of slightly older (perhaps 70s) French travelers.  There was one man and several women, each dragging impossibly large pieces of luggage.  They stood at the base of the escalator, looking upward at the ascending staircase, then down at their bags, then furtively about in search of a non-existent elevator, then back down at their bags.

I speak no French, but it was obvious that they were engaged in earnest discussion about whether they should try it.  Finally, one brave woman ventured forth, pushing a bag in each hand, and took the plunge.  Literally.

She went head first over both bags as soon as she stepped onto the moving staircase, but managed to prop herself up on them to right herself, and rode them to the top.  Two others followed without incident, and it seemed that they had found their groove, as we waited patiently in the rear.  I glanced elsewhere.  Then I heard it.

It was a subdued cry, unlike the gentleman at the rental counter who was still at full throttle.  Then her friends began yelling.  The lack of translation made the situation no less understandable.  I turned to see a hapless old lady flat on her back upon the escalator steps, feet flailing above her, her head down below, her massive suitcase on top of her, and a cane several feet behind her.  For some reason it was noticeable that one of her flailing feet had lost its shoe.  She tried in vain to raise her head even an inch above the step upon which it lied to protest her position, and helplessly glided toward a less than glorious arrival at the top.

Nancy dropped everything and ran past her friends, up the steps toward her.  I briefly searched for an emergency stop button for the escalator, but seeing none, followed.  It proved impossible to quickly lift her to her feet.  There we were, seconds from the top, trying to hold her head and body up enough to prevent her hair or clothing from being snagged by the teeth of the contraption.  Suddenly, someone found the stop switch and we came to an abrupt halt with her feet inches from the summit.

Have you ever tried lifting someone to their feet when they are flat on their back, on stairs, head pointing down catawampus, and to begin with, they walk with a cane?

Once the calamity was settled, we schlepped our bags to an actual elevator (at the other end of the building, naturally), searched around, and eventually followed our map to a deserted, narrow hallway lined with airport offices and decidedly uninviting signage, until finally reaching our destination.  As it turned out, it was the employee cafeteria.

Yes, all of this to reach a few tables occupied by persons in uniforms, staring at us.  But thankfully, they let us eat there.

The drive from the airport was uneventful until we inevitably reached the narrow, winding streets of small Italian towns clinging to the hills surrounding Lake Como.  Blind curves and spots that require cars to stop so that oncoming traffic can squeak by.  It was just like British country roads, except decorated with honking and the occasional “have a nice day” hand gesture.  At least they drive on the correct side of the street.

I exaggerate… to some extent.  The villages here are lovely, the villagers are mostly friendly, and the area has been a retreat destination for millennia. 

At one old church, I inspected a plaque upon a wall, dedicated to someone or something I could not decipher, but which by its Roman numerals had been placed there in the 1930s, although the church itself was much older.  I’m sure you’re familiar with historic markers that end with the names of government dignitaries at the time of the monument’s erection.  Lots of public buildings or makers in Arizona will list county supervisors, or a mayor, or the governor at the time.  I confess that in this case, it was a bit startling to see, following other names and as a matter of course, “Benito Mussolini.”

A sobering reminder that history plays out as merely a string of current events.

We walked cobblestoned hills, took boats about the lake, and took the kids on a “train” that runs upon the street between the towns.

Ah yes, the kids.  Our grand-nephews are here, Matt and Will, ages 3 and 6, respectively.  Naturally, they were the center of attention of the 8 adults there, and are really good little boys.  I was repeatedly  serenaded with “Bobo, the walking talking cat, hoo hoo,” a tune about me (Bobo) written long ago by my then 6 year-old daughter and her friends, which was shamelessly taught to these boys by my brother-in-law, who eggs them on at every opportunity.  Another generation.

Will is quite smart, as demonstrated, among other things, by his ability to outplay me in Rummikub, pronounced “Rummy Cube.”  They are both artists, which of course all children are until society beats the natural creativity out of us.

I mention this because Will presented me with the most accurate portrait I’ve ever seen of myself.  Witness the attention to detail in this work of art.  Note: I believe that the ears were drawn first.


will the kid.jpg

Of all of us, only Nan’s sister, Martha, speaks Italian.  She sounds beautiful in her more-than-passing conversation with the locals, remarkably retained from her college days.  The rest of us, for reasons that are inexplicable, assume that the language is some sort of broken Spanish, and keep trying to insert palabras de Español among our English, making no sense at all to the locals.  Perhaps it’s because the heritage of my brother-in-law, Fred, and thus of his offspring, is Italian.  So it feels incumbent upon us all to at least try.

And try he does, once intoning cheerfully to the befuddled staff of an establishment as he entered, “Buenos Aires!”

Blank stares.

One morning, he took the kids and their parents off walking in this hamlet of perhaps a thousand locals.  Being from Massachusetts, he said they were going off in search of a Dunkin’ Donuts.  Fred has a special kind of determination.  It was a miracle that they ever returned.

Fred’s initial plan for the last day was to hit every one of the “10 best things to do at Lake Como” before we all had to leave the day after.  Thankfully, our slothful selves prevailed, and more reasonable adventures were pursued.

After the final harrowing drive from Lake Como, we dropped Fred and Martha at the airport and settled in to spend a final couple of days in Milan.  Once we’d checked into our hotel that afternoon, we were desperate for food, but nearly everything was closed.  From 2:00 or so until 7:00, perhaps even 8:00 pm, nearly everything closes up shop – stores, restaurants, cafes, even bars were all barred up.

At last, we found a true hole-in-the-wall.  With a small entry and counter, you might dismiss it as some tiny convenience market but for a chalkboard menu on the sidewalk.  But if you walk in and behind the cash register, there’s this huge patio and indoor seating area hidden directly behind.  We sat inside, totally by ourselves, due to the afternoon siesta that nearly the whole city seems to take. 

When we opened our mouths to speak, one of the wait staff, who spoke only Italian, knew enough to say, “Oh, Americans,” and brought us different paper placemats than any of those on the other tables.  They were clearly directed to Americans, alright.  In English, the printed placemats read:  “Guide to mindful eating: Slow the Hell down!  Chew your food!  Put your fork down between bites!”  And then, in one corner it added: “Ignore health advice: Low fat, low carb, blah, blah, blah.”

The food was, predictably enough, good and plentiful.  We had been rescued.

Everything in central Milan seems built to impress.  Really grand structures.  At the plaza Duomo is a magnificent cathedral, begun in the 14th century and not completed until 1805, and is one of the most ornate structures I’ve ever seen.


cathedral.jpg

But immediately next to it is this other incredibly ornately decorated monument, soaring an exaggerated four stories, bearing the dramatic inscription, “A Vittorio Emanuele Il I Milanesi.”  The number of persons passing beneath its arched entry far outnumbered those visiting the cathedral itself.  What could this be, we wondered, A museum?  A palace?  Official government offices?  We searched online, and found this to be a monument to what Milan is truly all about – a shopping mall.

Seriously.  This massive, ornate structure was built 150 years ago as a shopping mall, which it still is.  You think America has cornered the market on materialism?  Think again.  At least the “food court” was a clear step up from ours.

‘Best way we found to casually cruise the city was to ride around on any of several historic street cars (San Francisco purchased theirs from Milan).  We set off to do so one day, and should have stuck to that plan.  Instead, we thought we’d hop on and off.  And hop off we did, to see another super-sized structure, Sforza Castle.  Medieval in origin, it had Renaissance and later repairs and additions, but was more massive than anything I’ve yet visited in the UK.  At one point, we sat down at a café in the center of one of its squares.  Nan had her cell phone on the table, planning the rest of our route.

Abruptly a young woman began jabbering away in Italian at us, laid a laminated poster upon our table, which seemed to be something about a lost cat.  One could not help but notice that she was breastfeeding her infant, by simply hiking up her t-shirt to provide the necessary access to her babe in arms.  She had another young friend with her, also breastfeeding.  I tried to avoid eye contact, even as we repeatedly tried to say we spoke only English.  She plaintively continued, seeming to beg for some sort of assistance, then exasperated, scooped up her laminated paper and departed as abruptly as she had arrived.

It took Nancy less than a minute to ask, “Where’s my cell phone?”

“What?”

She took it!!

I bolted in the direction our pickpocket had exited, and searched desperately, to no avail.  To one side, I noticed a patrol car.

We had already seen numerous officers during our brief time in the city.  “Polizia Locale” officers were plentiful.  They were uniformed, had marked cars, carried guns.  We had actually earlier mused about why they didn’t say “City of Milan” on their uniforms.  I sprinted toward the car and described my plight to the officer who spoke just a little English.

“Oh, I understand.  But I am not a real police officer, I am only a local police officer,” he tried to explain to his incredulous visitor.  He proceeded to give me handwritten directions to a real police station about a mile away, where I could file a report.

He was unable to take a report himself.  Presumably, had I been quicker in my pursuit of our thief, he could have used his gun to shoot her.

In hindsight, it was such an obvious ruse.  The distractions, the use of their infants to cause one to look away rather than stare and get a good look at them, the worn poster placed right on top of the object to be stolen, the sudden departure, rather than going to the next table, and the friend to pass the phone to, before they no doubt departed in opposite directions.

I gotta tell you, we both felt pretty gullible.  Shades of scams to come, preying upon the susceptible elderly, which we apparently have become.

It put a damper on our remaining time there.  We were already dealing with a hotel that didn’t have functioning key-cards, so that each time you wanted to go back to your room, you had to ask for someone to let you in, usually requiring a significant wait. 

On our flight home, our first leg was delayed.  We sprinted through the airport in Brussels, sat frustrated in a Passport Control line, and missed our connection.  After being directed to wait through customs a second time, we finally found what seemed to be the last employee of our airline in the airport, and managed to get booked on a fight ridiculously early the next morning.  We waited with a crowd of similarly hapless travelers for a ride to the hotel they’d assigned us.  When we finally got there, the hotel check-in system was down, with apparently no human intervention possible to override their “improved” automation.  All 20-some stranded passengers waited perhaps two hours, in a hotel lobby which had plenty of empty rooms, before they finally directed us to a different hotel.   

Some four hours after missing our plane, we got into our room at about 1:00 am, and had to rise at 5:00 to catch the bus back for our new flight.  Naturally, when we finally got to London, our bags were missing.  They didn’t find them for another few days.  I’ve never been so grateful to be reunited with underwear.

The travel Gods are telling us that it’s time to go home.  We’ve got one more short trip to Cornwall this week, then Dawn and Ant will be here and we’ll all close up this cottage.  We fly back to the States on July 26, but will stop in Massachusetts to hang with Nancy’s family there for a couple of weeks.  So we’ll be in Phoenix by mid-August.

By the time we get there, I’ll be very ready to be home.  It’s been a wonderful, enlightening experience.  We have new, dear friends.  But I so miss you all.  See y’all soon.

CMS Position on Native American Exemptions from State Medicaid Work Requirements Complicates AZ Waiver Request

A 2015 AZ law requires AHCCCS to annually ask the CMS for permission to require work (or work training) and income reporting for “able bodied adults” and a 5-year lifetime limit on AHCCCS eligibility.  The work requirement waiver requests turned in during the Obama Administration were denied, but the new administrator CMS has publicly said (and written) that they’re receptive to proposals from states to require work or community engagement for people who want to receive Medicaid.

Late last year AHCCCS submitted their annual official waiver request asking permission to implement the following requirements for certain adults receiving Medicaid services including a requirement to become employed, actively seek employment, attend school, or partake in Employment Support and Development activities (with exceptions) and a requirement to bi-annually verify compliance with the requirements and any changes in family income.  CMS has not yet ruled on the AZ request.

One of the exempted groups in the waiver request is American Indians.  Starting Friday (when HB 2228 takes effect) the exemption of tribal members won’t just be an administrative decision, but one required by Arizona law.  That’s because HB 2228 requires AHCCCS to exempt tribal members from their work requirement waiver requests.  Here’s the exact statutory language:

36-2903.09.  Waivers; annual submittal; definitions

B.  SUBSECTION A OF THIS SECTION DOES NOT INCLUDE OR APPLY TO AMERICAN INDIANS OR ALASKA NATIVES WHO ARE ELIGIBLE FOR SERVICES UNDER THIS ARTICLE, THROUGH THE INDIAN HEALTH SERVICE OR THROUGH A TRIBAL OR URBAN INDIAN HEALTH PROGRAM PURSUANT TO THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT AND THE INDIAN HEALTH CARE IMPROVEMENT ACT.

However, a letter signed by CMS official Brian Neale suggests that CMS won’t be approving waiver requests that exempt tribal members.  In a letter to tribal members he writes, regarding exempting tribal members from state Medicaid eligibility work requirements “… Unfortunately, we are constrained by statute and are concerned that requiring states to exempt AI/ANs from work and community engagement requirements could raise civil rights issues.”

In a nutshell, (beginning Friday) Arizona law will require AHCCCS to exempt American Indians from their directed work requirement waiver request (they have already administratively elected to do so).  CMS is on record saying that they’re constrained by statute and have civil rights concerns about allowing states to exempt American Indians from work requirement and reporting waivers. 

It stands to follow that CMS may very well deny Arizona’s request to exempt tribal members from work and reporting requirements despite our new law (36-2903.09 (B)). If that happens, there will surely be a legal review to determine exactly the intent of 36-2903.09 (B)

New Public Health Return on Investment Report

AzPHA member J. Mac McCullough, PhD, MPH, who serves as an Assistant Professor at Arizona State University and Health Economist at Maricopa County Department of Public Health was commissioned by AcademyHealth to write a research synthesis examining the return on investment for public health funding.

It’s a very nice and concise report.  It’s available online on the AcademyHealth website.  Here are some excerpts from the report

Federal, state, and local agencies spend approximately $250 per person per year on the public health system, whereas more than $10,000 is spent on health care per person per year. Public health spending has been falling as proportion of total health spending since approximately 2000 and falling in inflation-adjusted terms since the Great Recession. These declines have resulted in cuts to the public health workforce and to public health program portfolios.

While linking public health and health care spending to improved health outcomes can be tricky, the body of evidence supporting prevention is strong. For example, we know that investment in tobacco cessation can save $2-3 for every $1 invested and that childhood vaccinations can save $5-11 for every $1 invested.

One especially relevant set of studies utilized a unique dataset of public health department expenditures in California. Researchers used instrumental variables to show that a $10 increase in per capita spending led to a 0.6 percent increase in the proportion of the population in very good or excellent health4 and reduced all cause mortality by 9.1 per 100,000.23 Researchers monetized these estimates to determine that every $1 invested in public health in California resulted in $67 to $88 of benefits to society.24

a 2017 systematic review of international studies found that spending for individual public health interventions, services, or policies had a median ROI of $14.30 per $1 invested.

New AZ Public Health Laws Take Effect Friday

State legislators passed several new laws that will influence public health last session- but almost all of them won’t take effect until Friday (August 3). The Legislature has developed a report that report that summarizes all of this year’s bills. The health-related bills are on pages 99-108.  Here’s a snapshot:

  • HB 2088 will require school districts to: 1) develop intervention strategies to prevent heat-related illnesses, sudden cardiac death, and prescription opioid use; 2) notify parents when kids are bullied; and 3) tell parents if a student is suspected of having a concussion.  An ADHS concussion training & management report is due at the end of 2018.

  • HB 2196 will limit ambulance certificate of necessity (CON) hearings to 10 days unless the Administrative Law Judge determines that there’s an extraordinary need for more hearing days.  Hearings had previously gone on for many weeks or even months.

  • HB 2197 requires AZ health licensing boards to collect certain data from applicants (beginning January 2020).

  • HB 2228 directs AHCCCS to exempt tribal members from work requirement waiver requests (more on this later in the update).

  • HB2235 will set up a new licensed class of dental professionals called a Dental Therapist.  The next step is for the AZ Board of Dental Examiners to develop the scope of practice and license regulations.

  • HB 2323 authorizes contracted nurses to provide emergency inhaler medication in case of respiratory emergencies (takes effect this semester).

  • HB 2324 charges the ADHS with implementing a voluntary certification for Community Health Workers. The next steps are for the ADHS to establish the advisory committee and begin the Rulemaking to set up the certification process.

  • HB2371 sets up statewide licensure for food trucks. The licenses will have reciprocity in all county health and environmental service departments.

  • SB 1083 will require public schools (K-3) to have at least 2 recess periods beginning this semester.   Grades 4 and 5 will be required to have 2 recess periods beginning August 2019.

  • SB 1245 will develop a produce incentive program within the Supplemental Nutrition Assistance Program within ADES.

  • SB 1389 requires the ADHS to develop an HIV Action Plan.

  • SB 1465 requires the ADHS to adopt rules and license sober living homes.  It also allows them to contract with a third party to assist with licensure and inspections. They have a 2-year exemption from the regular rulemaking process.

  • Note: SB 1001 – The Arizona Opioid Epidemic Act was in a Special Session and became law several months ago. 

Ballot Measure Analysis Hearing Wednesday Morning

There will be several voter initiatives and some referendum issues for us to vote on in November. We don’t exactly know which measures will make it to the ballot yet because the Secretary of State is still validating the signatures etc. and there are some lawsuits challenging some of the measures too.

If you’ve read your voter publicity pamphlet in the past, you’ll remember that there’s an analysis of each ballot measure. The analyses are really important because they convert the statutory language into normal language- and many voters use them in their decision-making.  It’s important that they be objective and accurate.

The language for the Analyses are prepared by the Arizona Legislative Council and evaluated by Council of Legislators, who consider and adopt or amend the draft analyses. ARS 19-124 governs the process.  The analyses are supposed to “… include a description of the measure and shall be written in clear and concise terms avoiding technical terms whenever possible.  The analysis may contain background information, including the effect of the measure on existing law…“. 

The Legislative Council is holding a hearing this Wednesday (July 25, 2018) at 9:00 A.M., in House Hearing Room #3 to consider adopting (or amending) the draft analysis language for the Stop Political Dirty Money Amendment (draft analysis); the Clean Energy for a Healthy Arizona Amendment (draft analysis); the “Protect Arizona Taxpayers Act” (draft analysis); and the Invest in Education Act (draft analysis). 

I won’t be able to make it but I’m hoping some of you can take some time and attend.

Professional Development Opportunity: AZ Institute for Healthcare Leadership

Healthcare leaders throughout Arizona can to become better leaders through the Arizona Institute for Healthcare Leadership program. The program formerly known as the Arizona Hospital & Healthcare Leader Association’s Emerging Healthcare Leader Program has been developing healthcare leaders since 2006.

The Arizona Institute for Healthcare Leadership (AIHL) program provides high potential midlevel to senior level leaders within not for profit, for profit and government hospitals and healthcare organizations the necessary skills to become exceptional leaders. Participants have richly diverse backgrounds from many clinical and nonclinical aspects of healthcare including: IT, nursing, ambulatory care, rehab, pharmacy, physician practices, telemedicine, quality, finance, human resources, case management and more.

Fifty percent of the leaders graduating from the Arizona Institute for Healthcare Leadership in the past three years have been promoted, several to Chief Executive Officer. As the pace of change in healthcare accelerates and current leadership is promoted or leaves, these graduates will take their place. Arizona healthcare organizations with an eye to the future have been sending top talent to the AIHL program for over a decade. AIHL develops healthcare professionals with leadership skills including emotional intelligence, communication and the ability to deal with change; all needed to grow their career to the next level.

“Through this experience I became more aware of my emotional intelligence and its impact on the success of the organization, being a senior leader. I also learned to handle my inner Gremlin better as a female, minority leader. In addition, I learned so much from my peers in the program, their similar struggles and successes made me feel I am not and my organization is not alone working through the immense and unprecedented challenges of healthcare and generational leadership transitions.”

A 2016 graduate

“The content of this course has proven very valuable. It helped me to become more cognizant of how emotional intelligence influences my approach to the work, and the positions I pursue.  It provided tools and resources that are helpful in dealing with situations ranging from normal every day events, navigating an organization through crisis situations, and managing a multi-generational workforce. The ability to apply what I learned in this program to real-time, real-world scenarios led to my getting a promotion to a larger, more complex organization.  I strongly encourage participation in this program.”

A 2015 graduate

The full fee is $5,500, participants can save $250 by being an association member and another $250 by applying by Sept. 20 bringing the cost down to $5,000. With the class time, executive coaching, outside reading and project the average person will spend 10-20 hours a month, not including travel for the session each month.

Applications are being accepted now for the 2019 cohort (which runs from January – October 2019. Deadline to apply is 11/16/18.

Program overview and applications are available at www.RisingStarsLLC.com/AIHL For more information contact Joanne Schlosser at [email protected] or call 480-840-6024. 

Behavioral Health Advocacy Training Institute: Apply Now

The Eric Gilbertson Advocacy Institute for Behavioral Health (aka Institute) is designed for service recipients/participants, family members, Board Members, and individuals concerned about quality behavioral health in Arizona.  The goal of the training is to provide you a comprehensive overview of the Arizona behavioral health system and to assist participants in becoming effective advocates for those receiving behavioral health services.

The Institute provides information, training, and resources to participants on behavioral health issues at the individual, provider, and system level. The Institute will provide participants with opportunities to meet and talk with leaders and advocates in the Arizona behavioral health system.  As a participant, you’ll have an opportunity to meet and unite with others who have a similar interest in creating a powerful voice on important issues. You’ll also learn how various state agencies are responsible for the delivery of behavioral health services and how the legislative process works at the state and national levels to impact behavioral health policy. 

The Training Institute will cover the History of the Disability Movement and the Role of ADHS, ADES, AHCCCS, ADOE, the Courts & Corrections, the Role of the Regional Behavioral Health Authorities (RBHAs) & Complete Care Contractors Community Supports State & Federal Policy Legislative Process Organizing for Change.  The Application deadline is August 15.  For more information visit http://azabc.org/eg_institute/

Families USA Issue Brief: Adult Dental Services

States have great latitude to determine the scope of dental benefits they cover for adults through their Medicaid programs. Some states cover comprehensive benefits, others cover emergency dental care and some none (AZ provides emergency coverage up to $1000 per year for all adults and comprehensive coverage for kids).  This variation in coverage matters. Without adequate dental coverage, people face barriers to getting care they need to stay healthy.

To better understand the consequences of insufficient dental coverage, Families USA conducted a survey of states that cover emergency-only dental services.  In the issue brief Families USA found:

  • States that cover emergency dental services generally cover some services to address severe pain including extractions. But most don’t provide restorative care nor cleanings that would address underlying disease.
  • In some states, Medicaid managed care plans provide plan-specific “value added” benefits.
  • State Medicaid programs pay for hospital emergency department visits when appropriate dental services are not available.
  • More comprehensive benefits and fewer prior authorization requirements would encourage provider participation.
  • Low-income seniors and people with disabilities who rely on Medicaid and Medicare for health coverage are among those affected by the lack of dental coverage.

The Families USA Issue Brief concludes that emergency-only dental coverage is a start, but states should invest in comprehensive Medicaid dental coverage for adults if they want to effectively keep their populations healthier and reduce other health care costs. Here’s the full the full issue brief.

Substance Abuse Prevention Needs Assessment

AHCCCS is conducting a Statewide Substance Abuse Prevention Needs Assessment to better understand what prevention activities are going on and what the prevention needs in our communities are and about the experiences of folks who work or volunteer in substance abuse prevention. 

If you fit the bill, it would be great if you could take 10 minutes to support this important effort by taking this Arizona Substance Use Prevention Workforce Survey

Immigration Status, Public Benefits, Health & Access to Care: A Primer

With all the attention on immigration status and its intersection with public benefits and access to health care- I thought I’d take a crack at summarizing these issues for our membership.  Here goes:

Noncitizens make up about 7%  percent of the US population. It’s not surprising that they’re more likely to be low-income and uninsured than citizens- in part because of the opportunity limitations. In fact, 71% of undocumented adult noncitizens are uninsured.  By and large, many of them rely on Federally Qualified Health Centers for their primary care and other healthcare- in part because FQHCs have sliding fee scale service fees and serve immigrants regardless of their immigration status.

Medicaid generally limits eligibility for immigrants to qualified immigrants with refugee status or veterans and people lawfully present in the US for 5 years or more.  State Medicaid programs can elect to provide coverage to legally present immigrants before the 5-year waiting period ends (Arizona does not).

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (often referred to as PRWORA or welfare reform) is the federal law that created Medicaid’s “qualified immigrant” standard.

Other federal safety net programs like Temporary Assistance for Needy Families and the Supplemental Nutrition Assistance Program (food stamps) also apply the five-year waiting period for legally present immigrants.

States can get matching funds from Medicaid (CMS) when they choose to provide Medicaid coverage to legally present immigrants who are children or pregnant women before the end of the 5-year waiting period.  33 states have elected to cover lawfully residing immigrant children, and 25 states cover legally present pregnant women (Arizona does not).

The Affordable Care Act made it possible for the legally present immigrants who are ineligible for Medicaid due to being in the five-year waiting period to qualify for commercial coverage and subsidies on the Federal health insurance marketplace.

Immigrants eligible for Medicaid or employer-sponsored insurance face several coverage and service barriers.  As I mentioned in a blog a few weeks ago immigration officials consider the likelihood of individuals and families becoming a “public charge,” which can result in denied admission to the US or status as a lawful permanent resident.

Fear that using safety net services will mean that they’ll be considered a public charge contributes to some families of mixed immigration status avoiding use of services like TANF, Medicaid, SNAP etc.  Some eligible immigrants avoid services because they think family members will become involved in immigration enforcement actions.

Research findings by the Kaiser Family Foundation found that changes in healthcare use and decreased participation in Medicaid and the Children’s Health Insurance Program because of this immigration policy.

Anyway, it’s a complicated system but I hope this makes it a little clearer.