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Accessing Healthcare Services
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Accessing Services
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
HMO or Medi-Cal Managed Care Choose from a list of provider Primary care provider refers to
specialists
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Finding Services
Fee for service Medi-Cal, 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
Private insurance list of preferred providers
Private Pay 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
CCS Nurse Case Manager helps find
the special care center
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Eligibility
“Can I qualify or use this program” Can be based on
Age Family income Residence (where you live) Residence status (are you a citizen, are
you documented or undocumented) Disability
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Eligibility
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
Every program has an Appeal Process.
Learn 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 Information about healthcare
for people with disabilities Protection and Advocacy, Inc. The Health Consumer Center
of Los Angeles
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Where to Get More Information You can get information
about community resources and specific care centers through: Living Independently in Los
Angeles (LILA) LA 211
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Who Can Help Me?
Health Consumer Center of Los Angeles
Protection and Advocacy Inc. National Healthlaw Program
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Are Health Care Services Accessible?
Care that you can use and is helpful to you.
More than just wheelchair ramps or elevators.
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Accessibility
Financial• Affordable?• Is there a system that
pays for this care? 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?
Environmental/structural
• Structural barriers
• noise or other uncomfortable things
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Are Health Care Services Accessible?
Linguistic• Communicate?• Written
information?Adapted from: Los Angeles
Medical Home
Project for Children with Special Needs
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Coordinating care across systems
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
Tips for coordinating care List of the different systems (with
contact name, address and phone number)
• everyone on the list receive copies of records
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
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
Healthcare systems are responsible for things that are medically necessary necessary for your health and
usually means that something isn’t experimental.
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Knocking on the right door
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
An Advocate is someone who acts on behalf of themselves or others to bring about change
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Self-advocacy skills
A self-advocate Is assertive, this includes
• Objecting to things you don’t agree with
• asking questions • giving your opinion.
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
Need good information to make good decisions
• Ask questions
Need good information to make good recommendations
• Provide information and feedback
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Getting and giving information
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 historyKeep 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
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
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
Providers have an expectation that people will act in certain ways
• like middle-class white people
Different cultures have different behavior standards that might be misinterpreted
Understanding this can help you get better care
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Common misinterpretations Lack of eye contact
• Disinterested• May have autistic tendencies
Not asking questions• Satisfied with care• No questions• Disinterested
Saying yes to a plan and not following through
• Noncompliant
Understanding How You Might be Perceived
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Self-advocacy skills
Maintaining records Track progress. Makes it easy to share
information Advocate more effectively Paper trail
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Self-advocacy skills
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
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
Share information Ask questions and for help Let her/him know if there
are any problems
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Developing Resources
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
non profit health organizations (e.g., United Cerebral Palsy or the American Cancer Society)
Family Resource Centers
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Sources of Information
the Consumer Health Information Program (CHIPS)
support groups other parents the Internet
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Resources
Keep a list or notebook with resources you use or hear about. brochures Recommendations Resource lists Etc.
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Transition from Pediatric to Adult Services
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
Depending on the program, the transition may happen at different ages
• SSI – 18 years of age• CCS – 21 years of age
Important to learn how each service transitions and the adult services that are available.
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Age of Majority
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
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
Participate in • Taking care of their health• planning meetings and
appointments• record keeping
Learn• About their health• How to get information• What to do if there is a
problem.
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When Someone Says No:
Bureaucratic Systems are often operate by making people go away 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:
Appealing may be the only way of getting a “yes” answer
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When someone says no:
Learn our child’s medical (or service) system when things are going well.
Learn to appeal decisions
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When someone says no:
Make sure you are asking for something that the service system provides. The system may not
be the best source for that information
Use a trusted source for information about services and rights.
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When someone says no:
You can get legal help if you were turned down and it is something you are entitled to.
If you decide not to go back to that provider or use that system, let them know why.
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You may not understand:• Provider’s way of doing things• the language (jargon or acronyms)
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.
Going for healthcare is sometimes like going to another culture.
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Learn the culture of healthcare systems
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?
Getting good healthcare includes getting healthcare in a way that feels comfortable.
Different cultures may have different ways of looking at health, disabilities and illness, communicating, making decisions
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Does the healthcare system know how to serve you?
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
Look for providers who are culturally and disability competent. 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
Share information with your provider about your culture and what is comfortable for your family.
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Overcoming Language barriers
Getting information in your language of comfort is your right. It helps you understand what is being
presented, make good decisions, follow-through with the plan.
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Overcoming language barriers
Using children or friends to translate is not appropriate. 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
Important to get accurate translations Look for providers with bi-
lingual and bi-cultural staff Ask about staff training in
cultural competence
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Overcoming Language barriers
Ask about language capacity. 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
Ask for help with Coordinating appointments calling agencies
Ask your provider to use resources like language translating services
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Overcoming Language Barriers
Use community resources like 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
Special Needs Trusts 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 Taking a job might interfere with
their benefits like SSI and Medi-Cal.
• 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
Consolidated Omnibus Budget Reconciliation Act (COBRA) 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
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
