Expansion of Medi-Cal a Welcome Budget Boost for K’ima:w Medical Center
By KRISTAN KORNS, Two Rivers Tribune
Editor’s note: The following story contains descriptive text about the geographical area in which we live. We didn’t write it to annoy our readers, who are well aware of the region, but rather to familiarize a statewide audience with our neck of the woods. This story was part of a health fellowship project exploring the impacts the Affordable Care Act might have on clinics serving federally funded healthcare organizations. It will also be published by New America Media.
K’ima:w Medical Center and its ambulances serve some of the poorest and most isolated rural communities in parts of Humboldt, Siskiyou and Trinity Counties in Northern California.
From its location on the Hoopa Valley Indian Reservation, a square 12 miles on each side, K’ima:w’ s ambulance service is the only lifeline for people spread throughout hundreds of miles of forests and mountains and where the nearest hospital can be more than an hour or two away.
Andy Kinniman, an emergency medical technician (EMT), said, “We handle everything from over-the-bank and white water rescues to delivering babies. That’s a big difference between us and city ambulances. Everyone out here has delivered a baby.”
Rod Johnson, paramedic and acting Emergency Medical Services director, said his most memorable delivery out of the 11 he’s done so far, was twins where the second came out feet first and there was no time to turn it around.
“The cord had become caught or tangled and the baby was stuck halfway out because the cord was holding it in. I clamped and cut the cords so the baby could come down, and helped the baby out when its jaw got hung up on the pelvis,”
Johnson said. “We got both babies and the mother down to Mad River Hospital.”
It costs a lot to keep two ambulances with Advanced Life Support (ALS) equipment staffed and ready at all times, leading to budget shortfalls of close to $500,000 each year; most of which has been covered over the past 25 years by the Hoopa Valley Tribe.
“We give definitive care to people who are in need; we’re not looking in their wallets before putting on bandages,” Johnson said. “But if the funding isn’t there, we might not be able to continue. We can’t run an ambulance without money for gas.”
The area’s small towns, almost completely surrounded by the nearby Six Rivers and Trinity National Forests, cluster along the routes of the Klamath and Trinity Rivers.
They’re served by Highway 299 and Highway 96; two-lane roads that wind through the rugged mountainous terrain.
Unlike ambulances in urban areas, which make frequent 10 to 15-minute trips to nearby hospitals, the compensation for K’ima:w’s one and two-hour runs aren’t enough to cover basic costs.
Darcey McCovey, business office manager, said nine to 10 percent of their runs were completely uncompensated, while many of the rest were underpaid.
“The majority of our ambulance patients are covered by Medi-Cal, closely followed by Medicare,” McCovey said, noting that only about 27 percent of their runs are covered by private insurance.
“A one-hour run to the nearest in-patient facility in Arcata costs somewhere around $2,000,” McCovey said. “We get about $300 a run for Medi-Cal patients and just a little more for Medicare; the rest is written off.”
K’ima:w received a much-needed infusion of cash in November, when the Humboldt County Board of Supervisors agreed to provide $200,000 to keep both ambulances operating.
Humboldt County 5th District Supervisor Ryan Sundberg said, “For the last 20 to 25 years the Hoopa Valley Tribe has run and financed the ambulance service in Hoopa, Orleans, Weitchpec, Willow Creek, the 299 corridor all the way up into Trinity County, but now the Tribe is facing severe budget cuts because of sequestration.”
Hoopa Valley Tribal Chairperson Danielle Vigil-Masten said the Tribe couldn’t afford to take a half million dollar loss for another year and added that the Tribe was prepared to cut back to just a single ambulance serving only the Hoopa Reservation.
“Times are different now and we have to make tough choices,” Vigil-Masten said.
Humboldt County’s contribution, along with more contributions promised by the nearby Yurok and Karuk Tribes, will relieve some of the financial pressure facing K’ima:w.
Administrators at the clinic hope the Affordable Care Act’s (ACA) expansion of Medi-Cal eligibility will help do the same.
Al Federis, K’ima:w’s controller, said, “The main effect of the ACA for us is expanding the Medi-Cal population.”
Starting on January 1, 2014, income guidelines for Medi-Cal eligibility were increased from 100 percent of the Federal Poverty Level ($11,490 for a single person) to 138 percent ($15,856).
More importantly for an area with an average income of $14,740 per year, assets are no longer looked at when determining eligibility.
Falona Bailey, benefits coordinator and interim Contract Health Service (CHS) manager, said, “Before, when we signed people up, if they had any assets – like a bank account, vehicles, or retirement funds – that would be counted against them.”
“I signed-up two people today for Medi-Cal who were denied before the ACA came into effect because of their assets, and they qualify now,” Bailey said.
Bailey and Patient Benefits Clerk Dianna Scott help an average of three or four patients a day sign up for Medi-Cal coverage.
“We make it very easy for them,” Scott said. “We assist 100 percent in doing the paperwork.”
Both Bailey and Scott are certified enrollment counselors through Covered California, and were also trained by the California Rural Indian Health Board.
Approximately 80.5 percent of Hoopa Valley residents are Native Americans, with substantial tribal populations on the Yurok Reservation to the northwest, and in the nearby Karuk ancestral territories to the northeast.
“There are more people who qualify, we just need to get them in here to reapply,” Bailey said.
Johnson said he hopes to continue to deliver healthy mothers and babies to hospitals on the coast with locations like ‘Highway 96, mile marker 8.9’ written on the birth certificate. “We deal with calls where we really make a difference.”