Sexual And Reproductive Healthcare Model Using Universal HealthCare & Reproductive Justice Framework

Guiding Question:

If universal health coverage (UHC) cannot be achieved without the sexual and reproductive health (SRH) needs of the population being met, what does a combined model of SRH coverage, that is organized according to the combined UHC/RJ framework look like? And how can it be prioritized in the state of CAs new proposed UHC plan and process?

 

1. Look at insurance coverage for undocumented in state of CA, What is new about what Newsome is proposing?

Current:

Newsom in June 2021, proposed an ongoing $1.3 billion spending plan to expand Medi-Cal coverage to adults and seniors age 50 and over. Undocumented children were given extended coverage in 2016 and young adults up to the age of 26 also qualify for healthcare access under a plan passed in 2020. The state already offers some Medi-Cal coverage to undocumented individuals of all ages for emergency medical services and prenatal and maternity care.

Proposed:

The governor's proposed plan will offer coverage that would begin on Jan. 1, 2024 and would cost the state an ongoing $2.7 billion annually. The programs launch in the 2023-24 fiscal year is expected to cost $819.3 million. As the first State in the Nation to achieve universal health care coverage. That means full-scope Medi-Cal, including long-term care, (In-Home Supportive Services), and behavioral health to ALL low-income Californians, regardless of immigration status. Currently, undocumented people are eligible for Medi-Cal through age 26. Undocumented adults ages 50 and older will become eligible for Medi-Cal after May 1 2022. 

 

2. What type of coverage do immigrants (Documented vs. undocumented)  have - comparing undocumented in CA

Throughout this portion, I will discuss coverage for lawfully present Im/migrants (valid non-immigrants visas, qualified non-citizen whose immigration status doesnt have wait for period, circumstances or humanitarian status) and Undocumented Immigrant coverage. 

 

Coverage for Lawfully Present Immigrants

The lawful present immigrants are entitled to health coverage along the Health insurance Marketplace. In this context the lawful present refers to the immigrants who have valid non-immigrants visas, qualified non-citizen whose immigration status doesnt have wait for period, circumstances or humanitarian status that includes Special Juvenile Status, Convention Against Torture, victims of trafficking, Temporary Protected Status, refugees, granted withholding deportation, legal status that has been conferred by other laws which includes Family Unity individuals, temporary residential status and LIFE ACT HealthCare.gov. (n.d.). Coverage aims at ensuring there is no discrimination of immigrants by the American Community and have equal share of human rights and access to better healthcare and reproductive justice.

Lawfully Present Immigrants and Marketplace Savings

In the U.S., if one is a present lawful immigrant, one is granted an opportunity in the Marketplace to access health insurance from private. Furthermore, one might have eligibility for lower out-of-pocket cost and monthly premier at a low cost that is based on your income level. For instance, if the household income per year is above 400% FPL: you might have access to premium tax credits which decreases monthly income for a 2021 market health insurance plan. Annually the income between 100% and 400% federal poverty policy one qualifies for prime tax credits and other savings for marketplace insurance and finally for those whose annual household income is below 100% the FPL you usually qualify for exclusive tax credits in addition to savings in Marketplace insurance assuming you not eligible for Medicaid provided you will meet all requirements allowed (McDermott, 2021).

Immigrants CHIP and Medicaid

In this section, those immigrants who are qualified non-citizens are permitted for coverage through the Childrens Health Insurance Program (CHIP) and Medicaid but this is if only they meet residency rules and the state's income profile. This will enable them to have a clear access to healthcare without discrimination either by race, class or any other intersectionality (Hasstedt, K. Ansari-Thomas, & Desai 2018). Most of the certified non-citizens for example many green card holders for them to have access to CHIP and Medicaid coverage must have a waiting period of 5-years. In this case that means one must wait for 5 years after receiving qualified immigration status before they can have coverage to CHIP and Medicaid. However, there are some exceptions such as the LPRs, asylees and refugees who are not supposed to wait for the period of 5-years because of their status. Qualified non-citizen here refers to refugees, Lawful Permanent Residents (LPR/Green Card Holder), paroled into the U.S. for at least one year, battered non-citizens (victims of domestic violence who are attempting to become lawful permanent residents (LPRs), children, Haitian entrants, victims of trafficking among others.

Medicaid and CHIP Coverage for Lawful Residing Pregnant Women and Children

According to the author, states are not bound to rules but have options to get rid of the waiting period of 5-years and cover children and pregnant women who are lawfully residing in their state with Medicaid and CHIP. Pregnant women or a child is termed lawfully residing in case they are lawful present and their eligibility to CHIP or Medicaid in the state. For example, twenty-nine states, Commonwealth of the Northern Mariana Islands in addition to the District of Columbia choose to give Medicaid coverage to children and pregnant women who are lawfully residing without having to wait for 5-year (Hasstedt, K. Ansari-Thomas, & Desai, 2018). Moreover, twenty-one of those states provide CHIP coverage to all women and children lawfully residing. In case of an emergency medical condition, Medicaid caters for treatment and the costs incurred but only for those who meet all the requirement of Medicaid, such as state residency and income for them to be eligible but doesnt include immigrants and undocumented individuals.

Application for receiving CHIP and Medicaid benefits and getting insurance forms for the health insurance costs in the Marketplace does not make a person to be a public charge. This indicates that it doesnt affect ones chances of becoming a U.S. citizen or Lawful Permanent Resident. However there exist exceptions for those taking long term care in an institution at the expense of the government for example nursing facilities, usually face barriers when getting a green card.

 

Undocumented Immigrants:

Sexual And Reproductive Healthcare Model Using Universal HealthCare & Reproductive Justice Framework

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Currently, if someone turned 26 on or before January 1, 2020, you qualify for the following medi-cal coverage: Medi-Cal currently provides a core set of health benefits, including doctor visits, hospital care, immunization, pregnancy-related services and nursing home care. The Affordable Care Act ensures all Medi-Cal health plans offer what are known as Essential Health Benefits (EHB). These ten comprehensive services include the following categories:

  1. Outpatient (Ambulatory) services

  2. Emergency services 

  3. Hospitalization

  4. Maternity and Newborn care 

    1. Prenatal care

    2. Delivery and postpartum care

    3. Breastfeeding education

    4. Nurse midwife services

    5. Licensed midwife services

  5. Mental Health and Substance Use Disorder Services

  6. Prescription Drugs

  7. Programs such as physical and occupational therapy (known as Rehabilitative & Habilitative Services) and devices

  8. Laboratory services

  9. Preventive and wellness services & chronic disease management

  10. Childrens (Pediatric) services, including oral and vision care. 

 

3. Which SRH services are they using (and compare nationally if different) - need to dissect data

  • Tulare County, CA. A Case Study: https://www.kff.org/report-section/beyond-the-numbers-access-to-reproductive-health-care-for-low-income-women-in-five-communities-tulare-county-ca/

  • National Data Set from a multitude of ORGs: https://muse.jhu.edu/article/724525

 

4. Identify and Discuss Relevant Models of SRH coverage - 1. UHC and 2. RJ

  • https://eeca.unfpa.org/sites/default/files/pub-pdf/86_SRH%20UHC%20Guide%202019.pdf 

I like the idea of a model that shows a life course approach. Because it seems the state of CA has taken it upon themselves to let certain age groups qualify for Medi-Cal at different times. A life-Course approach allows for the viewer to see the importance of SRH for all ages, and under a UHC model, it shows that a comprehensive approach is required to effectively meet peoples sexual and reproductive health and rights (SRHR) needs regardless of immigration status.

  • file:///Users/josephineroberts/Downloads/9789240022867-eng.pdf - https://www.who.int/publications/i/item/9789240022867

 

5. Propose a combined model of SRH coverage, that is organized according to the combined UHC/RJ framework

 

WORKING MODEL: 

https://docs.google.com/presentation/d/1uChD4EduF5OjhCcKpQmW0EVq9-2K00DczgW3gOZEoqI/edit?usp=sharing

_________________________________________________________________________

Scholarly Article: Advocacy Piece (working Title) -  Reproductive Justice, Abortion Access and Human Rights for Undocumented Im/migrants: Universal Health Care & Reproductive Justice

 

  • UHC can hardly be achieved if the Sexual Reproductive Health needs of the population are not met. In other words, SRH and UHC are mutually reinforcing, and the State of CA should consider this when implementing Medi-Cal Healthcare for all Undocumented Im/migrants.

 

UHC and SRH Strategies: DRAFT

 

  1. Accountability: Target Population - Undocumented Im/migrants in the State of CA

  2. Supply: Healthcare clinics that accept MediCal

  3. Demand: Coverages for SRH 

  4. Quality or Need: Accessibility (hours, availability, language barriers)

  5. Cost: Price of care for both user and provider



Notes:

http://www.uhcwpr.info/sustainability-and-resilience/





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