Amending the Law of Financial Responsibility

Children’s Insurance Coverage Update

Making progress in the 12 year journey to fix a medical coverage gap that still exists for a child fighting for their life, we didn’t give up.  “We are doing this Mija” is all I can think as we traveled in the car from the California state’s capital office of our Assemblyman Raul Bocanegra to the office DHCS in Sacramento across the beautiful park that tributes hero’s.

As per our experience, we need to Amend the Law of Financial Requirements (as per: California Children’s Services) for Pediatric Care of “Sudden Onset” illness when the threat of “Death” is diagnosed… for the families affected who are living life as normal as they possibly under these circumstances.

This letter was submitted to Senator Hertzberg on June 24th, 2015.

 

June 24, 2015

SOPHIA F. HARTMAN’S “PLEA FOR LIFE OF OTHERS”

RE: AMENDMENT Robert W. Crown California Children’s Services Act: Section 123800 et. seq. of the California Health and Safety Code; California Code of Regulations, Title 22, Section 41514, et. seq.
CHILDREN’S SERVICES for CHILDREN WITH LIFE THREATENING ILLNESS AND/OR INJURY

Dear Senator Hertzberg and Staff ,

Thank you for meeting with me regarding the necessity to amend and update the Robert W. Crown California Children’s Services Act: Section 123800 et. seq. of the California Health and Safety Code and the corresponding administrative changes to the California Code of Regulations.

After personally experiencing the heartbreak and frustration of obtaining medical benefits for my daughter Sophia during her battle with a life threatening illness, I have attempted to make necessary changes to California Children’s Services Act . I was consistently told by representatives that Medi-Cal, Medicaid and/or ObamaCare would resolve and assist children who through no fault of their own, suddenly found themselves without coverage when they most needed it, while battling a life threatening illness or injury. As you know, during our discussion when I asked about coverage for a child who is uninsured after a parent loses their job and private insurance, I was told that provisions of the Hospital Presumptive Eligibility Program provided coverage. However, when I asked for the specific provisions within the Hospital Presumptive Eligibility Program that provided for coverage, no one could point out any such language. Where does it provide coverage for a child in HEALTH CRISIS for their life under the duress of loss of private insurance? How is any parent, guardian or child under this type of stress, expected to find the necessary information and/or obtain coverage. This has to be amended.

Once again, it has been asserted that Hospital Presumptive Eligibility Program would take care of this problem, yet the language for this cure, is not present. This is indicative of problems families in this situation are presently experiencing. So the fact of the matter is there is no language that is covering THE CHILD and even though this is to help, it is not helping, and that is what needs to be AMENDED.

The changes need are as follows:

1. The Economic Threshold need to increase, since it has not been addressed for 24 years in CCS. Anytime a child becomes uninsured, there needs to be continued medical care as if they are insured. It is not the Kids fault. The most vulnerable are our children. It is not their fault that they are not insured. They need to be insured immediately and for the duration which is necessary. It does not make sense for them to go from premium care for life to restricted care. Continual medical care is necessary when they are in life crisis. This is not supposed to happen.

2. None of the systems in place are addressing these problems. THIS HAS TO BE ADDRESSED.

3. There has to be ADMINISTRATIVE teeth that there is some type of appeal. There has to be someone that is going to review or look at appeal process that is stated in the law. The office is vacant.

The fact is that people think a child in crisis for life is covered, but there is no language that covers this situation and this is the problem. This particular legislation, what is supposed to helping children, is not working. The threshold level is way to low, it does not help children who were insured but by no fault of there own, they are uninsured and after quality care, they are not given less care than an undocumented worker’s child who has full coverage.

KEY POINT: Once a primary PARENT/caregiver loses insurance, their child is automatically a PRIVATE PATIENT, without an ability to pay. With PRESUMPTIVE MEDICAL CARE, COBRA, MEDI-CAL, OR OBAMA CARE.., THE START GUIDELINES… DO NOT allow for adequate time to access information, paperwork, etc… ESPECIALLY IF A CHILD IS IN A MOMENT TO MOMENT LIFE CRISIS FOR LIFE.. Services should remain uninterrupted while finalizing paperwork for additional PRESUMED coverage. *EVERY CHILD ADMITTED INTO A HOSPITAL under normal and customary procedures for Hospital Stay and Care are made to apply for CCS AND MEDI-CAL… as a back up for treatments necessary for the life of a child in case of personal private limited coverage. DENIAL IS GIVEN AT ONSET OF ADMITTANCE INTO A HOSPITAL because it is determined immediately that the income level surpasses the qualifying level in both CCS and Presumptive Medical care. Where is the language to protect the child with an already known DENIAL?

I ASK YOU… How many more families will have to experience the possible loss of their child in medical crisis for life based on BUREAUCRACY. THIS IS AN ADMINISTRATIVE DECISION… There has to be funding for this position to designate help at the most stressful time in a families life.

The fact that there is no one to review paperwork necessary STAT for life, is frustrating and UNFAIR… It should be the parent’s job to keep their child alive. Allowing coverage without interruption is HUMANE. IT IS THE RIGHT OF A UNITED STATES BORN CHILD. It was 12 year old Sophia’s right. At the end of her life, she experienced my PANIC and died scared in a hospital room as we watched from INFECTIONS as I FRANTICALLY SEARCHED for money or coverage. AS a private patient, we as her family could not afford the cost of HOSPICE… DEATH WITH DIGNITY WAS DENIED.

Again, thank you for taking this meeting with me. I believe that I conveyed changes necessary as set forth in this letter. I appreciate you bringing real changes to this system. BE A HERO… and SAVE THE LIFE OF OTHER’S WHO MAY BE IN THIS SAME SITUATION.

KNOWLEDGE IS POWERFUL, AND LOVE IS THE POWER OF THE WORLD.

Vivian Hartman
Sophia’s Angels ® Momma of Sophia
Humanist
Community Activist
Owner Buffalo Bruce’s Mercantile
Author
* REVIEW / COMPARE, AND FIGURE OUT HOW all involved CAN COMMUNICATE WITH CALIFORNIA CHILDREN’S SERVICES.

Sophia’s Story:

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