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County Indigent Care ProgramsCounty Indigent Care ProgramsAfter the Affordable Care ActAfter the Affordable Care Act
April 2015April 2015
Anthony Wright, Executive DirectorAnthony Wright, Executive DirectorSawait Hezchias-Seyoum, Policy AdvocateSawait Hezchias-Seyoum, Policy Advocate
Reorienting the Safety Net Reorienting the Safety Net for the Remaining Uninsuredfor the Remaining Uninsured
www.health-access.org
www.facebook.com/healthaccess
www.twitter.com/healthaccess
CALIFORNIA IMPLEMENTSMillions with new consumer protections; financial assistance4+ million Californians with new coverage
CALIFORNIA IMPROVESEARLY:* Low-Income Health Programs* Children with pre-existing conditions* Maternity coverageBETTER:* Exchange that negotiates & standardizes* Medi-Cal express lane enrollment options* Continuing CA’s inclusion of legal immigrants
including DACA students
Who Needs More Help?Who Needs More Help?ACA has millions of ACA has millions of ““winners,winners,”” who have new coverage, new who have new coverage, new access, and/or new financial help to afford coverage. access, and/or new financial help to afford coverage. Everyone wins with a health system more humane, more Everyone wins with a health system more humane, more rational, more transparent, with new consumer protections rational, more transparent, with new consumer protections and incentives aligned for improved quality & reduced cost. and incentives aligned for improved quality & reduced cost. Issues remain:Issues remain:•Medi-Cal year-round, but can be frozen out of Covered CAMedi-Cal year-round, but can be frozen out of Covered CA•No mandate if coverage is more than 8%No mandate if coverage is more than 8%
And And on affordability, some folks will need more helpon affordability, some folks will need more help::•Uninsured undocumented immigrantsUninsured undocumented immigrants•Those in Those in ““family glitchfamily glitch””: family members for workers with : family members for workers with employer based coverage affordable for just themselvesemployer based coverage affordable for just themselves•Some over 400% federal poverty level (typically older, in Some over 400% federal poverty level (typically older, in high-cost areas) who donhigh-cost areas) who don’’t have affordability guarantee.t have affordability guarantee.•Those in Exchange who find monthly premiums/cost Those in Exchange who find monthly premiums/cost sharing still a burden, and may/may not decline coverage.sharing still a burden, and may/may not decline coverage.
California May Have 3 California May Have 3 Million Remaining Million Remaining
UninsuredUninsured
Our Current Safety-NetOur Current Safety-Net Uninsured live sicker, die younger, one Uninsured live sicker, die younger, one
emergency from the financial ruin.emergency from the financial ruin. Emergency Rooms: But only to stabilize Emergency Rooms: But only to stabilize
emergencies; Bill and debt afterwards emergencies; Bill and debt afterwards – 2006 Fair Hospital Pricing Law 2006 Fair Hospital Pricing Law
www.hospitalbillhelp.org Private providers: clinics, hospital charity Private providers: clinics, hospital charity
carecare Counties. Counties.
– Counties have a Counties have a ““1700017000”” obligation to provide basic care obligation to provide basic care
– CaliforniaCalifornia’’s 58 counties continue to vary widely on s 58 counties continue to vary widely on their service to the uninsuredtheir service to the uninsured
– How they provide care; What care they provide; How they provide care; What care they provide; and to who, especially based on income & and to who, especially based on income & immigration status.immigration status.
3 Flavors of Counties3 Flavors of CountiesPUBLIC PUBLIC HOSPITALHOSPITAL•AlamedaAlameda•Contra CostaContra Costa•KernKern•Los AngelesLos Angeles•MontereyMonterey•RiversideRiverside•San BernardinoSan Bernardino•San FranciscoSan Francisco•San JoaquinSan Joaquin•San MateoSan Mateo•Santa ClaraSanta Clara•VenturaVentura
““ARTICLE 13ARTICLE 13”” FresnoFresnoMerced Merced OrangeOrangePlacerPlacerSacramentoSacramentoSan DiegoSan DiegoSan Luis ObispoSan Luis ObispoSanta BarbaraSanta BarbaraSanta CruzSanta CruzStanislausStanislausTulareTulareYolo*Yolo*
Others are part of CMSPOthers are part of CMSP(County Medical Services Program)(County Medical Services Program) 99
1010
Source of Major Apprehension:Source of Major Apprehension:Some County Health $ ReallocatedSome County Health $ Reallocated
Counties had2 options
for determining the redirected amount.
Each county must inform DHCS of tentative decision
by 11/1/13Must adopt a resolution by
1/22/14
60% of 1991 Health Realignment Funds
+60% of Maintenance of
Effort Maintenance of Effort is capped at 14.6% of the total value of each county’s 10-11
allocation.
County Savings Determination Process
(Formula)Lesser of:
(Revenues-Costs) x .80(.70 in 13/14)
Or County Indigent Care Health Realignment
Amount(=Health Realignment
Amount x Health Realignment Indigent Care Percentage)
With the Medi-Cal With the Medi-Cal expansion, AB85 expansion, AB85 reallocated up toreallocated up to$900 million of $1.4 $900 million of $1.4 billion in funds for billion in funds for countiescountiesfor public health and for public health and indigent careindigent care
Article 13 CountiesArticle 13 Counties 1111
KEY FINDINGS: EligibilityKEY FINDINGS: Eligibility
Our survey found that some counties Our survey found that some counties adjusted benefits but largely not adjusted benefits but largely not eligibility.eligibility.
A lot of apprehension about AB85, county A lot of apprehension about AB85, county realignmentrealignment
Many Other Counties in Many Other Counties in ““Wait and SeeWait and See”” ModeMode– CMSP: Eliminated optometry, mental health, CMSP: Eliminated optometry, mental health,
substance abuse; reduced dental; shortened substance abuse; reduced dental; shortened certification to 3 months.certification to 3 months.
Nothing in Funding Formula Requires Cuts Nothing in Funding Formula Requires Cuts in Eligibility—Allows Full Reimbursement of in Eligibility—Allows Full Reimbursement of Services for What Counties Provided BeforeServices for What Counties Provided Before– Need to Spend the $ to Get ReimbursedNeed to Spend the $ to Get Reimbursed– Limits Are On Use of State $ For Going FurtherLimits Are On Use of State $ For Going Further
FRESNOFRESNO
Amparo CidAmparo Cid Director of SRCP and AttorneyDirector of SRCP and Attorney California Rural Legal Assistance California Rural Legal Assistance
Foundation (CRLAF)Foundation (CRLAF)
Lawsuit to get out from legal injunction to care for Lawsuit to get out from legal injunction to care for the undocumentedthe undocumented
Preliminary vote to eliminate MISPPreliminary vote to eliminate MISP Effort to change safety-net program from hospital Effort to change safety-net program from hospital
contractcontract Board of Supervisor vote on April 7, 2015 to Board of Supervisor vote on April 7, 2015 to
continue revamped program: $5 million for continue revamped program: $5 million for specialty carespecialty care
Self-Reporting:Care Beyondthe ER forUndocumented Adults
AlamedaFresnoKernLos AngelesRiverside San FranciscoSan MateoSanta ClaraSanta CruzVentura
Prior to 2009:Contra CostaSacramentoYolo
KEY FINDINGS: EnrollmentKEY FINDINGS: Enrollment
2014 implementation of the Affordable Care Act led to 2014 implementation of the Affordable Care Act led to dramatic reductions in the number of Californians dramatic reductions in the number of Californians on county indigent care programson county indigent care programs—as counties —as counties successfully enrolled people in Medi-Cal and Covered successfully enrolled people in Medi-Cal and Covered CaliforniaCalifornia
–Low Income Health ProgramsLow Income Health Programs–Horizontal integration, Express lane enrollment, presumptive Horizontal integration, Express lane enrollment, presumptive eligibility, etc.eligibility, etc.
Counties with broad eligibility requirements are Counties with broad eligibility requirements are seeing strong continued needseeing strong continued need for their safety-net for their safety-net programs—with tens of thousands enrolled. programs—with tens of thousands enrolled.
Counties with restrictive eligibility requirements—Counties with restrictive eligibility requirements—especially those that exclude the undocumented—especially those that exclude the undocumented—are finding few if anyone left are finding few if anyone left in their indigent care in their indigent care programs.programs.
–Not because need isnNot because need isn’’t there, but because programs are not t there, but because programs are not oriented to the remaining uninsured.oriented to the remaining uninsured.
Steps ForwardSteps Forward
ACA Provides Significant Savings to ACA Provides Significant Savings to State/CountiesState/Counties
With Many Covered, Time to:With Many Covered, Time to:– Re-Orient Safety-Net, Do It BetterRe-Orient Safety-Net, Do It Better– The Lessons of LIHP: Primary/Preventative The Lessons of LIHP: Primary/Preventative
Medical Home, rather than episodic/emergency Medical Home, rather than episodic/emergency carecare
– Extending Eligibility to the Remaining Uninsured Extending Eligibility to the Remaining Uninsured ““Now We Can Say YesNow We Can Say Yes””
– Los Angeles, Alameda, San Francisco, Los Angeles, Alameda, San Francisco, Santa Clara, San Mateo, Etc.Santa Clara, San Mateo, Etc.
Bridges to a Statewide SolutionBridges to a Statewide Solution
LOS ANGELESLOS ANGELES
Sonya VasquezSonya Vasquez Policy DirectorPolicy Director Community Health Councils, Inc.Community Health Councils, Inc.
Primary Care Program Primary Care Program for low-income uninsured people in for low-income uninsured people in Los Angeles County. (MHLA is not insurance)Los Angeles County. (MHLA is not insurance)
FundedFunded by LAC Board of Supervisors ($61 million each year) by LAC Board of Supervisors ($61 million each year)
ServicesServices occur at contracted community clinics (primary occur at contracted community clinics (primary care) & county facilities (specialty, urgent and emergency care) & county facilities (specialty, urgent and emergency care)care)
PaymentsPayments for clinics as of April 1 for clinics as of April 1stst are $36 Per Member Per are $36 Per Member Per MonthMonth
QualificationsQualifications: Not eligible for Covered CA, Medi-Cal, , : Not eligible for Covered CA, Medi-Cal, , Employer coverage, etc; Uninsured, LA County resident, Age Employer coverage, etc; Uninsured, LA County resident, Age 6+ (as of now), Income below 138% Federal Poverty Level6+ (as of now), Income below 138% Federal Poverty Level
Program opened Program opened October 1October 1stst and stays open until total and stays open until total enrollment is met (estimated 146,000)enrollment is met (estimated 146,000)
EnrollmentEnrollment as of February 28 as of February 28thth was 93,253 (94% Latino) – was 93,253 (94% Latino) – 64% of target in 5 months64% of target in 5 months
My Health LA (MHLA)My Health LA (MHLA)
http://dhs.lacounty.gov/MHLA
Coalition formed Fall 2013 to strengthen the LA Coalition formed Fall 2013 to strengthen the LA county health safety-net infrastructure in order county health safety-net infrastructure in order to improve the quality of health care and to improve the quality of health care and increase access for the remaining uninsured.increase access for the remaining uninsured.
Almost 30 organizations representing LA Almost 30 organizations representing LA County residents includes advocacy groups County residents includes advocacy groups (health & immigration), labor, clinics, faith (health & immigration), labor, clinics, faith based and community based organizations.based and community based organizations.
Submitted recommendations, met with the Submitted recommendations, met with the county, held press events, participated in county, held press events, participated in stakeholder meetings, and convened consumer stakeholder meetings, and convened consumer forums. forums.
LA: Current ConcernsLA: Current ConcernsCapacity & FundingCapacity & Funding No formal outreach yet enrollment increasing 12,000-14,000 a monthNo formal outreach yet enrollment increasing 12,000-14,000 a month Benefits not comprehensive & only offered at community clinicsBenefits not comprehensive & only offered at community clinics Healthy Kids (0-5) program closing Healthy Kids (0-5) program closing
CONSUMER FOCUSED MARKETING AND OUTREACHCONSUMER FOCUSED MARKETING AND OUTREACH No formal outreach/education & limited consumer engagementNo formal outreach/education & limited consumer engagement Confusion about services, who is served and the impact on immigrationConfusion about services, who is served and the impact on immigration Information only in English and SpanishInformation only in English and Spanish
Enrollment OptionsEnrollment Options Only clinics can enroll & only at certain sites (although this is being Only clinics can enroll & only at certain sites (although this is being
reviewed)reviewed)
Prioritizing Data Collection and ReportingPrioritizing Data Collection and Reporting Only demographic data available (although this is expected to change)Only demographic data available (although this is expected to change)
Coordination of CareCoordination of Care Concerns about enrollees moving between community and county clinicsConcerns about enrollees moving between community and county clinics Dental Services are limited (technically not even a covered service)Dental Services are limited (technically not even a covered service)
SACRAMENTOSACRAMENTO
Nenick VuNenick Vu LeaderLeader Sacramento Area Congregations Sacramento Area Congregations
Together (ACT)Together (ACT)
Eliminated services to the undocumented in 2009; Eliminated services to the undocumented in 2009; reduced county clinic capacityreduced county clinic capacity New Board of Supervisors makeupNew Board of Supervisors makeup Options presented in Board Workshop in MarchOptions presented in Board Workshop in March
CONTRA COSTACONTRA COSTA
Alvaro Fuentes,Alvaro Fuentes,Executive Director,Executive Director,Community Clinic ConsortiumCommunity Clinic Consortiumof Contra Costa and Solano Countyof Contra Costa and Solano County
County eliminated services to adult undocumented County eliminated services to adult undocumented in 2009in 2009
Access to Care Stakeholders CollaborativeAccess to Care Stakeholders Collaborative Contra Costa CARES – proposed coverage programContra Costa CARES – proposed coverage program
Making #Health4All History Making #Health4All History *This Year**This Year*
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Secure and Expand our County Safety-Net Secure and Expand our County Safety-Net Programs: Programs: Counties are the last resort of coverage. Counties are the last resort of coverage. Some counties are enhancing their safety-net for the Some counties are enhancing their safety-net for the remaining uninsured, with programs like My Health LA. remaining uninsured, with programs like My Health LA. We need to encourage more counties to care for the We need to encourage more counties to care for the undocumented.undocumented.
Continuing CaliforniaContinuing California’’s Coverage of s Coverage of ““Deferred Deferred ActionAction”” Immigrants: Immigrants: The PresidentThe President’’s executive action s executive action had the impact of expanding the category of immigrants had the impact of expanding the category of immigrants covered by state-funded Medi-Cal. covered by state-funded Medi-Cal. We need to defend We need to defend and secure this major victory. Also: and secure this major victory. Also:
Making Progress to a Statewide Solution for Making Progress to a Statewide Solution for #Health4All:#Health4All: An effort now in its third year, we can An effort now in its third year, we can take another step to Health4All, expanding Medi-Cal to take another step to Health4All, expanding Medi-Cal to more immigrants, and setting up the structure for a more immigrants, and setting up the structure for a mirror marketplace so everyone can seek coverage.mirror marketplace so everyone can seek coverage.
New County OpeningsNew County OpeningsOther CountiesOther Counties: Not Just Sacramento, Contra : Not Just Sacramento, Contra Costa Costa CMSP Strategic Planning ProcessCMSP Strategic Planning Process
DAPA/PresidentDAPA/President’’s Executive Orders Executive Order– With federal papers/work authorization, likely qualifiesWith federal papers/work authorization, likely qualifies– Forces conversation at the county level about eligibilityForces conversation at the county level about eligibility– Reduces the county cost as state covers part of this Reduces the county cost as state covers part of this
populationpopulation
““Medi-Cal 2020Medi-Cal 2020”” Waiver Waiver– ““Public Safety Net System Transformation & Improvement Public Safety Net System Transformation & Improvement
Program.Program.”” Allow Use of DSH/Safety Net Care Pool $ for Primary, Allow Use of DSH/Safety Net Care Pool $ for Primary,
Coordinated, Upstream Care.Coordinated, Upstream Care. Would Be a Major Incentive for Public Hospital CountiesWould Be a Major Incentive for Public Hospital Counties
– Delivery System Reform Throughout Health SystemDelivery System Reform Throughout Health System– Integration with Other County Services & Potential SavingsIntegration with Other County Services & Potential Savings
Bradley ClevelandBradley Cleveland Planning and Health Policy ConsultantPlanning and Health Policy Consultant San Mateo County Union Community AllianceSan Mateo County Union Community Alliance Former Campaign Manager, Yes on AAFormer Campaign Manager, Yes on AA
Alameda Health System Alameda Health System (Highland Hospital, etc) (Highland Hospital, etc) HealthPACHealthPAC Reauthorizes 1/2 cent sales tax through 2034, Reauthorizes 1/2 cent sales tax through 2034, raises over $100 million per year raises over $100 million per year Campaign messages focused on critical trauma Campaign messages focused on critical trauma and emergency services, and county safety net and emergency services, and county safety net New reportNew report “Winning Revenues for the Remaining “Winning Revenues for the Remaining Uninsured”Uninsured”
ALAMEDAALAMEDA
RICH PEDRONCELLI, ASSOCIATED PRESS
The chairman of the California Legislative Latino Caucus plans to propose a new law that would expand access to health insurance for all Californians, including those living in the country illegally.
State Sen. Ricardo Lara, D-Bell Gardens, is working with a broad coalition of organizations to map out the details of a bill that would cover undocumented immigrants, who are excluded from insurance coverage under the national Affordable Care Act, or ACA.
“Immigration status shouldn’t bar individuals from health coverage, especially since their taxes contribute to the growth of our economy,” Lara said in a news release.
NEWS
State senator wants health care for all immigrantsBy ROXANA KOPETMAN / ORANGE COUNTY REGISTERPublished: Jan. 10, 2014 Updated: 6:04 p.m.
COUNTY EFFORTS A BRIDGE TO COUNTY EFFORTS A BRIDGE TO A STATEWIDE SOLUTIONA STATEWIDE SOLUTION
Continuing CaliforniaContinuing California’’s s Commitment to Covering Commitment to Covering
ImmigrantsImmigrants Progress made on California-specific efforts to cover:Progress made on California-specific efforts to cover:
–legal immigrants, including recent immigrants here legal immigrants, including recent immigrants here less than 5 years;less than 5 years;–People Residing Under the Color of Law (PRUCOL); People Residing Under the Color of Law (PRUCOL); now including DACA Dream Act students; to include now including DACA Dream Act students; to include those covered under DAPA when the Presidentthose covered under DAPA when the President’’s s executive order is upheld.executive order is upheld.
Legislative proposal mirrors ACA: SB4(Lara)Legislative proposal mirrors ACA: SB4(Lara)Similar to last yearSimilar to last year’’s SB1005(Lara):s SB1005(Lara):State-only Medi-Cal for those not legally present, State-only Medi-Cal for those not legally present, similar to other non-federally covered populationssimilar to other non-federally covered populations
–Building off emergency Medi-CalBuilding off emergency Medi-Cal Allowing undocumented immigrants to buy (unsubsidized, with their own money) coverage through Covered California. If federal waiver denied, set up “mirror marketplace.”
Financing #Health4AllFinancing #Health4AllLOS ANGELES TIMES:LOS ANGELES TIMES:
““Study sees modest costs in Study sees modest costs in healthcare for immigrants here healthcare for immigrants here illegallyillegally””By Patrick McGreevy * May 21, 2014By Patrick McGreevy * May 21, 2014
Increased health of poor Californians could reduce Increased health of poor Californians could reduce costs down the road, study sayscosts down the road, study says
Extending healthcare to people in the country illegally would cost the state a modest Extending healthcare to people in the country illegally would cost the state a modest amount more but would significantly improve health while potentially saving money amount more but would significantly improve health while potentially saving money for taxpayers down the road, according to a study released Wednesday.for taxpayers down the road, according to a study released Wednesday.
The study by the UCLA Center for Health Policy Research estimates that the net The study by the UCLA Center for Health Policy Research estimates that the net increase in state spending would be equivalent to 2% of state Medi-Cal spending, or increase in state spending would be equivalent to 2% of state Medi-Cal spending, or between $353 million and $369 million next year, while the net increase in spending between $353 million and $369 million next year, while the net increase in spending would be up to $436 million in 2019. Enrollment in Medi-Cal would increase by up to would be up to $436 million in 2019. Enrollment in Medi-Cal would increase by up to 730,000 people next year and up to 790,000 in four years.730,000 people next year and up to 790,000 in four years.
Financing #Health4AllFinancing #Health4All These Californians already in our health system today, These Californians already in our health system today,
getting care in the most expensive, least efficient way.getting care in the most expensive, least efficient way. More effectiively use existing dollars & revenue More effectiively use existing dollars & revenue
streams:streams:– Maintaining funds for restricted scope Medi-Cal for emergency Maintaining funds for restricted scope Medi-Cal for emergency
carecare– Savings from existing programs that serve this populationSavings from existing programs that serve this population– Natural recoupment from county realignment formulaNatural recoupment from county realignment formula– Leverage existing MCO and hospital provider feeLeverage existing MCO and hospital provider fee– More effectively use existing state-only Medi-CalMore effectively use existing state-only Medi-Cal– Opportunities under the Medi-Cal waiverOpportunities under the Medi-Cal waiver
President ObamaPresident Obama’’s executive action and deferred actions executive action and deferred action Decisions to deal with the remaining costs:Decisions to deal with the remaining costs:
– Additional revenues face a 2/3 voteAdditional revenues face a 2/3 vote– Making this a budget priorityMaking this a budget priority, against other priorities, against other priorities– Phasing in/starting with a down payment with aPhasing in/starting with a down payment with a proposal proposal
under a certain dollar amount.under a certain dollar amount.
#Health4All
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Core MessagesCore Messages
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Investing in California: Investing in California: Undocumented Californians are an Undocumented Californians are an economic engine for the state. An overwhelming percentage economic engine for the state. An overwhelming percentage work and pay taxes. They are an economic asset. Investing in work and pay taxes. They are an economic asset. Investing in them is investing in our state.them is investing in our state.
Prevention Makes Economic Sense: Prevention Makes Economic Sense: Emergency room Emergency room treatment is an expensive substitute for preventive care. It treatment is an expensive substitute for preventive care. It makes economic sense to invest in preventive services that makes economic sense to invest in preventive services that minimize the risk of chronic disease and more chronic minimize the risk of chronic disease and more chronic treatment later on.treatment later on.
Increasing Access to Affordable Care is the Responsible Increasing Access to Affordable Care is the Responsible Thing to do:Thing to do: Everyone—regardless of ability to pay or legal Everyone—regardless of ability to pay or legal status—should have access to affordable health care. After status—should have access to affordable health care. After Obamacare, the remaining uninsured, including the Obamacare, the remaining uninsured, including the undocumented, should have access to affordable care, undocumented, should have access to affordable care, including a comprehensive set of preventive services and a including a comprehensive set of preventive services and a health home.health home.
Organizing and Organizing and Communications: We Need Communications: We Need Action & Stories!Action & Stories!
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Opportunities Opportunities This YearThis Year
Focused Attention:Focused Attention:Now-JuneNow-June CountiesCounties
– SupervisorsSupervisors– AdministratorAdministrator– Health DepartmentsHealth Departments
StateState– GovernorGovernor– State Legislative LeadersState Legislative Leaders– Legislative ProcessLegislative Process– Budget ProcessBudget ProcessObstacles: Money, Messaging, Priorities, Obstacles: Money, Messaging, Priorities,
PoliticsPolitics
For more informationFor more informationWebsite: http://www.health-access.orgWebsite: http://www.health-access.orgBlog: http://blog.health-access.org Blog: http://blog.health-access.org
Facebook: www.facebook.com/healthaccessFacebook: www.facebook.com/healthaccessTwitter: www.twitter.com/healthaccessTwitter: www.twitter.com/healthaccess
Health Access CaliforniaHealth Access CaliforniaCapitol Office: 1127 11Capitol Office: 1127 11thth Street, Suite 234, Street, Suite 234, SacramentoSacramento, CA , CA
9581495814916-497-0923916-497-0923
Northern California Office:Northern California Office:414 13414 13thth Street, Suite 450, Street, Suite 450, OaklandOakland, CA 95612, CA 95612510-873-8787510-873-8787
Southern California Office:121 West Lexington Drive, Suite 246, Glendale, CA 91203
Question and AnswerQuestion and Answer
Note: Remember to type your Note: Remember to type your questions into the chat box.questions into the chat box.
Contact InformationContact Information Anthony WrightAnthony Wright, Executive Director, Health Access California , Executive Director, Health Access California
[email protected] Bradley ClevelandBradley Cleveland, Planning and Health Policy Consultant, San , Planning and Health Policy Consultant, San
Mateo County Union Community Alliance [email protected] County Union Community Alliance [email protected] Alvaro FuentesAlvaro Fuentes, Executive Director of the Community Clinic , Executive Director of the Community Clinic
Consortium of Contra Costa [email protected] of Contra Costa [email protected] Nenick VuNenick Vu, Sacramento Area Congregations Together , Sacramento Area Congregations Together
[email protected]@gmail.com Amparo CidAmparo Cid, Director of Sustainable Rural Communities Project , Director of Sustainable Rural Communities Project
[email protected]@crlaf.org Sonya VasquezSonya Vasquez, Policy Director of Community Health Councils , Policy Director of Community Health Councils
[email protected]@chc-inc.org Josue ChavarinJosue Chavarin, Program Associate, The California Endowment , Program Associate, The California Endowment
[email protected]@calendow.org
THANK YOU!THANK YOU!
