SIERRA VISTA — A health roundtable discussion Friday provided an overview of healthcare issues in the county, with a focus on both physical and mental health and Alzheimer’s disease.
Mignonne Hollis, executive director of the Arizona Regional Economic Development Foundation, arranged the meeting. She invited representatives from various agencies, governmental entities and businesses in the county so local concerns could be voiced and they could also hear about options the state and county provide.
Jamie Snyder, director of the Arizona Health Care Cost Containment System (AHCCCS), provided an overview of Arizona’s Medicaid program which has 1.9 million qualified Arizonans enrolled. AHCCCS covers one of every four people and 48 percent of the state’s children and 54 percent of babies born in Arizona. That is at a cost of around $2,000 less than the average program in the country. Federal funds pay for 79 percent of Medicaid costs, with just 13 percent coming from the state’s general fund, and 6 percent from non-appropriated state funds.
“One of our real commitments to the state is to provide quality care and do so in an efficient manner,” Snyder said. “The average across the country is around $7,900 per person per year and we’re spending around $6,000.”
The state began a new program in 2018 called Complete Care which joins physical and behavioral health services together to treat all aspects of health care needs under one chosen health plan, Snyder said. Complete Care encourages more coordination between providers within the same network, which means better health outcomes for patients, according to Snyder.
The program still allows a choice of health plans in geographic service areas and members have access to the same array of covered services and the network of providers. Now, people can have just one inclusive plan that covers their needs. Regional Behavioral Health Authorities (RBHAs) will continue to provide specific crisis services and serve members determined to have a serious mental illness, children in foster care, and members served by Department of Economic Services. Arizona Long Term Care System (ALTCS) plans will remain the same.
To better serve rural patients, AHCCCS broadened telehealth services to any of the people enrolled so rural communities could be provided with access to specialists.
Employment regulation to begin
On Jan. 1, 2020, able-bodied adults age 19-49 who do not qualify for an exemption must be employed for at least 80 hours per month or be actively seeking employment or attending school, Snyder explained. They may also be required to participate in other employment readiness activities like job skills training, life skills training and health education or engage in community service.
There are exemptions from the mandated work program, such as people who have serious mental disease, physical disabilities recognized by federal law, the homeless, those in other AHCCCS-approved work programs, pregnant women up to 60 days post-pregnancy and people deemed medically frail, she continued. Other exemptions are for caregivers responsible for care of a disabled person, members receiving active treatment for substance-abuse disorders, those with an acute medical condition, survivors of domestic violence, full-time high school, college or trade school students and designated caretakers of a child under the age of 18.
Opioid abuse plan
The state has also targeted its response to substance abuse, particularly opioids, through Medication Assisted Treatment (MAT) program which helps people in and on probation receive not just medical treatment for drug addiction, but for resulting ailments from the abuse of drugs. The program, in areas where initiated, has produced some positive results, according to Snyder. The program involves those who have been through rehabilitation and can offer support to addicts.
She noted the idea is to expand infrastructure and build capacity for state, regional and local collaborators to implement integrated behavioral health, care coordination and recovery support team approaches with 24 hour, seven day a week access to care.
The state’s response to opioid abuse includes the expansion of access to recovery support services, which includes help with housing, peer support groups, job assistance and supportive recovery programming. In the period from May 1, 2017, to April 30, 2018, AHCCCS treated 6,143 people for addiction. The following year, from May 1, 2018, to May 31, 2019, the total number of people treated rose to 14,949.
“We focus on quality. That’s our No. 1 concern,” Snyder added. “We do that with the concern to maintain the quality of the program. We want our people to access preventative care rather than the emergency room. The integration of behavioral health with physical health has been a big focus of our program.”
County health acknowledges provider problem
Cochise Health and Social Services (CHSS) director Carrie Langley explained the critical situation in the county due to the lack of specialist physicians and the difficulty attracting them to work and live in the county. Physicians need a certain number of patients to open a practice here and, all too often, there are not enough patients to keep doors open to specialty practices.
In two separate surveys in 2017 and 2018, Langley said, her staff found “Cochise County faces significant geographic, cultural and economic challenges in a county spread over 6,200 square miles and a population of just 129,000 people. We have a shortage of professional services, and we also have barriers people face to access the care they need; 98 percent of Cochise County is designated as a healthcare provider shortage area.”
Even though there are critical care hospitals in Bisbee, Benson and Willcox, a regional medical center in Sierra Vista, 10 clinics and eight mobile health clinic sites, the county lacks a sufficient number of specialized care providers. If people had access to the type of health care they require on a regular basis, emergency room visits would decline, added Langley.
The 2017 survey was taken to identify and prioritize the major issues threatening the health and well-being of residents, she explained. A few priorities were identified and topping the list was the lack of help for those with mental health and substance-abuse issues. Diabetes and obesity intervention and treatment is another area Langley said she wants to improve.
The 2018 survey gathered additional data focused on socioeconomic conditions affecting access to healthcare in the county.
This was a collaborative outreach to low-income, non-English-speaking people and migrant farm workers, as well as homeless, elderly, disabled and veteran populations.
A big problem was lack of adequate health insurance, particularly for those with mental health issues and substance abuse. Then there is the struggle with high deductibles and out-of-pocket expenses people just cannot pay if they are in a low-paying job. It can also be difficult finding affordable transportation to get to a doctor, whether within the county or in larger cities, like Tucson.
“They struggle to pay out-of-pocket expenses,” said Langley. “They can’t pay for their prescriptions and some go across the border to get the cheaper prices.”
Langley suggested some sort of agreement can be reached to allow medical students to reduce their student loan debt by serving in rural communities to bolster services.
The apprehension of Central American families has skyrocketed so far this year in a 262-mile stretch of border that U.S. Customs and Border Protection officials refer to as the Tucson Sector.
Statistics released recently by the federal agency show a 275 percent increase in arrests of families in the Tucson sector between fiscal year to date July 2018 and fiscal year to date July 2019. According to the CBP website, the Tucson sector encompasses 262 miles of linear border from the Yuma County line to the Arizona/New Mexico state line. It is made up of eight stations that are broken down into three corridors. These eight stations are located in Why, Casa Grande, Tucson, Nogales, Willcox, Sonoita, Bisbee, and Douglas. Apprehensions of family units for the entire southwest border of the U.S. — from Texas to San Diego — for that same time period climbed 456 percent.
In a roundtable session for the community hosted by the Cochise County Sheriff’s Office last week, officials also reported an uptick in the arrests of undocumented people by the sheriff’s office’s SABRE unit. SABRE stands for Southeast Arizona Border Region Enforcement. In July 2018, just under 50 undocumented people were arrested by the SABRE unit. That number quadrupled this July, when 200 were caught, figures show.
Cameras used by the sheriff’s office along the border also have captured more undocumented people attempting to come into the U.S. illegally. According to CCSO statistics, in July 2018 the cameras saw about 70 undocumented people attempting to cross over. This July, that number rose to just under 400.
Joe Curran, an agent with U.S. Customs and Border Patrol, said traditionally those trying to get into the U.S. have been single, Mexican males.
“(But now) massive groups of Central Americans are crossing into the U.S.,” Curran said. “We’re seeing families coming over.”
The families are largely coming from Honduras, Guatemala, El Salvador and Mexico. The first three countries are referred to by CBP and other law enforcement agencies as the “Northern Triangle.”
The Rev. Rosa Brown of St. John’s Episcopal Church in Bisbee and St. Stephen Episcopal Church in Douglas, said she is seeing more and more families fleeing those countries with hopes of reaching the U.S.
“What is going on in particular in Central America is the violence,” said Brown, whose churches are part of a humanitarian effort that feeds migrants living in a small tent at the Agua Prieta/Douglas border. The migrants are waiting to fill out applications for asylum. “The violence, as well as drugs, have been the topics in these countries for years, but it has escalated and many of these people are getting scared.”
Drug gangs in those countries target youngsters, Brown said. Many families are leaving because they want to save their children from that fate. Brown mentioned meeting a family recently whose father had been killed by a gang after he refused to allow his children to be taken by them.
“People just can’t take it anymore,” Brown said. “That’s why they’re leaving.”