How You Can Help Make a Healthier San Diego and Find Some Job Satisfaction Too

A.N.’s Story

Thirty-five-year-old A.N. worked in San Diego and supported himself. He wasn’t covered by medical insurance through his work but didn’t seem overly concerned about it since he was a healthy, productive member of society. However, last August his life changed in an instant. A.N. was involved in a serious motor vehicle accident and sustained severe trauma to his foot. Paramedics brought him to the ED, where both his medical and his financial needs were assessed. He qualified for medical care through the County of San Diego’s County Medical Services and underwent multiple surgeries, including amputation of his foot, during his month-long hospitalization.

Subsequently, he lost his job during the hospitalization. Without an income, he lost his housing as well. Hospital staff contacted the RN case managers at CMS when he became ready for discharge. While he continued with orthopedics, surgery, physical therapy, and other outpatient specialty visits, A.N. qualified for room and board housing through CMS. He was visited weekly by a CMS social worker, who helped him navigate medical and social assistance programs. During this time, he received food, housing, support, and assistance with transportation to medical visits. In turn, he gave encouragement to other patients undergoing surgical and medical treatments living at the same room and board.

He recovered from his surgeries and received a prosthesis. After several PT sessions, he learned how to walk again and now does so without a discernable limp. After receiving medical clearance from his surgeons, A.N. found a job and returned to work full-time. Six months later, he is completely self-sufficient and, again, a productive member of society.

What Is County of San Diego CMS?

The County of San Diego’s County Medical Services (CMS) Program is a medical assistance program available to San Diego County-eligible adult residents with serious medical conditions. The CMS Program assists medically indigent adult county residents who are not eligible for other government healthcare programs. CMS is not health insurance.

Patients may qualify for CMS assistance if they meet medical severity threshold (see below) and are:

• U.S. citizen or legal resident
• permanent resident of San Diego County
• 21 through 64 years of age
• not eligible for Medi-Cal
• determined to meet CMS financial requirements

CMS services may cover:

• medical visit for evaluation by primary care
• primary clinic follow-up care
• emergency care
• emergency hospital care
• prescription medications on the CMS Formulary
• specialist visits*
• surgical/diagnostic procedures*
• emergency medical transportation
• emergency dental care
• limited rehabilitation, medical equipment, and home health services*

*These services must be approved in advance by the AmeriChoice Medical Management Services Department.

Medical severity threshold is defined as:

• immediately life-threatening or significantly disabling physical conditions, such as myocardial infarction or trauma from MVA
• acute illnesses that could ultimately lead to disability or death, such as cholecystitis and gastric ulcer
• chronic illnesses, including diabetes and hypertension

Why Help?

The rewards of treating CMS patients are many, including the satisfaction of assisting a patient who may not have needed a physician in years and is now desperate for help. You could help a patient overcome an acute event and become healthy and strong enough to return to work. You might find satisfaction in working on a challenging case, and you will be sure to enjoy working with the CMS team of social workers and RN case managers. Or you could enjoy helping patients and their families address chronic illnesses in a way that will stave off long-term sequelae for many years.

Physicians like the appreciation they get from the patients they see from CMS. “These patients are so grateful to us, and thank us every time,” says staff at Dr. Musinski’s office in Encinitas. A referral clerk says of one of our RN case managers, “She helps me to help the patients.”

How You Can Help?

You can help care for indigent adult patients with acute and chronic medical conditions. As a contracted specialty physician, you will have access to an online eligibility website. Contracted providers also have the use of a new electronic system for submitting and reviewing treatment authorization requests. Please consider joining hundreds of other San Diego County physicians in providing a medical safety net to indigent, ill, adult residents of San Diego. To become a CMS provider, contact Rebecca Velie, contract administrator/compliance manager, via email at rebecca_g_velie@uhc.com or by phone at (858) 495-1360.