areas. one is in particular is to continue to make transportation assistance available and being conscious of that and making that. that's one burden that if patients can be lightened for burden, i think it's very important. they have enough to do. they have to get to dialysis and they have to get picked up. that would be one area. another area would be for the city of san francisco and state of california, united states to help patients who want to work and be able to encourage employers to do whatever necessary groundwork to help patients who want to work, continue to work or assume work while on dialysis. a lot of younger people, 30s,

40s, 50s who have jobs that they theoretically can continue to do very well. there are sedentary jobs and counselors and so on. when these people dielz most function well. if that can be helped by the committee, that will be very helpful to mostly young patients. >> i would want to second that. i agree. i think if there could be because the specific needs of dialysis patients, it is such they are so unique to their disease in comparison to other disabilities. also because

it's often so misunderstood by folks in the general public who again look at a person and they don't look like anything is wrong with them. employment is a very big issue. i don't know if there could be a special department or some sort of support for folks who were on dialysis and either finding employment and also advocating for them with their employers as well that they are not being lazy, they are not cutting out of work early. there is a significant disability that they are coping with that is preventing them from working a normal schedule. that would be very helpful finding employment as well. transportation absolutely and i would add greater access to mental health care and on going and more long -term. >> thank you. >> any other comment from staff?

>> yes. thank you. i just wanted to thank our councilman kostanian for bringing this to council today. your leadership and showing us not only the personal side of this issue but also the medical and social side has really helped us all understand a little bit more about your experience and also more about what we as a department and the council might be able to do to support you and others. so thank you. >> i would also like to mention that there are pamphlets and booklets and sheets of information about kidney disease on dialysis on the table. please help yourself. do we have any public comment? anyone on the bridge line?

no? sure. >> councilmember kostanian, part of the reason why you are bringing forward this issue today. i know in the past council meetings there have been discussions around transportation for dialysis patients, also with a possibility of them transferring to laguna honda. can you speak on that as well? >> i just came off dialysis earlier today so i'm not with it all today. bare with me. i really can't say anything about that, but maybe another

month or so that may come forth. any other questions? okay. >> i wanted to say again, thank you very much councilmember kostanian for your work on this and this you to our speakers. thank you very much. >> i have one more thing to say. i wanted to thank you all for taking time to present in the educational portion of a day in a life of kidney dialysis patient to the modc council and staff. to show our appreciation our family has made a donation to the kidney foundation in honor of your volunteerism. i want to thank the national kidney foundation in san francisco. she and her staff and kindness and support and in particular, julia who

is here today. this you also very much. i would also like to thank mod and council to start what i hope will be sharing with the community on dialysis and diseases for patients in san francisco. we have a wonderful mayor's disability office and mayor's disability council. and we are very lucky to have both of these extensions of the mayor's disability council and office here. so thank you all very much. i also wanted to give to you, dr. wiel and to you -- should i read it first?

>> on behalf of the council i would like to issue this certificate of for presenting a day in the life of the person with kidney disease. a donation has been made in your name to the national kidney foundation. >> thank you very much. it's an honor to have been here. i'm very grateful if as a result of this some small increment of help will be available to the patients. it

will have been very worthwhile for me. thank you very much. >> we would also like to issue a sesht if -- certificate of acknowledgment for a day in the life of a kidney patient and it has been made in your honor to the national kidney foundation. >> thank you again for hearing today and being so receptive about kidney issues. >> great. we are due for a break. we'll take a 10-minute break. >>

>> we are going to move the next item after item no. 9, but before item 5. the order is 8, 9, 7, 5, 10. so. item no. 8. affordable care act

information. it packets it's impacts on seniors and people with disabilities. we'll hear from gloria martinis from the medi-cal program from the san francisco services agency. >> thank you for having me here today. i was asked to give an overview of the changes that are happening under the affordable care act. i think gloria will be able to fill in the numbers of people who are impacted which is really helpful. amber cutler. the affordable care act are the expansion of the medi-cal program and the private marketplace or the exchanges also known and covered california the expansion of medi-cal is a huge, well, if we take a step babylonia, the affordable -- back, the

affordable care act is for people who didn't previously have health coverage on inadequate or unaffordable insurance. the marketplace is supposed to fill that void. the expansion of medi-cal it truly is expanding the medi-cal practice. how it's doing that is it's expanding the coverage from adults to ages 64. where medi-cal eligibility used to be 128 percent of the federal poverty level. the expanded population of income eligibility is 80 percent. it's about a person bho -- who has $14,000 income versus someone who has 16,000 over expanded medi-cal.

another way is there is no asset or resource limit which is a huge change. under traditional medi-cal you can only $16,000 over expanded medi-cal. another way is there is no asset or resource limit which is a huge change. under traditional medi-cal you can only have a $2,000 asset or resource limit which keeps the person below the poverty line all the time because they can never go over 2,000. on the expanded there is no limit. for the expanded medi-cal there is no link. before you had to be over 65 or disabled or maybe a link of a parent of a child. that is no longer required. in fact, the plan applies to individuals 19-64. anyone over is not eligible for the expansion program.

neither are ones who are already in a traditional medi-cal benefit program. so that really totally opens up the world of medi-cal to a very large numbers of people who were previously uninsured. primarily it's for the working poor or people with disabilities that would have resources and assets and would make them in eligible. now they are eligible for the expansion medi-cal. a huge population are those who do have resource or assets that puts them above the threshold for traditional medi-cal. particularly those individuals who are living with disabilities who might have just applied for social security disability and they are in that 2-year waiting period for medicare. they might not have been eligible

for traditional medi-cal because of those assets and resources. now they are going to receive services under the expansion medi-cal for medicare. another population are the medically needed with the share of cost medi-cal program. those individuals are currently paying, have to meet a share of cost responsibility in order to get coverage under medi-cal. now those individuals might qualify for expansion medi-cal and not have share of cost. that is great. they will have free medi-cal coverage. that is also good in san francisco. san francisco has programs that pay people's share of cost for them. that can free up some of that funding for additional needs since now they can qualify for expansion medi-cal. i think an issue with expansion medi-cal we

have to be aware of is individuals who obtain medicare or turn 65 are going to have to meet traditional eligibility for medi-cal again. that means they will have to have that lower income and they are going to have to meet that lower and resource asset limit. that really equates to individuals who are benefitting from the coverage under traditional medi-cal free of cost who suddenly get medicare. the people in a 2-year waiting period or turn 65 and become eligible for medicare. transitioning to medi-cal there are going to be issues there and we need to help people transition who are eligible for medi-cal. particularly people who need long-term services and support. that is what medi-cal would pay for that medicare is not paying for and we want to make sure they access that medi-cal again and they don't

disqualify themselves getting resources and not knowing they are going to transition into a new program. the other major part of medi-cal that affects individuals living with disabilities is the fact that the state of california has to offer the same benefit package to same individuals who receive traditional medi-cal and expansion medi-cal. in other states that have decided to expand their medi-cal programs, they don't always match their two benefit packages. had are in california they have done that. that really cuts down on administrative complexity but it also opens up the world of long-term services and support for the expansion population. that means that individuals who receive the expansion medi-cal are also going to have ak isses to ihhs, in