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 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 home supportive services program an long-term care. that is about the resource and asset limit. that's really important for people who are either get into expansion medi-cal and healthy when they came in and are going to have a need for services and maybe they weren't eligible for traditional medi-cal and because they are over the resource and asset limit and the income is over the

threshold. now they are going to be able to benefit from the long-term services and support that are going to be available under the medi-cal expansion program. a note under the ihs program, recently the state and working with counties have decided that individuals who come in through expansion who need ihhs are not going to need a separate disability determination and that is good because that is an administrative hurdle and will go through the certification for all people who apply for ihhs will go through and the county will do an assessment of need. the other program is covered california covered california is for individuals who have an income over 138 percent. it offers health insurance to people on the

marketplace. there is four different plan options from bronze to platinum. when you buy on the marketplace you also receive financial assistance. that financial assistance is what makes that insurance really affordable. you so you might not qualify for free health insurance under the expansion medi-cal, but you are probably going to get a lot of financial assistance to help pay for your health insurance under the marketplace. individuals can qualify for a premium assistance if they have national weather service between 100 percent and 400 percent of the poverty level. $46,000 you can have that and still get some form of financial assistance to purchase health insurance on the marketplace. there is also the availability of cost sharing assistance so individuals out of pocket expenses are also reduced. if

you have 150-200, those two things can be combined. for people with low income they are going to have low premiums and also have reduced out of pocket cost. the thing to note about covered california and buying insurance on the marketplace is that you are not eligible for financial insurance if you have insurance that is adequate. if you have medicare, you are not able to get financial assistance. if you have medi-cal you are not going to get financial assistance to purchase insurance on the marketplace and if you have insurance through your employer, and it's adequate and affordable, then you can't get financial assistance on the marketplace. i think those two things

combined really provide and opportunity for individuals who didn't have health insurance before to have health insurance coverage. i think that's all i have to say about the two programs. >> do we have any questions from councilmembers or comments? >> thank you. i came in a little late. was there an initial date for roll out of this or is this just talking about the on going process. >> january 1st is when everything rolled out. the expansion happened january 1st. and the ability to purchase became in october. open enrollment will end in march. >> in the next time for enrollment will be? >> next october. >> the enrollment period for the first year was extended quite a bit due to issues

with roll out. next year it will be a smaller window unless something happens. >> have you heard any initial feedback regarding this new system in place since january from some of the consumers? >> yes, there has been a lot of feedback. this is a huge change. on the covered california side they are responding well to any problems. the provider directories, they have had to take those down and off line because they have been inaccurate. a lot of the providers they thought were online aren't there. there is a lot of issues with materials going out and notices getting mixed up. that's normal with a huge transition. on the medi-cal expansion. this program is really difficult to, we are trying to put something into preexisting world where there are all of

those legibility requirements. i think gloria can talk to you about it a lot is putting the systems that we have already in place in california has been a challenge and keeping them in the rules no response place is a challenge. it's an on going process. a lot of that is happening behind-the-scenes. a lot of the consumers are not seeing that yet. but there are a lot of things too that aren't happening yet. >> do you have any follow up questions regarding your center? >> we actually don't provide direct service, but we do like to collect problems that people are seeing. thigh that -- i think that would be a good thing to do. the national program on help and the western center on law and poverty have been involved in the creation and mrelgs -- implementation of the program

covered california. >> any other questions? i just have one, you were discussing one with medi-cal program with higher allowances. can you spill those out a little bit more. say if someone is on expanded medi-cal and they go, they become 65 and they have to live by a more strict requirement to receive medi-cal. are we talking loss of home, are we talking, do they have to spend down everything in their savings? >> well, kind of. it depends. the very first thing that is different in expanded medi-cal is how income is counted. instead of using, the way that medi-cal income is counted under the traditional program is pretty complicated. there are a lot of -- the way the income in the household is counted. the different exceptions and deductions for income is a complicated process. when the affordable

care act was created they said we are going to make income count a lot easy eefrment -- easier. they are going to take a modified growth to tax. they would use the income and that was it. it used to be easy. the national health program put out over a 60 page book on that. it's not as easy as it seems. but it certainly is easier than the traditional medi-cal. yes, it's going to take counseling individuals who are transitioning to understand how their income will now be counted. with their resource and assets, we call it a cliff because you go from not having any assets and resource limit to having an asset and resource limit of

$2,000. there are certain things excluded like you can have one vehicle. the fact that you can only have $2,000 sitting in your bank account is a huge cliff when you didn't have that asset or resource. they will they would have to spend down in order to become eligible for traditional medi-cal. >> someone unlucky to be born maybe she's 6 4 this year has to learn two systems? >> yeah. exactly. it's very unfortunate. they will be transitioning so quickly and not able to take advantage of the new program for very long. >> any comments or questions from staff. >> we'll take public comment after our next speaker has spoken. thank you. ms. martinez? hi.

>> good afternoon. i just want to say two things before i start. i'm filling in for somebody who normally comes and unfortunately i do not have lots of number information for you all today. i want to apologize about that. i have some speaking points from the woman who normally comes. thank you. the first point i want to talk to is the fact that here in san francisco county we had over 43,000 medi-cal enrollment through january of this year and this includes those who transitioned from the low income program. these 30,000 applications that we've had

have been both for the expansion and for traditional medi-cal. and these are applications coming from all channels. mail in, walk in. online, quick transfer calls from covered california and even folks applying for coverage through the covered california website. in addition to these numbers the agency has helped enrolled 16,000 people into covered california these are numbers through end of december. then a reminder, just as amber mentioned, open enrollment for covered california ends march 31st. there is no open enrollment period for medi-cal. you can enroll year around. the reminder for

adults 19-64 including those with disabilities, a lot is repetitive from what amber went over. a reminder for adult 19-64 including those with disabilities who have their modified adjusted growth income at or below 138 percent of the federal poverty line would qualify for the new medi-cal expansion and the adults exceeding this threshold as well as seniors who do not qualify for the aca rules would to have apply for traditional medi-cal. this is very similar to the asset and resource requirement for the ssi program. accountable income is counted a lot differently under traditional medi-cal. and also i want to make a note that the applications for traditional

medi-cal have also increased since this year, since january. since a ca implementation. again, something else that amber has already mentioned. adults aging out of the expansion, going from 64-65, they are not automatically transitioned. we don't have enough information to do that because of those asset and resource requirements. they need to apply for medi-cal based on those traditional rules. and hsa is working in putting a process in place that would allow us to notify somebody 2-3 months in advance so they will know they are aging out and they can make the effort to get us the information we need so the transition can be seamless and hopefully automatic to some degree. again, there is specific considerations that an

individual has to make potential tax implications from one rule to the other because there's no property tax under the expansion. one last thing i have is hsa is in the process of renovating lobbying at the food stamp office on mission street the beginning of the summer. the public will begin soon to see new disability accommodation republican variations based -- renovations based on this council. >> thank you, it all does bare worth repeating. it's very complicated and confusing for a lot of folks. any questions for ms. martinez from the council? any from staff?

>> carla johnson. a quick clarification about the renovation on mission. i think the input for disability is more from staff of the mayor's office. one of the things we do from the access program is we do field inspections from all facilities to make sure they are fully ada compliant. this is one of our projects. we are proud to be a partner with you there. >> great. >> all right. i will ask for any public comment on this topic? >> thank you. james cansini with seniors and disability action. the issues coming

forward is really big. two things i want to acknowledge, not to say everything is great in san francisco because there is obviously problems but we are ahead of the game in comparison to other counties. one of the things is prior to becoming 65. they are going to notify them in advance. that's pretty important. i wanted to acknowledge that's a success. it's a positive step in the right direction and also at the statewide level something that is kind of really big. when i first found out about it, i thought wait, am i the only one that thinks it's a big thing? no. it is a big thing but that means you can get ihhs without becoming totally broke down to $2,000. that's big. i have