Advocates Raise Concerns Over Shift to Medi-Cal HMO Coverage
California's initiative to shift about 380,000 elderly residents and individuals with disabilities into Medi-Cal managed care plans has raised concerns among patient advocates who worry about its effects on continuity of care, the Sacramento Business Journal reports. Medi-Cal is California's Medicaid program.
The shift is part of the five-year, $10 billion Bridge to Reform program that aims to improve care, reduce costs and ease the transition to implementation of provisions of the federal health reform law in 2014.
Through May 2012, Californians in 16 counties are shifting from traditional fee-for-service Medi-Cal coverage to HMO plans. About 110,500 individuals statewide have transitioned thus far.
Medi-Cal beneficiaries who feel that the shift would compromise their quality of care can ask to remain in the fee-for-service option.
Advocates Raise Concerns
Anthony Wright, executive director at Health Access, expressed concern over "whether patients can continue with their primary care provider and specialists, or whether this information is being transferred."
Beneficiaries can keep their current physician for one year. However, some specialists might be in one plan's provider network but not in another.
According to the Business Journal, about 60% of patients who have enrolled in new health plans were assigned automatically or by default -- a trend that Wright says could suggest a lack of engagement in the transition.
Meanwhile, advocates for individuals with disabilities have warned that the transition could negatively affect access to programs and services.
Health Plans Respond
Health plan officials said the transition has been organized and positive.
Molina Healthcare has established a statewide disability collaborative to help with the transition, and new caregivers have been hired.
Lisa Rubino, president of Molina Healthcare, said that "we are going in the right direction" (Sacramento Business Journal, 10/28).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.