CALIFORNIA: TO SET UP PILOT PROJECT FOR CHILDREN
California HMOs and providers are preparing to designThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
"capitated pilot programs for treating seriously ill children
under Medicaid." MODERN HEALTHCARE reports that California law
"mandates that managed care pilots must test how best to treat"
the children. According to Susan Maddox, president and CEO of
the Children's Hospital Association, California "has already
turned down one pilot that would have cared for most of the
140,000 seriously ill Medi-Cal children through a consortium of
children's hospitals, university hospitals and key providers."
Until the results of the pilot project have been studied,
chronically ill children in the state "will continue to be seen
by the special providers that have been caring for them under the
California Children's Services Program (CCS)." However, they
will receive their primary care from a managed care plan.
PILOTS PLEASE: The California Department of Health Services
is expected to issue an RFP for the three-year pilot programs by
mid-year. According to Dr. Marydee Gregory, chief of children's
medical services at the state health department, the "state will
approve only a handful of pilots." She said that the "major
benefit" of the programs is expected to be improved coordination
and accessibility of special-needs care. Edwin Benjamins,
director of utilization and case management at L.A. Care, said
that he believes managed care will "improve access to care for
more children with serious illnesses." He said, "The process of
educating the providers and the HMOs is going to help identify
more of those children" (Kertesz, 2/17 issue).