MEDI-CAL/HEALTHY FAMILIES: Study Advises Against Lifting HMO Direct Marketing Ban

      While a bill under consideration in the Senate Health Committee would relax rules prohibiting HMOs from recruiting and marketing to low-income families, a study from the Health Consumer Alliance warns that such a change could "lead to increased fraud," the AP/San Jose Mercury News reports. The bill, which the Assembly already has approved, aims to increase Healthy Families and Medi-Cal enrollments by altering a 1996 law that banned HMOs from directly marketing to Medi-Cal or Healthy Families customers. Now, independent brokers assist enrollees in selecting their health plans, but cannot answer questions or fill out paperwork for clients. The bill would allow health plans to advise customers about available options under three conditions: if a child was switching from Medi-Cal to Healthy Families, if the child was a recent health plan customer or if the child's family had a relationship with the health plan. Stan Dorn, author of the study, titled "HMO Marketing to Children: Important Questions, Risky Answers," said of the proposed change, "We're fearful that health plan sales staff will go 'mano a mano' with low-income parents and engage in deceptive and coercive sales techniques, shifting parents and children away from current plans to inappropriate plans" (Coleman, 6/9). Dorn has suggested that making the application process and retention easier would help enroll more children. Lucy Quacinella, a National Center for Youth Law attorney, added that health plans "would not just be saying, 'Here's the Healthy Families program.' They'd also be saying, 'Pick me, pick me, pick me.' And why are they doing this? They're doing this because they want to clinch the deal." But John Grgurina, chief deputy director of the Managed Risk Medical Insurance Board that oversees Healthy Families, said that lifting parts of the ban would help insure more children, adding that the "bottom line is that there are still a lot of kids out there who are eligible but not enrolled." Michael Chee, a spokesperson for Blue Cross of California, agreed, saying that the insurer has the "experience, ... knowledge and ... track record for getting people signed up with health insurance" (Fisher, Sacramento Bee, 6/9).

Try It, You'll Like It
      The bill is "an experiment worth trying," an editorial in the Fresno Bee argues. The 250,000 children enrolled is "a start, but not enough," the editorial asserts, noting that the "one useful way" to enroll more children currently is forbidden. The "carefully crafted" bill under review would lift that barrier, while at the same time safeguarding clients from "worrisome door-to-door recruitment pitches" (Fresno Bee, 6/9).