Schwarzenegger Plan To Move Elderly, Disabled Medi-Cal Beneficiaries to HMOs Examined
The Sacramento Bee on Monday examined how Gov. Arnold Schwarzenegger's (R) proposal to redesign Medi-Cal could affect elderly and disabled beneficiaries, who would be required to switch from fee-for-service coverage to managed care plans (Benson, Sacramento Bee, 2/14).
Schwarzenegger's Medi-Cal reform plan, which was announced in January, would institute managed care in 13 counties that do not have it and move 550,000 more elderly and disabled beneficiaries in 27 counties from fee-for-service Medi-Cal into HMO coverage. About half of Medi-Cal beneficiaries currently receive coverage through managed care plans.
Schwarzenegger estimated that increased enrollment of Medi-Cal beneficiaries in managed care plans would in the long term save the state $136.6 million. The plan would be implemented in 2007 (California Healthline, 1/11). According to Schwarzenegger, the move would save the state $12.7 million over the next five years.
Eight counties currently require all Medi-Cal beneficiaries to enroll in HMO plans, but most counties allow elderly or disabled patients to continue seeing their usual doctors under traditional Medi-Cal coverage. According to the Bee, the shift is "a key part of the governor's proposal" because the affected beneficiaries account for two-thirds of the program's costs but only comprise about 25% of its enrollment.
According to the Bee, the "only real precedents" for the governor's proposal are five county-run HMOs, including Partnership HealthPlan, which serves all Medi-Cal beneficiaries in Solano, Napa and Yolo counties.
Chris Cammisa, medical director of Partnership, said, "There are huge opportunities [through HMO coverage] to improve the care of patients with chronic disease."
Schwarzenegger's plan would allow beneficiaries to sign up for commercial coverage or public plans, such as Partnership.
Kim Belshe, secretary of the Health and Human Services Agency, said, "The administration views managed health care as being a superior delivery system. A managed health plan gives an emphasis on prevention and early intervention."
The planned move "worries disability rights advocates, who say the change could disrupt care that people with severe medical needs are receiving," the Bee reports.
Deborah Doctor of the not-for-profit Protection and Advocacy group said, "To this day, there are significant problems people with disabilities have in getting medical care because of noncompliance with disability access laws," adding, "What is the assurance that the managed care providers will have all the medical services and accommodations in place?"
Sen. Denise Moreno Ducheny (D-Chula Vista), who on Thursday will preside over a meeting on the governor's redesign proposal, said, "I don't think I have a major objection [to] the idea that you might be able to include more people in managed care." She added, "The big question is, will some of these rural counties they're proposing to expand into have the doctors and plans to make it realistic?" (Sacramento Bee, 2/14).
Additional information on Schwarzenegger's Medi-Cal redesign plan is available online.