A Few Questions Linger as California Prepares To Eliminate MRMIB Programs

Legislators yesterday held open the budget item to eliminate the Managed Risk Medical Insurance Board. MRMIB is still scheduled for elimination July 1, but a number of concerns arose around the programs it administered.

From uncertain budget numbers to concerns about oversight for former MRMIB programs shifting to the Department of Health Care Services, enough questions arose to cause the Senate Budget and Fiscal Review Subcommittee on Health Human Services to leave the MRMIB budget elimination item open.

Although the fiscal details have yet to be determined, MRMIB’s days as a separate agency are numbered.

“Our mission has always been to get uninsured Californians coverage,” said John Ramey, MRMIB’s executive director. “With the expansion of the Medi-Cal program and creation of the Covered California exchange in California, from a broad perspective it’s easy to say how many of these kinds of programs do we need? That maybe we don’t need the smallest and most insignificant of them. So the time has come.”

Sen. Bill Monning (D-Carmel) pointed out that the original charge of MRMIB was to provide health insurance to high-risk Californians who couldn’t get coverage in the commercial arena, and that issue has become moot with the implementation of the Affordable Care Act.

“One of the reasons for this transition … is the ACA specifically prevents a plan from denying coverage for preexisting conditions,” Monning said. “That is primarily the reason for the timing of this transition.”

Sen. Ellen Corbett (D-San Leandro) wanted to know why the program was slated to get a full year of funding when it’s due to be eliminated in July.

“As part of the May [budget] revision, we will definitely be looking at MRMIB again,” said Toby Douglas, director of DHCS, “… to see what we do and new estimates and the future of the MRMIB program.”

Shawn Martin, managing principal analyst for Health and Human Services at the Legislative Analyst’s Office, said the LAO was not convinced of an urgent need for this transition.

“As we looked through the rationale for doing this,” Martin said, “we felt they made a case for doing it, but it wasn’t an especially compelling case.”

It is unclear that moving MRMIB to DHCS would maintain or improve effectiveness, or improve accountability, Martin said.

“We didn’t find that it would improve efficiency or effectiveness. It’s a lift-and-shift, where they take existing resources from MRMIB and move them over to DHCS,” he said. “And it is unlikely it would improve accountability, since MRMIB holds monthly meetings, and our understanding this would no longer occur. It’s unclear if the department would provide the same level of detail about the budget.”

Douglas maintained it was an important transition.

“In terms of effectiveness, there is value in bringing like programs together,” he said.

DHCS plans to change the name of the Access for Infants and Mothers program sparked some pushback.

“We do oppose the name change,” said Lynn Kersey, executive director of Maternal and Child Health Access in Los Angeles. “[AIM] is a comprehensive program, covering all of what women go through, not just pregnancy. We think it’s very different and distinctive and should remain that way.”

That sentiment was echoed by Shannon Smith-Crowley, legislative advocate for the American College of Obstetricians and Gynecologists of California.

“It’s got great name recognition for patients and providers, and for physicians,” Smith-Crowley said. “With all of the other changes in the health care arena, it would be nice to have this one recognizable successful program that everybody still recognizes, so we would support keeping the name as is.”

Douglas said it’s a case of simplifying processes. “While the program will stay pretty much the same,” he said, “the name will change to Medi-Cal so we don’t have all these small little programs that can be confusing.”

Sen. Corbett asked Douglas when the budget subcommittee might get some of these “important components” of the MRMIB elimination.

“In the next four to six weeks, we will get you more information on that,” Douglas said.  

“We’ll look forward to that and we’ll keep you to that,” Corbett said.

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