Expansion Hearing Highlights County-State Struggle
California health officials and legislators yesterday had a lively discussion over the two proposed choices for the optional Medi-Cal expansion.
At the onset, yesterday’s discussion in the Budget Subcommittee on Health and Human Services centered on the Brown Administration’s choices for a state-based or county-based approach to implementing expansion of Medi-Cal to adults up to 138% of federal poverty level, which is expected to open eligibility to as many as 1.4 million Californians.
But the meat of the conversation evolved into something else. Since counties have pretty firmly asserted they’re in favor of the state-based plan, and state officials have not stated a preference for either option, choosing one approach over another was not really the main issue during yesterday’s hearing.
Appropriations Approves Medi-Cal Expansion
The state Senate Committee on Appropriations endorsed a bill expanding Medi-Cal eligibility to 1.4 million Californians and to simplify the enrollment process for all Medi-Cal beneficiaries.
The special session approval Monday means SBX1-1 by Sen. Ed Hernandez (D-West Covina) is headed to the Senate floor as soon as the end of this week. The Assembly version of the legislation — ABX1-1 by John Pérez (D-Los Angeles) — won committee approval last week is pending a floor vote now.
“This is very important because we want to make sure we get as many individuals with coverage so they don’t utilize the system the way they utilize it now — which is, those who don’t have insurance would go to the emergency rooms,” Hernandez said.
Oversight Hearing on CBAS Transition Generates Sparks
A legislative oversight hearing last week on the transition of about 37,000 frail and elderly enrollees from the Adult Day Health Care program, which was eliminated by the state, into the Community Based Adult Services managed care program was marked by skepticism and criticism.
One year after the settlement of a lawsuit led to the creation of the CBAS program, legislators and advocates for the elderly questioned the state’s handling of the transition at a hearing of the Assembly Budget Subcommittee on Health and Human Services.
Department of Health Care Services Director Toby Douglas testified that 80% of the ADHC enrollees were found eligible for CBAS. Douglas’ statement that “about 80% of the class members from the settlement transitioned” into the CBAS program elicited skepticism at the hearing and questions about the department’s math.
Notice, Grace Period at Issue in Rescission Rules
California Insurance Commissioner Dave Jones filed a cross-appeal in the ongoing fight over how to implement California’s 2010 passage of AB 2470, authored by then-Assembly member Hector De La Torre (D-South Gate). The bill, approved by Gov. Arnold Schwarzenegger, banned rescission of consumers’ health coverage except in cases of non-payment or fraud.
The rules laid out by Commissioner Jones spelling out how insurers needed to comply with the law were challenged in court by the Association of Life & Health Insurance Companies in 2011. This year, on Feb. 1, the association filed an appeal of a decision by Sacramento Superior Court judge Michael Kenny, and on Feb. 25, the Commissioner announced his department filed a cross-appeal on two different aspects of the ruling.
Jones is appealing the judge’s decision to narrow the scope of the noticing requirement. Jones also is asking for a more-defined grace period before insurers can rescind coverage based on non-payment.
Geographic Regions Set at Six, But Only for Now
Floor votes in the Assembly and Senate yesterday approved the first bills of the special session on health care. The bills would eliminate pre-existing conditions as a means for denying health insurance coverage. They also would establish new geographic rating regions to help determine variable rates by area in California, one provision in the bills that recently has become contentious.
The Assembly passed ABX1-2 by Assembly member Richard Pan (D-Sacramento) on a 53-25 vote. The Senate passed its version of the bill, SBX1-2 by Ed Hernandez (D-West Covina), where the vote was 26-10-1.
Most of the objections raised yesterday on the Senate and Assembly floors to the two bills came from Republicans who oppose the Affordable Care Act. No one raised objections to the number of geographic rating regions, but that’s one detail in both bills that’s still wide open to change.
Uncertain Assumptions in Health Care Budget Estimate, LAO Says
Two reports released yesterday by the Legislative Analyst’s Office analyzing Gov. Jerry Brown’s proposed health care budget for 2013-14 found a number of points of concern, according to Mark Newton, deputy legislative analyst at the LAO.
“What we wanted to do is lay out that there are some budget risks here,” Newton said. Many of those risks, he said, should still be in the budget, but they remain important fiscal unknowns, rather than dependable income sources.
“[Some of this] is not meant so much to be a critique, but more a recognition of budget uncertainty,” Newton said.
Bridge Plan Approved by Exchange Board
California’s Health Benefit Exchange board yesterday approved a plan to seamlessly allow low-income Medi-Cal managed care beneficiaries to choose a health plan offered by the exchange, now known as Covered California.
The idea is to allow movement between Medi-Cal and Covered California when beneficiaries’ circumstances change, so more people can stay insured without disruption. The exchange plans to launch the program in April 2014.
Up to 840,000 Californians could be eligible for it, according to David Panush, director of government relations for Covered California.
Rating Regions Headed for Floor Debate
The debate over geographic rating regions has not ended, despite being approved by the Assembly and Senate health committees last week and by the Senate Committee on Appropriations on Friday.
Competing interests want to change it — in different ways.
At the appropriations committee meeting Friday, two groups took oppose-unless-amended positions on the six-region legislation, but were not in agreement on how to divide the geographic rating regions in California.
Officials Dispute Suggestion of ‘Wrong’ Estimate
Managed Risk Medical Insurance Board officials last week bristled at the suggestion that MRMIB somehow made a bad estimate of its budget that resulted in a $116 million general fund shortfall in the Healthy Families program. With an additional $216 million in federal money that hasn’t come to California because of the shortfall, the total deficit now amounts to $332 million, according to MRMIB executive director Janette Casillas.
Casillas, at a MRMIB board meeting last week, responded to state officials’ comments that the shortfall stemmed from a mistaken estimate for how much money would be needed for the Healthy Families program in 2013.
“Our forecasting and budget assumptions have been right on every time,” Casillas told the board. “But what has occurred here is not a challenge with budgeting or forecasting, but with the budget process itself. We know what we need, it’s not about making wrong assumptions.”
Historic Week in Health Care Reform
California has been working on health care reform for years, but this week’s legislative special session had that distinctive sound of a starting gun for the last, big dash toward the Affordable Care Act finish line.
On Tuesday, when Assembly Committee on Health chair Richard Pan (D-Sacramento) convened the opening hearing for the special session on health care, it clearly meant a lot to him.
“Welcome to the first extraordinary session of 2013,” Pan said. “As you know, California has been the first in the nation to establish a health benefit exchange under the Affordable Care Act. … We are bringing California in line with the new culture of care.”