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Children’s Services May Get Extra Year Before Move to Managed Care Starts

The state Senate Committee on Health this week approved a bill to delay the move to managed care for California Children’s Services, a program for Medi-Cal children with rare and complicated diseases.

AB 187, by Assembly member Rob Bonta (D-Oakland), would put off the state’s planned shift of children in the CCS program for a year, till January 2017.

“As you know, CCS is a vital program that our most medically vulnerable children with diseases such as hemophilia, congenital heart disease and cerebral palsy,” Bonta said. “The current CCS program is expiring in January 2016, this bill extends the CCS carve-out for one year.”

Erin Kelly, executive director of the Children’s Specialty Care Coalition, said the plan released in June by the Department of Health Care Services to move roughly one-third of CCS children in 19 counties by July 2017 into managed care is too ambitious and could harm the fragile, high-needs population in the program.

“The timeline is rapid,” Kelly said. “The coalition, along with other stakeholders, have significant concerns about the department’s proposal in its current form, and feel the department’s rush to pass this proposal during this legislative session could potentially have unintended consequences to the health and well-being of children enrolled.”

Pip Marks, manager of Family Voices of California, a statewide collaborative of parent-run children’s centers, based in San Francisco, said DHCS has done a good job involving stakeholders, and she particularly likes the new “whole child” approach the state is taking.

“Our primary concern is access to care. One of the most important components of CCS is that our children … have timely access to specialty care,” Marks said. “Children with very special health care needs … must be seen and cared for by providers and facilities who understand their unique conditions.”

The big concern of going to Medi-Cal managed care, Marks said, is that the networks wouldn’t include some of the needed subspecialty providers and therapists for rare and specialized diseases.

“Commercial managed care health plans have a reputation of inadequate provider networks,” Marks said. “There is a concern that children with serious CCS medical conditions may not get the access to the appropriate services.”

Committee Chair Sen. Ed Hernandez (D-West Covina) said he’s not too concerned about passage of the CCS extension by the Legislature — but that doesn’t mean the bill would become law, he said.

“My concern is potentially getting a veto of the extension,” Hernandez said.

“I think it’s important that the Legislature be part of that conversation, along with the stakeholders,” he said. “What I don’t want to see is us to go down the road we did with Healthy Families, that we did with the duals, that we’ve done with Medi-Cal. I want to make sure this segment of the population is protected.”

The health committee approved the bill 8-0. It now heads to the state Senate Committee on Appropriations.

Related Topics

Capitol Desk Medi-Cal