Medi-Cal Waiver Gets Senate Committee Approval After Unusual Third Tier of Testimony

You know you’re in murky legislative territory when the format of a health committee meeting has to be changed to accommodate the complicated nature of the proposed bill.

In this case, it was AB 342 by John Perez (D-Los Angeles), which the Senate Health Committee eventually approved at its hearing last week. It is the companion Medi-Cal waiver bill to SB 208, which recently passed the Assembly Health Committee.

Usually, committees hear pro and con testimony, but for AB 342, Senate committee chair Elaine Alquist (D-Santa Clara) made a third category. “It’s a hybrid category just for this one bill,” Alquist said. “For those who are neither opposed nor support, but have concerns.”

The renewal of the Medi-Cal waiver between California and the federal government is a complicated issue and the still-undefined details of national health care reform add another layer of “what-ifs” to the complex topic.

The current Medi-Cal waiver ends Aug. 31. When you combine the large amount of federal Medicaid money coming to California with the equally large number of details still to be worked out, you get an interesting dynamic — even the bill’s supporters have outstanding concerns, and even the bill’s detractors see the need for the legislation to proceed.

Toby Douglas, chief deputy director of California’s Department of Health Care Services: “The (Schwarzenegger) administration strongly supports this legislation. We’ve been working for the last year on these proposals.”

The new five-year waiver would expand the number of childless adults covered in the Medi-Cal program, as well as the number of those who fall between 133% and 200% of poverty level. It establishes mandatory managed care for seniors and people with disabilities. It uses more federal dollars for the state’s safety net system, including infrastructure improvements. And it has some new provisions for the state’s “dual eligibles” — those seniors who qualify for both Medi-Cal and Medicare — to better integrate their health care.

“It’s very complicated,” health care expert Peter Harbage of Harbage Consulting said. “What’s clear about the waiver is that it’s an opportunity to bring greater federal support to California, as well as flexibility around the rules that control Medicaid.”

Harbage, who wrote an analysis of the 2005 waiver for the California HealthCare Foundation and has been working for labor union SEIU on the current version, says there’s a big difference between now and the last time California had to negotiate the federal waiver five years ago.

“The 2005 waiver was basically a way for federal government to limit its financial liability. This waiver is being seen more as an opportunity to get it right, to strengthen the safety net.”

Terri Thomas, a representative of the California Association of Public Hospitals and Health Systems, a proponent of the bill, summed up the promise and provisos of the legislation nicely: “This provides a framework for enrolling seniors and the disabled, for enrolling the uninsured,” she said. “It contains placeholder language, and there are a number of issues that remain for public hospitals in the counties, but we think it’s been a good working effort. There are holes here, but we don’t want to see progress impeded in any way.”

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