Insuring a Better Future for the State?

State officials and health care experts yesterday said the governor’s decision to sign on to optional expansion of Medi-Cal could be a huge step forward for California’s health system — and a huge challenge, as well, they said.

More than 700 stakeholders gathered in downtown Sacramento for the  annual conference of the Insure the Uninsured Project heard dozens of experts evaluate how far California has come in implementing health care reform, and how far it still has to go.

Adding roughly 1.4 million Californians to Medi-Cal eligibility in the optional expansion (adding adults up to 138% of federal poverty level) may be fully funded by the federal government for the first three years, but it also brings a boatload of work to the state. It’s worth the extra effort for the sake of beneficiaries and for the savings the state stands to make in reduced hospital and emergency department costs, said Diana Dooley, state Secretary of Health and Human Services.

“This is a particularly important moment in health care reform in California,” Dooley said. “We have tried to frame the [new optional] expansion in terms of its important structural change between the counties and the state.”

The successful implementation of the Low Income Health Plan in most California counties has helped lead to consideration of two options of optional expansion, Dooley said.

“One would be expansion of the LIHPs to build on the work already invested in the counties. The other option is to add the newly eligible to existing eligibles in a state-run program,” Dooley said.

That decision is wide open, according to Dooley. She said the hundreds of stakeholders at yesterday’s conference could exert influence over that discussion in the coming months. “We have to discuss the structural opportunities that these represent, and the fundamental realignment this will require,” Dooley said. “We still need to determine which path makes the most sense for the people enrolled in it.”

Cindy Mann, CMS deputy administrator, said other states are watching what California is doing in many areas — creation of the exchange, development of its waiver, work on the Coordinated Care Initiative as well as navigating the optional expansion.

“It is groundbreaking, what you’re doing here by taking charge to shape your health care marketplace for Californians,” Mann said. The goal of Medi-Cal expansion and establishing the exchange, she said, “is not to simply have more people [covered]. It is to deliver better health care, the highest level of care, and at a lower cost. It is a gateway to better care and lower costs.”

Mann said one of the bigger developments — creation of a single, streamlined application form for all health care services that can be filled out by phone, online or in person — has now been released.  “It’s online, the paper application draft and online application draft,” Mann said. “The questionnaire is available to look at now, and there will be a 30-day comment period before it’s finalized.”

Toby Douglas, director of the Department of Health Care Services, rolled out a long list of the health care reforms his department is involved in including the Coordinated Care Initiative, the LIHP program, the conversion of seniors and persons with disabilities to Medi-Cal managed care, conversion of the Healthy Families program to Medi-Cal, managed care expansion to rural counties, eligibility reform, meaningful use of electronic health records and telehealth.

“For just one example, what’s going on with payment reform,” Douglas said. “We’ve been moving to [a system of] bundled payments to hospitals, that should increase transparency and lower costs. And that’s just one example of what we’re doing on the payment front.”

The LIHP project was a particular point of pride for Douglas, who said enrollment has exceeded his most optimistic expectations.

“This is not just about Medi-Cal, but how it interacts with the larger health care delivery system. There is still a lot to do,” Douglas said.