Assembly member Holly Mitchell (D-Los Angeles) had a good-natured but pointed story to tell at a recent hearing she chaired of the Assembly Budget Subcommittee on Health and Human Services.
Her anecdote was directed toward Toby Douglas, director of the Department of Health Care Services, regarding one of the major transitions the department is charged with making.
“I told the director that every two years, I have a performance appraisal,” Mitchell said. “And that’s called Election Day. Where everyone in my district … can determine whether or not I should come back. And so I asked the director, who could we hold accountable in the department.”
Mitchell swept her hand toward Douglas. “And he very proudly said, he was,” she said. “So we know who to call.”
Douglas has been at the center of many large-scale changes over the past few years in the state’s health care system. At an Assembly hearing last week, he updated legislators on several projects and explained what his department hopes to accomplish in the near future.
“What we’re guided by is making sure we’re improving the overall outcomes, the overall experience, as well as reducing costs,” Douglas said. “Our mission is to improve the health of all Californians.”
Department Oversees Coverage for 10 Million People
California is moving many people receiving subsidized health insurance coverage into Medi-Cal managed care plans. That includes about 380,000 seniors and persons with disabilities; roughly 860,000 children in the Healthy Families program; and about one million “dually eligible” seniors through the upcoming Coordinated Care Initiative.
Those high-profile transitions are only part of the tasks and territory covered by DHCS. Â
“Our biggest focus is the Medi-Cal program, which we project to serve about 8.3 million Californians in the budget year,” Douglas said. “We have taken on additional responsibilities for community mental health, substance abuse, family planning, as well as cancer screening services and prostate cancer.”
Those additional services recently shifted to DHCS serve about 1.8 million Californians, Douglas said. Approximately 500,000 people now have been signed up for the Low Income Health Plan, which is an early Medi-Cal expansion effort.
“So when you add it up, 8.3 and 1.8 and 500,000,” Douglas said, “you get a department serving over 10 million Californians through the Department of Health Care Services.”
To put that in perspective, the total population in California is about 38 million, meaning that more than one-fourth of California’s population receives some kind of benefit from one overarching department.
“We both deliver care directly, and we purchase care through our managed care plans, providing primary care, specialty care, outpatient and inpatient services, as well as long-term services and supports,” Douglas said. “We also have other important programs with the Department of Health Care Services, including the Genetically Handicapped Persons program, the California Children’s Services program, the newborn hearing screening program, all of which provide specialized care for vulnerable populations.”
Woven into all these responsibilities is implementation of the Affordable Care Act, including the mandatory and optional expansions of Medi-Cal, several major information technology projects, delivery system reconfigurations, new payment designations and the reworking and coordination of rural and Indian health programs across the state.
“There are a lot of changes still going on within the department,” Douglas said, referring to absorption of formerly separate departments into DHCS, including mental health, alcohol and substance abuse. “We believe we can do it in a way that strengthens them within our department.”
Overall, Douglas said, there is a lot of change, and change is hard.
“With any transition,” Douglas said, “they’re not easy, and they take a lot of work, making sure the consumers we serve continue to receive services.”
‘The Plate Is Already So Full’
The department has taken on so much that many health advocates and lawmakers have openly wondered if Douglas and the DHCS have bitten off too much.
“The plate is already so full,” Mitchell said, “I’m leery of their ability to follow through on everything.”
Douglas has repeatedly said the department will take whatever time is needed to make all of the transitions work. For example, the first phase of the Healthy Families transition was divided into three parts, so the state could implement it over the first four months of the year.
The biggest transition, the duals demonstration project (part of the Coordinated Care Initiative), has been undertaken with careful incorporation of stakeholder input, Douglas said, and the transition won’t occur until it’s ready.
“We’re not moving forward till monitoring is in place and our plans are ready,” Douglas said. “We are committed to providing transparency, and there are many ways we are providing quality assurance and oversight.”