Groups Calling for Pause in Transition

Children’s advocates last week called for a pause in the transition of kids from the Healthy Families program to Medi-Cal managed care. At a legislative hearing Thursday, advocates said the state had promised a relatively seamless transition of 860,000 children to managed care, but that gaps in coverage have already occurred — with the more-difficult phases of the transition yet to come.

The outcry was prompted, in part, when the families of an estimated 207 children who were receiving autism services through the Healthy Families program recently were told their coverage had to be stopped because of the state’s Healthy Families transition.

“From the beginning, we’ve heard assurances that there would be no loss in coverage for children, but we’re seeing it now,” said Serena Kirk, senior policy associate at Children’s Defense Fund California. She said the state’s monitoring effort isn’t working as well as it should be because it didn’t deal with the problems of these 200 families until they’d already been refused services.

“This was not detected by monitoring efforts. What all these families have in common is these people were told literally days before their coverage stopped that they could not get these services. And they were told by their providers, not the state or the health plans,” Kirk said. “We believe no children should be additionally transitioned until this issue is taken care of.”

That sentiment was echoed by a number of children’s advocates at the hearing.  

“We urge a suspension of the transition of any kids until this problem is fully solved,” said Kelly Hardy, director of health policy for Children Now. “We believe this is indicative of a larger problem. There’s a lot of paper monitoring and reporting, but kids still have lost services. Parents called health lines, and kids still lost services.”

About 600,000 children have made the transition to Medi-Cal managed care so far. The state has spent a lot of time and energy to make sure this transition goes smoothly, according to said Rene Mollow, deputy director of benefits and eligibility at the Department of Health Care Services.

“We’ve undertaken network adequacy reports and to the extent concerns have been raised we have been making changes,” Mollow said at the hearing. “We’re making sure we ensure the successful transition of these children.”

Sen. Bill Monning (D-Carmel) said the number of transitions to managed care at DHCS — Healthy Families, seniors and persons with disabilities, rural areas and the duals demonstration project — has lawmakers concerned about continuity of care.

“With so many of these shifts,” Monning said, “these are issues of paramount importance to us.”

Beth Capell, legislative advocate for Health Access California, said the concern over 207 children is magnified by the knowledge that the next phases of the transition are expected to be more complicated.

“We suspect this is the tip of the iceberg,” Capell said. “For Phase 3 and Phase 4, … we have fear that we’re going to see a repeat of the problems we saw in the seniors and persons with disabilities transition. I’m sure the department doesn’t want to see that, but we fear we’re setting ourselves up for that kind of situation.”