The state needs to be extremely careful with the children being phased out of the Healthy Families program because they’re in danger of losing access to care and services if that transition doesn’t go smoothly, according to a new issue brief from the Lucile Packard Foundation for Children’s Health, based in Palo Alto.
The issue brief follows on the heels of last week’s release of a study on the level of care and services provided to children with chronic illnesses, a study which ranked California near the bottom of the nation in several categories, including access to pediatric specialists.
The two issues — care of chronically ill children and implementation of the Healthy Families transition — are inextricably linked, said Edward Schor, senior vice president of programs and partnerships for the Packard Foundation.
“My concern is there won’t be much attention paid to these issues until they truly become problematic for the families, and enough noise is made that the state takes care of it [after damage is done],” Schor said. “Specialty services and behavioral health could be particularly impacted.”
Schor said the transition from Healthy Families to Medi-Cal managed care is not a bad shift, and offers California children benefits they would not have under the aegis of Healthy Families, such as access to the Early Periodic Screening, Diagnosis and Testing program.
“I think it’s a two-edged sword,” Schor said, “and we don’t know which edge is going to cut.”
The concern is not about the transition itself, Schor said, but about possible gaps in continuity of care that could be created by the shift.
“On the one hand, the benefit package will be increased, so that’s good,” Schor said. “On the other hand, the access to health care providers under Medicaid is likely to be more challenging, because the Medicaid reimbursement rate tends to be lower, and the Medi-Cal rate in California is about the lowest in the country.”
Schor said the real question is if the state knows that some children are at Â risk for continuity-of-care disruptions, “What is the state doing in anticipation of those transition problems, what safeguards have been put in place, what monitoring is going on to hear about problems?” Schor asked. “What is the Â state doing to anticipate them as well as just hearing them when they happen?”
Jane Ogle, deputy director for the Department of Health Care Services, said the state is doing plenty to anticipate problems with the transition — from daily check-ins with participating health plans to constant monitoring of the call center set up to specifically tackle questions and concerns from Healthy Families beneficiaries.
“The assessment of network adequacy was not only for primary care, but also for subspecialty care, and it was found to be sufficient in all of the networks they’ve found so far,” Ogle said.
Schor suggested it could be a good idea to set up one group whose responsibility is monitoring and investigating access issues, “like an Office of Continuity Maintenance,” Schor said.
“The state has said in their plan they’ll do monitoring,” Schor said. “In the past, the state has been reluctant to spend dollars on evaluation, so they tend to do in-house evaluation. It will be important that the state articulate clearly what their evaluation plan is, and what they’d do if they find problems in that evaluation.”
Schor and the Packard Foundation’s issue brief said rural areas are of particular concern, where access to care and services have always been an issue.
“Some of these kids live in areas of the state where they already have trouble accessing pediatric subspecialty care,” Schor said. “It’s very tenuous for them already. So how the change happens could be much more dramatic for these kids where you already have access problems.”