Same Providers in Healthy Families and Medi-Cal?

Yesterday’s distribution of a summary of new Healthy Families data by the state Department of Health Care Services caused some advocates to scratch their heads.

The state wants to move 875,000 children out of Healthy Families and into Medi-Cal in the next 16 months. It’s an idea that has been floated before, and has been vigorously opposed by providers, who would rather have the higher reimbursement of Healthy Families. California’s Medi-Cal reimbursement rates are among the lowest Medicaid rates in the nation.

The new data indicate most providers and health plans in the Healthy Families program also serve Medi-Cal beneficiaries.

DHCS director Toby Douglas said the health plans of the two programs “are all pretty much the same except for Blue Shield.” He said that the “provider networks are more and more the same,” as well.

The new data will probably be a key topic at today’s stakeholder meeting in Sacramento.

“That’s not something anecdotally we hear from provider groups,” Vanessa Cajina of the Western Center on Law and Poverty said. “We have heard other things.”

Cajina made it a point to say her group is fully supportive of the concept, and is more interested in monitoring the transition. “Medi-Cal has a wider scope of benefits than the Healthy Families program has. Those kids would have reduced cost-sharing. So should the transition happen in a smooth way, it would be a net positive, we think.”

The data itself has not been released, only the summary of that data. If it’s accurate that up to 91% of Healthy Families providers are also Medi-Cal providers, then Cajina said that might mark the beginning of a new perception of the transition.

“Last year, this was not a popular proposal among the provider community,” she said. “But now there might be a different reaction.”

In addition to today’s stakeholder meeting, the Healthy Families transition also will be taken up next Wednesday by MRMIB, the agency that currently oversees Healthy Families.