Healthy Families, Seniors Initiatives Questioned

In the governor’s May budget revision released this week, in addition to $2.5 billion in new cuts to health care in California, there were a couple of proposals that raised big red flags for many health care advocates.

In particular, two budget items took a lot of heat: the effort to move about 1 million dual-eligible Californians into managed care programs; and the state’s plan to move 870,000 children out of the Healthy Families program and into Medi-Cal care.

In both cases, advocates said the state is taking on way too much, too quickly — putting the two most vulnerable populations in California at real risk.

Kristen Golden Testa, health director of The Children’s Partnership, said her organization and others like it have tried to take an open-minded approach to the Healthy Families conversion, since everyone knows the state is in a severe financial crunch. In the most recent budget, she said, the state proposes to push almost a million kids into Medi-Cal over the period of a single year.

“Elimination of an entire program that has been a success in covering children, that is disappointing,” Testa said. “It will not only jeopardize access for all of these children, but also for the children already in Medi-Cal who won’t be able to get access, either.”

Currently, there are about 3.5 million children who are Medi-Cal beneficiaries, Testa said. Because California has some of the lowest Medicaid reimbursement rates in the nation, some of those children already have a hard time finding a health provider who can afford to see them. Add in another million children to the pool, she said, and expect an access problem.

When the proposal showed up in Gov. Jerry Brown’s January version of the budget, Testa and other advocates asked the state to consider a more phased-in approach suggested by an Urban Institute study — with about 200,000 children converted in the first year.

“We just don’t think it’s worth taking the risk,” Testa said. “We were a little disappointed after he didn’t consider that [in the May revise]. It also creates savings for the state, but not at the same level, and without as much risk [to children’s health].”

Anthony Wright, executive director of Health Access California, had several objections to the budget proposal, but it was the duals project that stood out to him. The Coordinated Care Initiative will start shifting Californians eligible for both Medi-Cal and Medicare into Medi-Cal managed care in eight counties in the first year. That’s down from the 10 counties requested by the Department of Health Care Services, but it’s still processing roughly two-thirds of the duals in the first year. And that’s too much, too fast, Wright said.

“We have lots of questions with the timetable they’re on,” Wright said. “It’s a very aggressive timetable, and we think there could be significant impacts on actual care.”

According to Norman Williams, deputy director of the DHCS Office of Public Affairs, there has been enormous thought and energy committed to the duals transition, and the state has held a vast number of stakeholder events to get more input on it.

“We’re going to do this right, and very carefully,” Williams said. “Our top priority is, we want to minimize any disruption in coverage, so there’s no undue disruption.”

Williams said the state’s money crunch is a real pressure, but that the duals conversion is being done with improved patient care as the central motivator.

“The reason we’re moving at this pace,” he said, “is we think we can do it effectively. And on top of that [the state] needs the general fund savings, but that’s just one of the positives.”

Combining Medicare and Medicaid funding sources and all of their services into one program could really help the vulnerable elder population, Williams said.

“The Coordinated Care Initiative has a lot of promise for the population we serve in California. We’re treating the whole person with an umbrella approach, so you can have one point of contact that will help you navigate the system,” Williams said. “It can provide immediate benefit, once the conversion occurs.”