Latest California Healthline Stories
Assembly Takes Up Health Care ‘Loophole’
The Assembly this week is expected to debate a bill that would penalize large employers who reduce workers’ hours or wages in an attempt to move those employees off company-sponsored health care and into Medi-Cal coverage.
“We want to close that loophole that allows some of the largest and most profitable businesses in California to skirt their responsibility under the Affordable Care Act,” said Assembly member Jimmy Gomez (D-Los Angeles), author of AB 880.
Some large employers, he said, want to lower wages or hours of employees so those workers would earn a low-enough wage to become eligible for Medi-Cal, “dumping them onto the backs of the taxpayers,” Gomez said.
Health Insurers Owed $271 Million
State officials this week said the Healthy Families program owes $271 million in services already provided by its network of 20 health care insurers and the program needs legislative help to fix the problem.
Healthy Families’ overall shortfall is projected to be $366 million for the year, a deficit caused by expiration of the managed care organization tax in December. Last week, the Senate budget subcommittee on Health and Human Services delayed a vote on the MCO tax.
“The Legislature failed to extend the MCO tax, therefore MRMIB did not have sufficient cash to pay for the Healthy Families program invoices,” said Tony Lee, deputy director for administration at the Managed Risk Medical Insurance Board, which oversees the Healthy Families program. Lee spoke Wednesday at the monthly MRMIB board meeting.
Plan Proposed to Cover Autistic Children
A Senate subcommittee last week proposed a $50 million solution to temporarily address the lack of coverage of a type of autism treatment under Medi-Cal — a gap in care that recently affected hundreds of Healthy Families children when the state moved them to Medi-Cal managed care plans.
The new proposal would appropriate $50 million to make sure Medi-Cal children with autism are able to receive applied behavioral analysis treatment — known as ABA therapy — through the end of 2013. The assumption is that ABA therapy will be available as an essential health benefit under the Affordable Care Act starting in 2014.
“Clearly this item is to bridge a gap of service,” said Sen. Bill Monning (D-Monterey), chair of the Senate Budget Subcommittee on Health and Human Services, at a hearing last week.
School Nurses Case to Supreme Court
The California Supreme Court today will hear oral arguments about the safety and well-being of schoolchildren with diabetes. The case centers on school nurses, but nursing leaders say it could set precedent for the practice of nursing in California.
Cash-strapped school districts across the state have laid off school nurses, creating a dilemma for diabetic children who need insulin shots during school hours.
The state has argued that non-medical personnel can administer the shots. State officials say requiring nurses to do the job endangers children’s ready access to insulin injections and puts their health at risk.
Federal Court Upholds 10% Medi-Cal Provider Cut
The United States Ninth Circuit Court of Appeals on Friday upheld the right of California to impose a 10% rate reduction on providers of Medi-Cal services.
The long-awaited ruling is the last judicial step, short of the U.S. Supreme Court, for the controversial cut to hospitals, physicians, emergency transport and dentists. Provider groups have said they would likely appeal the rate reduction to the Supreme Court.
The federal ruling lifted the injunctions on implementing the reductions. Outside of a Supreme Court appeal, the federal judicial panel clearly stated there would be no further appeals considered.
Exchange Rates Make ‘Great Day For California’
Covered California, the state’s health benefit exchange, yesterday announced a rate structure for its health insurance plans that came in at a much more affordable price than first projected.
That was great news for exchange officials and it accounted for much of the pomp around that rare circumstance during yesterday’s announcement.
“This is really a great day for California,” said Diana Dooley, secretary of the state’s Health and Human Services agency and chair of the Covered California board. “We have come a long way and we have a long way to go,” she said. “We are moving to make Californians healthier and give them the financial security they need.”
Task Force To Examine Developmental Centers
Diana Dooley, secretary of the state’s Health and Human Services agency, yesterday announced formation of a task force to take a hard look at the viability of closing four developmental centers in California.
“I don’t know if the four developmental centers we operate can all close,” Dooley said. “I want to hear from the stakeholders with an open mind. Clearly there is a problem with these centers, but we also have to address the fiscal issues. If they cannot operate, then we should look at a timeline for closing them.”
Developmental centers in California have come under fire recently — with allegations of chronic abuse of patients, investigations by multiple government agencies and loss of federal certification. The state has taken a number of steps, particularly at Sonoma Developmental Center, to investigate possible abuses and improve safety of the centers’ clients.
San Francisco Leading the Way in Health Data Applications
The city of San Francisco is leading the way in using health data in innovative ways and it’s paying off in a big way, according to several city officials who spoke yesterday at the Healthy Communities Data Summit.
The summit was held in San Francisco and that meant a number of success stories were local, but the conference cast a wide net in its approach to innovation prompted by public release of health data.
“We have so many compelling examples of how free data can help health practices,” said summit panelist Cheryl Wold, owner of Wold and Associates, a community health consulting firm based in Pasadena. “More and more people are using that data to create health solutions.”
Administrative Change for High-Risk Subscribers
The Pre-Existing Condition Insurance Plan (PCIP), a federally-funded, state-run interim program, is moving from state to federal oversight for the rest of the year.
A high-risk pool for people unable to secure health care insurance under pre-Affordable Care Act rules, PCIP is temporary because the new federal reform law prohibits insurers from denying coverage based on pre-existing conditions.
Now the “state-run” part of that program is also on its way out, as California will shift control and management of the program to federal officials, according to administrators at the Managed Risk Medical Insurance Board (MRMIB), which currently runs PCIP in California.
Federal Ruling, State Law May Conflict
In 2011, the Legislature went along with the governor’s plan to cut Medi-Cal provider rates by 10%. Provider groups immediately went to the courts to stop it, saying that patient access to care would be threatened by such a severe reduction. Now the final decision rests with a federal judge. A ruling is expected soon.
If a federal judge signs off on the law, Medi-Cal providers in California will have rates cut by 10% and also will need to pay back two years’ worth of that 10% reduction. The effect would be a 15% rate cut for the next four years and a 10% cut thereafter.
The 10% cut represents about $600 million a year to the California budget.