Latest California Healthline Stories
Higher Profile Coming to Exchange
California’s health benefit exchange is nearing its move into the mainstream public spotlight — but there is a lot of work still ahead, according to experts who gathered in Sacramento yesterday for a roundtable discussion of the exchange.
Yesterday’s symposium, called “Covered California: The Challenges and Opportunities of California’s Health Benefit Exchange,” was presented by the University of Southern California’s Price School of Public Policy and the USC Schaeffer Center for Health Policy and Economics and Quintiles.
Assembly member Richard Pan (D-Sacramento) acknowledged that creation of the exchange has helped place California at the head of the health care reform pack, but he said that leadership role doesn’t change the 2014 deadline that’s looming for health care reform and the exchange.
Insuring a Better Future for the State?
State officials and health care experts yesterday said the governor’s decision to sign on to optional expansion of Medi-Cal could be a huge step forward for California’s health system — and a huge challenge, as well, they said.
More than 700 stakeholders gathered in downtown Sacramento for the annual conference of the Insure the Uninsured Project heard dozens of experts evaluate how far California has come in implementing health care reform, and how far it still has to go.
Adding roughly 1.4 million Californians to Medi-Cal eligibility in the optional expansion (adding adults up to 138% of federal poverty level) may be fully funded by the federal government for the first three years, but it also brings a boatload of work to the state. It’s worth the extra effort for the sake of beneficiaries and for the savings the state stands to make in reduced hospital and emergency department costs, said Diana Dooley, state Secretary of Health and Human Services.
Medical Marijuana Case in State Supreme Court
The California Supreme Court today in San Francisco will hear oral arguments over a legal conundrum involving medical marijuana. The city of Riverside wants to ban sale of medicinal marijuana, a decision that may violate state law ensuring legal access to it. At the same time it adheres to federal law banning marijuana’s sale and use.
To Riverside officials opposed to marijuana sales, the answer is pretty simple: “A medical marijuana dispensary constitutes ‘a Prohibited Use’ ” in Riverside’s zoning code, which makes it a public nuisance, the city’s attorneys wrote in a legal brief. “Any use which is prohibited by state and/or federal law is also strictly prohibited,” the attorneys said.
But marijuana advocates, in their own brief, said Riverside officials are prohibiting the distribution of medicine, and that’s against state law.
Finance, Health Care Linked in Expansion Effort
State health care and finance officials met for the first time with stakeholders Friday to outline some of the differences between two possible approaches — state-based or county-based — to implementing the state’s optional Medi-Cal expansion.
Many details of the proposed expansion of Medi-Cal are unknown, state officials said Friday because they’re waiting for more federal guidance in many areas. One important detail is known: the federal government will fully pay for the expansion benefits for new enrollees for the first three years.
Diana Dooley, the state’s Secretary of Health and Human Services, said implementing the expansion will be influenced in equal parts by financial and health care considerations.
First Step in Reform: Primary Care
The heart of a successful reform effort under the Affordable Care Act will be the creation and implementation of the patient-centered medical home model of care, according to testimony at an Assembly Committee on Health hearing in the Capitol Tuesday.
“We need to look at better management of chronic conditions,” said Assembly member Richard Pan (D-Sacramento), chair of the Committee on Health. “It’s one of the greatest cost factors in our health care system.”
How much cost?
Using Data to Simplify Medi-Cal Enrollment
A different approach to Medi-Cal eligibility renewal was floated yesterday at an informational seminar in Sacramento.
The idea is to limit the amount of forms and paperwork in renewing Medi-Cal eligibility. That might be accomplished in part by using statistical analysis of eligibility data to determine which beneficiaries don’t need to fill out new forms when their Medi-Cal benefits are up for renewal, said Stan Dorn, senior fellow at the Urban Institute, a Washington, D.C.-based think tank.
“The traditional way to handle Medicaid enrollment is very paperwork-intensive,” Dorn said. “The applicant fills out a piece of paper, supplies immigration documents and pay stubs. Then when eligibility is renewed, there’s a new form mailed to them, and they need current pay stubs and so on. … But now accessing that data and processing it is much cheaper and more reasonable and plausible than it was then.”
Packard Issue Brief Analyzes HF Transition
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.
Managed Care Tax Key in Healthy Families Shortfall
The Healthy Families program is short by almost $100 million, according to California health officials. That number will rise, officials said, because the current deficit only covers the program’s operation for January and half of December.
The problem is restricted to this year, however, since the roughly 860,000 children in Healthy Families — California’s federally subsidized Children’s Health Insurance Program — are being moved into Medi-Cal managed care plans. This year’s transition is planned in four phases. The first phase began Jan. 1.
“This (the funding shortfall) doesn’t have anything to do with the transition,” said Diana Dooley, Secretary of Health and Human Services. “It has to do with a failure to extend the MCO (Managed Care Organization) tax.”
Exchange Outreach Grants Worth $43 Million
Community groups are eligible for a total of $43 million in outreach grants, according to a plan released Friday by officials at Covered California, the new state’s new insurance exchange.
The goal of the outreach effort is for community groups to help get the word out about Covered California and the exchange is willing to pay for that help. About $40 million has been slated for individual coverage outreach, and another $3 million will go to help raise awareness of the Small-business Health Options Program, said Oscar Hidalgo, director of communication and public affairs at the exchange.
“The idea here is to reach out to communities through all kinds of organizations — community groups, faith-based groups, even city and county governments — so they can help raise awareness and provide some education on Covered California,” Hidalgo said.
Three Items on Special Session Agenda
Gov. Jerry Brown (D) yesterday called for an extraordinary legislative session on health care. In his State of the State speech Brown said the special session beginning Monday would “deal with those issues that must be decided quickly if California is to get the Affordable Care Act started by next January,” he said.
Brown also said the two options for Medi-Cal expansion — a state- or county-based approach — would not be decided as part of the special session.
“The broader expansion of Medi-Cal … is incredibly complex and will take more time,” Brown said. “Working out the right relationship with the counties will test our ingenuity and will not be achieved overnight.”