Latest California Healthline Stories
CMS Weighs in on Enrollment Question
Federal health officials have informed the state that CMS would favor passive enrollment with an opt-out provision but it does not support lock-in enrollment for the dual-eligible demonstration project in California.
That’s according to Kevin Prindiville, deputy director of the National Senior Citizens Law Center in Oakland, who spoke to CMS officials on Friday.
“CMS has told us that’s all they will allow,” Prindiville said. “It’s not a big surprise, but it’s very welcome. We think the passive enrollment system is problematic in some ways, but CMS has said all along they would allow passive enrollment, but there would have to be a way to opt out at any time.”
Community Dental Beneficiaries Go to Liberty
Community Dental Services health plan, plagued with financial troubles and quality-of-care problems, has shut down its managed care dental plan in Sacramento and Los Angeles counties.
On Friday, the state announced that all 16,000 Medi-Cal beneficiaries at CDS, the bulk of them in Sacramento County, would switch to Liberty Dental Plan of California. Also making the change will be 4,000 non-Medi-Cal patients. State officials said beneficiaries’ providers would remain the same in almost every case.
The failure of CDS may be good news for the state and the beneficiaries in the plan, since that company had the lowest utilization rate among the five health plans providing dental coverage in Sacramento County. The state has been under fire recently because of low utilization rates in the pilot “geographic managed care” system. In the 2010-2011 fiscal year, fewer than one-third of Sacramento County Medi-Cal children went to a dentist, compared with a utilization rate of nearly 50% for the rest of the state.
State Proposes Delaying Start Date For Budget Cuts
The state is planning to delay the starting date for budget cuts by switching implementation from the start of the year to calendar year, according to a Department of Health Care Services summary of possible changes to trailer bill language for the May budget revision.
That’s one of many revisions outlined in the summary. The DHCS changes reflect input and concerns from stakeholders.
Subcommittee Puts Co-Pay Idea on Hold
Co-pay is back. Last year, the Legislature passed and the governor signed a budget trailer bill that included Medi-Cal co-payments of $5 for some provider visits, up to $50 for emergency department visits and up to $100 for patients admitted to the hospital.
That move required a CMS waiver but in February, federal officials denied it. Now, with the May budget revision, a scaled-down version of co-payments is back on the table.
Yesterday, an Assembly budget subcommittee heard testimony on the subject and decided to hold co-pay approval for a later date.
Kaiser Balks at Joining Healthy Families Conversion to Medi-Cal
The planned switch of Healthy Families children into Medi-Cal could leave as many as 43,000 children looking for new health care providers if the state can’t convince Kaiser Foundation Health Plan to join the effort.
That number would grow to 189,000 children if the state eventually converts all Healthy Families children to the Medi-Cal program.
On Tuesday, the Senate budget subcommittee for Health and Human Services rejected a plan to move the entire Healthy Families population of 875,000 kids to Medi-Cal all at once, instead starting with a pool of roughly 200,000 “bright line” children — beneficiaries who are at or below 133% of federal poverty level.
Healthy Families Conversion Slowing Down
California health officials need to go a little slower in their plan to move 875,000 children out of the Healthy Families program and into Medi-Cal managed care, according to a Senate budget subcommittee that voted yesterday to reject the state’s full plan.
It did endorse the transition of about 200,000 Healthy Families “bright line” children to Medi-Cal — those beneficiaries at or below 133% of federal poverty level. The Affordable Care Act requires that those children be moved to Medi-Cal by 2014, so California would get a head start on that effort, according to John Bacigalupi from the state Department of Finance.
“We support this because it would create efficiency by consolidating health care for the state’s children under a single program,” Bacigalupi said.
Slower, Phase-In Approach for CBAS
The Department of Health Care Services has announced the conversion of adult day health care centers to a managed care system has been divided into a two-part process.
About 12% of the centers, which serve about 8% of the state’s ADHC population, will still make the conversion to managed care by July 1. That leaves the bulk of the centers — including Los Angeles County centers which serve two-thirds of the state’s Medi-Cal beneficiariens receiving ADHC care — to make the transition three months later, on Oct. 1.
“It was really welcome news,” said Lydia Missaelides, executive director of the California Association of Adult Day Services. “It was clear nobody was ready yet. I think the Department [of Health Care Services] has been listening to stakeholders. I was really relieved. Not that October is so far away, but this is definitely good news.”
Cal eConnect ‘Not Able To Move Fast Enough’
Cal eConnect, an important part of the state’s ambitious health information exchange effort, is no longer the same independent entity it was when it was born two years ago. The organization’s efforts to make electronic health records ubiquitous in California will continue, officials said, but under a different organizational umbrella.
At a meeting last week, the 22-member board rescinded its cooperative grant agreement with the state.
On Wednesday, state officials announced that Cal eConnect will now be part of the Institute for Population Health Improvement at UC-Davis. Officials said the same work will continue in a new administrative structure.
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.
Senate Committee Rejects Care Changes
The Senate Budget Subcommittee on Health and Human Services last week voted to reject a proposal to change some nursing home and hospital regulations.
That happened before this week’s release of Gov. Jerry Brown’s new budget proposal that includes a slew of budget reductions to hospitals and nursing homes.
Hearings on the latest round of cuts — including $2.5 billion in reductions to health care programs in California — are scheduled to start today when the Assembly Budget Subcommittee on Health and Human Services holds its first budget revise hearing. According to chair Holly Mitchell (D-Los Angeles), it will be the 18th hearing of that subcommittee this year alone.