Latest California Healthline Stories
New Report Offers Healthy Families Alternatives
The state wants to shift 875,000 children in the Healthy Families program into Medi-Cal over a nine-month period, beginning in October. The state estimates the move will save $156 million over the next two fiscal years.
But according to a soon-to-be-released study, that plan could limit access to care for California’s children, and the state might be better served to move more slowly.
A report commissioned by the Urban Institute looked at four possible directions for the Healthy Families program. Report author Stan Dorn said the move to Medi-Cal has some definite advantages for California children — particularly for those at or below 133% of the federal poverty level. Those children will make that transition in 2014 anyway, as required by the Affordable Care Act.
Few People Aware of Medical Review Program
It has been 11 years since California launched its Independent Medical Review program, an appeals process that allows Californians to challenge denial or delay of coverage by private health care insurers.
In the Capitol Building in Sacramento yesterday, a policy briefing laid out the findings of a new report on IMR that includes praise for its effectiveness and some recommendations on how to make the program stronger.
The briefing was sponsored by the California HealthCare Foundation, which commissioned the report and publishes California Healthline.
Adult Day Health Services Budget Looks Familiar
The recent state budget proposal includes the expected cost of the Community-Based Adult Services program for next year: roughly $83 million.
That number is eerily close to last year’s budget estimate for the Keeping Adults Free from Institutions program, which was an alternative adult day services plan that the Legislature passed in June. The Legislature approved $85 million for the KAFI program, which was designed as a half-price replacement for the adult day health care program.
Gov. Jerry Brown (D) vetoed KAFI.
State Gets Resistance to Moving All Healthy Families’ Kids
A coalition of not-for-profit children’s groups yesterday sent a letter to California officials asking them to scale back the state’s ambitious plan to move 875,000 children out of the Healthy Families program and into a new Medi-Cal managed care program.
“We do not support the governor’s proposal,” Suzie Shupe of California Coverage and Health Initiatives said. “We have some very serious concerns about it. It’s a very rapid timeline, for one, and in our view does not detail the kind of safeguards that need to be in place, and the monitoring of access to that care, to make sure kids do get access to quality health care.”
Yesterday’s letter was a joint effort from Children Now, The Children’s Partnership, PICO California, the Children’s Defense Fund California and United Ways of California, as well as CCHI. It calls for a scaled-back version of the governor’s proposal.
Assembly Passes Mental Health, Addiction Coverage Bill
To Assembly member Jim Beall (D-San Jose), it just makes sense. When private insurers fail to cover addiction and mental health services, he said, the cost of those illnesses fall on the state.
“If you don’t treat it, it gets worse. If it gets worse, it gets shoved over to the public sector,” Beall said. “And then, if it gets shoved into the public sector, it gets worse. Then they end up in prison, with a substance abuse or mental health problem in prison, and this is costing the state way too much money. We need to stop the cycle.”
Beall is the author of AB 154, a bill requiring insurers to cover mental health and addiction services, which passed the Assembly floor late last week.
Personal Stories Highlight Oral Chemotherapy Bill
New legislation proposed by Assembly member Henry Perea (D-Fresno) would require health plans to provide chemotherapy in pill form, in some cases.
“This bill will provide greater access for oral chemotherapy treatment,” Perea said on the Assembly floor late last week. “This is the right thing to do, to allow people access to lifesaving drugs.”
Perea introduced the measure with his personal account of caring for his mother, who he said was diagnosed with stage 2 lung cancer just over a year ago. During the long, eight-hour chemo infusion in the hospital, he learned quite a lot about cancer and chemo from patients and professionals.
Single Payer 2 Votes Short in Senate
The idea of a single-payer health care system in California stalled on the Senate floor yesterday, falling two votes short of passage.
Reconsideration of the bill was granted, though, so proponents of SB 810 by Mark Leno (D-San Francisco) have until Tuesday to reintroduce the bill. First they will have to come up with two big votes. The bill failed on a 19-15 vote.
“We don’t want to follow the path of Europe, where the economy is in trouble, where the Euro is failing,” Sen. Ted Gaines (R-Roseville) said. “It’s not the example we should follow. We don’t have the money. I don’t know where the money’s going to come from.”
Court Agrees to New Mental Health Plan for Sacramento County
A federal district judge yesterday approved the final settlement of a lawsuit that challenged a plan by Sacramento County to restructure and downsize its mental health system. Yesterday’s settlement means mental health services will remain at their current levels in the county — and, in fact, may even improve, given a number of proposals the county still hopes to adopt.
The county hopes to save money by consolidating two county-operated clinics into one, according to Mary Ann Bennett, director of the county’s Division of Mental Health.
“One of them is in a leased facility,” Bennett said. “So we want to get out of the leased facility, and we will get some savings there.”
Judge Calls ADHC Settlement a Win-Win
A federal judge yesterday gave her official stamp of approval to last month’s settlement of a lawsuit challenging the state’s transition plan for adult day health care services.
“It’s a good result in a challenging time,” according to attorney Elissa Gerson of Disability Rights California, which brought the lawsuit.
During yesterday’s hearing, U.S. District Judge Saundra Brown Armstrong said the settlement outcome was actually better than it would have been if the case went to trial and DRC eventually won it.
Senate Sends Ombudsman Bill to Assembly
The state Senate yesterday passed SB 345 by Lois Wolk (D-Davis), a bill designed to give more independence and power to the Long-Term Care Ombudsman program. It now heads to the Assembly for committee and floor approval.
“Most of the provisions in this law simply clarify state and federal law,” bill author Wolk said. “What has happened in this ombudsman program is the office is not effectively being an advocate for people in long-term care and local [ombudsman] offices.”
State ombudsman Joseph Rodrigues begs to differ, and has testified against the bill in committee hearings, saying that the proposed law is duplicative and establishes additional requirements without additional funding.