Latest California Healthline Stories
Communities of Color Hit Hardest by Health Cuts, Advocates Say
Health care officials and advocates expressed serious concern over Democratic Gov. Jerry Brown’s latest round of budget proposals that include reductions to community clinics, hospitals, and programs such as Healthy Families and CalWORKs.
“We have much more need than resources to provide for it,” Diana Dooley, secretary of California’s Health and Human Services Agency, said in a conference call with stakeholders. “I fully understand your concern. These are consequential reductions. All of these cuts have consequences.”
Both health officials and advocates seem a little weary of the constant and continued reductions. According to Ellen Wu of the California Pan-Ethnic Health Network, acknowledging that the reductions are hard is getting a little harder to hear.
Exchange Board Has One Meeting To Consider HHS List
Just before the most recent California Health Benefit Exchange board meeting, the federal Health and Human Services agency released its list of proposed essential health benefits. Aimed at ensuring that health plans in individual and small group markets offer a minimum of coverage — both inside and outside of health benefit exchanges — the HHS proposed list is scheduled to take effect in 2014.
Board members got a quick briefing on the proposed requirements, since comments on them are due at the end of January. That leaves the board with one more meeting — on Jan. 17 — to approve comments on those benefit requirements, according to Peter Lee, executive director of the board.
“It’s something we didn’t expect to see,” Lee said. “We didn’t know it was coming.”
Federal Court Halts Some Medi-Cal Cuts
A federal judge last month blocked California’s plan to cut Medi-Cal provider reimbursement rates to skilled nursing facilities and pharmacies. State officials said they will appeal the decisions.
The two lawsuits were brought by Managed Pharmacy Care and the California Hospital Association.
“We’re pleased by the court decision,” Jan Emerson-Shea of CHA said. “We believe it is the right thing to put the interests of patients first.”
State Says IHSS Court Order Kept Counties in Dark
There are three levels of exemption for some Californians from the 20% trigger cuts to In-Home Supportive Services, according to officials from the Department of Social Services.
Counties, which administer IHSS programs through county welfare departments, haven’t heard about any of these exemptions because a federal temporary restraining order halted the implementation of those cuts, according to Michael Weston of DSS.
Basically, he said, implementation of changes and communication about IHSS with the counties halted when the court issued its temporary restraining order. Meanwhile, the exemption process continued to be developed within the department, Weston said.
Disability Case Takes Unusual Turn
A federal judge temporarily halted automatic “trigger cuts” to the state’s budget that would reduce In-Home Supportive Services by 20%. A hearing on the issue, originally scheduled this month, is now scheduled Jan. 19.
In the meantime, a state declaration filed in the case said 66,000 Californians would be exempt from the cuts — including all children younger than age 21.
“In total, approximately 66,000 IHSS recipients will be completely exempt from the 20% reduction, which is roughly 15% of all IHSS recipients,” according to a declaration by Eileen Carroll, deputy director of the Adult Programs Division at the Department of Social Services.
Disabilities Case Waits on Supreme Court Ruling
A federal judge last week issued a stay of a court case challenging the freezing of some provider reimbursement rates for services for the developmentally disabled in California — effectively putting off the case until February or March, after the U.S. Supreme Court issues a ruling in a similar case it is currently hearing.
U.S. District Judge Morrison England Jr. denied the state’s request to dismiss the case. He also denied the plaintiffs’ request for a preliminary injunction on the rate freeze.
He cited a pending CMS ruling on health care provider costs that could also inform the court case. But the big one to wait for is the Supreme Court case, Douglas v. Independent Living Center, according to Tony Anderson of the Arc of California, which brought the case for the developmentally disabled.
Mental Health Services Heading to DHCS
Integration of care is one of the touchstones of the health care reform conversation. It’s a big and complicated task, though, to integrate health care for the 7.5 million Californians on Medi-Cal.
The state is taking a big step toward that goal by shifting Medi-Cal mental health benefits away from the Department of Mental Health and into the Department of Health Care Services by July 1 of next year. The idea is to incorporate mental health care and substance abuse treatment into people’s overall health care, so that it’s not a segmented benefit.
The tricky part is the transition, because you don’t want a disruption in care while you’re changing that organizational structure, according to Toby Douglas, director of DHCS.
PCIP Enrollment Numbers Rise a Bit
The federally funded, state-run Pre-Existing Condition Insurance Plan has always been a bit of a tough sell.
It costs money, for one thing (premiums vary according to age and geography). And eligibility can be challenging: you have to have a pre-existing condition and be uninsured for six months.
That last requirement may be the toughest hurdle because those people with pre-existing conditions that are severe enough to be denied private insurance would have a hard time going uninsured for half a year.
PCIP Program Gets Last-Minute Funding
Last month, it looked like the federally funded, state-run Pre-Existing Condition Insurance Plan was about to reach its beneficiary limit. The Managed Risk Medical Insurance Board, which oversees the program, was considering closing enrollment.
At yesterday’s board meeting, officials said 813 new enrollees had been added to the system in the past month — leaving fewer than 800 slots still open. But MRMIB had good news up its sleeve.
“We received the 2012 amendment for the PCIP contract from the feds,” MRMIB Executive Director Janette Casillas said, “and they have given us an increase.”
Trigger Cuts Not the Only Worry for Disabled
Yesterday’s announcement of $1 billion in trigger cuts for California’s budget includes two provisions that hit the developmentally disabled community.
One of those provisions, to scale back In-Home Supportive Services by 20%, is already in court. A federal judge last week issued a temporary restraining order to halt implementation of that cut, pending a hearing scheduled for tomorrow.
The other big budget reduction for the disabled — a $100 million cut to the Department of Developmental Services — is going to be much more difficult to fight in court, according to Tony Anderson, executive director of The Arc of California, which advocates for the developmentally disabled.