Latest California Healthline Stories
Senate Committee Takes Aim at Long-Term Care
The numbers are scary, according to policy experts and legislators at a Senate Subcommittee on Aging and Long-Term Care meeting yesterday:
• The cost of care in a nursing home in California is approximately $6,000 a month, and the cost of part-time, in-home care is roughly $1,700 a month, according to state officials.
• Both those numbers are expected to double in less than 20 years to $12,000 a month for nursing home care and $3,400 a month for in-home help, according to committee Chair Elaine Alquist (D-Santa Clara).
• California has more than four million seniors right now. That figure is expected to more than double to 8.8 million by 2030, according to Steven Wallace of the UCLA Center for Health Policy Research.
• About one-third of the respondents in a UCLA survey say they couldn’t afford one month of nursing home care, Wallace said.
Health Insurance Rate Regulation May Be On November Ballot
The contentious issue of regulating California’s health care insurance industry is back.
After AB 52 by Mike Feuer (D-Los Angeles) and Jared Huffman (D-San Rafael) was shelved at the end of the last legislative session, that looked like the final word on the prospect of regulating health insurance rates.
Yesterday, Consumer Watchdog filed paperwork to take health insurance rate regulation to the voters.
Stakeholders Map Out Next Tasks for HIE
The health information exchange revolution is under way in California.
“There is tremendous enthusiasm across the state for what’s happening in HIE,” according to David Lansky of the Pacific Business Group on Health, who spoke at yesterday’s Health Information Exchange Stakeholder Summit 2011 in Sacramento.
“We represent large purchasers of health insurance, so in a way it’s odd that we’re so involved in this,” Lansky said. “But we feel HIE is a critical, foundational support tool for transforming the health care delivery system.” The health care reform effort aims to make health care affordable and high-quality, he said, “And we can’t make it succeed without this project.”
Chronic Care Becoming a Chronic Problem
To lower costs and increase quality of care, policymakers in California need to address how to better treat the chronically ill — those patients at the center of health care spending in the state.
That was the conclusion of a health care panel discussion last week in the Capitol Building in Sacramento, put on by the Center for Health Improvement as part of the California Health Policy Forum.
“This is a huge worldwide epidemic,” according to panelist Sophia Chang. “About two in five Californians have at least one chronic condition — and half of these people have two or more of these conditions.”
Access Issues Behind ADHC Exemptions
The Department of Health Care Services recently exempted 69 adult day health care centers from the 10% reimbursement cut. Because the cutback is retroactive to June 2011, it spared payback of a large amount of retroactive money for those mostly rural ADHCs.
“That is really good news for Contra Costa County,” Debbie Toth — executive director of the Mt. Diablo Center for Adult Day Health Care in Pleasant Hill — said. “We would have had to pay back a lot of money through June. And we’ve already gone through our reserves, so we wouldn’t have been able to do that.”
The 10% cut would’ve put centers in Contra Costa County over the edge, Toth said. “Our direct care staff is required by regulation, so there’s no way … I couldn’t reduce my cost by 10%.”
Assembly Hearing Laments a Torn Safety Net
It’s not just the 10% payment cut to a range of Medi-Cal services in California that have legislators and providers lining up in protest, according to Assembly member Holly Mitchell (D-Los Angeles), it’s the combined effect of all the cuts that came before as well.
“We are here to hear and understand the actual impact of the cuts we made this year,” Mitchell said yesterday at a hearing convened by Assembly Budget Subcommittee No. 1 on Health and Human Services. “And we also need to hear the cumulative impacts of cuts from previous years,” she said. “This economic crisis has hit our children very hard, and we need to hear what these cuts will do to those children.”
Down the street from the Capitol Building hearing, protesters representing the developmentally disabled gathered outside the offices of the Department of Health Care Services, the agency implementing the state’s cuts and that worked with CMS to get federal approval of the cutbacks.
Which Providers Get 10% Reimbursement Cuts?
Toby Douglas did not bring good tidings. Yesterday, the director of the Department of Health Care Services outlined the recently approved 10% cuts for California providers of Medi-Cal services.
“This is really hard,” Douglas said. “These are extremely painful reductions.”
The California Hospital Association on Tuesday filed a lawsuit in federal court in Los Angeles seeking to halt the implementation of Medi-Cal rate cuts approved last week by CMS.
Exchange Board Has Little Interest in Health Care Co-Ops
The federal government is ready to hand out $3.8 billion in loans to start up not-for-profit, member-governed health plans called consumer-operated and -oriented plans, or co-ops.
A deadline recently passed for the first round of applications, with a number of states taking up the idea, but not California.
So far, California has been pretty cool on the idea. At the August meeting of the Health Benefit Exchange board, concern was raised over what a co-op’s market share would be, and that a co-op might undermine what the exchange wants to do by dividing up its pool of participants.
Effort for Settlement of ADHC Lawsuit
State officials and advocates for seniors and the disabled are meeting today trying to work out a settlement of a lawsuit over adult day health care.
Today’s settlement conference comes exactly one week before a federal hearing of the suit brought by Disability Rights California, scheduled Nov. 8. The court is asked to determine whether the state’s transition plan is adequate to handle the needs of roughly 35,000 frail, elderly and disabled patients. The state’s ADHC program ceases to be a Medi-Cal benefit on Dec. 1.
Yesterday, advocates took to the sidewalk outside of the Ronald Reagan State Office Building in Los Angeles, marching up and down in front of the government center with “Stop Elimination” signs.
Access at Issue in Medi-Cal Cuts
You would think providers would be up in arms over having their Medi-Cal reimbursement rates cut — once again.
After all, California had one of the lowest Medicaid provider rates in the nation, even before this recent 10% reduction. But according to Carol Havens, president of the California Academy of Family Physicians, the rate reduction really affects patients, not doctors.
“Providers now, at the current level of reimbursement, have to make a decision about how many Medi-Cal patients they will see,” Havens said. “Since it actually costs them money to see Medi-Cal patients, they have to limit the numbers in their practice. So now, in a practical sense, these cuts will put an increased burden on that decision, and they’ll likely see fewer Medi-Cal patients.”