State Agency Nearing Extinction: ‘We Have Accomplished Our Mission’

It’s a little quieter these days in the hallways and cubicles of the Managed Risk Medical Insurance Board, the state agency that has overseen programs including Healthy Families, Access for Infants and Mothers and California’s Preexisting Condition Insurance Plan.

The Affordable Care Act, combined with the state’s creation of a health benefit exchange and expansion of the Medi-Cal program, have pre-empted the services offered at MRMIB and the agency is due to shut down at the end of this fiscal year — June 30.

Earlier this month, executive director Janette Casillas retired, along with Terresa Krum, the chief deputy director. Those were the top two administrative positions at MRMIB. Jeanie Esajian, deputy director for legislation and external affairs at MRMIB, switched jobs and now works for CalPERS.

That makes staff meetings a little lonely these days, said John Ramey, the current executive director.

“Not very many state agencies are able to say, ‘Well, we did it. We accomplished our mission,'” Ramey said. “So there is some celebration here. This is what a lot of us have spent our lives working towards and we’re happy to have succeeded.”

Ramey was the first executive director of MRMIB when it began in 1990, so he has seen the agency come full circle.

“The attitudes of staff members are very good here,” Ramey said, “because we look at it as a positive. It’s consistent with the mindset here, that it’s mission accomplished.”

The major programs for children and their families at MRMIB — Healthy Families and AIM — are being taken over by the Department of Health Care Services. Two other programs, the Major Risk Medical Insurance Pool and PCIP, were developed to handle high-risk consumers who couldn’t get coverage. That precarious situation has been eliminated by the ACA which prohibits insurers from turning customers away because of pre-existing conditions.

“The goal was always to get people decent health care coverage they can afford through this agency, and now that’s happening,” Ramey said.

“From the governor’s perspective,” said MRMIB chief counsel Morgan Staines, “he has established the exchange and he set up Medicaid expansion. And this is in some ways the whole mission of MRMIB, to get people without adequate coverage, to make that happen for them, that’s what all the programs were about.”

The AIM children transition into DHCS on Feb. 1, Ramey said. MRMIB will work only with the mothers in the AIM program, some MRMIP clients and a small group of people from three counties (San Francisco, San Mateo and Santa Clara counties) in the County Children’s Health Initiative Program.

“July 1 is the magic date for everything,” Ramey said. “The responsibility will pass over to DHCS by July 1.”

MRMIB now is down to three members — “so we have to have all three present to have a quorum [for any board meetings],” Ramey said.

The board, led by chair Cliff Allenby, set a different kind standard for state agencies, Ramey said.

“The style of governance at MRMIB has been transparency,” he said. “We are, I think, justifiably proud of the record of this agency. The exchange board, in a lot of ways, is patterned on MRMIB. So we hope some of the positive aspects of that governance can be maintained.”

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