Latest California Healthline Stories
Managed-care plans, which reap billions in taxpayer dollars to coordinate care for low-income Americans on Medicaid, outsource crucial treatment decisions to subcontractors that aren’t directly accountable to the government. In California, health officials say one firm improperly withheld or delayed care for hundreds of people.
The money was paid on behalf of more than 400,000 people who may have been ineligible for the public program, a state audit found. One had been dead for four years before payments stopped.
How a California health plan’s CEO and her husband, an executive consultant, got rich off the taxpayer-funded program for the poor. Critics see a conflict of interest, the plan doesn’t, and the state has no rules either way.
State regulators and insurers are looking into SynerMed, which medical groups depend upon to handle their finances and business operations. The groups, serving 1 million patients, fear a messy fallout.
Complaints are rising against for-profit insurance companies that manage Medicaid for about 600,000 Iowans. The privatization of Medicaid is a national trend affecting more than half of the 74 million Americans,and 13.5 Californians, who get their health care through the state-federal program.
It’s the second fine this year for California’s largest health plan, the only one to be penalized by Medi-Cal officials since at least 2000. The HMO says it will hand the information over by next month.
Advocates say California’s Medicaid program is violating its own rules by overturning decisions that would allow seriously ill patients to stay out of managed care and keep their doctors.
LogistiCare often shows up late, if at all, and compromises patient safety, according to a public interest firm’s lawsuit. The company says the allegations are inaccurate.
The California Nurses Association, representing some 100,000 registered nurses, is regarded statewide and nationally as a progressive political powerhouse. “Politicians are afraid” of the activists they turn out, said one critic.
The health insurance company, which operates in 12 states plus Puerto Rico, grew out of a network of Southern California clinics founded in 1980. Despite lower-than-expected profits in 2016, Molina’s track record of working with low-income patients has generally served it well under Obamacare.