Latest California Healthline Stories
If Individual Mandate Is Overturned, States Still Have Lots of Options
As they await a ruling from the Supreme Court on the Affordable Care Act, state officials are weighing their options if the individual mandate is struck down. And there are a number of choices to consider.
Will FQHCs Get Lower Adult Health Rate?
A federal judge last week heard arguments for and against issuing a temporary restraining order against the state’s plan to reduce payments for adult day health services. The California Primary Care Association filed suit on behalf of federally qualified health centers.
U.S. District Court judge James Ware heard the case last week. He has 30 days to issue a ruling.
In a similar case last month filed by the Adult Day Health Care Association, a federal judge declined to issue a preliminary injunction against the state and upheld the Department of Health Care Services’ plan to set new rates for day service providers in the recently launched Community Based Adult Services program.
Newborn Test Takes Baby Step Forward
A bill to require hospitals to screen all newborns for congenital heart conditions recently was presented to the Assembly Committee on Appropriations — where it was expected to get a rough reception. Instead, AB 1731 (Marty Block, D-San Diego) was moved to the suspense file, where it will await next month’s budget discussions.
“The test … only costs $3 per baby,” Block said at last week’s hearing. “If undetected, congenital heart disease can require subsequent emergency room visits, and additional medical costs are much higher than the treatment cost if the baby’s condition had been caught earlier.”
Block was addressing fiscal concerns first raised in the Assembly Committee on Health. In addition to California hospitals’ cost of administering the screening test to newborns, the Assembly analysis estimates additional cost to the Department of Health Care Services to launch and run the program — up to $1 million annually, as well as start-up costs of $300,000.
Risks, Rewards Higher for Managing Dual Eligibles
California health plan officials say the experience of shifting seniors and persons with disabilities into Medi-Cal managed care plans over the past year will help as the state moves dual eligibles — beneficiaries of both Medicare and Medi-Cal — into managed care this year.
Opposition to Ombudsman Bill Evaporates
Joe Rodrigues, the State Long-Term Care Ombudsman, has removed his opposition to SB 345 by Lois Wolk (D-Davis), a Senate bill designed to reform the ombudsman’s office.
Rodrigues said the bill authors made a number of amendments to the measure. He now supports the bill presented at a legislative committee hearing earlier this week.
“We were able to work with them on coming to some agreements that will benefit the program and strengthen the [ombudsman’s] office,” Rodrigues said. “It made some of the good things to do in the bill less burdensome, such as the advisory council and the annual report. The bill looks very different today than it was a year and a half ago when it was first introduced.”
Health Plans’ Quality for Duals in Question
Seven of the eight health plans in California’s pilot project to shift dual eligibles into managed Medi-Cal have inferior quality ratings for treating Medi-Cal beneficiaries, according to a report released yesterday.
The ambitious plan for 1.1 million Californians eligible for both Medicare and Medi-Cal benefits will start with a pilot program in four counties — Los Angeles, Orange, San Diego and San Mateo. The state hopes to expand the pilot project to as many as 10 counties, pending legislative approval.
The report from National Senior Citizens Law Center, citing the state Department of Health Care Services’ own quality assessment, shows seven plans earned a rating of 1 out of 5 stars in overall Medi-Cal performance.
San Diego Barbershops Offer Shave, Haircut and Health Screening
Volunteers this month will descend on barbershops in Southeast San Diego to screen African-American men for diabetes and high blood pressure during a multicity event aimed at raising awareness and addressing health disparities.
Health Facilities Get Improvement Boost
The federal government yesterday issued $722 million in renovation and construction grants to community health centers, including $122 million in grants to California facilities.
Dean Germano, CEO of Shasta Community Health Center in Redding, said his center’s $5 million capital grant announced yesterday will pay for about half of a planned $10 million building addition.
“The plans are completed, and we were waiting on a decision from HHS to see if we could do this,” Germano said.
‘The Passage of Power’ and the Passage of Medicare
A long-awaited biography of Lyndon Johnson goes inside White House strategy in the early 1960s. Does the battle to pass Medicare hold any lessons for today?
Subcommittee Approves Change for Sacramento County Dental Program
Recent controversy over dental services in Sacramento County came to a head at an Assembly budget subcommittee hearing yesterday. The root of the problem is the county’s children’s dental care program, organized as a managed care pilot project that has been plagued with access problems over its 18-year history.
In fiscal year 2010-11, about 31% of the children eligible for dental care in Sacramento County actually saw a dentist (compared to a statewide average of about 50%). It is the only county in the state with a mandatory managed care dental program, which pays a per-person, capitated rate, whether beneficiaries receive dental care or not.
State legislators are considering changing that system to allow a voluntary option for beneficiaries to switch to fee-for-service. State health care officials are asking to keep the current system, with some major reforms to boost those low utilization rates.