Latest California Healthline Stories
Legislation Would Require On-Time Medicaid Payments
Sarane Baker-Collins remembers the time well. “We went for months without a [Medi-Cal] payment. We kept doing our work, and the state didn’t pay us for months. It’s almost criminal what the state did to us.”
Baker-Collins runs three small homes for residents with developmental disabilities in Santa Rosa. In the wake of the budget impasse of 2008, California had to shut off payments to Baker-Collins and other health care providers until a budget could be agreed upon.
Some Medi-Cal providers went as long as 60 days without reimbursement. For a small not-for-profit on a thin margin like the one run by Baker-Collins, that’s a cost hard to bear.
Could New Not-for-Profit Requirement Limit Patient Access?
State health officials recently outlined new requirements for the transition of adult day health care centers into the nascent Community Based Adult Services program. They include the stipulation that centers must be not-for-profit to qualify for Medi-Cal funding.
Many centers are for-profit, particularly in Los Angeles County where the bulk of day care beneficiaries live. Advocates worry the change could decrease access to care if for-profits are unwilling or unable to make the conversion to not-for-profit status.
Elissa Gershon, a senior attorney for Disability Rights California, said the new not-for-profit requirement could make it difficult for some beneficiaries to find care.
‘Value’ in Health Insurance Acquires New Meaning
Insurers and employers are expanding the scope of value-based insurance design, leaving their mark on customized programs that challenge the typical cost-sharing arrangements adopted by many payers.
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.”
State Starts Year Facing Multiple Lawsuits, Hearings
California health care officials are fighting a number of lawsuits in courts ranging from the U.S. Supreme Court to federal district courts. The budget crisis in California has prompted drastic cuts in health care services, triggering more than half a dozen legal challenges.
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.”
Ateev Mehrotra of RAND Corporation Talks About the Growth Potential of Retail Clinics
Ateev Mehrotra, a policy analyst at the RAND Corporation, spoke with California Healthline about how the demand for retail clinics might increase in response to a growing shortage of primary care providers and a nationwide push to lower health care costs.
New Year, New Deals? Breaking Down Health Plan, Doctor Alliances
Is California driving the next health care earthquake? A striking batch of insurers and physician groups are teaming up — and shaking up the industry — with the Golden State at the epicenter.
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.