Latest California Healthline Stories
Dual Eligibles a Tricky Population To Manage
The state Department of Health Care Services wants to integrate care for about 1.1 million dual eligibles in California — people eligible for both Medicare and Medi-Cal services — by moving them to managed care plans.
“These two insurance programs don’t necessarily work well together,” according to Neal Adams, deputy director of the California Institute for Mental Health. “The benefit design is not equal across all platforms.”
Adams was part of a stakeholder summit convened last week by DHCS to discuss the dual eligible demonstration project. It was the first of three stakeholder meetings this month. Others are scheduled Dec. 12 in San Francisco and Dec. 15 in Los Angeles.
Judge Temporarily Stops IHSS Cuts
A federal judge in Oakland issued a temporary restraining order last week, suspending the state’s planned reduction of 20% to In-Home Supportive Services to 370,000 Californians.
Judge Claudia Wilken scheduled a hearing Dec. 15 to decide whether a preliminary injunction should be granted. The state has the option to move that court date, if it desires.
The judicial action came right before the state was set to send notices to IHSS participants — most of whom are seniors — notifying them of the reduction in services. The so-called trigger cuts were ordered by the Legislature back in June, to go into effect Jan. 1, if fiscal targets weren’t met in December. Those targets are unlikely to be met.
Inland Empire Readies Low-Income Health Plans
Low-income individuals in San Bernardino and Riverside counties will have access to two new health insurance programs beginning in 2012. The plans have been developed in preparation for a larger expansion of Medi-Cal in 2014 as required by the Affordable Care Act.
California Leading Payment Reform Effort
Steve McDermott runs a physicians group, but it’s his role as patient that makes him an expert on payment reform, he said.
“I had hip replacement surgery and let me say, it is a wonderful thing,” McDermott said. “I went from a grumpy old man to, well, just an old man. But yeah, it probably saved my marriage.”
But a look at the bill could’ve sent him back over the line far past grumpy, if he didn’t have medical insurance. The cost of a hip replacement, he said, is out of whack. “The cost is about $70,000 — not including surgery,” McDermott said. “And the number of uninsured in California is at about 23%, and that’s just unacceptable. If the health care system is the number-one cause of bankruptcies in the state, that’s not good.”
Mental Health Needs High, Treatment Low
About two million Californians are under stress and need some kind of mental health care — and are not getting the help they need, according to a UCLA study released yesterday.
“There are a lot of people with mental health needs, and they aren’t getting adequate care,” UCLA researcher David Grant said. “Men are less likely to seek and receive the care they need, and immigrants definitely aren’t getting their care needs met. And even native-born Latinos and Asians are unlikely to seek treatment, so that’s a definite target for the state to consider.”
The report from the UCLA Center for Health Policy Research is based on 2007 data from the California Health Interview Survey.
Medicare Physicians Nervously Await Yearly ‘Doc Fix’
In the wake of the congressional debt panel’s failure to come up with long-range budget solutions, California physicians are nervously awaiting the annual holiday tradition of a temporary “doc fix” to adjust the equation that determines how much they’ll get paid for treating Medicare beneficiaries.
Ruling To Prompt New ADHC Transition
It’s too early to know some details of the newest transition plan for adult day health care services, according to state officials. The final settlement of a lawsuit challenging the state’s first transition plan will be released tomorrow, and the federal judge in the case will issue a ruling on the settlement in two weeks.
But that doesn’t stop people from raising questions.
“Which [current ADHC] centers will be eligible to become CBAS (Community Based Adult Services) centers?” Lydia Missaelides of the California Association of Adult Day Services asked. The CBAS program is created in the settlement as a partial replacement for Medi-Cal benficiaries. To save money, state officials eliminated the ADHC program as a Medi-Cal benefit.
For Mentally Ill, Home Is Where the Health Home Pilot Is
Which grant was buried in the week’s news? Rhode Island won a big award for its health insurance exchange efforts, but a second CMS announcement — that the Ocean State was approved for a Health Home Medicaid project — could have major implications for mental health care.
Lyle Hurst of the Encore Fellowships Network Talks About Supporting Social-Purpose Groups
Lyle Hurst, network developer for the Encore Fellowships Network, spoke with California Healthline about a program that matches mid-career workers from the private sector with social-purpose organizations, including community clinics.
Three Meetings To Address Duals Conversion
This week, the state begins a series of stakeholder meetings across California, all looking at different aspects of the ambitious task of converting more than one million people who receive both Medicare and Medi-Cal benefits — known as dual eligibles — to a more comprehensive model of care.
According to Peter Harbage, who has been leading the information-gathering component of the effort, this is an important month in the process. Now that the first wave of input has been solicited, the three meetings scheduled for December can dive deeper into the details.
“The main goal is to talk about the design of the duals demonstration project, so the state can get a better understanding what people believe the challenges and opportunities are, and what consumer protections need to be done,” Harbage said.