Latest California Healthline Stories
New Transition Plan, New ADHC Options
There’s an interesting phrase in the state’s new transition plan for the adult day health care program: “ADHC-like services.”
It’s one of the care options listed in the state’s recently released transition plan, and it will be part of the discussion today in Sacramento, when the Department of Health Care Services holds an ADHC stakeholder meeting.
“Current ADHC [centers] could provide ADHC-like services under the waiver,” according to Toby Douglas, the director of DHCS. “There are ways we can do that as part of the transition plan.”
The California Department of Health Care Services has been updating its transition plan to make sure patients in the adult day health care program have somewhere to go when those services officially end on Dec. 1.
DHCS hopes its new plan will help the roughly 35,000 Californians enrolled in about 300 ADHC centers across the state.
“Working with the Department of Aging, the Department of Social Services and the Department of Developmental Services, DHCS has created a multi-faceted approach to provide comprehensive health risk assessments, care coordination, case management and appropriate ongoing services to former ADHC clients,” according to the new transition plan.
Should State Consolidate Health Plan Regulation? How, When?
California is the only state with two bureaucracies keeping tabs on health insurers. Should California consolidate health care regulation in one agency? If so, how and when? We asked experts and stakeholders to weigh in.
How Should the Exchange Adjust Risk?
William Dow, a professor of health economics at UC-Berkeley, said the idea is relatively simple.
“In theory, each individual patient comes with a dollar amount representing their gain or loss to the insurance company,” Dow said at a recent forum in Sacramento. “And that means every enrollee should have the same profit amount.”
If higher risk patients, such as those with diabetes, pay a slightly higher premium, Dow said, that balances the risk that companies take in insuring them.
Lessons Learned From PacAdvantage Failure
The Pacific Business Group on Health (PBGH) has had some experience in running a small group purchasing pool. It’s the organization that took over the Health Insurance Plan of California (HIPC), which was renamed the Pacific Health Advantage or PacAdvantage and operated for a total of 13 years, ending in 2006.
That organization was similar in concept to California’s Health Benefit Exchange. A new report from PBGH outlines some of the lessons the exchange might learn from PacAdvantage’s slow demise.
“The biggest lesson is, exchanges are naturally vulnerable to adverse selection,” according to report co-author Bill Kramer, the executive director of national health policy at PBGH. “When the Pacific Business Group on Health took over HIPC, it was inheriting an adverse selection problem. At a certain point, the adverse selection becomes irreversible and there’s no way to get out of it.”
Date Set, Plaintiffs Get Support in High Court Medi-Cal Case
First up on the Supreme Court’s docket this fall is a California case determining whether Medi-Cal beneficiaries and providers have the right to sue the government. The ruling — no matter which side it favors — is expected to have far-reaching implications.
Cost Drops for Patients with Pre-Existing Conditions
Enrollment for the Pre-Existing Condition Insurance Plan (PCIP) just got a big boost.
Cost has long been suspected as one of the limiting factors to signing up people to the federally funded PCIP program. Now, according to officials of the Managed Risk Medical Insurance Board (MRMIB), the cost of premiums in the plan are about to drop by an average of 18%.
“We have new premiums now with a significant reduction in cost,” MRMIB chair Cliff Allenby said, “at an average of 18%, which is anywhere from 8.2% to 24.3% lower cost.”
Remember the Co-Ops? Overlooked Plan Raises Questions
Two years after lawmakers and activists battled over the fate of the public option, its erstwhile replacement — a plan to create health cooperatives — was finally unveiled last month.
Dental Trips Emphasized for Young Children
Low-income children are not getting good dental care, even though many of them have coverage through the state. Shelley Rouillard would like to do something about that.
Rouillard, deputy director of benefits and quality monitoring at the Managed Risk Medical Insurance Board (MRMIB), is leading an effort at MRMIB to get more young children to see the dentist — as early in their lives as possible, she said.
“Studies show that the younger the child (who gets dental care) the less it costs over their life for dental services,” Rouillard said. “So we want the percentage of kids who see a dentist to change, and we’re targeting the youngest kids. We’d like the children ages 0 to 3 to start being seen.”
Exchange Board Handles New Move Quietly
During the most recent board meeting of the California Health Benefit Exchange, board members gingerly approached the last item on the agenda — would the board stick its toe in political waters?
“I don’t know that it’s the board’s place to do this,” board member Paul Fearer offered at one point. Chair Diana Dooley, secretary of the state HHS agency, announced right at the start of the meeting she would abstain from legislative issues.
But clearly the board felt it was the board’s place to get involved in legislative waters — past the toes and ankle and maybe up to the knee — as it voted 3-0 on several motions to involve the exchange board’s input and opinion on half a dozen legislative bills.