Latest California Healthline Stories
Study: Insurers Are Palliative Care Innovators
Six major health insurers in California are expanding access to palliative care by providing more specialized case management and opening up the hospice benefit beyond its Medicare boundaries, according to a new study expected to be released today.
The study, “A Better Benefit: Health Plans Try New Approaches to End-of-Life Care,” is accompanied by a second paper in today’s scheduled release: “End-of-Life Care in California: You Don’t Always Get What You Want.” The two papers are funded and published by the California HealthCare Foundation, which publishes California Healthline.
The study of the six largest health plans was based on interviews with stakeholders and with health plan directors, as well as reviews of published studies and academic reports, to determine the extent of palliative care alternatives at those plans.
Managing Medi-Cal With Enrollment Up, Spending Down
We asked legislators, state officials and consumer advocates how California should manage Medi-Cal with enrollment going up by millions next year and reimbursements going down perhaps by as much as 10%.
Money to Be Made, Saved with Biosimilars?
A heated fight has developed over legislation to regulate a biotech development that hasn’t yet hit the U.S. market. On Wednesday, the state Senate Committee on Health will take up the topic of biosimilars and the surprisingly robust debate they’ve sparked.
“Legislation like this is a typical brand ploy,” said Brynna Clark, senior director for state affairs at the Generic Pharmaceutical Association, at a Senate Business and Professions committee hearing earlier this month. “It is being pushed by companies who stand to lose $60 billion in patent [expirations]. They don’t have a compelling interest to allow competition to the marketplace.”
That’s the opposition to the bill. Now a proponent:
“Quite frankly, I am shocked at the insensitivity that has been shown to patients during this debate,” said Eve Bukowski, vice president for state government affairs at the California Healthcare Institute, a not-for-profit research and advocacy organization. For cancer patients like Bukowski, who might need biosimilars treatment and who want their physician to be informed about a change in medication, she said, “Are our opponents really suggesting this is too much to ask? … Really?”
Legislature OKs First Special Session Bills
The Assembly and Senate yesterday voted to approve two similar bills that would reform the individual health insurance market and ban pre-existing conditions as a reason for denying health insurance.
They are the first bills from the special session on health care reform to pass legislative floor votes.
The bills now must pass a procedural vote by both houses of origination before heading to the governor’s desk. The governor’s office has expressed support for the bills, so both are expected to be signed into law.
No Diversion of Mental Health Money
A Senate budget subcommittee last week rejected a plan to divert roughly $34 million a year for mental health services to a CalWORKs (California Work Opportunity and Responsibility to Kids) fund.
The California Department of Finance wanted to redistribute realignment money so half the funds currently going to mental health services would instead be shared equally between mental health and CalWORKs starting in 2015-16.
“The realignment funds going into the CalWORKs maintenance of effort subaccount are capped at $1.1 billion, at which point any additional funds, or growth over that amount, are routed to the mental health subaccount,” said Judy Bowman from the Department of Finance, at last week’s Senate Budget Subcommittee for Health and Human Services hearing. “This … would adjust that structure so that those growth funds … would instead be split evenly between the mental health subaccount and the CalWORKs maintenance of effort subaccount.”
Autism, Dental, Mental Health Focus of Transition Concerns
The volume is increasing in a chorus of concern about the transition of Healthy Families children to Medi-Cal managed care. Parents, advocates and state officials are worried about losing access to autism treatment, lower reimbursement for dental services and unusually low numbers of kids getting mental health care.
Committee OKs ‘Culture Change’ Spending
A new bill aimed at changing the culture of long-term care in part by redirecting nursing home penalty fees passed a surprisingly controversial hearing yesterday before the Assembly Committee on Health.
AB 973 by Assembly member Sharon Quirk-Silva (D-Fullerton) would direct roughly $150,000 a year in state penalty funds collected from long-term care facility violations to be used to “change the culture” at nursing homes, Quirk Silva said.
” ‘Culture change’ usually makes you think, well, what is that?” Quirk-Silva said. In this case, she said, “Culture change means looking at a shift in how we operate in our nursing homes, toward a more person-centered change in our long-term care facilities.”
Are High-Risk Pools a Preview of Obamacare’s Failure?
Two months ago, the Obama administration suspended enrollment in an Affordable Care Act program that offers insurance coverage for sick residents. Some observers say the move is indicative of larger ACA snags to come, while others say the high-risk pools have isolated problems.
Searching For The Right Insurance Under Obamacare
Q: I work at a family-owned restaurant and my boss has cut back my insurance coverage. I have to pay a lot more out of pocket on top of my monthly premium. Can I find a better deal on insurance under health reform? A: How’s this for a definitive answer: Possibly. You may be able […]
Autism Families Directed to Regional Centers
Department of Health Care Services director Toby Douglas testified yesterday that some Healthy Families participants will probably lose a type of autism service in the transition to Medi-Cal managed care plans.
The service — applied behavioral analysis — is still covered by Medi-Cal, Douglas said, but in a different way. Families with an autistic child will need to reapply for the service through the state’s regional centers, where eligibility criteria are stiffer. Some children who qualified in Healthy Families may not be eligible under new guidelines, officials said.
Douglas testified yesterday before the Assembly Budget Subcommittee on Health and Human Services. His disclosure rubbed a number of legislators the wrong way.