Latest California Healthline Stories
Healthy Families’ First Phase Done, Now Comes the Harder Part
California is in the thick of moving almost one million children from Healthy Families to Medi-Cal managed care. With a shortened first phase of 178,000 kids successfully completed, attention turns to the next two phases that will shift coverage for about 485,000 children.
Administrative Law Office OKs Autism Measures
The California Office of Administrative Law on Monday approved emergency regulations governing health insurers’ treatment of autism coverage.
The regulations were issued by the Department of Insurance to implement details of the California Mental Health Parity Act as well as to implement SB 946 by Sen. Darrell Steinberg (D-Sacramento), an autism treatment law passed in 2011.
“These emergency regulations will ensure that insurance companies cover medically necessary treatment,” Insurance Commissioner Dave Jones said in a written statement. “Autistic children and their families should now, without delay, receive the transformative treatment that will enable them to succeed in school, their families and communities.”
Stakeholders See California as National Model for Revamping Mental Health Care Services
Kirsten Barlow of the California Mental Health Directors Association, Sonoma County Mental Health Director Michael Kennedy, Rusty Selix of the California Council of Community Mental Health Agencies and Senate President Pro Tempore Darrell Steinberg spoke with California Healthline about California’s experience revamping its mental health care system.
As Mass. Goes, So Goes California? Questioning the Safety Net’s Future
Although county officials are worried that expanded insurance coverage under the Affordable Care Act could prompt newly insured Californians to turn away from safety-net facilities, Massachusetts health reformers say that hasn’t been their experience.
Of the roughly 2,600 appeal hearings filed over eligibility for the Community Based Adult Services program, only 47 are still to be heard, according to Michael Weston, deputy director of public affairs for the Department of Social Services.
Administrative law judges from the Department of Social Services heard the appeal hearings and then forwarded their opinions to Toby Douglas, director of the Department of Health Care Services, the agency that issued the denials of eligibility. Douglas reviewed each case and made the final ruling on CBAS eligibility.
According to Douglas, about 49% of the appellants were granted eligibility as a result of the appeal.
Geographic Rating Regions Amended
The Assembly and Senate last week introduced amendments to SBX1-2 by Sen. Ed Hernández (D-West Covina) and ABX1-2 by Assembly member Richard Pan (D-Sacramento), which change the geographic rating regions for the individual and small health insurance markets in California.
The amendments establish the 19-region plan, the same regions adopted by the Legislature last year for larger-market insurers.
The state’s health benefit exchange, Covered California, favored the 19-region plan in part because it mirrors last year’s large-market legislation and could avoid consumer and industry confusion.
Inland Empire Provider Positioning for Growth in Reform
On the heels of opening a new hospital and medical plaza, Loma Linda University Health is planning to build a 150,000 square-foot medical campus in San Bernardino. Experts say the health system is positioning itself for changes in competition and reimbursement from health care reform.
Floor Votes in Favor of Expansion Bills
The state Assembly and Senate yesterday passed companion bills to expand Medi-Cal eligibility to more than one million Californians making up to 138% of federal poverty level. The bills also simplify the Medi-Cal enrollment process.
“This bill takes an important step to make sure California remains a leader in health care reform,” said Assembly Speaker John Pérez (D-Los Angeles), author of ABX1-1. “And this also helps bring billions of dollars in federal funds into California.”
The Senate passed its version of the legislation, SBX1-1, authored by Sen. Ed Hernandez (D-West Covina). The expansion will be fully funded with federal money for the first three years, declining to 90% in 2020.
Expansion Hearing Highlights County-State Struggle
California health officials and legislators yesterday had a lively discussion over the two proposed choices for the optional Medi-Cal expansion.
At the onset, yesterday’s discussion in the Budget Subcommittee on Health and Human Services centered on the Brown Administration’s choices for a state-based or county-based approach to implementing expansion of Medi-Cal to adults up to 138% of federal poverty level, which is expected to open eligibility to as many as 1.4 million Californians.
But the meat of the conversation evolved into something else. Since counties have pretty firmly asserted they’re in favor of the state-based plan, and state officials have not stated a preference for either option, choosing one approach over another was not really the main issue during yesterday’s hearing.
Should California Expand Providers’ Scope of Practice?
Hoping to bolster the ranks of providers able to deal with millions of newly insured Californians, the California Legislature this month will consider a proposal to give mid-level health care practitioners more autonomy and authority. We asked legislators and stakeholders if that’s a good idea.