Latest California Healthline Stories
State ‘De-links’ Mandatory Enrollment from Duals Project
The Department of Health Care Services last week announced a new provision of Cal MediConnect that would establish a means of abandoning the state’s duals demonstration project if it doesn’t meet a financial benchmark.
The department also wants to “de-link” mandatory enrollment from the demonstration project, according to Jane Ogle, deputy director at DHCS.
“On the program side, we de-linked mandatory enrollment of duals. That way, we’ll have long-term services and supports as Medi-Cal benefits,” she said.
DHCS Transparency Bill Moves Forward
The Senate Committee on Health this week approved a bill that would set new standards of accountability and transparency at the Department of Health Care Services.
AB 209 by Assembly member Richard Pan (D-Sacramento) received unanimous committee approval Wednesday and now heads for a Senate floor vote, the step before it can be sent to the governor’s desk.
The bill wants to hold the department accountable for problems that arise with patients moving to Medi-Cal managed care plans with stronger, measurable benchmarks, Pan said.
Reversing Medi-Cal Cuts Priorty for Latino Lawmakers
Members of the legislative Latino Caucus on Tuesday laid out their agenda that includes some form of reversal of the 10% reduction in payments to Medi-Cal providers.
The Legislature passed the 10% cut in 2011, but it was delayed until a federal appeals court ruling upheld the reduction two weeks ago. State officials said the bulk of the cutbacks will begin in September.
Although the case may be appealed to the U.S. Supreme Court, the federal appeals court ruling May 24 puts pressure on the Legislature to come up with an alternative. Some lawmakers — including the Latino Caucus — have been working to craft a legislative answer. Two members of the Latino Caucus in particular have been front-and-center in efforts to reverse the rate cuts.
Protesters Swarm Sacramento to Protest Medi-Cal Cuts
The Capitol yesterday swarmed with protesters upset about a 10% cut in reimbursements to Medi-Cal providers that has raised concerns about the state’s ability to provide access to Medicaid beneficiaries.
“Health care, especially in the hospitals, it’s not always working,” said Sonia De La Torre, a hospital worker who got on a bus at 4 a.m. yesterday in Corona (Riverside County) to attend the Sacramento rally. “When people come into the hospital with no insurance, they get basic care, at best. We want to make sure people get treatment.”
Police estimated 8,000 people gathered outside the Capitol Building yesterday. Musicians took the main stage early in the day, replaced later by speakers including event organizers and legislators.
Budget Process Latest Way to Reverse Cuts
Thousands of providers, patients, health care professionals and other protesters are expected to gather today outside the Capitol Building to support the idea of reversing a 10% Medi-Cal provider rate cut. Organizers say it will be the largest health care protest in Sacramento history.
“We have people hopping on buses in Oceanside at 4 in the morning to get here,” said Molly Weedn, director of media relations for the California Medical Association. “People are coming from all over the state, and we’ve seen support from both sides in the Legislature. All of this [support] shows that the public doesn’t want Medi-Cal to be cut, so that’s why we’re doing this.”
It has been a tough couple of weeks for proponents of reversing the rate cut made in 2011 and not yet implemented because of court battles.
Assembly Takes Up Health Care ‘Loophole’
The Assembly this week is expected to debate a bill that would penalize large employers who reduce workers’ hours or wages in an attempt to move those employees off company-sponsored health care and into Medi-Cal coverage.
“We want to close that loophole that allows some of the largest and most profitable businesses in California to skirt their responsibility under the Affordable Care Act,” said Assembly member Jimmy Gomez (D-Los Angeles), author of AB 880.
Some large employers, he said, want to lower wages or hours of employees so those workers would earn a low-enough wage to become eligible for Medi-Cal, “dumping them onto the backs of the taxpayers,” Gomez said.
Health Insurers Owed $271 Million
State officials this week said the Healthy Families program owes $271 million in services already provided by its network of 20 health care insurers and the program needs legislative help to fix the problem.
Healthy Families’ overall shortfall is projected to be $366 million for the year, a deficit caused by expiration of the managed care organization tax in December. Last week, the Senate budget subcommittee on Health and Human Services delayed a vote on the MCO tax.
“The Legislature failed to extend the MCO tax, therefore MRMIB did not have sufficient cash to pay for the Healthy Families program invoices,” said Tony Lee, deputy director for administration at the Managed Risk Medical Insurance Board, which oversees the Healthy Families program. Lee spoke Wednesday at the monthly MRMIB board meeting.
Plan Proposed to Cover Autistic Children
A Senate subcommittee last week proposed a $50 million solution to temporarily address the lack of coverage of a type of autism treatment under Medi-Cal — a gap in care that recently affected hundreds of Healthy Families children when the state moved them to Medi-Cal managed care plans.
The new proposal would appropriate $50 million to make sure Medi-Cal children with autism are able to receive applied behavioral analysis treatment — known as ABA therapy — through the end of 2013. The assumption is that ABA therapy will be available as an essential health benefit under the Affordable Care Act starting in 2014.
“Clearly this item is to bridge a gap of service,” said Sen. Bill Monning (D-Monterey), chair of the Senate Budget Subcommittee on Health and Human Services, at a hearing last week.
School Nurses Case to Supreme Court
The California Supreme Court today will hear oral arguments about the safety and well-being of schoolchildren with diabetes. The case centers on school nurses, but nursing leaders say it could set precedent for the practice of nursing in California.
Cash-strapped school districts across the state have laid off school nurses, creating a dilemma for diabetic children who need insulin shots during school hours.
The state has argued that non-medical personnel can administer the shots. State officials say requiring nurses to do the job endangers children’s ready access to insulin injections and puts their health at risk.
Federal Court Upholds 10% Medi-Cal Provider Cut
The United States Ninth Circuit Court of Appeals on Friday upheld the right of California to impose a 10% rate reduction on providers of Medi-Cal services.
The long-awaited ruling is the last judicial step, short of the U.S. Supreme Court, for the controversial cut to hospitals, physicians, emergency transport and dentists. Provider groups have said they would likely appeal the rate reduction to the Supreme Court.
The federal ruling lifted the injunctions on implementing the reductions. Outside of a Supreme Court appeal, the federal judicial panel clearly stated there would be no further appeals considered.