Latest California Healthline Stories
Higher Primary Care Rate Welcome News for California
Earlier this month, CMS made it official: The federal government will pay Medi-Cal primary care physicians in California at the same rate as Medicare in 2013 and 2014.
The higher rate, confirmed by CMS officials on Nov. 2, means more than just paying more to family practice, pediatrics and internal medicine physicians, said Kevin Prindiville, deputy director of the National Senior Citizens Law Center, a national legal advocacy group with an office in Oakland.
“We hope this will improve access,” Prindiville said, “and there aren’t too many things in our market-driven system that can do that.”
Uninsured Eligible for Mental Health Services
When major portions of the Affordable Care Act are implemented in 2014, almost all of the 500,000 uninsured Californians who were previously identified as being in need of mental health services will be eligible for those services, either through Medi-Cal expansion or the exchange, according to a study released yesterday by the UCLA Center for Health Policy Research.
“Last year we did a mental health report, and what we found is there are 500,000 or so people in California who are uninsured and in need of mental health services, so this year we wanted to see who among them would be eligible for coverage under the Affordable Care Act,” said Imelda Padilla-Frausto, lead author of the report released yesterday.
“We found about half of them would be eligible through expansion, and another 42% through the exchange,” Padilla-Frausto said. “That’s practically everyone. It’s a huge improvement for those adults who don’t have insurance coverage.”
No Agenda Yet for Special Session
The one-month delay in the legislative special session on health care should not affect the content of the discussion, according to Assembly member Richard Pan (D-Sacramento), who chairs the Assembly Committee on Health.
“The purpose of the special session is that there’s legislation that is really important to get passed prior to the Jan. 1, 2014 [Affordable Care Act] deadline,” Pan said. “So this will allow us to pass these bills and have them take effect prior to that time. So in [terms of the special session move from December to January], it doesn’t change anything.”
In August, Gov. Jerry Brown (D) announced he would convene a special session in the Legislature after the national election in November, to address elements of the Affordable Care Act. That special session was expected to happen sometime in December.
Advocates’ Challenge to Adult Day Process Denied
A federal judge ruled last week to deny a motion that would have forced the Department of Health Care Services to alter the way it is handling enrollment in the new Community Based Adult Services program.
The ruling means CBAS enrollment will continue without changes unless Disability Rights California, the health advocacy group that filed the motion, appeals the ruling. Deadline for appeal is Friday.
“The federal Magistrate recommended full denial of the plaintiffs’ motion regarding their concern with the state’s implementation of the Adult Day Health Care settlement agreement,” Norman Williams, director of public affairs for DHCS, said in a written statement.
Letter from Congress Focuses on Healthy Families Transition
California’s effort to move approximately 860,000 children from the Healthy Families program has drawn national attention.
Twenty-two members of the House of Representatives, including House Speaker Nancy Pelosi (D-San Francisco), last week sent a letter to state health officials, urging caution in the Healthy Families transition to Medi-Cal managed care.
The transition is slated to begin Jan. 1 when almost half the Health Families kids — about 415,000 — make the switch. The state still needs CMS approval for the plan.
Health Care Special Session Slated for January
California’s legislative special session on health care won’t take place until January, according to officials at the California Health and Human Services agency.
Gov. Jerry Brown (D) told legislators in August he will convene a special session in the Legislature “to continue [the] important work of implementing the Affordable Care Act,” Brown wrote in a letter to California legislators. The session was expected to be convened in December.
The special session will be held concurrently with the regular legislative session that begins Jan. 7.
Saving Money, Lives with Mental Health Program
A new study by the UCLA Center for Healthier Children, Families and Communities suggests an intensive and integrated mental health program called Full Service Partnerships is likely to save the state money at a return rate of $1.27 for every dollar spent.
The FSP program is designed to care for individuals with serious mental illness by taking a holistic approach to their care, according to Renay Bradley, chief of research and evaluation at the UCLA center.
“The idea is, if you have individuals who are particularly challenged, such as homeless individuals or just people who need a lot of assistance, they’re funneled into FSPs,” Bradley said. “And they do whatever it takes to get them to a decent level of functioning.”
Covered California’s Plans to Become Self-Sufficient
California’s health benefit exchange, now also known as Covered California, eventually is supposed to run by itself without state or federal money. The exchange board took a couple of steps toward that end at Wednesday’s board meeting.
It released its draft Level II establishment grant proposal, which now will be forwarded to federal officials. The proposal is a blueprint for how the exchange will operate in California.
As part of the proposal, exchange officials laid out plans for the exchange to be self-sufficient by 2017.
Long Busy Day for the Exchange Board
The Health Benefit Exchange board issued a draft establishment grant proposal Wednesday, which is basically a blueprint of the exchange’s business and operational plan through 2017, the year it is supposed to become self-sufficient.
The board also took on a number of other issues on Wednesday, including imminent submission of its quality health plans proposal to the Office of Administrative Law. The eight-hour meeting had a get-down-to-business tone, partly in response to the reelection of President Obama, which ensures a smoother track for implementation of the Affordable Care Act.
“We’ve been moving full steam ahead for over a year now,” said Peter Lee, executive director of the HBEx board. “So this is a good meeting to have right after the election.”
‘California’s Budget Situation Has Improved Sharply’
Yesterday’s long-term budget forecast for sunnier skies in California by the Legislative Analyst’s Office could also mean good things for the state’s health care programs, according to the LAO and health experts.
“For the first time in a decade, we’ve stabilized our budget problem,” said Mac Taylor, head legislative analyst at the LAO. “We are looking at a much more positive outlook in the future. This is nothing like we’ve had to look at in the past.”
The state still faces a $1.9 billion deficit for the fiscal year 2013-14 — that’s about half current shortfall and half operating deficit for next year, according to Taylor — but that is just the current projection and could shift, based on a number of factors, Taylor said.