Latest California Healthline Stories
Heat Over Healthy Families Compromise Plan
Yesterday’s state budget compromise between legislative leaders and the governor includes a provision that 880,000 children in the Healthy Families program will complete the shift to Medi-Cal managed care within a year, beginning Jan. 1. State officials, who had been using an enrollment figure of 875,000, now say the Healthy Families programs serves 880,000 California children.
The timing of the shift ticks off Suzie Shupe, executive director of California Coverage and Health Initiatives (formerly known as the Children’s Health Initiative).
“We are really outraged over this deal that was struck,” Shupe said. “Despite both houses of the Legislature supporting the notion of transitioning just the bright-line kids, I can’t believe they decided to eliminate a popular and successful program in one fell swoop like this.”
Senate Rejects ACA/Exchange Bill
If the Supreme Court overturns part or all of the Affordable Care Act in a ruling expected within the next 10 days, California should be ready, according to Senator Tom Harman (R-Huntington Beach).
Harman yesterday introduced SB 1321, which would require the California Health Benefit Exchange to submit a report to the Legislature within 90 days, if the Supreme Court reverses any part of the ACA.
The Senate Committee on Health rejected the measure.
Details of Exchange Begin to Emerge
California Health Benefit Exchange Board members yesterday heard presentations on a number of topics including stakeholder opinions on qualified health plans, potential exchange users’ opinions on what they need from the exchange and possibilities for creating call centers. All of those discussions seemed to lead to the same two things: cost and service.
“If we drop the ball on service, we will drop the ball on everything,” said Peter Lee, executive director of the exchange board. “Service matters.”
Lee was discussing the results of a discussion group of possible users of the exchange, who articulated what they would want in an exchange. He was also referring to a report submitted yesterday on defining the parameters for qualified health plans that will participate in the exchange.
Exchange Looks at Outreach, Focus Groups, By-Laws
The Supreme Court decision on the fate of the national health care reform law, expected this week or next, could have a significant impact on the work and purpose of the California Health Benefit Exchange.
But that isn’t slowing the project one bit.
Today, the exchange board meets to discuss some big agenda items: outreach, marketing, insurance coverage assisters and agents, the second phase of its establishment grant and yet another look at its bylaws.
HHS Funds Health Innovations Aimed at Improving Care, Saving Money
HHS on Friday announced 17 new recipients of health care innovation grants in California, the largest of which was a $19 million award for the Pacific Business Group on Health to expand its coordinated care project.
Nationwide, 81 innovation grants were dished out. Last month, HHS issued 26 innovation awards, including four in California. In all, California received 21 of the 107 grants.
“This means a significant expansion of something where we’ve seen good results so far,” said David Lansky, CEO of the Pacific Business Group on Health. PBGH received $19 million from HHS to expand the Intensive Outpatient Care Program in collaboration with the California Quality Collaborative, a network of providers in California.
Study Estimates High Enrollment for Exchange
As many as 2.1 million Californians will get subsidized health insurance coverage through the state’s new Health Benefit Exchange by 2019, according to a study released yesterday by the UC-Berkeley Labor Center and UCLA Center for Health Policy Research.
Another 1.1 million from the unsubsidized individual health insurance market are expected to join the exchange as well, said UCLA researcher Dylan Roby. That would bring the estimated total to about 3.2 million.
State Under Fire for Adult Service Denials, Appeals
Dana O’Callaghan, a social worker for Americare Adult Day Health Center in San Diego, accompanied a young mentally ill patient to an appeals hearing last week — one of the first of approximately 1,800 scheduled appeals of denial of Medi-Cal eligibility for California’s new Community Based Adult Services program for adult day health care.
O’Callaghan wasn’t prepared for what she saw and heard.
“I expected something informal, but when I got there, the attorneys [for the state] were so meticulous about every little thing, every word,” O’Callaghan said. “They questioned the validity of this document [I had written], they questioned my intent. It was not, let’s hear what you have to say, it was more like grilling you on what you do, the dates of your paperwork, that kind of thing.”
Health Care Task Force Starts Up
This is not your usual task force, according to Diana Dooley, secretary of the state Health and Human Services department. This one, she said, is less interested in the ideal and more focused on producing real-world results. The idea is to figure out which programs across the state improve health care and keep costs down and then encourage and support them.
Dooley was in Los Angeles yesterday to co-chair the first meeting of the health care task force created last month by Gov. Jerry Brown (D). Dooley said the first gathering could not have gone much better.
“I thought it was energized, and energizing,” she said. “It went a long way toward really substantively addressing a meaningful plan, to see what it would look like for California to be healthier in 10 years than it is today. And how do we make some real changes to improve health, lower cost and reform the delivery system. I thought it was a great start.”
Copay Proposal for Some Drugs, Emergency Visits
The Senate Committee on Budget and Fiscal Review last week approved a significantly scaled-down version of a copay proposal for Medi-Cal beneficiaries.
The Legislature last year passed a more extensive copay proposal that was projected to save $511 million in general fund dollars for the state. It called for $5 per physician visit and $50 for an emergency department visit . In February federal health care officials nixed that plan.
The current proposal would impose a copay of $3.10 for non-preferred drugs, with an exception for patients who receive those medications by mail, and a $15 copay for non-emergency use of the emergency room.
Long-Term Care Crisis Is Now, Report Says
By 2030, the number of Californians 85 and older will rise by 40% and the overall senior population will comprise about 18% of all Californians. That’s the sobering news from a fact sheet released this week by the SCAN Foundation, a not-for-profit organization that tracks long-term care issues.
“There are many changes evolving here in the state, so being able to articulate that we’re in a time of increasing need is important,” said Gretchen Alkema, vice president for policy and communications at SCAN. “We feel there will be increasing needs in the state, especially when we’re seeing a scaling-back for providing those services.”
The higher demand for senior services, particularly from the 85-plus population, coupled with budget cuts to health care programs adds up to a potentially huge problem, Alkema said. “We need to transform our systems of care, and not just for seniors because we know those long-term care needs aren’t created in a vacuum, they’re usually brought on by a number of chronic conditions.”