Latest California Healthline Stories
Getting a Head Start on Medi-Cal Expansion
For a program no one’s really heard of, this one is pretty successful.
Counties started enrolling people into the Low-Income Health Program in July 2011, and four months later (at the most recent count in November) about 260,000 Californians were enrolled in it, according to Linda Leu, a health care policy analyst with Health Access California.
“It is a really great opportunity for those who are low-income, and who have been left out of programs like Medicaid [or, in California, Medi-Cal],” Leu said.
And with an acronym like LIHP, the perfect time to publicize the program is on Valentine’s Day, she said.
State Considers Coverage Mandates
The deadline to pass legislation left over from last year has come and gone, with single payer, insurance rate regulation and the basic health plan all temporarily halted. The next big legislative push is coming up fast, as all new bills for 2012 have to be introduced by the end of next week, on Feb. 24.
A number of health-related laws recently were passed by the state Senate or Assembly. Many of them call for coverage mandates by health insurance providers.
Report Looks at SHOP Exchange Viability
The first series of forums put on by Small Business Majority went to small towns and cities across California to raise the notion of a business-specific health insurance exchange — the Small Business Health Options Program, known as SHOP. The idea is to pool small business resources and buying power — separate from the California Health Benefit Exchange’s individual market — so business owners can get a better, more financially stable option for health insurance.
Now, a second set of forums — with experts from California, as well as from other states that have tried similar projects — has finished. This week the Small Business Majority released a report summarizing the points brought up in those forums.
“Affordability is the number one issue to small business owners,” according to Terry Gardiner of Small Business Majority. “Most companies who have not offered insurance say it’s because it’s too expensive, they cant afford it. And the ones who actually are providing coverage, they are struggling.”
Same Providers in Healthy Families and Medi-Cal?
Yesterday’s distribution of a summary of new Healthy Families data by the state Department of Health Care Services caused some advocates to scratch their heads.
The state wants to move 875,000 children out of Healthy Families and into Medi-Cal in the next 16 months. It’s an idea that has been floated before, and has been vigorously opposed by providers, who would rather have the higher reimbursement of Healthy Families. California’s Medi-Cal reimbursement rates are among the lowest Medicaid rates in the nation.
The new data indicate most providers and health plans in the Healthy Families program also serve Medi-Cal beneficiaries.
Douglas: Healthy Families Similar to Medi-Cal
State Department of Health Care Services Director Toby Douglas explained the reasoning behind the state’s plans for the Healthy Families program during the Insure the Uninsured Project’s 16th annual statewide conference in Sacramento yesterday.
Acknowledging that the proposal to shift 875,000 children out of Healthy Families and into Medi-Cal on a relatively fast timeline is a little controversial, Douglas said it’s part of a bigger plan.
“It’s all about delivery system reform,” Douglas said. “It’s about moving toward organized delivery systems.”
Study: Uninsured Face Similar Debt as Medi-Cal Beneficiaries
More Californians are borrowing money to pay for health care services — and two-thirds of them have medical insurance, according to a new study by the UCLA Center for Health Policy Research.
“When you think you’re insured, you still end up paying a percentage and that adds up, into thousands of dollars,” report author Shana Alex Lavarreda said. “So having insurance doesn’t mean you will have things paid for.”
Another surprising finding, Lavarreda said, is that uninsured Californians face a similar medical debt level to those who have insurance through Medi-Cal.
New Report Offers Healthy Families Alternatives
The state wants to shift 875,000 children in the Healthy Families program into Medi-Cal over a nine-month period, beginning in October. The state estimates the move will save $156 million over the next two fiscal years.
But according to a soon-to-be-released study, that plan could limit access to care for California’s children, and the state might be better served to move more slowly.
A report commissioned by the Urban Institute looked at four possible directions for the Healthy Families program. Report author Stan Dorn said the move to Medi-Cal has some definite advantages for California children — particularly for those at or below 133% of the federal poverty level. Those children will make that transition in 2014 anyway, as required by the Affordable Care Act.
Few People Aware of Medical Review Program
It has been 11 years since California launched its Independent Medical Review program, an appeals process that allows Californians to challenge denial or delay of coverage by private health care insurers.
In the Capitol Building in Sacramento yesterday, a policy briefing laid out the findings of a new report on IMR that includes praise for its effectiveness and some recommendations on how to make the program stronger.
The briefing was sponsored by the California HealthCare Foundation, which commissioned the report and publishes California Healthline.
Adult Day Health Services Budget Looks Familiar
The recent state budget proposal includes the expected cost of the Community-Based Adult Services program for next year: roughly $83 million.
That number is eerily close to last year’s budget estimate for the Keeping Adults Free from Institutions program, which was an alternative adult day services plan that the Legislature passed in June. The Legislature approved $85 million for the KAFI program, which was designed as a half-price replacement for the adult day health care program.
Gov. Jerry Brown (D) vetoed KAFI.
State Gets Resistance to Moving All Healthy Families’ Kids
A coalition of not-for-profit children’s groups yesterday sent a letter to California officials asking them to scale back the state’s ambitious plan to move 875,000 children out of the Healthy Families program and into a new Medi-Cal managed care program.
“We do not support the governor’s proposal,” Suzie Shupe of California Coverage and Health Initiatives said. “We have some very serious concerns about it. It’s a very rapid timeline, for one, and in our view does not detail the kind of safeguards that need to be in place, and the monitoring of access to that care, to make sure kids do get access to quality health care.”
Yesterday’s letter was a joint effort from Children Now, The Children’s Partnership, PICO California, the Children’s Defense Fund California and United Ways of California, as well as CCHI. It calls for a scaled-back version of the governor’s proposal.