Latest California Healthline Stories
Disability Case Takes Unusual Turn
A federal judge temporarily halted automatic “trigger cuts” to the state’s budget that would reduce In-Home Supportive Services by 20%. A hearing on the issue, originally scheduled this month, is now scheduled Jan. 19.
In the meantime, a state declaration filed in the case said 66,000 Californians would be exempt from the cuts — including all children younger than age 21.
“In total, approximately 66,000 IHSS recipients will be completely exempt from the 20% reduction, which is roughly 15% of all IHSS recipients,” according to a declaration by Eileen Carroll, deputy director of the Adult Programs Division at the Department of Social Services.
Disabilities Case Waits on Supreme Court Ruling
A federal judge last week issued a stay of a court case challenging the freezing of some provider reimbursement rates for services for the developmentally disabled in California — effectively putting off the case until February or March, after the U.S. Supreme Court issues a ruling in a similar case it is currently hearing.
U.S. District Judge Morrison England Jr. denied the state’s request to dismiss the case. He also denied the plaintiffs’ request for a preliminary injunction on the rate freeze.
He cited a pending CMS ruling on health care provider costs that could also inform the court case. But the big one to wait for is the Supreme Court case, Douglas v. Independent Living Center, according to Tony Anderson of the Arc of California, which brought the case for the developmentally disabled.
Mental Health Services Heading to DHCS
Integration of care is one of the touchstones of the health care reform conversation. It’s a big and complicated task, though, to integrate health care for the 7.5 million Californians on Medi-Cal.
The state is taking a big step toward that goal by shifting Medi-Cal mental health benefits away from the Department of Mental Health and into the Department of Health Care Services by July 1 of next year. The idea is to incorporate mental health care and substance abuse treatment into people’s overall health care, so that it’s not a segmented benefit.
The tricky part is the transition, because you don’t want a disruption in care while you’re changing that organizational structure, according to Toby Douglas, director of DHCS.
PCIP Enrollment Numbers Rise a Bit
The federally funded, state-run Pre-Existing Condition Insurance Plan has always been a bit of a tough sell.
It costs money, for one thing (premiums vary according to age and geography). And eligibility can be challenging: you have to have a pre-existing condition and be uninsured for six months.
That last requirement may be the toughest hurdle because those people with pre-existing conditions that are severe enough to be denied private insurance would have a hard time going uninsured for half a year.
PCIP Program Gets Last-Minute Funding
Last month, it looked like the federally funded, state-run Pre-Existing Condition Insurance Plan was about to reach its beneficiary limit. The Managed Risk Medical Insurance Board, which oversees the program, was considering closing enrollment.
At yesterday’s board meeting, officials said 813 new enrollees had been added to the system in the past month — leaving fewer than 800 slots still open. But MRMIB had good news up its sleeve.
“We received the 2012 amendment for the PCIP contract from the feds,” MRMIB Executive Director Janette Casillas said, “and they have given us an increase.”
Trigger Cuts Not the Only Worry for Disabled
Yesterday’s announcement of $1 billion in trigger cuts for California’s budget includes two provisions that hit the developmentally disabled community.
One of those provisions, to scale back In-Home Supportive Services by 20%, is already in court. A federal judge last week issued a temporary restraining order to halt implementation of that cut, pending a hearing scheduled for tomorrow.
The other big budget reduction for the disabled — a $100 million cut to the Department of Developmental Services — is going to be much more difficult to fight in court, according to Tony Anderson, executive director of The Arc of California, which advocates for the developmentally disabled.
How To Protect Seniors During Duals Conversion?
Yesterday’s stakeholder meeting to help plan the duals conversion pilots was partially notable for what it was not.
It was not rancorous, it was not loud and the discussion went relatively smoothly for the Department of Health Care Services, compared with last week’s grilling of DHCS over the smaller conversion of SPDs (seniors and persons with disabilities) to managed care.
“Hearing the issues here today is very important for us,” Melanie Bella of CMS said at the end of the meeting. “A couple of things we said were non-negotiable here are stakeholder involvement, meaningful stakeholder involvement and consumer protections.”
Clashing Views of Transition for Seniors, Disabled
Either the state’s transition to managed care is going great, or it’s a confusing mess.
That would depend on who’s talking. At a joint oversight hearing last week, convened by the Senate and the Assembly committees on health, government officials outlined a generally positive picture for the effort to move Medi-Cal seniors and people with disabilities (SPDs) from Medi-Cal fee-for-service to managed care.
“The transition of seniors and people with disabilities into managed care is part of the triple mandate from [the federal] HHS,” according to Jane Ogle, deputy director at the Department of Health Care Services. “Better health, better quality and more cost-effective care.”
Free Data Spark Innovation, Proponents Say
One of the keys to successful health care innovation is the freeing-up of data, according to Todd Park, chief technology officer for the federal HHS.
“We are working on so many exciting things right now, but the initiative we’re most excited about is the health data initiative,” Park said. “We are unleashing the power of open data and open innovation.”
Park was one of a group of experts who convened in Sacramento Wednesday for a health information technology forum put on by the Center for Health Improvement. One of the co-sponsors was the California HealthCare Foundation, which publishes California Healthline.
New Evidence of Seniors’ Vulnerability
Kathryn Kietzman and other researchers from the UCLA Center for Health Policy Research conducted a series of interviews with California seniors and their families over a one-year period. Their ongoing monitoring yielded worrisome results, Kietzman said — particularly seeing the effect on those seniors of a number of seemingly small budget cuts.
“Even those seniors with low-level needs were strongly affected by these cuts,” Kietzman said, referring primarily to a 3.6% reduction in In-Home Supportive Services and also to a cutback in monthly Supplemental Security Income and State Supplementary Payments. “What we saw was a culmination of sometimes little cuts, sometimes bigger cuts,” she said. “Many times we follow these things at the policy level, but [here] we’ve seen changes at the individual level, particularly for people with chronic care conditions.”
Those cutbacks don’t begin to compare with the state’s trigger cut of 20% of IHSS care, and a state-estimated halving of service to people currently receiving adult day health care services, Kietzman said.