Latest California Healthline Stories
Mandatory Enrollment Draws Attention From Legislators
The state wants to move fee-for-service Medi-Cal beneficiaries who are seniors and persons with disabilities into managed care plans. At the same time, the state is in the initial stages of launching a demonstration project to eventually move up to 1.1 million dual eligibles — those eligible for both Medicare and Medi-Cal benefits — into managed care.
Today in Sacramento, those two significant efforts get some legislative oversight. The Senate and Assembly health committees are holding a joint hearing on how those two efforts will be conducted.
“We want the health care system to be more efficient, but without sacrificing patient care,” Assembly member Bill Monning (D-Carmel) said. “The objective [of both efforts] is to improve patient care. So this is an opportunity to have some transparency for the public and some oversight.”
Dual Eligibles a Tricky Population To Manage
The state Department of Health Care Services wants to integrate care for about 1.1 million dual eligibles in California — people eligible for both Medicare and Medi-Cal services — by moving them to managed care plans.
“These two insurance programs don’t necessarily work well together,” according to Neal Adams, deputy director of the California Institute for Mental Health. “The benefit design is not equal across all platforms.”
Adams was part of a stakeholder summit convened last week by DHCS to discuss the dual eligible demonstration project. It was the first of three stakeholder meetings this month. Others are scheduled Dec. 12 in San Francisco and Dec. 15 in Los Angeles.
Judge Temporarily Stops IHSS Cuts
A federal judge in Oakland issued a temporary restraining order last week, suspending the state’s planned reduction of 20% to In-Home Supportive Services to 370,000 Californians.
Judge Claudia Wilken scheduled a hearing Dec. 15 to decide whether a preliminary injunction should be granted. The state has the option to move that court date, if it desires.
The judicial action came right before the state was set to send notices to IHSS participants — most of whom are seniors — notifying them of the reduction in services. The so-called trigger cuts were ordered by the Legislature back in June, to go into effect Jan. 1, if fiscal targets weren’t met in December. Those targets are unlikely to be met.
California Leading Payment Reform Effort
Steve McDermott runs a physicians group, but it’s his role as patient that makes him an expert on payment reform, he said.
“I had hip replacement surgery and let me say, it is a wonderful thing,” McDermott said. “I went from a grumpy old man to, well, just an old man. But yeah, it probably saved my marriage.”
But a look at the bill could’ve sent him back over the line far past grumpy, if he didn’t have medical insurance. The cost of a hip replacement, he said, is out of whack. “The cost is about $70,000 — not including surgery,” McDermott said. “And the number of uninsured in California is at about 23%, and that’s just unacceptable. If the health care system is the number-one cause of bankruptcies in the state, that’s not good.”
Mental Health Needs High, Treatment Low
About two million Californians are under stress and need some kind of mental health care — and are not getting the help they need, according to a UCLA study released yesterday.
“There are a lot of people with mental health needs, and they aren’t getting adequate care,” UCLA researcher David Grant said. “Men are less likely to seek and receive the care they need, and immigrants definitely aren’t getting their care needs met. And even native-born Latinos and Asians are unlikely to seek treatment, so that’s a definite target for the state to consider.”
The report from the UCLA Center for Health Policy Research is based on 2007 data from the California Health Interview Survey.
Ruling To Prompt New ADHC Transition
It’s too early to know some details of the newest transition plan for adult day health care services, according to state officials. The final settlement of a lawsuit challenging the state’s first transition plan will be released tomorrow, and the federal judge in the case will issue a ruling on the settlement in two weeks.
But that doesn’t stop people from raising questions.
“Which [current ADHC] centers will be eligible to become CBAS (Community Based Adult Services) centers?” Lydia Missaelides of the California Association of Adult Day Services asked. The CBAS program is created in the settlement as a partial replacement for Medi-Cal benficiaries. To save money, state officials eliminated the ADHC program as a Medi-Cal benefit.
Three Meetings To Address Duals Conversion
This week, the state begins a series of stakeholder meetings across California, all looking at different aspects of the ambitious task of converting more than one million people who receive both Medicare and Medi-Cal benefits — known as dual eligibles — to a more comprehensive model of care.
According to Peter Harbage, who has been leading the information-gathering component of the effort, this is an important month in the process. Now that the first wave of input has been solicited, the three meetings scheduled for December can dive deeper into the details.
“The main goal is to talk about the design of the duals demonstration project, so the state can get a better understanding what people believe the challenges and opportunities are, and what consumer protections need to be done,” Harbage said.
Three new maternity coverage laws were passed this year in California, but that doesn’t necessarily mean the people who need that coverage will get it, according to experts who gathered at a recent meeting in the Capitol Building.
“Just passing a new law we found isn’t enough,” according to Jenya Cassidy of the California Work and Family Coalition, which co-sponsored the event. “It’s also really important that you need to empower people to use the rights they have.”
According to Cassidy, many women of reproductive age who qualify for services and protections under California law aren’t aware of them.
California Hospitals Ask Courts To Halt Cuts
Some California hospitals would take a significant and long-lasting hit from Medi-Cal reimbursement cuts recently approved by CMS, according to the California Hospital Association, which this week filed a petition in federal court to put a temporary halt to those reductions.
CHA’s lawsuit and injunction request are separate from the court action taken earlier this week by the California Medical Association and other provider organizations.
“They’re two entirely different lawsuits,” Jan Emerson-Shea of CHA said. “We have filed a declaration with the court, asking the court to stop certain cuts that were approved by the CMS and were retroactive to June 1. It’s all related to the same set of cuts, but we’re suing based on the hospital cuts.”
Design Element the First Step Toward No-Wrong-Door
California took an important first step toward implementation of the Health Benefit Exchange last week when it unveiled the initial design for enrolling Californians and determining their eligibility in 2014.
The initial design of the project, called Enroll UX 2014 (UX stands for “user experience”), was presented to the Health Benefit Exchange board by project director Terri Shaw.
“We have teams from 11 states participating in the process,” Shaw said. “The objectives are two-fold — to develop a first-class user experience, and to ensure retention of consumers.”