Latest California Healthline Stories
PCIP Enrollment Could Be Capped in Two Months
State officials may need to curtail enrollment in the federally funded Pre-Existing Condition Insurance Plan in as little as two months from now, if more federal dollars aren’t allocated to it.
That was the word last week from the Managed Risk Medical Insurance Board, which oversees the federal PCIP program. It was surprising news, given its history since the program launched last year.
Every month, at every board meeting, the report was always the same — that the flow of enrollees into the program was increasing, but at a surprisingly slow rate.
Lawsuit Settlement Ends Fight Over ADHC
Really, it’s all about Esther Darling.
The 74-year-old is the poster child for adult day health care services. She had a stroke, deals with diabetes and congestive heart failure, takes multiple medications and receives care and treatment at a day center in Yolo County.
“If it wasn’t for the [ADHC] therapy, I wouldn’t be able to walk today,” Darling said. “They said I wouldn’t walk anymore, but I was determined to prove them wrong.”
Rural Critical Care Access Hospitals Could Get Hit
Health care services across the country are expecting to be slammed if the congressional debt-reduction super committee makes its deadline and submits a plan to reduce the federal deficit by Wednesday, but rural California could take a particularly big hit, according to a Washington, D.C., policy expert who spoke in Sacramento yesterday.
In addition to Medicare reimbursement rate cuts, other reduction proposals have included eliminating all rural hospital payment programs, according to David Lee, a governmental affairs expert for the National Rural Health Association.
“There are a number of possible cuts that directly affect rural health care, but this one — that all rural hospital payment programs could be abolished — has come up over and over again,” Lee said, addressing the annual conference of the California State Rural Health Association.
Closed ADHC Centers Make State’s Exempt List
The state Department of Health Care Services recently released a list of 64 adult day health care centers among roughly 300 in the state that will be exempt from the recently approved 10% reduction in Medi-Cal reimbursements. Those centers will be not be charged retroactively to June as other proividers will be, nor will they be subject to the 10% cut going forward because they serve a mostly rural population that the federal government wants to make sure gets access to care.
“These are the centers that the state feels are critical to maintaining access, in order to follow federal law,” according to Norman Williams of DHCS.
But 13 of the 64 centers on the exempt list have already closed, some of them last year.
Settlement Expected in ADHC Lawsuit
Disability Rights California is close to settling its adult day health care lawsuit against the California Department of Health Care Services, according to a joint release from the two parties.
Today’s scheduled federal court date has been moved to Thursday, by mutual agreement. But according to the joint statement, the court date may not be necessary.
“This brief court date postponement is necessary to enable the parties to finalize a settlement, the details of which will be available on Thursday,” the release said.
Judge About To Rule on ADHC Issues
Tomorrow, a federal judge is scheduled to hear the long-delayed court case challenging the state’s adult day health care transition plan.
Both sides are trying to hash out a compromise settlement. Representatives from Disability Rights California, which filed the suit, and the state Department of Health Care Services met four days last week and may talk again today in an attempt to avoid the all-or-nothing judicial decision.
The state is due to eliminate ADHC as a Medi-Cal benefit on Dec. 1. The lawsuit challenges the efficacy of the transition plan proposed by DHCS to provide necessary care for 35,000 ADHC beneficiaries.
Senate Committee Takes Aim at Long-Term Care
The numbers are scary, according to policy experts and legislators at a Senate Subcommittee on Aging and Long-Term Care meeting yesterday:
• The cost of care in a nursing home in California is approximately $6,000 a month, and the cost of part-time, in-home care is roughly $1,700 a month, according to state officials.
• Both those numbers are expected to double in less than 20 years to $12,000 a month for nursing home care and $3,400 a month for in-home help, according to committee Chair Elaine Alquist (D-Santa Clara).
• California has more than four million seniors right now. That figure is expected to more than double to 8.8 million by 2030, according to Steven Wallace of the UCLA Center for Health Policy Research.
• About one-third of the respondents in a UCLA survey say they couldn’t afford one month of nursing home care, Wallace said.
Health Insurance Rate Regulation May Be On November Ballot
The contentious issue of regulating California’s health care insurance industry is back.
After AB 52 by Mike Feuer (D-Los Angeles) and Jared Huffman (D-San Rafael) was shelved at the end of the last legislative session, that looked like the final word on the prospect of regulating health insurance rates.
Yesterday, Consumer Watchdog filed paperwork to take health insurance rate regulation to the voters.
Stakeholders Map Out Next Tasks for HIE
The health information exchange revolution is under way in California.
“There is tremendous enthusiasm across the state for what’s happening in HIE,” according to David Lansky of the Pacific Business Group on Health, who spoke at yesterday’s Health Information Exchange Stakeholder Summit 2011 in Sacramento.
“We represent large purchasers of health insurance, so in a way it’s odd that we’re so involved in this,” Lansky said. “But we feel HIE is a critical, foundational support tool for transforming the health care delivery system.” The health care reform effort aims to make health care affordable and high-quality, he said, “And we can’t make it succeed without this project.”
Chronic Care Becoming a Chronic Problem
To lower costs and increase quality of care, policymakers in California need to address how to better treat the chronically ill — those patients at the center of health care spending in the state.
That was the conclusion of a health care panel discussion last week in the Capitol Building in Sacramento, put on by the Center for Health Improvement as part of the California Health Policy Forum.
“This is a huge worldwide epidemic,” according to panelist Sophia Chang. “About two in five Californians have at least one chronic condition — and half of these people have two or more of these conditions.”