Latest California Healthline Stories
Legislators, Advocates, State Officials Attend ADHC Hearing
A legislative hearing yesterday took on the task of unraveling the legal, administrative and medical tangles generated by the elimination of adult day health care as a Medi-Cal benefit in California.
The likely closure of up to 300 ADHC centers across the state on Dec. 1 — and what will happen to the medically fragile population of roughly 35,000 seniors and the disabled in California who use those centers — has produced a swell of deep worry and frustration in the ADHC community and in Sacramento.
Advocates have charged the Department of Health Care Services with ignoring the needs of the ADHC population and shunning the advice and input of center directors and experts associated with that program.
Assembly ADHC Hearing Offers All Sides
Anyone who has been on vacation since the start of the year and missed Sacramento’s debate over the fate of the adult day health care program gets a chance to hear every part of it, all at once, today.
The Assembly Committee on Aging and Long-Term Care is holding a hearing today on ADHC — its importance to Californians, the reasons for its elimination as a Medi-Cal benefit, the details of transition for about 35,000 ADHC patients and the pending legal decision that could either approve or reject that state transition plan.
Department of Health Care Services Director Toby Douglas will attend the hearing and outline the state’s plan. ADHC advocates will make an appearance, as well, as will a representative of the legal team that is suing the state over its elimination of the ADHC benefit.
Rate Regulation, Basic Health Headed to Floor?
The state Legislature reconvenes today, starting with a Senate Committee on Appropriations hearing with 167 items on the agenda. The Assembly’s Appropriations Committee meets Wednesday, with 184 items to consider.
Those numbers will be whittled down for this week’s hearings, but generally Appropriations is the final destination before an actual floor vote for any bill that might spend money. That’s why the two committees will have so many menu items from which to choose.
Among the bills that still need to clear the Appropriations hurdle is AB 52 — by Assembly members Mike Feuer (D-Los Angeles) and Jared Huffman (D-San Rafael) — which is the health insurance rate regulation bill. Also up is the bill to create a Basic Health Program, SB 703, by Sen. Ed Hernandez (D-West Covina).
American Indian Providers Get Help With EHRs
Christine Schmoeckel of the state’s Office of Health Information Integrity was pretty happy yesterday.
“Our newest news is that we have a fourth regional extension center in California,” she said. “This is great news, that we now have four centers.”
Schmoeckel was hosting yesterday’s California health information technology stakeholders’ meeting, in part because many health IT leaders are in Southern California this week, meeting with the Office of the National Coordinator for Health IT.
Uninsured Healthier Than Current Medi-Cal Beneficiaries
Helen Lee was surprised by a few of the findings in a study released last week by the Public Policy Institute of California.
“We find a relatively young population among the uninsured,” the PPIC policy fellow said. “In fact, more than half were in the 19 to 40 group.”
Up to three million Californians will join the ranks of the insured under the expansion of coverage in 2014 mandated by the federal Affordable Care Act. So it’s important to know the demographic makeup of all of those potential enrollees, Lee said.
State Lambasted Over Transition Plan, Lack of Communication
Jill Yungling was trying to hold in her exasperation yesterday, but it just kept spilling over.
“It is appalling to me how they can sit up there and say all of these things, and it’s all so full of holes,” Yungling said, “and we’re just supposed to sit down here and believe them.”
Yungling came from Carmichael to attend yesterday’s adult day health care stakeholder meeting in Sacramento. The California Department of Health Care Services convened the session to discuss the elimination of ADHC as a Medi-Cal benefit, a move that is likely to shutter most of the 300 ADHC centers across the state.
New Transition Plan, New ADHC Options
There’s an interesting phrase in the state’s new transition plan for the adult day health care program: “ADHC-like services.”
It’s one of the care options listed in the state’s recently released transition plan, and it will be part of the discussion today in Sacramento, when the Department of Health Care Services holds an ADHC stakeholder meeting.
“Current ADHC [centers] could provide ADHC-like services under the waiver,” according to Toby Douglas, the director of DHCS. “There are ways we can do that as part of the transition plan.”
The California Department of Health Care Services has been updating its transition plan to make sure patients in the adult day health care program have somewhere to go when those services officially end on Dec. 1.
DHCS hopes its new plan will help the roughly 35,000 Californians enrolled in about 300 ADHC centers across the state.
“Working with the Department of Aging, the Department of Social Services and the Department of Developmental Services, DHCS has created a multi-faceted approach to provide comprehensive health risk assessments, care coordination, case management and appropriate ongoing services to former ADHC clients,” according to the new transition plan.
How Should the Exchange Adjust Risk?
William Dow, a professor of health economics at UC-Berkeley, said the idea is relatively simple.
“In theory, each individual patient comes with a dollar amount representing their gain or loss to the insurance company,” Dow said at a recent forum in Sacramento. “And that means every enrollee should have the same profit amount.”
If higher risk patients, such as those with diabetes, pay a slightly higher premium, Dow said, that balances the risk that companies take in insuring them.
Lessons Learned From PacAdvantage Failure
The Pacific Business Group on Health (PBGH) has had some experience in running a small group purchasing pool. It’s the organization that took over the Health Insurance Plan of California (HIPC), which was renamed the Pacific Health Advantage or PacAdvantage and operated for a total of 13 years, ending in 2006.
That organization was similar in concept to California’s Health Benefit Exchange. A new report from PBGH outlines some of the lessons the exchange might learn from PacAdvantage’s slow demise.
“The biggest lesson is, exchanges are naturally vulnerable to adverse selection,” according to report co-author Bill Kramer, the executive director of national health policy at PBGH. “When the Pacific Business Group on Health took over HIPC, it was inheriting an adverse selection problem. At a certain point, the adverse selection becomes irreversible and there’s no way to get out of it.”