Latest California Healthline Stories
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.
Personal Stories Highlight Oral Chemotherapy Bill
New legislation proposed by Assembly member Henry Perea (D-Fresno) would require health plans to provide chemotherapy in pill form, in some cases.
“This bill will provide greater access for oral chemotherapy treatment,” Perea said on the Assembly floor late last week. “This is the right thing to do, to allow people access to lifesaving drugs.”
Perea introduced the measure with his personal account of caring for his mother, who he said was diagnosed with stage 2 lung cancer just over a year ago. During the long, eight-hour chemo infusion in the hospital, he learned quite a lot about cancer and chemo from patients and professionals.
‘Value’ in Health Insurance Acquires New Meaning
Insurers and employers are expanding the scope of value-based insurance design, leaving their mark on customized programs that challenge the typical cost-sharing arrangements adopted by many payers.
Ateev Mehrotra of RAND Corporation Talks About the Growth Potential of Retail Clinics
Ateev Mehrotra, a policy analyst at the RAND Corporation, spoke with California Healthline about how the demand for retail clinics might increase in response to a growing shortage of primary care providers and a nationwide push to lower health care costs.
Five Health Care Issues To Watch in 2012
Mark your calendars: A slew of ACA-related payment reforms, health IT changes and health insurance exchange updates will debut next year — even as constitutional questions over the law come to an end. (Maybe.)
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.”
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.”
Inland Empire Readies Low-Income Health Plans
Low-income individuals in San Bernardino and Riverside counties will have access to two new health insurance programs beginning in 2012. The plans have been developed in preparation for a larger expansion of Medi-Cal in 2014 as required by the Affordable Care Act.
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.