Latest California Healthline Stories
Timeline Delineates Duals Project Tasks
The state Department of Health Care Services has released a timeline of deadlines and target dates for its Coordinated Care Initiative, also known as the duals demonstration project.
Eventually, the duals project hopes to move about one million Californians dually eligible for Medi-Cal and Medicare benefits into Medi-Cal managed care plans. The idea, state officials have said, is to provide better, more integrated care by pooling the funding sources from two disparate programs. Coordinated care could provide stronger case management, offer needed services and save state and federal dollars.
The pilot program in eight counties, beginning in March, 2013, will serve about 700,000 of the state’s dual eligibles.
How Much Will States’ Medicaid Expansions Really Cost?
State officials are wrestling with whether to join the Affordable Care Act’s Medicaid expansion, but as part of their evaluation process, many are relying on cost estimates that are not accurate.
Rural Clinics Hope DHCS Email Will Turn Tide in Medi-Cal Benefits Lawsuit
The Department of Health Care Services has been accused of withholding information in a court case — information that has the potential to change the reimbursement status of rural health centers and federally qualified health centers in California, according to court documents filed Monday in the U.S. Court of Appeals Ninth Circuit by the California Association of Rural Health Clinics.
Officials from DHCS could not comment on the lawsuit, according to Norman Williams, deputy director of public affairs for DHCS.
“As this matter is in active litigation, DHCS will provide its response to CARHC’s recent motion in an upcoming court filing,” Williams said.
The Medicaid Mess: Where Do States Stand on ObamaCare Expansion?
State leaders are wrestling with whether to take part in the Affordable Care Act’s newly voluntary Medicaid expansion. Several policy and political concerns are driving their decisions.
Copay Proposal for Some Drugs, Emergency Visits
The Senate Committee on Budget and Fiscal Review last week approved a significantly scaled-down version of a copay proposal for Medi-Cal beneficiaries.
The Legislature last year passed a more extensive copay proposal that was projected to save $511 million in general fund dollars for the state. It called for $5 per physician visit and $50 for an emergency department visit . In February federal health care officials nixed that plan.
The current proposal would impose a copay of $3.10 for non-preferred drugs, with an exception for patients who receive those medications by mail, and a $15 copay for non-emergency use of the emergency room.
State Health Officials Intrigued by New Medi-Cal Data
Len Finocchio is a numbers guy, so he’s genuinely excited by a new set of survey data that paints a picture of recipients’ impressions of the Medi-Cal program.
“There is lots of data, lots of it,” said Finocchio, associate director of the Department of Health Care Services. “We will be continuing to mine it for a long time, to get insights about how to make the program better.”
Last week, the California HealthCare Foundation, which publishes California Healthline, released a survey of the attitudes and concerns of Medi-Cal beneficiaries. It has been a relatively long time since a similar survey was completed in 2000, so state health care officials were extremely pleased to get updated information, Finocchio said.
Duals Project Goes to CMS for Approval
It was a big moment for officials in the Department of Health Care Services.
“We are thrilled to be getting this in,” said Jane Ogle, deputy director of DHCS. “It’s a big project. So to get this in, we’re all really excited. This is the result of a year’s planning, a year of planning and work with advocates and stakeholders and within the department. And all of that comes together in this document.”
The project is the Coordinated Care Initiative, also known as the duals demonstration project, and the document is the project’s final plan, which was submitted late last week to CMS.
CMS Weighs in on Enrollment Question
Federal health officials have informed the state that CMS would favor passive enrollment with an opt-out provision but it does not support lock-in enrollment for the dual-eligible demonstration project in California.
That’s according to Kevin Prindiville, deputy director of the National Senior Citizens Law Center in Oakland, who spoke to CMS officials on Friday.
“CMS has told us that’s all they will allow,” Prindiville said. “It’s not a big surprise, but it’s very welcome. We think the passive enrollment system is problematic in some ways, but CMS has said all along they would allow passive enrollment, but there would have to be a way to opt out at any time.”
Community Dental Beneficiaries Go to Liberty
Community Dental Services health plan, plagued with financial troubles and quality-of-care problems, has shut down its managed care dental plan in Sacramento and Los Angeles counties.
On Friday, the state announced that all 16,000 Medi-Cal beneficiaries at CDS, the bulk of them in Sacramento County, would switch to Liberty Dental Plan of California. Also making the change will be 4,000 non-Medi-Cal patients. State officials said beneficiaries’ providers would remain the same in almost every case.
The failure of CDS may be good news for the state and the beneficiaries in the plan, since that company had the lowest utilization rate among the five health plans providing dental coverage in Sacramento County. The state has been under fire recently because of low utilization rates in the pilot “geographic managed care” system. In the 2010-2011 fiscal year, fewer than one-third of Sacramento County Medi-Cal children went to a dentist, compared with a utilization rate of nearly 50% for the rest of the state.
Subcommittee Puts Co-Pay Idea on Hold
Co-pay is back. Last year, the Legislature passed and the governor signed a budget trailer bill that included Medi-Cal co-payments of $5 for some provider visits, up to $50 for emergency department visits and up to $100 for patients admitted to the hospital.
That move required a CMS waiver but in February, federal officials denied it. Now, with the May budget revision, a scaled-down version of co-payments is back on the table.
Yesterday, an Assembly budget subcommittee heard testimony on the subject and decided to hold co-pay approval for a later date.