Latest California Healthline Stories
Health Plans’ Quality for Duals in Question
Seven of the eight health plans in California’s pilot project to shift dual eligibles into managed Medi-Cal have inferior quality ratings for treating Medi-Cal beneficiaries, according to a report released yesterday.
The ambitious plan for 1.1 million Californians eligible for both Medicare and Medi-Cal benefits will start with a pilot program in four counties — Los Angeles, Orange, San Diego and San Mateo. The state hopes to expand the pilot project to as many as 10 counties, pending legislative approval.
The report from National Senior Citizens Law Center, citing the state Department of Health Care Services’ own quality assessment, shows seven plans earned a rating of 1 out of 5 stars in overall Medi-Cal performance.
Expansion of Safety Net Sparks Debate
The 17 health care clinics run by the Molina Medical Group, which care for many low-income patients, should qualify as safety net providers in California, according to the group’s owners. AB 2002 by Gil Cedillo (D-Los Angeles) would redefine the state’s process for establishing Medi-Cal safety net providers to allow centers like Molina’s to be included.
“This bill would create a fair definition of a safety net provider,” according to Gilbert Simon, a physician at Sacramento Family Medical Center who testified at an Assembly Committee on Health hearing earlier this week. Sacramento Family Medical Center is a Molina Healthcare partner. Molina Healthcare is a for-profit company operating in 16 states and headquartered in Long Beach.
“Physician groups across the state are preparing and building sustainable networks to provide medical homes to patients [for the expansion of health care enrollment in 2014], and it is imperative that we acknowledge the true nature of the safety net,” Simon said, “and take steps to acknowledge its expanding role.”
The Department of Health Care Services may need an abacus to keep track of all of the lawsuits being levied against it.
A ruling is expected as early as today in a lawsuit brought against DHCS by the California Primary Care Association and several other providers.
The CPCA hopes a federal judge will grant a temporary restraining order to halt a lower reimbursement rate for adult day health services in the recently launched Community Based Adult Services program.
State Names Four Counties for Duals Project
California took a big step yesterday, officially unveiling the four counties that will kick off the three-year project to eventually shift 1.1 million dual eligibles — Californians eligible for both Medi-Cal and Medicare — to a Medi-Cal managed care program.
The first four participants in the Coordinated Care Initiative are Los Angeles, Orange, San Diego and San Mateo counties. The Department of Health Care Services currently has authority to start the program in those counties, but legislation is pending in Sacramento that would expand authority for the number of participating counties — up to 10 of them by 2013.
The trailer bill language for that legislation has been finalized. The trailer bill is expected to be included in the budget package in June, DHCS officials said.
Ironing Out Details of Duals Conversion
State officials met with stakeholders in Sacramento yesterday to answer questions and work out the final details of the duals demonstration project — an ambitious plan to enroll an estimated 700,000 dual-eligible Californians in 10 counties into Medi-Cal managed care.
Enrollment will be mandatory for beneficiaries eligible for both Medi-Cal and Medicare. Jane Ogle, deputy director of health care delivery systems at the Department of Health Care Services, was quick to point out that beneficiaries would keep their own physician, even if that physician is not in the Medi-Cal network, and that beneficiaries have the power to opt out of the demonstration project, if they want.
“There is no need to assign a new doctor to people,” Ogle said. “There just is no need to do that.”
Hearing Focuses on Children’s Dental Care
Assembly member Richard Pan (D-Sacramento) knew the subject was a little out of the ken of the workforce committee, but that it was too important to be ignored.
“One of principles in looking at whether we have an adequate workforce is to make sure we can take care of our patients,” Pan said. “We need to take care of the oral health needs of children, and that depends, in part, on availability of coverage, and payment for those services.”
Pan, chairman of the Assembly Select Committee on Health Care Workforce and Access to Care, presided over a recent hearing on children’s oral health in Sacramento County.
Legislature Examines Duals Transition
Toby Douglas took a good amount of heat last Wednesday at an Assembly joint hearing of the committee on Aging and Long-Term Care and the Budget subcommittee on Health and Human Services.
Douglas — director of the state Department of Health Care Services — with a full array of budget cuts, program transitions and agency reorganization on his plate, has been making presentations and fielding questions at a number of legislative hearings recently. None of them has been a cakewalk, but this hearing was a little more barbed than most.
Complaints and concerns ranged from a perceived lack of choice to worry over rapid-fire changes.
More People May Be Eligible for Adult Day Services
There was a glimmer of good news for the 35,000 adult day health care Medi-Cal patients in California. It looks like a much higher percentage of them than previously estimated will be eligible to receive the new benefit called Community Based Adult Services.
Department of Health Care Services Director Toby Douglas originally said he expected about 50% of current ADHC patients to qualify for the new program. ADHC will be eliminated as a Medi-Cal benefit on Mar. 31 and the CBAS program starts Apr. 1.
Now it looks like 70% to 80% of those receiving the ADHC benefit will qualify for CBAS, according to Catherine Blakemore, executive director of Disability Rights California, which is monitoring the state’s assessment and placement of ADHC patients.
From Supreme Court to Appeals Court
Yesterday’s decision by the U.S. Supreme Court had a ripple effect in California, influencing a number of lawsuits in the state over health care cuts.
Four lawsuits have been filed over the 10% Medi-Cal provider rate cuts, and in all four cases, a federal judge has issued a temporary injunction blocking those cuts. In another court case, an injunction halted 20% trigger cuts to Californians receiving In-Home Supportive Services.
All of those cases were waiting to see what the Supreme Court would decide in Douglas v. Independent Living Center of Southern California. Yesterday’s decision to send that case back to the Ninth Circuit Court of Appeals was a huge victory for patient rights’ groups, according to Melinda Bird, a Disability Rights California attorney.
Can Health Equity Be a Moneymaker?
Sometimes the right thing might also be the financially beneficial thing.
Physician groups are gathering today in Sacramento for a conference on disparities in health care related to race, language and geography. This time, the debate is not just about the moral imperative to promote equity in health care, but also about the clinical and financial impetus to make that move.
“The thing that has changed, as more people are brought into systems of care with accountability, health organizations are going to be looking at avoidable cost as well as avoidable risk,” according to Wells Shoemaker, medical director of the California Association of Physician Groups, which organized the conference.”It’s sort of the low-hanging fruit when you’re looking for avoidable costs.”