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The battle in Ventura County over reimbursement rates has been raging for months, with the pharmacists saying the current rates will eventually force many out of business.
The proposals for low-income adults are flying somewhat under the radar as flashier issues like single-payer grab the spotlight.
The Department of Health Care Services says less than a quarter of adults on Medi-Cal saw a dentist within the last year.
KPCC offers information about the new regulation that allows patients with congestive heart failure, advanced cancer, liver disease and chronic obstructive pulmonary disease to get more services to address suffering associated with their illness.
In the early hours of Friday morning the House passed a spending deal to very quickly reverse a government shutdown that was triggered at midnight. The bill includes many of the Democrats’ top health care priorities, but they had to compromise in some places as well.
Local pharmacists have been in battle with the health plan since OptumRx launched its program as Gold Coast’s new pharmacy benefit manager.
Anthony Wright, executive director of the nonprofit Health Access California, cites an expected $6.1 billion surplus he said could have been used to move California toward universal health care coverage. Instead, health spending only gets a modest bump in Gov. Jerry Brown’s proposed budget.
“If Bobby doesn’t have this medication, he will die. It’s as simple as that,” said Tracy Belt, a mother who has a son with Type 1 diabetes. Congress has passed a short-term funding fix for the Children’s Health Insurance Program, but lawmakers are stills squabbling over how to pay for a longer-term solution.
The state has already eliminated legal residency requirements for Medicaid coverage for people under 19. But Assemblyman Phil Ting, who heads the Assembly’s budget committee, wants to extend that to all ages.
Pharmacists have for months said the new reimbursement rates that were established after OptumRx took over control of reimbursement as the new pharmacy benefit manager for the Gold Coast Health Plan’s medication program are far below what they need to stay afloat.