Latest Morning Briefing Stories
Insuring a Better Future for the State?
State officials and health care experts yesterday said the governor’s decision to sign on to optional expansion of Medi-Cal could be a huge step forward for California’s health system — and a huge challenge, as well, they said.
More than 700 stakeholders gathered in downtown Sacramento for the annual conference of the Insure the Uninsured Project heard dozens of experts evaluate how far California has come in implementing health care reform, and how far it still has to go.
Adding roughly 1.4 million Californians to Medi-Cal eligibility in the optional expansion (adding adults up to 138% of federal poverty level) may be fully funded by the federal government for the first three years, but it also brings a boatload of work to the state. It’s worth the extra effort for the sake of beneficiaries and for the savings the state stands to make in reduced hospital and emergency department costs, said Diana Dooley, state Secretary of Health and Human Services.
Finance, Health Care Linked in Expansion Effort
State health care and finance officials met for the first time with stakeholders Friday to outline some of the differences between two possible approaches — state-based or county-based — to implementing the state’s optional Medi-Cal expansion.
Many details of the proposed expansion of Medi-Cal are unknown, state officials said Friday because they’re waiting for more federal guidance in many areas. One important detail is known: the federal government will fully pay for the expansion benefits for new enrollees for the first three years.
Diana Dooley, the state’s Secretary of Health and Human Services, said implementing the expansion will be influenced in equal parts by financial and health care considerations.
Using Data to Simplify Medi-Cal Enrollment
A different approach to Medi-Cal eligibility renewal was floated yesterday at an informational seminar in Sacramento.
The idea is to limit the amount of forms and paperwork in renewing Medi-Cal eligibility. That might be accomplished in part by using statistical analysis of eligibility data to determine which beneficiaries don’t need to fill out new forms when their Medi-Cal benefits are up for renewal, said Stan Dorn, senior fellow at the Urban Institute, a Washington, D.C.-based think tank.
“The traditional way to handle Medicaid enrollment is very paperwork-intensive,” Dorn said. “The applicant fills out a piece of paper, supplies immigration documents and pay stubs. Then when eligibility is renewed, there’s a new form mailed to them, and they need current pay stubs and so on. … But now accessing that data and processing it is much cheaper and more reasonable and plausible than it was then.”
Access Denied? Implications of Medi-Cal Pay Cut
Can you expand Medicaid coverage while cutting provider payments and still preserve access to care? California officials think so, but patient advocates aren’t so sure.
So Far, Healthy Families Transition Going Smoothly
So far, so good. Several weeks into the first phase of shifting 860,000 children from Healthy Families into Medi-Cal managed care plans, there have been relatively few complaints and few signs of problems.
Provider Rate Cut Case May Linger
The state budget proposed by Gov. Brown counts on $488.4 million in savings from rate reductions to Medi-Cal providers in keeping with a law passed in 2011 that hasn’t yet been implemented because it’s been held up in court.
Last month, a three-judge panel in federal Circuit Court overruled previous injunctions issued by federal appellate judges. However, the injunctions will remain in place and provider reimbursements won’t be cut at least until the end of this month. Litigants in each of the four lawsuits have until Jan. 28 to file a re-hearing request.
At least one of those litigants — the California Hospital Association — is going to file a re-hearing request, according to Jan Emerson-Shea, CHA’s vice president of external affairs.
State Plans Retroactive Payment Rate Hikes
The good news for primary care physicians is the federal program to raise Medicaid reimbursement rates starts Jan. 1.
The bad news is Medi-Cal providers in California may have to wait several months to retroactively receive the higher payment.
California health officials have to wait for federal approval of a state plan amendment, which will take time, said Norman Williams, deputy director of public affairs for the Department of Health Care Services.
Duals Project Edges Closer to Completion
More than 300 people attended a Department of Health Care Services seminar yesterday offering details of the duals demonstration project, also known as the Coordinated Care Initiative.
The department recently released several reports, including a draft of the care coordination and long-term services and supports readiness standards. Those guidelines are a big step toward the state’s readiness plan it eventually will need to submit to CMS, said Jane Ogle, deputy director of DHCS, at yesterday’s seminar.
The state released a summary of some of the significant details in the reports:
Higher Primary Care Rate Welcome News for California
Earlier this month, CMS made it official: The federal government will pay Medi-Cal primary care physicians in California at the same rate as Medicare in 2013 and 2014.
The higher rate, confirmed by CMS officials on Nov. 2, means more than just paying more to family practice, pediatrics and internal medicine physicians, said Kevin Prindiville, deputy director of the National Senior Citizens Law Center, a national legal advocacy group with an office in Oakland.
“We hope this will improve access,” Prindiville said, “and there aren’t too many things in our market-driven system that can do that.”
Republicans Changing Tune — but not Shifting Critical Tone — on Medicaid
A handful of prominent conservatives have dropped their fight against the Affordable Care Act and its Medicaid expansion, but GOP leaders say the program still needs immediate reform.