Latest Morning Briefing Stories
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.
Healthy Families, Seniors Initiatives Questioned
In the governor’s May budget revision released this week, in addition to $2.5 billion in new cuts to health care in California, there were a couple of proposals that raised big red flags for many health care advocates.
In particular, two budget items took a lot of heat: the effort to move about 1 million dual-eligible Californians into managed care programs; and the state’s plan to move 870,000 children out of the Healthy Families program and into Medi-Cal care.
In both cases, advocates said the state is taking on way too much, too quickly — putting the two most vulnerable populations in California at real risk.
Risks, Rewards Higher for Managing Dual Eligibles
California health plan officials say the experience of shifting seniors and persons with disabilities into Medi-Cal managed care plans over the past year will help as the state moves dual eligibles — beneficiaries of both Medicare and Medi-Cal — into managed care this year.
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.”