Latest Morning Briefing Stories
Mandatory Enrollment Draws Attention From Legislators
The state wants to move fee-for-service Medi-Cal beneficiaries who are seniors and persons with disabilities into managed care plans. At the same time, the state is in the initial stages of launching a demonstration project to eventually move up to 1.1 million dual eligibles — those eligible for both Medicare and Medi-Cal benefits — into managed care.
Today in Sacramento, those two significant efforts get some legislative oversight. The Senate and Assembly health committees are holding a joint hearing on how those two efforts will be conducted.
“We want the health care system to be more efficient, but without sacrificing patient care,” Assembly member Bill Monning (D-Carmel) said. “The objective [of both efforts] is to improve patient care. So this is an opportunity to have some transparency for the public and some oversight.”
Dual Eligibles a Tricky Population To Manage
The state Department of Health Care Services wants to integrate care for about 1.1 million dual eligibles in California — people eligible for both Medicare and Medi-Cal services — by moving them to managed care plans.
“These two insurance programs don’t necessarily work well together,” according to Neal Adams, deputy director of the California Institute for Mental Health. “The benefit design is not equal across all platforms.”
Adams was part of a stakeholder summit convened last week by DHCS to discuss the dual eligible demonstration project. It was the first of three stakeholder meetings this month. Others are scheduled Dec. 12 in San Francisco and Dec. 15 in Los Angeles.
Inland Empire Readies Low-Income Health Plans
Low-income individuals in San Bernardino and Riverside counties will have access to two new health insurance programs beginning in 2012. The plans have been developed in preparation for a larger expansion of Medi-Cal in 2014 as required by the Affordable Care Act.
Three Meetings To Address Duals Conversion
This week, the state begins a series of stakeholder meetings across California, all looking at different aspects of the ambitious task of converting more than one million people who receive both Medicare and Medi-Cal benefits — known as dual eligibles — to a more comprehensive model of care.
According to Peter Harbage, who has been leading the information-gathering component of the effort, this is an important month in the process. Now that the first wave of input has been solicited, the three meetings scheduled for December can dive deeper into the details.
“The main goal is to talk about the design of the duals demonstration project, so the state can get a better understanding what people believe the challenges and opportunities are, and what consumer protections need to be done,” Harbage said.
Assembly Hearing Laments a Torn Safety Net
It’s not just the 10% payment cut to a range of Medi-Cal services in California that have legislators and providers lining up in protest, according to Assembly member Holly Mitchell (D-Los Angeles), it’s the combined effect of all the cuts that came before as well.
“We are here to hear and understand the actual impact of the cuts we made this year,” Mitchell said yesterday at a hearing convened by Assembly Budget Subcommittee No. 1 on Health and Human Services. “And we also need to hear the cumulative impacts of cuts from previous years,” she said. “This economic crisis has hit our children very hard, and we need to hear what these cuts will do to those children.”
Down the street from the Capitol Building hearing, protesters representing the developmentally disabled gathered outside the offices of the Department of Health Care Services, the agency implementing the state’s cuts and that worked with CMS to get federal approval of the cutbacks.
Which Providers Get 10% Reimbursement Cuts?
Toby Douglas did not bring good tidings. Yesterday, the director of the Department of Health Care Services outlined the recently approved 10% cuts for California providers of Medi-Cal services.
“This is really hard,” Douglas said. “These are extremely painful reductions.”
The California Hospital Association on Tuesday filed a lawsuit in federal court in Los Angeles seeking to halt the implementation of Medi-Cal rate cuts approved last week by CMS.
Austerity Won’t Help Physician Shortage, Experts Predict
Cutbacks in Medicare and Medicaid could make it more difficult to deal with a physician shortage in California that threatens to become more severe as millions of newly insured people join the reformed health care system. California groups are lobbying to streamline and subsidize the training of new primary care doctors.
Access at Issue in Medi-Cal Cuts
You would think providers would be up in arms over having their Medi-Cal reimbursement rates cut — once again.
After all, California had one of the lowest Medicaid provider rates in the nation, even before this recent 10% reduction. But according to Carol Havens, president of the California Academy of Family Physicians, the rate reduction really affects patients, not doctors.
“Providers now, at the current level of reimbursement, have to make a decision about how many Medi-Cal patients they will see,” Havens said. “Since it actually costs them money to see Medi-Cal patients, they have to limit the numbers in their practice. So now, in a practical sense, these cuts will put an increased burden on that decision, and they’ll likely see fewer Medi-Cal patients.”
State Laying Foundation for Duals Conversion
The state’s Department of Health Care Services released a series of draft papers this week, outlining some of the concerns and aims of its planned conversion program, which will eventually offer managed care choices to dual eligibles — those Californians who are eligible to receive both Medi-Cal and Medicare benefits.
The latest paper, released yesterday and expected to be posted on the DHCS website today, looks at the possible scope of that transition and finds it could include many more than the 150,000 people originally estimated for the conversion program.
“There are 370,000 duals in Los Angeles County alone,” according to Peter Harbage of Harbage Consulting, who worked on the papers. “There are another 250,000 in the next four largest counties. The paper opens the conversation on that point, as well as on other key issues.”
State Appeals Ruling on Disability Funding
In May, a federal judge issued an injunction to halt the state’s freeze on funding for programs for the developmentally disabled.
Yesterday, California attorneys were back in court, this time at the 9th Circuit U.S. Court of Appeals in Pasadena, to ask that the May decision be overturned.
Craig Cannizzo, who argued the case on behalf of individuals with developmental disabilities, said this case has far-reaching implications because the state did not get permission from CMS for the rate freeze.