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.”
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.
‘The Passage of Power’ and the Passage of Medicare
A long-awaited biography of Lyndon Johnson goes inside White House strategy in the early 1960s. Does the battle to pass Medicare hold any lessons for today?
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.”
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.
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.”