Medi-Cal

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Judge Rules on Medi-Cal Backlog, Orders Timely Access to Benefits

(s_falkow: Flickr)

(s_falkow: Flickr)

By David Gorn, California Healthline

On Thursday, an Alameda County Superior Court judge issued a preliminary injunction requiring the state to adhere to a 45-day limit for processing Medi-Cal applications.

The ruling by Judge Evelio Grillo was a victory for health care advocates in a lawsuit over the state’s extensive backlog in processing Medi-Cal applications. The Medi-Cal expansion and the first open enrollment period for Covered California brought millions of applications to the door of the Department of Health Care Services, which oversees Medi-Cal.

Computer issues hampered the processing of many of those applications, and in March 2014 the backlog of unprocessed claims peaked at more than 900,000 applications. It took many months to clear the bulk of those applications. Some of them are still hanging fire almost a year later, said Jen Flory, senior attorney in the Sacramento office of the Western Center on Law and Poverty. Continue reading

Gov. Brown: ‘Not A Lot Left in Budget’ to Cover Undocumented

(Justin Sullivan/Getty Images)

(Justin Sullivan/Getty Images)

Gov. Jerry Brown unveiled his $164.7 billion budget proposal Friday and while health figures big, the governor also stopped short of funding some key advocacy goals.

For starters, there’s no money set aside in the budget to provide health insurance to undocumented immigrants. The “Health for All Act” was re-introduced in December, after falling short in the legislature last year. But when Brown was asked specifically about covering the undocumented, he said “There’s not a lot of money left in the budget. … It’s very tight.”

Then there are the million undocumented immigrants in California estimated to be eligible for deferred action under President Obama’s executive order. Advocates say that these immigrants, once approved for deferred action, become eligible for Medi-Cal, as long as they qualify by income. Continue reading

Brown on Health Coverage: “Right Thing to Do. But It Isn’t Free.”

Gov. Jerry Brown is sworn in as California governor for the fourth time. (Andrew Nixon/Capital Public Radio)

Gov. Jerry Brown is sworn in as California governor for the fourth time. (Andrew Nixon/Capital Public Radio)

Jerry Brown was sworn into his fourth term as governor of California Monday morning. In a wide-ranging inaugural address (that doubled as a State of the State address), he included some brief remarks about the Affordable Care Act.

Here’s the text of what he said:

Along with education, health and human services constitute a major part of what state government does. And in the past few years we have made massive commitments in this area, which will require increasing levels of spending, the full extent of which is not yet known. For example, two years ago California embraced the Affordable Care Act, dramatically increasing its health insurance coverage under the Medi-Cal program. The state will enroll 12.2 million people during this new budget year, a more than 50 percent increase.

Providing the security of health coverage to so many Californians who need it is the right thing to do. But it isn’t free. Although the federal government will temporarily foot much of the bill, new state costs – now and more so in the future – will run into the billions.

Before we take a deeper look at his statements about Medi-Cal, let’s go back a year ago to last year’s budget. Then, Brown’s budget proposal included an additional $670 million for Medi-Cal, at least in part because of the expected additional costs due the expansion of Medi-Cal under the Affordable Care Act. Perhaps more importantly, “The Medi-Cal caseload is expected to be approximately 24 percent of the state’s total population,” the governor said when he released last year’s budget.

Speed forward a year. Obamacare sign-ups surged in California during 2014 and outstripped all estimates. Specifically in Medi-Cal, it’s not 24 percent of the population that is covered by the program, it’s closer to 33 percent.

While the ACA  pays for 100 percent of the people who are newly eligible for Medi-Cal, many people who signed up in 2014 were already eligible before the ACA expansion. They just had not enrolled. With all the hoopla around the ACA, plenty of those previously-eligible people signed up. Many refer to this as the “woodwork” effect.

Estimates are of the 2.4 million people who signed up for Medi-Cal by Mar. 31, about 800,000 of them were previously eligible. The federal government funds those people at the non-expansion rate of 50 precent. That’s why in the May revision of his budget, Gov. Brown included an additional $1.2 billion to fund the caseload.

Brown closed his brief remarks about health with a remark about the state’s costs “in the future.” The federal government is funding 100 percent of the Medi-Cal expansion only through 2016. Come 2017, the match will start to drift down and ultimately end at 90 percent. Yes, this is still a generous federal outlay. But 10 percent of billions of dollars is a lot of money.

The governor is expected to release his budget proposal on Friday.

New Health Laws Set to Take Effect in California

(Justin Sullivan/Getty Images)

(Justin Sullivan/Getty Images)

The new year will bring in hundreds of new laws in California, including a landmark law that permits undocumented individuals to obtain a driver’s license and another requiring that all eggs sold in California come from chickens living in bigger spaces.

Many of those new laws have to deal with health. Some take effect on Jan. 1, others in July. Here’s a look at some of them:

Assisted Living Homes: A new law increases 100-fold the top fine for violations of state regulations by assisted living facilities for the elderly. The fine is jumping from a mere $150 to $15,000. AB2236 takes effect July 1 and was part of a package of bills signed by the governor that tighten state oversight of the 7,500 assisted living homes in California. It’s the most significant overhaul of the industry in almost 30 years. Continue reading

Toby Douglas Looks Back at 10 Years Heading DHCS

(Courtesy: California HealthCare Foundation)

(Courtesy: California HealthCare Foundation)

By Rachel Dornhelm, California Healthline

Toby Douglas has spent 10 years at the state’s Department of Health Care Services, the last four as director of the department. He has seen and instituted big changes in the department, changing the way health care is delivered to more than 11 million Medi-Cal beneficiaries.

During his tenure, the Affordable Care Act was passed and implemented; Douglas oversaw the expansion of Medi-Cal as well as a huge shift of more than 80 percent of the state’s Medi-Cal ranks from fee-for-service to managed care plans.

Douglas is set to retire in January. I sat down with him recently to ask about the changes he has seen — and overseen — in his time in office, starting with a look at what struck him as the most important development in health care during his time as the head of the agency.

“When I step back and I think of our time here in the department and what we’ve achieved,” he said, “it really centers around the Medi-Cal program. We have all of our populations now that are in coordinated systems of care.” He called the Medi-Cal managed care approach “a big change,” for all low-income populations eligible for Medi-Cal.  Continue reading

Covered California Enrollment ‘Very Strong’ So Far

Covered California executive director Peter Lee. (Max Whittaker/Getty Images)

Covered California executive director Peter Lee. (Max Whittaker/Getty Images)

More than 290,000 people have signed up on Covered California, the state’s health insurance marketplace, officials announced Wednesday. That number includes both people who qualify for private health insurance on the exchange or Medi-Cal.

People need to sign up by Dec. 15 for coverage that starts Jan. 1.
Open enrollment started Nov. 15. Of the 130,000 people who have qualified for Covered California, nearly 50,000 of them have both completed the application and selected a plan. That compares to about 30,000 people who selected a plan during the first month of open enrollment last year.

In a press call, Peter Lee, executive director of Covered California, called that pace “very strong.” People have until Monday to sign up for coverage that will start Jan. 1. “We expect that the next few days and this weekend, we’ll see continued and even growing interest in enrollment,” Lee said. Continue reading

Map: See How Obamacare Transformed Health Insurance Coverage in California

By Ronald Campbell, CHCF Center for Health Reporting

In 2013, 6.6 million Californians lacked health insurance.

Then came the rollout of the Affordable Care Act. By April of this year, Covered California, the
state’s health insurance marketplace, had enrolled 1.4 million people, although not all of them were previously uninsured. Today 1.12 million remain enrolled. An additional 2.5 million people enrolled through July in Medi-Cal, the state’s health plan for the poor.

In the map, click on a county to see the pre-ACA uninsured rate — and the number of people who signed up for Covered California or Medi-Cal. The Census Bureau will have data on 2014 total insurance coverage in September 2015.

Health Reform in California: A State of Accelerating Change

Gail Fulbeck and her husband paid $2,500 a month for health insurance in 2013. This year, they signed up for a Covered California plan and pay $165. (Lauren Whaley/Center for Health Reporting)

Gail Fulbeck and her husband paid $2,500 a month for health insurance in 2013. This year, they signed up for a Covered California plan and pay $165. (Lauren Whaley/Center for Health Reporting)

By Deborah Schoch and Lauren M. Whaley, CHCF Center for Health Reporting

Gail Fulbeck, 64, relies on her body for work. She hauls soda, energy drinks, snacks and water to the 23 vending machines she owns around downtown Sacramento.

The physical demands of her job, coupled with her husband’s history of migraines and bad knees, make health insurance essential.

Last year, Fulbeck and her husband paid a monthly insurance premium of $2,555.

Starting Jan. 1 of this year, the couple’s premium for a nearly identical plan totaled $165. It was, she said, almost unbelievable. Continue reading

Senator to Reintroduce Health Insurance Bill for Undocumented Immigrants

(Justin Sullivan/Getty Images)

(Justin Sullivan/Getty Images)

It’s the beginning of the new legislative session in Sacramento, and one lawmaker isn’t wasting time. Sen. Ricardo Lara (D-Long Beach) is expected to reintroduce a bill Monday to extend health insurance to all undocumented immigrants.

The Health For All Act would do two things for undocumented immigrants: extend Medi-Cal coverage to those who are low income and create a new marketplace to mirror Covered California, where those with incomes 138-400 percent of poverty could purchase subsidized health insurance.

Undocumented immigrants are not eligible for any Obamacare benefits, so they cannot use the existing Covered California exchange. Continue reading

Newly Protected Immigrants Will Be Eligible for Medi-Cal, Advocates Say

President Barack Obama announces executive actions on U.S. immigration policy Thursday. ( Jim Bourg-Pool/Getty Images)

President Barack Obama announces executive actions on U.S. immigration policy Thursday. ( Jim Bourg-Pool/Getty Images)

California undocumented immigrants who are eligible for deferred deportation under President Obama’s executive action are expected to be eligible for Medi-Cal, as long as they meet income guidelines, advocates said Thursday.

Medi-Cal is the state’s health insurance program for people who are low income.

Under federal law, these immigrants are not eligible for other benefits of the Affordable Care Act, including subsidies on the Covered California exchange. Continue reading