Medi-Cal

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Video: Why the New Autism Benefit Is So Important to Medi-Cal Families

By Jeremy Raff

Effective this week, Medi-Cal now covers a key autism therapy, and some 12,000 kids stand to benefit statewide. One of the children who will benefit is Timothy Wilson, a bubbly 6-year-old who will now be able to get Applied Behavior Analysis (ABA) through Medi-Cal, the state’s insurance program for people who are low income. ABA is the clinical standard of care for autism.

Timothy was 2 when he was diagnosed with autism spectrum disorder. “He didn’t say mama, didn’t say dada,” says his mother, Jazzmon Wilson. He threw tantrums and hardly made eye contact. “You just see all your dreams go by the wayside.”

The Wilsons enrolled him in the Regional Center of the East Bay, where children under 3 receive state-funded services. He began ABA therapy, which breaks down everyday skills into bite-sized, learnable portions, then uses repetition, memorization and rewards to reinforce or discourage behaviors. Parents learn to lead their child in the therapy as well. In the video, Jazzmon works with Timothy — or Bubba as she calls him. Seeing him now, it’s hard to believe how affected he was at a younger age.

Jazzmon praises Timothy during an Applied Behavioral Analysis session.

Jazzmon praises Timothy during an Applied Behavioral Analysis session. (Jeremy Raff/KQED)

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Advocacy Groups File Lawsuit Over Medi-Cal Backlog

(s_falkow: Flickr)

(s_falkow: Flickr)

By Anna Gorman, Kaiser Health News

California’s lingering backlog of Medi-Cal applications has left hundreds of thousands of people unable to access the health care they are entitled to receive, according to a lawsuit filed Wednesday by a coalition of health advocates and legal services groups.

A Tulare County man had applied for Medi-Cal but died of a pulmonary embolism while waiting for the state to confirm his eligibility.

The lawsuit, filed in Alameda County Superior Court, says the state is failing to process applications within 45 days as required by law. Some applicants have been waiting to receive their Medi-Cal cards since the end of last year, according to the suit. The applicants include children, pregnant women and adults with life-threatening health conditions, who advocates say are either postponing treatment or paying cash to see doctors.

Medi-Cal is the state’s version of Medicaid, the publicly funded health insurance program for low-income Americans. About 11 million people receive Medi-Cal benefits in California, including 2.2 million who applied since January. Roughly 350,000 applications are still pending. Continue reading

Autism Benefit Finally a Reality for Children on Medi-Cal

Jazzmon Wilson with her son Timothy, 6, who has autism. (Jeremy Raff/KQED)

Jazzmon Wilson with her son Timothy, 6, who has autism and has benefited greatly, Wilson says, from Applied Behavior Analysis therapy, now covered by Medi-Cal. (Jeremy Raff/KQED)

By David Gorn

California health officials Monday are launching a new benefit for thousands of children with autism who are covered by Medi-Cal, California’s low-income health program.

“He’s doing things other kids can do. And it’s those little moments, it makes you just so grateful.”

That makes California the first state in the nation to implement new federal standards on autism care.

The new benefit includes coverage of the clinical standard of care for autism treatment — Applied Behavior Analysis, also known as ABA therapy. That treatment has shown significant results for a cross-section of children with autism.

Of the 5 million children on Medi-Cal in California — that’s roughly half the state’s total children — there are an estimated 75,000  who likely have autism spectrum disorder. Of those children, experts expect about 12,000 children to access the new benefit, based on utilization figures from programs in other states. Continue reading

Details of Autism Benefits — Like Provider Rates — Coming After Rollout

(Getty Images)

(Getty Images)

By David Gorn, CaliforniaHealthline

At the first stakeholder meeting last week to review California’s new autism Medi-Cal coverage, state health officials said many details have yet to be worked out. Medi-Cal is California’s Medicaid program.

New benefits, which include coverage of applied behavior analysis — also known as ABA therapy — begin next week.

Department of Health Care Services officials said many details — including the crucial figure of what the reimbursement rates will be — still need to be worked out. Rates will be discussed at the next stakeholder meeting Oct. 16, officials said. Continue reading

For Some, Medi-Cal Might Mean Ultimately Losing Their Homes

Anne-Louise Vernon in front of her home in Campbell. (Photo: Pauline Bartolone)

Anne-Louise Vernon in front of her home in Campbell. She recently enrolled in Medi-Cal then found out the state could use proceeds from her home to recover costs of her health care. (Photo: Pauline Bartolone)

By Pauline Bartolone, Kaiser Health News

Anne-Louise Vernon had been looking forward to signing up for health insurance under Covered California. She was hoping to save hundreds of dollars a month. But when she called to enroll, she was told her income wasn’t high enough to purchase a subsidized plan.

“It never even occurred to me I might be on Medi-Cal,” she said, in reference to the state’s version of Medicaid, “and I didn’t know anything about it.”

She says she asked whether there were any strings attached.

“And the woman said very cheerfully, “Oh no, no, it’s all free. There’s nothing you have to worry about, this is your lucky day.’” she recounts.

Vernon signed up for Medi-Cal on the phone from her home in Campbell. But months later, she learned online about a state law that allows California to take assets of people who die if they received health care through Medi-Cal after the age of 55. Continue reading

Feds Want California to Clear Medi-Cal Backlog

State officials have until Monday to submit plan. (Justin Sullivan/Getty Images)

State officials must submit plan by Monday. (Justin Sullivan/Getty Images)

By Phil Galewitz, Kaiser Health News

Tired of waiting for states to reduce their backlogs of Medicaid applications, the Obama administration has given California and five other states until Monday to submit plans to resolve issues that have prevented more than 1 million low-income or disabled people from getting health coverage.

600,000 people signed up, but not yet enrolled, in Medi-Cal.

“CMS is asking several state Medicaid agencies to provide updated mitigation plans to address gaps that exist in their eligibility and enrollment systems to ensure timely processing of applications and access to coverage for eligible people,” said Aaron Albright, a spokesman for the Centers for Medicare & Medicaid Services. He said the agency will monitor states’ progress in solving the problems getting people enrolled in the state-federal insurance program for the poor.

In addition to California, the other states are Alaska, Kansas, Michigan, Missouri and Tennessee. Continue reading

Nearly a Million People Backlogged in Medi-Cal Expansion

It's not clear when the backlog will be cleared. (Getty Images)

It’s not clear when the backlog will be cleared. (Getty Images)

By Helen Shen, Kaiser Health News

A massive backlog of Medi-Cal applications is well into its third month, and California officials have provided little information about how and when the largest such bottleneck in the nation might be cleared.

The California Department of Health Care Services in Sacramento first reported 800,000 pending applications in April. By May, that number had grown by 100,000 and has not budged much since. As the state works through older applications, new ones continue each day to enter the system, which has been plagued by computer glitches and inefficient procedures for verifying applicants’ personal information.

There are no estimates of processing times or how long delays will persist, though a state official said last month that new applications in May appeared to have slowed. Continue reading

Another Step Closer to Autism Therapy as Medi-Cal Benefit?

(Getty Images)

(Getty Images)

By David Gorn, California Healthline

CMS officials last week approved a state plan amendment for the state of Washington that includes autism therapy as a Medicaid benefit.

It’s the second state in a month to receive that go-ahead from the federal government, and it means autism coverage should be a Medi-Cal benefit in California, as well, according to Kristin Jacobson, president of Autism Deserves Equal Coverage, a not-for-profit autism advocacy group.

The budget passed this week by the California Legislature omitted autism therapy as a Medi-Cal benefit.

Autism advocates hope one day soon CMS will make it clear that applied behavior analysis treatment — known as ABA therapy — should be a required benefit for all states receiving Medicaid, including California. Continue reading

In Alameda County, Leaving Jail Doesn’t Have to Mean Losing Health Care

Rodrigo Salido, recently released from Santa Rita jail in Dublin, Calif., enrolls in Medi-Cal at Healthy Oakland clinic. (Courtesy: PBS NewsHour)

Rodrigo Salido, recently released from Santa Rita jail in Dublin, Calif., enrolls in Medi-Cal at Healthy Oakland clinic. (Courtesy: PBS NewsHour)

By Sarah Varney, Kaiser Health News and PBS NewsHour

It’s been two months since Rodrigo Salido left the maximum security wing at Santa Rita jail, about 40 miles east of San Francisco in Alameda County. It’s also been two months since Salido had medication for his bipolar disorder.

In Alameda County officials estimate 18,000 offenders in its two jails will now qualify for Medi-Cal.
A drug, Risperdal, prescribed by a jailhouse psychiatrist, had quelled Salido’s angry moods. “It helped me be more relaxed,” he said. “Not as much on the edge and feeling like everybody is out to get me.”

Now Salido, who served two years for burglary, assault and gang involvement, has no health insurance and until recently had few options for refilling his medication.

Many inmates leave county jails and state prisons with mental health problems and chronic physical ailments — and no health coverage. Because they typically are not custodial parents, ex-offenders have long been ineligible for a public health insurance program aimed at kids, mothers and the disabled. Continue reading

SEIU Teams Up with California Hospitals, Withdraws Ballot Initiatives

(Getty Images)

(Getty Images)

The California Hospital Association and Service Employees International Union say they have reached a “unique agreement” that will “change the face of healthcare in California.”

And in the process, the two ballot initiatives SEIU backed — that would have put dramatic limits on both hospital charges and CEO compensation — are being withdrawn.

The partnership was announced Tuesday morning, is effective immediately, and runs through December 31, 2017. In a long call with reporters, both sides emphasized what they called the centerpiece of the deal: a $100 million “joint advocacy fund.” Continue reading