Medi-Cal

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Pressure Rising to Restore Medi-Cal Provider Rates

FILE PHOTO: Doctors in an emergency room in Panorama City, Calif. (David McNew/Getty Images)

FILE PHOTO: Doctors in an emergency room in Panorama City, Calif. (David McNew/Getty Images)

By David Gorn, California Healthline

A protest Wednesday at the Capitol Building will highlight proposed legislation to reverse cuts to Medi-Cal provider rates.

In 2011 during a bleak budgeting period, the Legislature agreed to cut most Medi-Cal provider payments by 10 percent. The cutbacks were held up in legal battles for two years, and the court eventually sided with the state. Implementation came from the state in stages, and primary care providers started getting the lower reimbursement rate this year, on Jan. 1.

Last month, Assembly member Rob Bonta (D-Alameda), who chairs the Assembly Committee on Health, introduced a bill — AB366 — to reverse the cuts made in 2011.

Protest at Capitol Building aims to reverse cuts.

“This is my top priority,” Bonta said. “The reason I’m interested in health policy is to maximize quality care and access for as many people as possible. And access within Medi-Cal is not what it needs to be.”

The number of providers participating in Medi-Cal has dropped, Bonta said, because they lose money on Medi-Cal patients and can’t afford to take on too many of them.

Legislation to restore Medi-Cal rates has been floated before and failed. Bonta said those efforts were setting the groundwork for this push. Continue reading

More Pressure on Providers in Face of Medi-Cal Expansion

Dr. Davi Pakter, of Berkeley LifeLong Clinic, prepares to see patients. (Julie Small/KQED)

Dr. Davi Pakter, of Berkeley LifeLong Clinic, (right) prepares to see patients. (Julie Small/KQED)

Medi-Cal — the public health insurance program for low-income Californians — is growing faster under federal health care reform than the state expected. Twelve million residents — nearly a third of the state’s population — now rely on Medi-Cal, and that’s increased pressure to find more doctors willing and able to treat patients for what has historically been low reimbursement rates.

At the LifeLong Clinic in West Berkeley most of the patients waiting to see a doctor are on Medi-Cal. Among them, 26-year-old Amanda Hopkins, says she enrolled half a year ago when the state expanded the benefits program.

“It’s been relieving to have Medi-Cal and know that if something happened — I needed an ambulance or there was an emergency — I wouldn’t have to worry about being in debt thousands of dollars,” she said. Continue reading

Schools Helping Families Enroll in Covered California and Medi-Cal

A parent talks to a health care enrollment specialist at a health insurance sign-up event at Natomas Unified in Sacramento. (Courtesy: The Children's Partnership)

A parent talks to a health care enrollment specialist at a health insurance sign-up event at Natomas Unified in Sacramento. (Courtesy: The Children’s Partnership)

By Jane Meredith Adams, EdSource

With huge numbers of California children still uninsured, schools are beginning to take the lead in letting families know that affordable health care coverage is available.

The deadline to sign up for a Covered California plan is this Sunday.
In school libraries and courtyards from Sacramento to Los Angeles and beyond, trained enrollment counselors have been invited to set up folding tables, commandeer desk space and corral parents before the Feb. 15 sign-up deadline for Covered California, the state’s health insurance marketplace created under the Affordable Care Act.

And the outreach will increase. Under a new state law, all California schools must include in their 2015-16 enrollment packets information about options for health care coverage and how to get help with the sign-up process. The law, Assembly Bill 2706, authored by Roger Hernández, D-West Covina, is intended to reduce the number of children who are eligible for health insurance subsidies but remain uninsured. Continue reading

Half of California’s Children Now Covered by Medi-Cal

Sarah Boone, a behavior analyst with the social services agency EMQ FamiliesFirst, evaluates Ernesto Santiago, 6, of San Jose for autism therapy services. (Barbara Feder Ostrov/Kaiser Health News)

Sarah Boone, a behavior analyst with the social services agency EMQ FamiliesFirst, evaluates Ernesto Santiago, 6, of San Jose for autism therapy services. (Barbara Feder Ostrov/Kaiser Health News)

By Barbara Feder Ostrov, Kaiser Health News

California’s Medi-Cal program has grown to cover nearly half of the state’s children, causing policymakers and child advocates to question the ability of the taxpayer-funded program to adequately serve so many poor kids.

In the past two years alone, the program has added nearly 1 million young people up to age 20, including those newly eligible for Medi-Cal coverage under the Affordable Care Act. The increase brings the total number of young people on Medi-Cal to 5.2 million, more than ever before.

Medi-Cal is California’s version of Medicaid and the largest program of its kind in the nation.

Many pediatricians and specialists already refuse to accept new Medi-Cal patients, at least in part because the program offers among the lowest payment rates in the country. New rate cuts took effect this January. Health care advocates say adding more children to the mix will only worsen the likelihood of timely treatment. Continue reading

Governor Appoints New Director of Health Care Services

Jennifer Kent was  most recently executive director of Local Health Plans of California.

Jennifer Kent was most recently executive director of Local Health Plans of California. (Courtesy: DHCS)

By David Gorn, California Healthline

On Monday, Gov. Jerry Brown (D) appointed Jennifer Kent as the new director of the Department of Health Care Services, a $9 billion state agency that oversees the Medi-Cal program.

DHCS is the agency that oversees Medi-Cal.    
Kent had most recently been the executive director of Local Health Plans of California, an organization representing 14 not-for-profit public health plans across the state.

“I’m very excited,” Kent said. “It’s a big job, so I’m both thrilled and a little overwhelmed.”

Kent replaces Toby Douglas, who was DHCS director for the past four years. Kent has worked at DHCS in the past — in fact, she and Douglas were both deputy directors in the department at the same time. Kent worked at the department from 2004 to 2007. She headed legislative affairs for Gov. Arnold Schwarzenegger (R) and has experience in both the public and private spheres of health care. Continue reading

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