Medi-Cal

RECENT POSTS

May 25, 2013 | 9:54 AM | By

Appeal Denied: Medi-Cal Rate Cuts Poised to Move Forward

By Judy Lin, Associated Press

A federal appeals court on Friday denied a second request by California doctors, pharmacists and hospitals seeking to undo the state’s 10 percent provider rate cut for treating the poor.

The 9th U.S. Circuit Court of Appeals denied an appeal from medical providers to rehear their case, which allows Gov. Jerry Brown to begin implementing the cuts retroactively. A three-judge panel had ruled against them in December on the grounds that trial courts cannot block the state from making cuts that were approved by the U.S. Department of Health and Human Services.

Health providers vowed they will continue to press lawmakers to restore the 10 percent reimbursement rate cut to the state’s Medicaid program, known as Medi-Cal. Continue reading →

FILED UNDER: KQED blogs, Policy, Medi-Cal, Provider Rate Cuts
May 15, 2013 | 5:00 AM | By

Brown Backs State-Run Medi-Cal Expansion

By Mina Kim

(Justin Sullivan/Getty Images)

(Justin Sullivan/Getty Images)

Gov. Jerry Brown’s revised budget plan is a mixed bag for health advocates and some county officials.

Brown said the state would take the lead on a key provision of the federal health law — expanding Medi-Cal to more than one million Californians. Brown scrapped earlier plans to consider a more complicated, county-based system.

But Brown anticipates recouping more than $300 million from the counties next fiscal year – money that pays for public health programs and care for the uninsured. Brown’s rationale? With the full implementation of federal health reform next year, more people will enroll in Medi-Cal and fewer people will show up to county emergency rooms.

Farrah McDaid Ting with the California State Association of Counties says Brown’s proposal makes no sense. She says plenty of people will still rely on county services in 2014.

They are “people who qualify for Medi-Cal but don’t sign up, people who have a hard time signing up or staying on programs, the undocumented in our communities and those who are in between private health plans,” McDaid Ting said. “We need to retain enough funds to serve those people.” Continue reading →

FILED UNDER: Money, Policy, Reform, Affordable Care Act, California Budget, Medi-Cal
March 22, 2013 | 10:04 AM | By

What’s Up With the California Health Care Overhaul Bills?

(seliaymiwell/flickr)

(seliaymiwell/flickr)

While President Obama’s health care overhaul turns three on Saturday, many states are scrambling to get everything ready for the full rollout on January 1. California was the first state to pass legislation to set up a marketplace, and the Legislature has done a lot of work since. But there’s still a lot left to do — and fast.

To bring you up to date, three major sets of bills are before the Legislature in its Affordable Care Act special session. (Six bills total; Assembly and Senate have their own versions of three proposals).

Of those, two issues are key:

  • Reforming the individual market
  • Medi-Cal expansion (the state’s health insurance program for the poor.

As David Gorn of the CaliforniaHealthline reports, the California Legislature went on spring recess yesterday. These ACA bills are outstanding, much to the frustration of advocates. These special session bills take effect in 90 days, once they are passed. ACA proponents had hoped passage would have happened already. Continue reading →

FILED UNDER: Reform, Affordable Care Act, Medi-Cal, Obamacare, Science
March 4, 2013 | 9:36 AM | By

Empty Promise? Experts Question Doctor Supply to See California’s Newly Insured Poor

By Emily Bazar, CHCF Center for Health Reporting

Dr. Hasmukh Amin, a Bakersfield pediatrician, accepts Medi-Cal patients but says he has to turn away 25-30 people every day who are seeking a pediatrician who accepts Medi-Cal. Here he examines Marcus and Major Thompson. (Henry A. Barrios/The Californian)

Dr. Hasmukh Amin, a Bakersfield pediatrician, accepts Medi-Cal patients but says he has to turn away 25-30 people every day who are seeking a pediatrician who accepts Medi-Cal. Here he examines Marcus and Major Thompson. (Henry A. Barrios/The Californian)

In less than one year — Jan. 1, 2014 — Obamacare’s promise to bring health care to perhaps 1 million more poor California residents will be tested. That’s when Medi-Cal, the publicly funded health program for the poor and disabled, launches a huge statewide expansion.

But making a promise is one thing, and delivering is another.

In some places, it’s already tough for many poor California residents to find a doctor who is able –- or willing — to see them when they need one.

From the sprawling Los Angeles basin to the sparsely populated rural north, many medical providers who currently see these patients say they are overwhelmed, a situation that could worsen when those newly covered by Medi-Cal arrive for care.

The epicenter is California’s Central Valley, where high rates of uninsured residents, coupled with persistent doctor shortages, create a potentially combustible brew that could thwart the success of the health care law.

“We’re not even talking about 2014,” said Carmen Burgos of the Greater Bakersfield Legal Assistance program. Burgos helps low-income Kern County residents access health care and dental services. “Good luck finding a doctor who takes Medi-Cal now.” Continue reading →

FILED UNDER: Policy, Reform, Affordable Care Act, Medi-Cal, Obamacare, Physician Supply
February 26, 2013 | 12:19 PM | By

Obama Administration Files Brief in Support of Medi-Cal Provider Cuts

In a move that is expected to have repercussions across the country, the Obama Administration on Monday filed a brief in the Ninth Circuit Court in support of Gov. Jerry Brown’s proposed 10 percent payment cuts to Medi-Cal providers.

Some background: The provider cuts were approved by CMS back in 2011, but then immediately challenged by the California Medical Association (and others) in federal court. A federal judge blocked the cuts. The state of California appealed to the Ninth Circuit. A three-judge panel approved the cuts. The CMA asked for an en banc review by all of the judges.

And that’s where we are today, with the Obama Administration’s brief.

The timing is interesting, as it comes when the National Governors Association is meeting in Washington, and the Obama Administration is trying to convince states to implement the Medicaid expansion portion of the health care overhaul. As the New York Times reports, the Administration seems to be in support of giving states flexibility: Continue reading →

FILED UNDER: KQED blogs, Reform, ACA, Affordable Care Act, Medi-Cal, Provider Cuts
January 29, 2013 | 11:19 AM | By

Are There Enough Medi-Cal Doctors in Kern County? How About Statewide? Who Knows?

People wait in line at Clinica Sierra Vista at the East Bakersfield Community Health Center. Some were waiting before they opened at 7:30am. (Casey Christie / The Californian)

People wait in line at Clinica Sierra Vista at the East Bakersfield Community Health Center. Some were waiting before they opened at 7:30am. (Casey Christie / The Californian)

Once Obamacare is fully implemented in January, hundreds of thousands of Californians will move from the ranks of the uninsured to the insured. That’s the good news. The downside: many California counties already face a shortage of primary care doctors — a shortage that is especially acute in the Central Valley.

How those newly insured — especially those who will be enrolled under Medi-Cal — will access care is an especially pressing question in Kern County, as the CHCF Center for Health Reporting has been exploring under a series, Desperate for Doctors.

“It would be really helpful for policymakers to have an agreed upon set of facts.”

A chief problem is not only the shortage of primary care doctors, but also the question of whether physicians accept Medi-Cal patients. If individuals and families hold Medi-Cal insurance, but can’t find a doctor who will accept it, their new coverage isn’t much help. Continue reading →

FILED UNDER: Place Matters, Reform, Affordable Care Act, Doctor Shortage, Medi-Cal
January 11, 2013 | 1:30 PM | By

State vs. County Showdown Over Funding the Medi-Cal Expansion?

(Justin Sullivan/Getty Images)

Gov. Brown is proposing California's counties relinquish some of their state health funding once the Affordable Care Act is in place. (Justin Sullivan/Getty Images)

We’re now 354 days from the rollout of the Affordable Care Act next Jan. 1. While the governor declared the state’s participation in the Medicaid expansion at his budget unveiling yesterday, he also proposed two ways to handle that expansion.

Under one scenario, the state will continue to administer the program. Under the other, each of California’s 58 counties will oversee running Medi-Cal, California’s version of Medicaid, for its own residents.

The Affordable Care Act dictates that the federal government will pay 100 percent of the cost for those people newly eligible for Medicaid, and in both proposals, the state’s position is that California counties will get some fiscal relief once those federal dollars start flowing.

But don’t get too excited, counties.

California Secretary of Health and Human Services Diana Dooley yesterday referred to a “conversation” around “appropriate sharing” that needs to happen between the state and its counties around financial responsibilities.

“There’s an assumption we’ve been fully funded. That is simply not accurate.”

“Conversation” might prove to be a euphemism for what could become a vocal debate between the state and the counties. And maybe between counties themselves.

Alex Briscoe, Director of Alameda County’s Health Care Services Agency, told me this morning that “sharing” presumes that current state funding is sufficient to meet the needs of the indigent poor, an idea he called “simply preposterous.” Continue reading →

FILED UNDER: Money, Reform, Affordable Care Act, California Budget, Medi-Cal, Medicaid Expansion
December 10, 2012 | 4:16 PM | By

Feds to States on Medicaid: Expand Fully or No New Funding

HHS Secretary Kathleen Sebelius, shown here speaking at a conference in Washington last week. (Chip Somodevilla/Getty Images)

HHS Secretary Kathleen Sebelius, shown here speaking at a conference in Washington last week. (Chip Somodevilla/Getty Images)

The Obama Administration handed down a key rule Monday on its health care overhaul having to do with Medicaid, or Medi-Cal in California. States must expand to the federally mandated 138 percent of poverty in order to receive matching funds for those newly eligible for the program.

Because the Supreme Court ruling in June had struck down the requirement that states participate or lose existing match funds, some states thought there might be flexibility in the expansion. But the answer to that question is a clear “no” as Secretary of Health and Human Services Kathleen Sebelius explained in a letter to governors.

In a briefing last week, California’s Health and Human Services Secretary Diana Dooley indicated she was waiting for guidance from the feds about the Medicaid expansion and might not expand to the full 138 percent limit.

In an email, a spokesperson for the state’s department of health and human services said staff is currently evaluating the new information and declined to comment further at this time.

Consumer advocates said it was good to have the matter settled. “We thought that it was the case,” Anthony Wright, Executive Director of Health Access told me in a phone call, “but it’s good for the federal government to provide clarity and hopefully this allows the states to move forward with all deliberate speed.”

It’s expected that more than four million Californians will be newly eligible for Medi-Cal. Under the Affordable Care Act, the federal government will pay 100 percent of the cost of those new eligibles from 2014 to 2017. After that, the match will phase down to 90 percent by 2020.

FILED UNDER: Reform, Affordable Care Act, Medi-Cal, Medicaid
December 7, 2012 | 11:03 AM | By

How Many Dentists Accept Children on Medi-Cal? Depends on Who You Ask

New report says one in four dentists accept state’s Denti-Cal insurance; older reports say closer to two-thirds

By Emily Bazar, CHCF Center for Health Reporting

(Paul Goyette/Flickr)

(Paul Goyette/Flickr)

I’ve spent many months reporting on dental care for poor California children, looking into what kind of access they have to treatment.

(About half of kids in the Medi-Cal dental program see a dentist annually, although figures vary wildly by county.)

But I haven’t focused as much on the dentists who participate in the program, called Denti-Cal.

A new report by health care consultant Barbara Aved does just that. Based on her research, Aved concludes that 25 percent of California’s general dentists participate in the program.

Why not more? Here are some of Aved’s primary conclusions, based in part on a survey of dentists in five counties that she says reflect California as a whole. Out of about 2,000 general and pediatric dentists invited to participate, 322 responded.

  • Of dentists who do not participate, 97 percent cited the state’s low reimbursement rates as the No. 1 reason. California’s rates, Aved said, are among the lowest in the nation.

“Unlike physician practices, dental practices are in large part solo or two-person practices,” she said. “It’s really like a small business. Economically, it just doesn’t make sense to do business where you’re not going to be fully reimbursed.” Continue reading →

FILED UNDER: Money, Policy, Dental Care, Medi-Cal
December 5, 2012 | 3:25 PM | By

What Will the ACA Look Like in California? Getting to the Nitty Gritty Now

(seliaymiwell/flickr)

(seliaymiwell/flickr)

More than 200 people filled a Sacramento hotel meeting room yesterday to celebrate the 25th anniversary of Health Access, the consumer health advocacy group. But it wasn’t all party — the event featured a four-hour symposium with speakers including Diana Dooley, secretary of the state Health and Human Services agency; key legislators who chair health committees; and long time health advocates.

And everyone was focused on one thing: implementation of the Affordable Care Act.

After joking that “I quake in my boots” over the amount of work that needs to be done between now and January 1, 2014, Secretary Dooley sounded a distinctly cautionary note of what to expect as the rollout of Obamacare progresses in California. “It’s going to take years to make this work,” she told the crowd. “There are going to be fits and starts, speed bumps that we’ll have to get over.”

She talked about her concerns around affordability and capacity. Then she reminded the crowd of the wait for more information from the feds. For example, the Affordable Care Act promises to fund 100 percent of those newly eligible for Medicaid. But in an acknowledgement to the “fiscal cliff” discussions in Washington, she said it’s unclear if some of that money may be pulled back. Continue reading →

FILED UNDER: Policy, Reform, Affordable Care Act, Medi-Cal