Medi-Cal

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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

Obamacare in Jail: How San Francisco Policy Helps Inmates

A new law permits San Francisco Sheriff Department staff to enroll people into health plans. (Thomas Hawk/Flickr)

A new law permits San Francisco Sheriff Department staff to enroll people into health plans. (Thomas Hawk/Flickr)

The San Francisco Sheriff’s Department is implementing a new city law allowing its staff to enroll inmates into health insurance under the Affordable Care Act. Sheriff Ross Mirkarimi believes that making sure people have health coverage when they’re released will help prevent them from committing another crime and coming back.

“I believe that will go a long way to helping us improve public safety by using a public health strategy,” he said.

Health insurance sign-ups available to all inmates at the San Francisco county jail.

He estimates this will help save taxpayers millions of dollars.

One inmate – Sophia – recently requested help signing up for health insurance. Sophia, who asked that her last name not be used, was caught driving a stolen car in January and sentenced to three months in the county jail. She says that was because she stopped getting treatment for her substance abuse and mental health problems when her health insurance expired. Continue reading

Waiting For Medi-Cal To Kick In

Teresa Martinez, 62, works as a hairdresser at a Koreatown hair salon. She earns about $10,000 per year and cannot afford to buy private health coverage (Photo by Heidi de Marco/KHN).

Teresa Martinez, 62, works as a hairdresser at a Koreatown hair salon. She earns about $10,000 per year and cannot afford to buy private health coverage (Photo by Heidi de Marco/KHN).

by Anna Gorman, KHN

For most of Teresa Martinez’s life, buying health insurance has been out of the question. She works at a Koreatown hair salon, earning about $10 per cut – not nearly enough to afford private coverage.

With a long list of ailments including dizziness, blurry vision and leg pain, she eagerly applied last year for a county program that would cover her for free until Obamacare set in.

“I thought at long last, I would be able to go to the doctor and get what I need,” said Martinez, 62, who lives in East Los Angeles. “I was so excited. But that was short lived.”

The state has 45 days to process the Medi-Cal applications but it often takes longer and the waiting period varies — sometimes widely — by county.

Without any explanation, Martinez received a denial letter from the Healthy Way Los Angeles, a temporary coverage program for low-income people. Later she applied for Medicaid — known as Medi-Cal in California — which was expanded under the Affordable Care Act to include people like Martinez without dependent children.

But a health clinic worker told her she may have to wait months for approval — and to hold off on appointments until she has her official card.

Nearly 2 million Californians have gained coverage with the expansion of the Medi-Cal program for poor and disabled people, including those who transitioned from temporary programs like Healthy Way LA. Continue reading

New Bill Would Extend Health Coverage to Undocumented Immigrants

(Getty Images)

(Getty Images)

Anna Gorman, Kaiser Health News

In a push to cover immigrants excluded from the nation’s health reform law, a California state senator has proposed legislation that would offer health insurance for all Californians, including those living here illegally.

The bill, SB 1005, would extend state-funded Medi-Cal to low-income immigrants who, because they are in the country without permission, are now eligible only for emergency and pregnancy coverage. It would also create a marketplace similar to Covered California to offer insurance policies to higher income immigrants who lack legal status.

It’s not clear how much the new coverage would cost or how the state would fund it.

Sen. Ricardo Lara, a Democrat who represents Long Beach and southeast Los Angeles, announced the proposed legislation at a press conference Friday. He said immigrants contribute to the California economy and deserve to have access to health insurance. Continue reading