California Healthline: Capitol Desk

Pre-Existing Condition Reform Passes

Thu, 31 May 2012 08:00:00 GMT

When state Sen. Ed Hernandez introduced his bill SB 961 to the Senate floor yesterday, the West Covina Democrat's speech was laden with the historic nature of the legislation.

"As we all know, on March 23rd of 2010, the president of the United States of America signed into law the comprehensive health care reform bill known as the Patient Protection and Affordable Care Act," Hernandez said.

"I feel tremendous responsibility to ensure that California continues to lead the nation in implementing federal reform," he said, "and that we serve as a model for the rest of this country."

CMS Weighs in on Enrollment Question

Wed, 30 May 2012 08:00:00 GMT

Federal health officials have informed the state that CMS would favor passive enrollment with an opt-out provision but it does not support lock-in enrollment for the dual-eligible demonstration project in California.

That's according to Kevin Prindiville, deputy director of the National Senior Citizens Law Center in Oakland, who spoke to CMS officials on Friday.

"CMS has told us that's all they will allow," Prindiville said. "It's not a big surprise, but it's very welcome. We think the passive enrollment system is problematic in some ways, but CMS has said all along they would allow passive enrollment, but there would have to be a way to opt out at any time."

Community Dental Beneficiaries Go to Liberty

Tue, 29 May 2012 08:00:00 GMT

Community Dental Services health plan, plagued with financial troubles and quality-of-care problems, has shut down its managed care dental plan in Sacramento and Los Angeles counties.

On Friday, the state announced that all 16,000 Medi-Cal beneficiaries at CDS, the bulk of them in Sacramento County, would switch to Liberty Dental Plan of California. Also making the change will be 4,000 non-Medi-Cal patients. State officials said beneficiaries' providers would remain the same in almost every case.

The failure of CDS may be good news for the state and the beneficiaries in the plan, since that company had the lowest utilization rate among the five health plans providing dental coverage in Sacramento County. The state has been under fire recently because of low utilization rates in the pilot "geographic managed care" system. In the 2010-2011 fiscal year, fewer than one-third of Sacramento County Medi-Cal children went to a dentist, compared with a utilization rate of nearly 50% for the rest of the state.

State Proposes Delaying Start Date For Budget Cuts

Fri, 25 May 2012 08:00:00 GMT

The state is planning to delay the starting date for budget cuts by switching implementation from the start of the year to calendar year, according to a Department of Health Care Services summary of possible changes to trailer bill language for the May budget revision.

That's one of many revisions outlined in the summary. The DHCS changes reflect input and concerns from stakeholders.

Subcommittee Puts Co-Pay Idea on Hold

Thu, 24 May 2012 08:00:00 GMT

Co-pay is back. Last year, the Legislature passed and the governor signed a budget trailer bill that included Medi-Cal co-payments of $5 for some provider visits, up to $50 for emergency department visits and up to $100 for patients admitted to the hospital.

That move required a CMS waiver but in February, federal officials denied it. Now, with the May budget revision, a scaled-down version of co-payments is back on the table.

Yesterday, an Assembly budget subcommittee heard testimony on the subject and decided to hold co-pay approval for a later date.

Kaiser Balks at Joining Healthy Families Conversion to Medi-Cal

Wed, 23 May 2012 08:00:00 GMT

The planned switch of Healthy Families children into Medi-Cal could leave as many as 43,000 children looking for new health care providers if the state can't convince Kaiser Foundation Health Plan to join the effort.

That number would grow to 189,000 children if the state eventually converts all Healthy Families children to the Medi-Cal program.

On Tuesday, the Senate budget subcommittee for Health and Human Services rejected a plan to move the entire Healthy Families population of 875,000 kids to Medi-Cal all at once, instead starting with a pool of roughly 200,000 "bright line" children -- beneficiaries who are at or below 133% of federal poverty level.

Healthy Families Conversion Slowing Down

Tue, 22 May 2012 08:00:00 GMT

California health officials need to go a little slower in their plan to move 875,000 children out of the Healthy Families program and into Medi-Cal managed care, according to a Senate budget subcommittee that voted yesterday to reject the state's full plan.

It did endorse the transition of about 200,000 Healthy Families "bright line" children to Medi-Cal -- those beneficiaries at or below 133% of federal poverty level. The Affordable Care Act requires that those children be moved to Medi-Cal by 2014, so California would get a head start on that effort, according to John Bacigalupi from the state Department of Finance.

"We support this because it would create efficiency by consolidating health care for the state's children under a single program," Bacigalupi said.

Slower, Phase-In Approach for CBAS

Mon, 21 May 2012 08:00:00 GMT

The Department of Health Care Services has announced the conversion of adult day health care centers to a managed care system has been divided into a two-part process.

About 12% of the centers, which serve about 8% of the state's ADHC population, will still make the conversion to managed care by July 1. That leaves the bulk of the centers -- including Los Angeles County centers which serve two-thirds of the state's Medi-Cal beneficiariens receiving ADHC care -- to make the transition three months later, on Oct. 1.

"It was really welcome news," said Lydia Missaelides, executive director of the California Association of Adult Day Services. "It was clear nobody was ready yet. I think the Department [of Health Care Services] has been listening to stakeholders. I was really relieved. Not that October is so far away, but this is definitely good news."

Cal eConnect 'Not Able To Move Fast Enough'

Fri, 18 May 2012 08:00:00 GMT

Cal eConnect, an important part of the state's ambitious health information exchange effort, is no longer the same independent entity it was when it was born two years ago. The organization's efforts to make electronic health records ubiquitous in California will continue, officials said, but under a different organizational umbrella.

At a meeting last week, the 22-member board rescinded its cooperative grant agreement with the state.

On Wednesday, state officials announced that Cal eConnect will now be part of the Institute for Population Health Improvement at UC-Davis. Officials said the same work will continue in a new administrative structure.

Healthy Families, Seniors Initiatives Questioned

Thu, 17 May 2012 08:00:00 GMT

In the governor's May budget revision released this week, in addition to $2.5 billion in new cuts to health care in California, there were a couple of proposals that raised big red flags for many health care advocates.

In particular, two budget items took a lot of heat: the effort to move about 1 million dual-eligible Californians into managed care programs; and the state's plan to move 870,000 children out of the Healthy Families program and into Medi-Cal care.

In both cases, advocates said the state is taking on way too much, too quickly -- putting the two most vulnerable populations in California at real risk.

Senate Committee Rejects Care Changes

Wed, 16 May 2012 08:00:00 GMT

The Senate Budget Subcommittee on Health and Human Services last week voted to reject a proposal to change some nursing home and hospital regulations.

That happened before this week's release of Gov. Jerry Brown's new budget proposal that includes a slew of budget reductions to hospitals and nursing homes.

Hearings on the latest round of cuts -- including $2.5 billion in reductions to health care programs in California -- are scheduled to start today when the Assembly Budget Subcommittee on Health and Human Services holds its first budget revise hearing. According to chair Holly Mitchell (D-Los Angeles), it will be the 18^th hearing of that subcommittee this year alone.

May Budget Revise Hits Health Care Hard

Tue, 15 May 2012 08:00:00 GMT

Health care reductions made up more than one-third of the additional $6.5 billion Governor Jerry Brown (D) needed to trim since the last budget proposal in January. Five months ago, the governor was only staring down a $9.2 billion deficit. Now it's estimated at $15.7 billion.

Brown's new proposal released yesterday included about $2.5 billion in cost reductions to health care programs.

The plan calls for new cuts for hospitals and nursing homes, more cutbacks in Medi-Cal services and another reduction to In-Home Supportive Services.

May Budget Revise Hits Health, Human Services

Mon, 14 May 2012 08:00:00 GMT

Governor Jerry Brown's May revision of the state budget released this morning includes about $2.5 billion in cost-saving measures to health care programs.

"They're pretty serious cuts," Brown said today. "Cuts to Medi-Cal, to hospitals, to nursing homes, to CalWORKS, this is all very real. But California has been living beyond its means, and it has to be balanced at the day of reckoning. This is the day of reckoning."

According to the Democratic governor's proposed budget, $1.2 billion in cost-reduction will come from Medi-Cal, about $880 million from CalWORKS, $225 million from In-Home Supportive Services and about $161 million from other health care programs, such as the AIDS Drug Assistance Program.

New Budget to Hit Health Care Programs?

Mon, 14 May 2012 08:00:00 GMT

Before Governor Jerry Brown (D) came out with the January budget, some in the health care community speculated that new budget cuts wouldn't hit health programs -- because there wasn't much left that could be cut back.

But that proved untrue, when reductions hit Medi-Cal, Healthy Families and In-Home Supportive Services.

Assembly Casts Its Vote for Vaccinations

Fri, 11 May 2012 08:00:00 GMT

The Assembly yesterday approved a measure to require parents to meet with a licensed medical provider if they want to exempt their children from immunizations. After consultation, practitioners would sign an exemption form for parents.

Bill author Richard Pan (D-Sacramento) said AB 2109 makes sure parents make an informed decision about vaccinations.

"So they can make an informed decision about the impact this would have, not just on their own children but on the school and in the greater community," Pan said. "This is extremely important, to protect the public safety in our communities. Immunizations are one of the most important preventative measures, one of the most-effective measures we've had, to try to protect our communities from infectious diseases."

Laura's Law Advocate Objects to Plan

Thu, 10 May 2012 08:00:00 GMT

The Assembly Committee on Health on Tuesday approved a proposal designed to change the way some counties handle people who are having a mental health crisis.

"Consumers, mental health professionals, law enforcement and others are working side-by-side developing ways to de-escalate crisis situations, while reaching out to consumers and providing much-needed mental health services," said Wesley Chesbro (D-Arcata), author of AB 2134.

"This bill simply tells counties to have a best practice in place for crisis response before proceeding with the countywide involuntary treatment program," Chesbro said. "It's that simple."

Disability Rights Withdraws Contempt Filing -- For Now

Wed, 09 May 2012 08:00:00 GMT

A contempt-of-court motion filed against the Department of Health Care Services was recently withdrawn by Disability Rights California, though adult day health care advocates said they might re-file later.

"We still think we're right and the department is wrong," said Elissa Gershon, a senior attorney at Disability Rights California. "But once we began having discussions, it became clear it wasn't something that was as appropriate to bring before a federal judge."

There were two main sticking points in the contempt filing, one of which has been worked out, Gershon said.

Will FQHCs Get Lower Adult Health Rate?

Tue, 08 May 2012 08:00:00 GMT

A federal judge last week heard arguments for and against issuing a temporary restraining order against the state's plan to reduce payments for adult day health services. The California Primary Care Association filed suit on behalf of federally qualified health centers.

U.S. District Court judge James Ware heard the case last week. He has 30 days to issue a ruling.

In a similar case last month filed by the Adult Day Health Care Association, a federal judge declined to issue a preliminary injunction against the state and upheld the Department of Health Care Services' plan to set new rates for day service providers in the recently launched Community Based Adult Services program.

Newborn Test Takes Baby Step Forward

Mon, 07 May 2012 08:00:00 GMT

A bill to require hospitals to screen all newborns for congenital heart conditions recently was presented to the Assembly Committee on Appropriations -- where it was expected to get a rough reception. Instead, AB 1731 (Marty Block, D-San Diego) was moved to the suspense file, where it will await next month's budget discussions.

"The test … only costs $3 per baby," Block said at last week's hearing. "If undetected, congenital heart disease can require subsequent emergency room visits, and additional medical costs are much higher than the treatment cost if the baby's condition had been caught earlier."

Block was addressing fiscal concerns first raised in the Assembly Committee on Health. In addition to California hospitals' cost of administering the screening test to newborns, the Assembly analysis estimates additional cost to the Department of Health Care Services to launch and run the program -- up to $1 million annually, as well as start-up costs of $300,000.

Opposition to Ombudsman Bill Evaporates

Fri, 04 May 2012 08:00:00 GMT

Joe Rodrigues, the State Long-Term Care Ombudsman, has removed his opposition to SB 345 by Lois Wolk (D-Davis), a Senate bill designed to reform the ombudsman's office.

Rodrigues said the bill authors made a number of amendments to the measure. He now supports the bill presented at a legislative committee hearing earlier this week.

"We were able to work with them on coming to some agreements that will benefit the program and strengthen the [ombudsman's] office," Rodrigues said. "It made some of the good things to do in the bill less burdensome, such as the advisory council and the annual report. The bill looks very different today than it was a year and a half ago when it was first introduced."

Health Plans' Quality for Duals in Question

Thu, 03 May 2012 08:00:00 GMT

Seven of the eight health plans in California's pilot project to shift dual eligibles into managed Medi-Cal have inferior quality ratings for treating Medi-Cal beneficiaries, according to a report released yesterday.

The ambitious plan for 1.1 million Californians eligible for both Medicare and Medi-Cal benefits will start with a pilot program in four counties -- Los Angeles, Orange, San Diego and San Mateo. The state hopes to expand the pilot project to as many as 10 counties, pending legislative approval.

The report from National Senior Citizens Law Center, citing the state Department of Health Care Services' own quality assessment, shows seven plans earned a rating of 1 out of 5 stars in overall Medi-Cal performance.

Health Facilities Get Improvement Boost

Wed, 02 May 2012 08:00:00 GMT

The federal government yesterday issued $722 million in renovation and construction grants to community health centers, including $122 million in grants to California facilities.

Dean Germano, CEO of Shasta Community Health Center in Redding, said his center's $5 million capital grant announced yesterday will pay for about half of a planned $10 million building addition.

"The plans are completed, and we were waiting on a decision from HHS to see if we could do this," Germano said.

Subcommittee Approves Change for Sacramento County Dental Program

Tue, 01 May 2012 08:00:00 GMT

Recent controversy over dental services in Sacramento County came to a head at an Assembly budget subcommittee hearing yesterday. The root of the problem is the county's children's dental care program, organized as a managed care pilot project that has been plagued with access problems over its 18-year history.

In fiscal year 2010-11, about 31% of the children eligible for dental care in Sacramento County actually saw a dentist (compared to a statewide average of about 50%). It is the only county in the state with a mandatory managed care dental program, which pays a per-person, capitated rate, whether beneficiaries receive dental care or not.

State legislators are considering changing that system to allow a voluntary option for beneficiaries to switch to fee-for-service. State health care officials are asking to keep the current system, with some major reforms to boost those low utilization rates.

Mixed Reviews at Basic Health Program Briefing

Mon, 30 Apr 2012 08:00:00 GMT

The state Legislature is considering a bill to create a Basic Health Program in California. If adopted, SB 703 by Ed Hernandez (D-West Covina) would create low-cost health care insurance for as many as one million low-income Californians.

One of the options offered states in the Affordable Care Act, the Basic Health Program shares some goals with the Health Benefit Exchange, though the cost of insurance is expected to be significantly lower under the BHP.

That prospect would seem to be a slam-dunk proposition for patient advocates, but it's not as simple as that.

Expansion of Safety Net Sparks Debate

Fri, 27 Apr 2012 08:00:00 GMT

The 17 health care clinics run by the Molina Medical Group, which care for many low-income patients, should qualify as safety net providers in California, according to the group's owners. AB 2002 by Gil Cedillo (D-Los Angeles) would redefine the state's process for establishing Medi-Cal safety net providers to allow centers like Molina's to be included.

"This bill would create a fair definition of a safety net provider," according to Gilbert Simon, a physician at Sacramento Family Medical Center who testified at an Assembly Committee on Health hearing earlier this week. Sacramento Family Medical Center is a Molina Healthcare partner. Molina Healthcare is a for-profit company operating in 16 states and headquartered in Long Beach.

"Physician groups across the state are preparing and building sustainable networks to provide medical homes to patients [for the expansion of health care enrollment in 2014], and it is imperative that we acknowledge the true nature of the safety net," Simon said, "and take steps to acknowledge its expanding role."

Senate Committee Approves New Type of Nursing Home

Thu, 26 Apr 2012 08:00:00 GMT

A new idea elbowed its way into the familiar pile of health care legislation in the Senate Committee on Health yesterday. A nursing home model -- the "Green House Project" -- bucks the cold, institutional feel of many long-term care facilities.

"SB 1228 is a transformative bill that will eliminate red tape and save money. It is a revolutionary model of care," Senate member Elaine Alquist (D-San Jose) said, presenting her bill to the committee yesterday.

"It puts the 'home' back into nursing home," Alquist said.

Health Debt Bill Passes Committee

Wed, 25 Apr 2012 08:00:00 GMT

Melanie Rowen, a woman with multiple sclerosis living in San Francisco, appeared before the Assembly Committee on Health yesterday to talk about money -- or rather, lack of it.

When she first found out she had multiple sclerosis, Rowen had health care insurance but her medication was still expensive. "My insurance plan required me to pay 30% of it," Rowen said. "I couldn't afford it, but I put it on credit cards." As she watched her disease progress, she saw her bank account drain away and her health care debt pile up.

Assembly member Fiona Ma (D-San Francisco) hopes to prevent similar scenarios with AB 1800 which would establish a limit on annual out-of-pocket expenses for prescription medications for insured Californians.

Assembly Committee Approves Newborn Screening

Tue, 24 Apr 2012 08:00:00 GMT

There is a relatively easy answer to a serious disease that hits newborns in California, according to Assembly member Marty Block (D-San Diego).

"This bill is designed to ensure that newborns are screened for critical congenital heart disease," Block said, presenting his bill, AB 1731, to the Assembly Committee on Health.

"It is known as CCHD, it causes severe and life-threatening illness, and affects secen to nine of every 1,000 live births in the U.S. This will bring California's newborn screening program into alignment with the most up-to-date public health standards and practices," Block said.

Three Bills Aim To Change Nursing Home Care

Mon, 23 Apr 2012 08:00:00 GMT

The Assembly Committee on Health last week approved two bills to alter nursing home care in California and it will hear a third one this week.

AB 1752 by Mariko Yamada (D-Davis), expected to be heard in tomorrow's health committee hearing, is called the Nursing Facility Bed Hold Protection Act of 2012. It would require the Department of Health Care Services to penalize facilities for refusal to readmit a patient on appeal.

The Assembly health committee passed two other nursing home-related bills last week, also authored by Yamada.

Senate Hearing Tackles Flu Vaccination Rate

Fri, 20 Apr 2012 08:00:00 GMT

It's important to the general public that health care workers receive influenza inoculations, according to Senate member Lois Wolk (D-Davis), who was recently before the Senate Committee on Health to introduce SB 1318, which she hopes will increase the vaccination rate among health care professionals.

The bill would protect "our most vulnerable patients -- infants, seniors and those who are immune-compromised," Wolk said. "It would ensure that health care workers receive the influenza vaccination, or wear a mask during influenza season. It's a choice: Get vaccinated, or wear the mask. We want to decrease the deaths from influenza, and increase the safety at hospitals."

The California Nurses' Association and the Service Employees International Union are against the policy, in part because they see it as singling out people who opt out of getting the vaccine, by making them wear a mask in patient care areas.

Pre-Existing Condition Reform Passes Committee

Thu, 19 Apr 2012 08:00:00 GMT

The Senate Committee on Health yesterday passed SB 961 by Ed Hernandez (D-West Covina), which would change the individual health insurance market in California, in part by halting insurer denials based on pre-existing conditions. It is similar to a bill -- AB 1461 by Bill Monning (D-Carmel) -- approved by the Assembly health committee one day earlier.

Both measures are designed to conform to the federal Affordable Care Act, Hernandez said, in advance of many other states.

"While some of you may not support the Affordable Care Act, it is currently the law of the land," Hernandez said yesterday in introducing the measure. "And California continues to serve as a model for the rest of the nation."

Immunization Procedure Passes Committee

Wed, 18 Apr 2012 08:00:00 GMT

Richard Pan is a pediatrician as well as an Assembly member, so the bills he authors on children's health care carry a little more weight with his fellow legislators.

But Pan (D-Sacramento) had his hands full yesterday in the Assembly Committee on Health, as he introduced AB 2109, a bill that would require licensed providers to educate parents about the risks of skipping immunizations -- for their children as well as others in the community. The bill would require providers to sign an exemption form specifying that parents had been educated about the risks but still chose against vaccinations.

"We want to make sure parents or guardians have an opportunity to talk to a licensed health care professional," Pan said. "And the reason for that is, that decision doesn't just impact that child. It impacts the larger community."

State Wins Case to Cut Adult Day Provider Rates

Tue, 17 Apr 2012 08:00:00 GMT

After four similar cases went against the state in the past few months, the Department of Health Care Services won in court late Friday, when a federal judge refused to issue a preliminary injunction against Medi-Cal cutbacks.

The lawsuit, brought by the Adult Day Health Care Association, challenged the department's plan to cut Medi-Cal provider rates by 10%. Judges in four other cases issued preliminary injunctions halting those cuts, including suits brought by the California Medical Association and the California Hospital Association.

The difference in this case, according to DHCS spokesman Norman Williams, lies in a previous settlement of another case over the state's adult day health services. That settlement prompted the creation of a replacement program, Community-Based Adult Services, and included an agreement that covered the lower rates.

Bill Would Expand Clinics' Hiring Options for Mental Health Care Providers

Mon, 16 Apr 2012 08:00:00 GMT

Palm Springs has a problem that is shared in rural communities across California, according to J.M. Evosevich, a marriage and family therapist from Palm Springs who is a past president of the California Association of Marriage and Family Therapists. Evosevich said at a recent Assembly hearing that clinics throughout rural California have a problem: They can't find enough social workers to take care of people's mental health needs.

"There's a waiting list for people that need mental health care, and they can't provide it because they don't have the [mental health] providers," Evosevich said. "We are uniquely qualified to deal with marriage and family therapies. And those services are lacking in our area."

AB 1785 by Bonnie Lowenthal (D-Long Beach) aims to change. The bill came before the Assembly Committee on Health last week.

Health Committee Approves Additions to Medical Review Plan

Fri, 13 Apr 2012 08:00:00 GMT

The independent medical review process in California needs an update according to Senate member Ed Hernandez (D-West Covina) who introduced SB 1410 at Wednesday's Senate Committee on Health hearing.

"This bill deals with the Independent Medical Review program as an important safeguard for consumers of health care in California," Hernandez said. "Collectively these changes will improve the effectiveness and transparency of the IMR program."

Hernandez said the bill adds three improvements to the current IMR process in the state.

'It Can Be Costly to Treat CCS Kids'

Thu, 12 Apr 2012 08:00:00 GMT

Assembly member Cathleen Galgiani (D-Tracy) is well aware of the budget crisis in California. But she's also aware of another crisis in children's hospitals, she said.

"It can be costly to treat CCS (California Children's Services) kids," Galgiani said. "The Department was considering reimbursing hospitals at their negotiated California Medical Assistance Commission or otherwise known as CMAC rate. This bill would clarify [that] reimbursement."

The CMAC rate is a hospital rate of reimbursement negotiated by the California Medical Assistance Commission. The state Department of Health Care Services would like to switch to that rate. Galgiani's AB 1728 instead would maintain the current reimbursement rate, which is a hospital’s interim rate. The CMAC rate would go into effect unless this bill is passed.

Essential Health Benefit Bill Clears Committee

Wed, 11 Apr 2012 08:00:00 GMT

Bill Monning, chair of the Assembly Committee on Health, knew the moment was a big one.

"We are serving as policymakers in extraordinary times," Monning (D-Carmel) said yesterday at the health committee hearing. "For up to 5 million Californians, we have the opportunity before us to set essential health benefits."

Monning introduced AB 1453, which laid out a plan for what essential benefits will be covered in California under the Affordable Care Act. The proposed set of benefits is modeled on the Kaiser small group HMO plan.

Keeping Up With DHCS Lawsuits

Tue, 10 Apr 2012 08:00:00 GMT

The Department of Health Care Services may need an abacus to keep track of all of the lawsuits being levied against it.

A ruling is expected as early as today in a lawsuit brought against DHCS by the California Primary Care Association and several other providers.

The CPCA hopes a federal judge will grant a temporary restraining order to halt a lower reimbursement rate for adult day health services in the recently launched Community Based Adult Services program.

Medi-Cal Cuts Face Another Preliminary Injunction

Mon, 09 Apr 2012 08:00:00 GMT

The Department of Health Care Services has been on the losing end so far of four court cases over the 10% cut in Medi-Cal provider rates. In each of the four cases, preliminary injunctions were granted to halt the cuts from specific provider groups, such as emergency transport, hospitals, pharmacies, physicians and dentists.

Now it's adult day service providers' turn for a judicial ruling.

A decision is expected today from federal judge Christina Snyder on a request for another preliminary injunction. This one is from adult day health providers who worked under the Adult Day Health Care program before it was terminated and replaced by the Community Based Adult Services program, or CBAS.

Food Distribution Inequity a Target of Talks

Fri, 06 Apr 2012 08:00:00 GMT

Paula Daniels is the senior advisor on food policy in Los Angeles County, but a lot of people don't really understand what she's working on.

"People don't always get it," Daniels said. "There's an enormous amount of policy that's related to the food system. When you think about the whole system, the kind of food, how it's grown, how you get it, where it's distributed, there's regulatory policy, there's economic policy. And from an environmental justice point of view, it cuts across every line."

Daniels spoke yesterday in Los Angeles at an event called "An Appetite for Equity: Ensuring Access to Healthy Foods." It's the first of three meetings across the state sponsored by the California Pan-Ethnic Health Network. The next event is Apr. 11 in Fresno; the final one is Apr. 19 in Oakland.

State Names Four Counties for Duals Project

Thu, 05 Apr 2012 08:00:00 GMT

California took a big step yesterday, officially unveiling the four counties that will kick off the three-year project to eventually shift 1.1 million dual eligibles -- Californians eligible for both Medi-Cal and Medicare -- to a Medi-Cal managed care program.

The first four participants in the Coordinated Care Initiative are Los Angeles, Orange, San Diego and San Mateo counties. The Department of Health Care Services currently has authority to start the program in those counties, but legislation is pending in Sacramento that would expand authority for the number of participating counties -- up to 10 of them by 2013.

The trailer bill language for that legislation has been finalized. The trailer bill is expected to be included in the budget package in June, DHCS officials said.

Tulare County Hospitals Want to Form LIHP

Wed, 04 Apr 2012 08:00:00 GMT

Senate member Jean Fuller (R-Bakersfield) is not interested in leaving federal health care dollars on the table.

That's why she introduced a bill last week in the Senate Committee on Health that would enable local hospital districts in Tulare County to gain access to about $4.5 million in federal money over the next 18 months for a local Low Income Health Program (LIHP).

"Under current law, the county's non-participation [in LIHP] precludes hospitals from leveraging the federal dollars that are available under the Medicaid waiver," Fuller said last week in a Senate health hearing. "We can improve health care access with this, particularly in rural areas."

New Adult Program Launches With a Few Issues Still To Be Resolved

Tue, 03 Apr 2012 08:00:00 GMT

It was January 2011 when the governor first red-lined the Adult Day Health Care program for elimination as a Medi-Cal benefit. Since then, it has been rescued, cut in half, eliminated altogether, reinstated and replaced.

Yesterday the replacement program, Community Based Adult Services, went into effect. For about 32,000 former beneficiaries of ADHC, the changeover will go relatively unnoticed. Most of the currently open centers are expected to remain open, and CBAS benefits are similar to those in the now extinct ADHC program.

"It's a culmination of months of hard work, developing a program that's appropriate and useful for former ADHC participants," Norman Williams of the Department of Health Care Services said. "We had a goal of a program that would allow people to remain independent and living in the community."

Out With ADHC, In With CBAS

Mon, 02 Apr 2012 08:00:00 GMT

The CBAS era has officially begun.

Late Friday night, CMS approved implementation of the Community Based Adult Services program. That means the state has successfully eliminated adult day health care as a Medi-Cal benefit, and is replacing it with CBAS, starting today.

According to officials from the Department of Health Care Services, almost 32,000 of the nearly 40,000 ADHC beneficiaries have been deemed eligible for CBAS. That's more than 80% of the ADHC population.

State: DHCS Contempt Motion Won't Delay New Program Launch

Fri, 30 Mar 2012 08:00:00 GMT

Attorneys gathered in U.S. District Court yesterday morning to argue whether or not the state Department of Health Care Services should be found in contempt of court for its handling of the adult day health transition.

That argument will wait a week, at least. After meeting two hours yesterday, the two sides agreed to delay court proceedings.

"At this point the parties have been working on a possible solution. We hope to have a decision by next Friday," Disability Rights California attorney Elissa Gershon told the federal magistrate hearing the case.

Ironing Out Details of Duals Conversion

Thu, 29 Mar 2012 08:00:00 GMT

State officials met with stakeholders in Sacramento yesterday to answer questions and work out the final details of the duals demonstration project -- an ambitious plan to enroll an estimated 700,000 dual-eligible Californians in 10 counties into Medi-Cal managed care.

Enrollment will be mandatory for beneficiaries eligible for both Medi-Cal and Medicare. Jane Ogle, deputy director of health care delivery systems at the Department of Health Care Services, was quick to point out that beneficiaries would keep their own physician, even if that physician is not in the Medi-Cal network, and that beneficiaries have the power to opt out of the demonstration project, if they want.

"There is no need to assign a new doctor to people," Ogle said. "There just is no need to do that."

Changes Intended to Smooth MRMIP Operation

Wed, 28 Mar 2012 08:00:00 GMT

Assembly member Bill Monning (D-Carmel) is chair of the Assembly Committee on Health, but at yesterday's meeting he went to the other side of the dais to present a piece of new legislation.

Monning's AB 1526 would eliminate the annual and lifetime limits on coverage in the Major Risk Medical Insurance Program, popularly known as MRMIP.

"This bill is related to two goals I've had since I started in the Assembly. And number one is to make MRMIP more affordable for people who are in dire need of it," Monning said. "And the other goal was, to actually meet Mister Mip."

Pediatric Centers Must Pay Retroactively

Tue, 27 Mar 2012 08:00:00 GMT

If you were running a business on a shoestring budget, how hard would it be to pay off a lump sum payment equal to 10% of costs for the past 10 months?

That's the question Terry Racciato would like to ask officials at the Department of Health Care Services.

Racciato, president of two Together We Grow pediatric day health centers in San Diego, is facing the prospect of paying the state $200,000 or more for what she considers to be a state administrative mistake.

Advocates File Contempt Motion Against State

Mon, 26 Mar 2012 08:00:00 GMT

The settlement now is officially unsettled.

Disability Rights California, which filed and then settled a lawsuit challenging the transition of adult day health care by the Department of Health Care Services, now has filed a contempt motion saying that DHCS officials have not been following the terms of the agreement.

That settlement prompted the state's creation of the Community Based Adult Services program, due to launch Sunday, the day after ADHC is eliminated as a Medi-Cal benefit.

Legislative Hearing Looks at Transition Plans

Fri, 23 Mar 2012 08:00:00 GMT

During a Senate subcommittee review of a number of state health care proposals yesterday, one theme seemed to stand out: People are unhappy with them.

The budget subcommittee on Health and Human Services heard proposals by the Department of Health Care Services to cut health plan rate reimbursement for Healthy Families' children by 25%. In addition, DHCS intends to move 900,000 children from that program into Medi-Cal managed care. The committee also heard from a long parade of people who opposed those proposals.

After all the testimony and acrimony, subcommittee chair Mark DeSaulnier (D-Concord) didn't quite know what to say.

Solution to Physician Shortage May Lie in Mid-Level Practitioners

Thu, 22 Mar 2012 08:00:00 GMT

Ed Hernandez, an optometrist, can see it coming.

The Democrat Senate member from West Covina yesterday helped convene the second hearing in a week to explore the looming shortage of primary care providers in California. The addition of millions of newly insured along with a likely decline in the number of physicians in California is an equation that worries Hernandez. He said the gap is unlikely to be filled in traditional ways.

"Last week we looked at the shortage of providers in California, a shortage that will not lessen," Hernandez said yesterday at a joint meeting of the Senate Committee on Health and the Senate Committee on Business, Professions and Economic Development.

Aid for Pregnant Women Pushes Through Committee

Wed, 21 Mar 2012 08:00:00 GMT

Holly Mitchell, for the first time in recent memory, was speechless.

Assembly member Mitchell (D-Los Angeles), who is known for being voluble and quick-tongued, yesterday had a bill before the Assembly Committee on Human Services.

AB 1640 is designed to allow low-income pregnant women to use TANF money (federal Temporary Assistance for Needy Families) without proving that they're in their third trimester of pregnancy.

Hearing Focuses on Children's Dental Care

Tue, 20 Mar 2012 08:00:00 GMT

Assembly member Richard Pan (D-Sacramento) knew the subject was a little out of the ken of the workforce committee, but that it was too important to be ignored.

"One of principles in looking at whether we have an adequate workforce is to make sure we can take care of our patients," Pan said. "We need to take care of the oral health needs of children, and that depends, in part, on availability of coverage, and payment for those services."

Pan, chairman of the Assembly Select Committee on Health Care Workforce and Access to Care, presided over a recent hearing on children's oral health in Sacramento County.

Pediatric Centers Argue Retroactive Payments Don't Make Sense

Mon, 19 Mar 2012 08:00:00 GMT

California's 14 pediatric day health centers are a form of home health agency serving a 21-and-under population. Those are two groups exempted from the state's 10% Medi-Cal provider rate reductions in June.

PDHC operators assumed they were exempt from that rate reduction. That notion was reinforced by the absence of PDHCs on the list of providers in the state plan amendment (SPA) that the state sent to CMS for approval of the rate decrease.

Officials at the Department of Health Care Services, when alerted about the discrepancy, recently decided that, yes, PDHCs should be exempt from that rate decrease. This was great news for the PDHCs, which operate on a tight and limited budget -- except for one thing.

Counties, EDs Could Benefit from Pilot Project

Fri, 16 Mar 2012 08:00:00 GMT

California's emergency psychiatric demonstration project, approved this week by CMS, may help counties deal with financial stress from a payment system half a century old.

"This is a great opportunity for California to participate in a demonstration that will help ensure patients receive appropriate, high-quality care when they need it most," Norman Williams of the DHCS said. The project will provide "reimbursement to private psychiatric hospitals for certain services for which Medicaid reimbursement has historically been unavailable," Williams said.

That is good news for counties, crowded hospital emergency departments and patients with acute psychiatric problems, according to Patricia Ryan, executive director of the California Mental Health Directors Association.

Trying To Provide Solutions to Patient Access

Thu, 15 Mar 2012 08:00:00 GMT

California is in a bit of a fix, according to Senate member Ed Hernandez (D-West Covina), chair of the Senate Committee on Health.

The state doesn't have enough physicians and other primary care providers now, according to some estimates. That shortage will become more acute in 2014 when the Affordable Care Act brings up to four million newly insured Californians into the system, looking for providers to care for them.

"2014 is essentially here," Hernandez said yesterday at a Senate health committee hearing on primary care workforce issues. "We have had a historic piece of legislation pass at the federal level, the most historic health legislation since the Lyndon Johnson administration, when the Medicare Act was passed. But there are a lot of unknowns still, including how to implement it."

Who Cares for the Caregivers?

Wed, 14 Mar 2012 08:00:00 GMT

Caregivers make up a sizable volunteer workforce in California -- people who put in about 1.7 billion hours of care last year and didn't get paid for it. If they did, all of that work is valued at more than $20 billion. In California, where more than 10,000 people turn 65 every day, the need for that workforce will only grow.

That's according to a raft of testimony yesterday at the Capitol Building in Sacramento, before a joint hearing of two committees: Human Services and Aging and Long-Term Care.

The state doesn't do much for this vast and contributing population, and is about to do even less, according to Michelle Pope, executive director for Alzheimer's Services of the East Bay, who testified yesterday before the joint committee.

Health Insurers, Physician Group Oppose Ballot Initiative

Tue, 13 Mar 2012 08:00:00 GMT

It's not even a ballot measure yet, but it's certainly getting ballot-measure treatment.

Yesterday, a coalition of health insurance organizations, the California Medical Association, the California Hospital Association and other groups announced they were joining forces to fight a ballot measure designed to regulate health insurance rate increases.

"This initiative does nothing to address the cost drivers in the health care system," according to Paul Phinney, president-elect of the CMA. "I just think this initiative is the wrong idea."

Legislature Examines Duals Transition

Mon, 12 Mar 2012 08:00:00 GMT

Toby Douglas took a good amount of heat last Wednesday at an Assembly joint hearing of the committee on Aging and Long-Term Care and the Budget subcommittee on Health and Human Services.

Douglas -- director of the state Department of Health Care Services -- with a full array of budget cuts, program transitions and agency reorganization on his plate, has been making presentations and fielding questions at a number of legislative hearings recently. None of them has been a cakewalk, but this hearing was a little more barbed than most.

Complaints and concerns ranged from a perceived lack of choice to worry over rapid-fire changes.

California Mandates 48 Specific Areas of Coverage

Fri, 09 Mar 2012 08:00:00 GMT

An analysis released yesterday by the California Health Benefits Review Program shows that a large cross-section of Californians -- about 32 million people -- will be covered by health care mandates passed by the Legislature. There are now 48 of those mandates that either require coverage or require an offer of coverage, and another five mandates that deal with more general terms and conditions of coverage.

That is not the final word on the number of mandates. CHBRP was asked to evaluate three more legislative bills recently that deal with mandated coverage of tobacco cessation, prescription drugs and children's immunizations. In addition, some of the 16 bills the agency analyzed last year are up for approval this year. They include mandates ranging from mental health coverage to oral chemotherapy treatment.

State-passed mandates could have a financial impact on the health plans that need to cover those conditions and also may affect the list of essential health benefits offered by the California health benefit exchange.

More People May Be Eligible for Adult Day Services

Thu, 08 Mar 2012 08:00:00 GMT

There was a glimmer of good news for the 35,000 adult day health care Medi-Cal patients in California. It looks like a much higher percentage of them than previously estimated will be eligible to receive the new benefit called Community Based Adult Services.

Department of Health Care Services Director Toby Douglas originally said he expected about 50% of current ADHC patients to qualify for the new program. ADHC will be eliminated as a Medi-Cal benefit on Mar. 31 and the CBAS program starts Apr. 1.

Now it looks like 70% to 80% of those receiving the ADHC benefit will qualify for CBAS, according to Catherine Blakemore, executive director of Disability Rights California, which is monitoring the state's assessment and placement of ADHC patients.

Survey: Californians Concur on Need for Prevention

Wed, 07 Mar 2012 08:00:00 GMT

At a joint Assembly and Senate health hearing yesterday, results of a Field Poll unveiled a few days shy of the official release indicate that an overwhelming majority of Californians (about 80% of those surveyed) believe government and schools need to pitch in to fight childhood obesity and that preventive health programs pay for themselves in reduced health care costs to the state.

That tied in nicely with the intent of the hearing, which was convened by the two legislative health committees to look at ways to focus health policy toward prevention of chronic conditions such as obesity, heart disease and diabetes.

"When we look at the fact that individual [health] behavior and people's environment contribute to about 70% of our health care costs, it should really be addressed," according to Larry Cohen, founder and executive director of the Prevention Institute and a panelist at the hearing. "But our health care investment is only about 4% in prevention."

Central Valley Residency May Stay Open

Tue, 06 Mar 2012 08:00:00 GMT

Paul Hensler, CEO of Kern Medical Center in Bakersfield, said yesterday he plans to keep the family practice residency program intact.

Two weeks ago, the hospital announced it was closing that residency program to the incoming class of six residents, though the program itself would continue. Yesterday, Hensler said he and community members have been working hard to come up with a solution to keep the program.

"There are two scenarios," Hensler said, "to either make the [Family Practice] department more cost-effective, or to develop a collaborative program with the community here."

Welfare to Work Seen As Health Issue

Mon, 05 Mar 2012 08:00:00 GMT

Phil Ansell, director of the Los Angeles County Department of Social Services, has watched funding for the CalWORKs program diminish over recent years. At an Assembly hearing late last week, Ansell held both hands apart, as if measuring a decent-sized fish in the air.

"If this balloon is our welfare-to-work program," he said, then moved his hands closer together, "we have managed to shrink it without tearing it."

If the governor's recently proposed cuts to CalWORKs go through, though, Ansell said it's likely that balloon will pop.

Organizing the Mental Health of California

Fri, 02 Mar 2012 08:00:00 GMT

Assembly member Wesley Chesbro (D-Arcata) is nothing if not optimistic.

But at last week's Assembly hearing on mental health issues, even he was having a little trouble trying to make lemonade of the budget cuts to mental health services.

"We have gotten to the point where we're cutting things that were originally designed to save costs," Chesbro said of one particular mental health-related program, the caregiver resource centers.

"At this point," Chesbro said, "we're like the farmer eating his seed corn."

Study Looks at Language Barriers to Exchange Coverage

Wed, 29 Feb 2012 08:00:00 GMT

Communities of color are expected to make up a large portion of the California Health Benefit Exchange population. Many potential enrollees have limited English skills, which could get in the way of obtaining coverage.

That's according to a report due to be released today as a joint project of the UCLA Center for Health Policy Research, the California Pan-Ethnic Health Network and the UC Berkeley Center for Labor Research and Education.

"We estimate that about 2.65 million nonelderly adults will be eligible for the exchange. Of that 2.65 million, about 67% of them are people of color," UCLA researcher Daphna Gans said. "That's mostly Latino, followed by African American, then Asian."

Dental Problems Showing Up as Emergencies

Tue, 28 Feb 2012 08:00:00 GMT

A study being released today by the Pew Foundation found that 83,000 emergency department visits in California in 2007 were due to preventable dental problems. That rate of dental emergencies is likely growing quickly, according to Shelly Gehshan, director of the national Pew Children’s Dental Campaign.

"It is the wrong service, in the wrong setting, at the wrong time," Gehshan said.

"These are people who come in with dental pain, and they're desperate. The emergency room can't cure that, so they don't really get the problem taken care of."

Exemption Granted for Pediatric Day Health

Mon, 27 Feb 2012 08:00:00 GMT

For months, Terry Racciato has been trying to get the state to reverse its imposition of a 10% Medi-Cal provider rate cut on the 14 pediatric day health care centers in California.

Racciato, who runs two PDHC centers in the San Diego area, has been arguing with the Department of Health Care Services that pediatric day health care services should be exempted from that 10% rate cut, as home health agencies were.

On Friday, the state agreed.

Hearing Examines States' Behavioral Health Restructuring

Fri, 24 Feb 2012 08:00:00 GMT

The state has big plans for restructuring the behavioral health system in California. State legislators held a rare four-committee joint hearing this week to hear about the details of that reorganization, and to raise concerns about it.

"We understand the need to streamline and cut costs," Sen. Ed Hernandez (D-West Covina) said, "but at what cost?"

Assembly member Holly Mitchell (D-Los Angeles) said California's consumers must be at the center of all discussion about changing health care policies and programs.

"I think it is critical to pause, as a body," Mitchell said, "to make sure consumers aren't harmed by this streamlining of our departments."

From Supreme Court to Appeals Court

Thu, 23 Feb 2012 08:00:00 GMT

Yesterday's decision by the U.S. Supreme Court had a ripple effect in California, influencing a number of lawsuits in the state over health care cuts.

Four lawsuits have been filed over the 10% Medi-Cal provider rate cuts, and in all four cases, a federal judge has issued a temporary injunction blocking those cuts. In another court case, an injunction halted 20% trigger cuts to Californians receiving In-Home Supportive Services.

All of those cases were waiting to see what the Supreme Court would decide in Douglas v. Independent Living Center of Southern California. Yesterday's decision to send that case back to the Ninth Circuit Court of Appeals was a huge victory for patient rights' groups, according to Melinda Bird, a Disability Rights California attorney.

Working Out the Details of the Exchange

Wed, 22 Feb 2012 08:00:00 GMT

James Robinson can sum up the ultimate ideal and goal of the health benefit exchange in California:

"We want to cover all services, for everyone, without prior authorization," he said. "And without having to pay for it."

Robinson, director of the UC Berkeley Center for Health Technology, was part of a panel discussion at yesterday's California Health Benefit Exchange board meeting. Health experts chimed in on a series of panel discussions designed to help the board make sense of the complexity of the new exchange.

Adult Day Care Transition Gets Another Month

Tue, 21 Feb 2012 08:00:00 GMT

The state's move on Friday to shift the transition date for Adult Day Health Care elimination by a month was borne of a request by CMS, according to officials from the Department of Health Care Services.

Advocates say the delay may be due to the scattered nature of the state's transition so far.

"It's been a royal mess," Corinne Jan of the Family Bridges ADHC in Oakland said. "Lots of duplications on the lists. Some people got a notice they were eligible [for the alternate program], then another saying they're not. Lots of confusion."

More Uninsured Could Put Pressure on State

Fri, 17 Feb 2012 08:00:00 GMT

A UCLA Center for Health Policy Research report showed that 670,000 Californians lost employer-based health insurance in 2008 and 2009. That is a far cry from the earlier estimate of 2 million newly uninsured in the state. But what's interesting about the new number, according to the report's lead author Shana Lavarreda, is that it indicates that a new class of uninsured has been rising.

"The uninsured here is less and less an undocumented [worker] problem, and now it's more of a Main Street problem," Lavarreda said.

A majority -- if not all -- of those working-age Californians who lost coverage over that two-year period could have been considered residents of "Main Street."

Can Health Equity Be a Moneymaker?

Thu, 16 Feb 2012 08:00:00 GMT

Sometimes the right thing might also be the financially beneficial thing.

Physician groups are gathering today in Sacramento for a conference on disparities in health care related to race, language and geography. This time, the debate is not just about the moral imperative to promote equity in health care, but also about the clinical and financial impetus to make that move.

"The thing that has changed, as more people are brought into systems of care with accountability, health organizations are going to be looking at avoidable cost as well as avoidable risk," according to Wells Shoemaker, medical director of the California Association of Physician Groups, which organized the conference."It's sort of the low-hanging fruit when you're looking for avoidable costs."

Can Regional Planning be a Health Issue?

Wed, 15 Feb 2012 08:00:00 GMT

Earlier this week, Assembly member Bill Monning (D-Carmel) made a memorable appearance at a Capitol Building briefing on the health care needs and opportunities for minorities in California.

Monning held up a bright yellow plastic barrel-shaped mug by its thick handle -- it was almost a foot tall and looked like it weighed a couple of pounds.

"On the way up here, I went into an AM/PM [market], and saw this thing," Monning said, hefting the giant mug with the Too Much Good Stuff logo on it. "If you bought one of these, you'd get a free soda. They'd fill this thing up for you."

Getting a Head Start on Medi-Cal Expansion

Tue, 14 Feb 2012 08:00:00 GMT

For a program no one's really heard of, this one is pretty successful.

Counties started enrolling people into the Low-Income Health Program in July 2011, and four months later (at the most recent count in November) about 260,000 Californians were enrolled in it, according to Linda Leu, a health care policy analyst with Health Access California.

"It is a really great opportunity for those who are low-income, and who have been left out of programs like Medicaid [or, in California, Medi-Cal]," Leu said.

And with an acronym like LIHP, the perfect time to publicize the program is on Valentine's Day, she said.

State Considers Coverage Mandates

Mon, 13 Feb 2012 08:00:00 GMT

The deadline to pass legislation left over from last year has come and gone, with single payer, insurance rate regulation and the basic health plan all temporarily halted. The next big legislative push is coming up fast, as all new bills for 2012 have to be introduced by the end of next week, on Feb. 24.

A number of health-related laws recently were passed by the state Senate or Assembly. Many of them call for coverage mandates by health insurance providers.

Report Looks at SHOP Exchange Viability

Fri, 10 Feb 2012 08:00:00 GMT

The first series of forums put on by Small Business Majority went to small towns and cities across California to raise the notion of a business-specific health insurance exchange -- the Small Business Health Options Program, known as SHOP. The idea is to pool small business resources and buying power -- separate from the California Health Benefit Exchange's individual market -- so business owners can get a better, more financially stable option for health insurance.

Now, a second set of forums -- with experts from California, as well as from other states that have tried similar projects -- has finished. This week the Small Business Majority released a report summarizing the points brought up in those forums.

"Affordability is the number one issue to small business owners," according to Terry Gardiner of Small Business Majority. "Most companies who have not offered insurance say it's because it's too expensive, they cant afford it. And the ones who actually are providing coverage, they are struggling."

Same Providers in Healthy Families and Medi-Cal?

Thu, 09 Feb 2012 08:00:00 GMT

Yesterday's distribution of a summary of new Healthy Families data by the state Department of Health Care Services caused some advocates to scratch their heads.

The state wants to move 875,000 children out of Healthy Families and into Medi-Cal in the next 16 months. It's an idea that has been floated before, and has been vigorously opposed by providers, who would rather have the higher reimbursement of Healthy Families. California's Medi-Cal reimbursement rates are among the lowest Medicaid rates in the nation.

The new data indicate most providers and health plans in the Healthy Families program also serve Medi-Cal beneficiaries.

Douglas: Healthy Families Similar to Medi-Cal

Wed, 08 Feb 2012 08:00:00 GMT

State Department of Health Care Services Director Toby Douglas explained the reasoning behind the state's plans for the Healthy Families program during the Insure the Uninsured Project's 16th annual statewide conference in Sacramento yesterday.

Acknowledging that the proposal to shift 875,000 children out of Healthy Families and into Medi-Cal on a relatively fast timeline is a little controversial, Douglas said it's part of a bigger plan.

"It's all about delivery system reform," Douglas said. "It's about moving toward organized delivery systems."

Study: Uninsured Face Similar Debt as Medi-Cal Beneficiaries

Tue, 07 Feb 2012 08:00:00 GMT

More Californians are borrowing money to pay for health care services -- and two-thirds of them have medical insurance, according to a new study by the UCLA Center for Health Policy Research.

"When you think you're insured, you still end up paying a percentage and that adds up, into thousands of dollars," report author Shana Alex Lavarreda said. "So having insurance doesn't mean you will have things paid for."

Another surprising finding, Lavarreda said, is that uninsured Californians face a similar medical debt level to those who have insurance through Medi-Cal.

New Report Offers Healthy Families Alternatives

Mon, 06 Feb 2012 08:00:00 GMT

The state wants to shift 875,000 children in the Healthy Families program into Medi-Cal over a nine-month period, beginning in October. The state estimates the move will save $156 million over the next two fiscal years.

But according to a soon-to-be-released study, that plan could limit access to care for California's children, and the state might be better served to move more slowly.

A report commissioned by the Urban Institute looked at four possible directions for the Healthy Families program. Report author Stan Dorn said the move to Medi-Cal has some definite advantages for California children -- particularly for those at or below 133% of the federal poverty level. Those children will make that transition in 2014 anyway, as required by the Affordable Care Act.

Few People Aware of Medical Review Program

Fri, 03 Feb 2012 08:00:00 GMT

It has been 11 years since California launched its Independent Medical Review program, an appeals process that allows Californians to challenge denial or delay of coverage by private health care insurers.

In the Capitol Building in Sacramento yesterday, a policy briefing laid out the findings of a new report on IMR that includes praise for its effectiveness and some recommendations on how to make the program stronger.

The briefing was sponsored by the California HealthCare Foundation, which commissioned the report and publishes California Healthline.

Adult Day Health Services Budget Looks Familiar

Thu, 02 Feb 2012 08:00:00 GMT

The recent state budget proposal includes the expected cost of the Community-Based Adult Services program for next year: roughly $83 million.

That number is eerily close to last year's budget estimate for the Keeping Adults Free from Institutions program, which was an alternative adult day services plan that the Legislature passed in June. The Legislature approved $85 million for the KAFI program, which was designed as a half-price replacement for the adult day health care program.

Gov. Jerry Brown (D) vetoed KAFI.

State Gets Resistance to Moving All Healthy Families' Kids

Wed, 01 Feb 2012 08:00:00 GMT

A coalition of not-for-profit children's groups yesterday sent a letter to California officials asking them to scale back the state's ambitious plan to move 875,000 children out of the Healthy Families program and into a new Medi-Cal managed care program.

"We do not support the governor's proposal," Suzie Shupe of California Coverage and Health Initiatives said. "We have some very serious concerns about it. It’s a very rapid timeline, for one, and in our view does not detail the kind of safeguards that need to be in place, and the monitoring of access to that care, to make sure kids do get access to quality health care."

Yesterday's letter was a joint effort from Children Now, The Children's Partnership, PICO California, the Children's Defense Fund California and United Ways of California, as well as CCHI. It calls for a scaled-back version of the governor's proposal.

Assembly Passes Mental Health, Addiction Coverage Bill

Tue, 31 Jan 2012 08:00:00 GMT

To Assembly member Jim Beall (D-San Jose), it just makes sense. When private insurers fail to cover addiction and mental health services, he said, the cost of those illnesses fall on the state.

"If you don't treat it, it gets worse. If it gets worse, it gets shoved over to the public sector," Beall said. "And then, if it gets shoved into the public sector, it gets worse. Then they end up in prison, with a substance abuse or mental health problem in prison, and this is costing the state way too much money. We need to stop the cycle."

Beall is the author of AB 154, a bill requiring insurers to cover mental health and addiction services, which passed the Assembly floor late last week.

Personal Stories Highlight Oral Chemotherapy Bill

Mon, 30 Jan 2012 08:00:00 GMT

New legislation proposed by Assembly member Henry Perea (D-Fresno) would require health plans to provide chemotherapy in pill form, in some cases.

"This bill will provide greater access for oral chemotherapy treatment," Perea said on the Assembly floor late last week. "This is the right thing to do, to allow people access to lifesaving drugs."

Perea introduced the measure with his personal account of caring for his mother, who he said was diagnosed with stage 2 lung cancer just over a year ago. During the long, eight-hour chemo infusion in the hospital, he learned quite a lot about cancer and chemo from patients and professionals.

Single Payer 2 Votes Short in Senate

Fri, 27 Jan 2012 08:00:00 GMT

The idea of a single-payer health care system in California stalled on the Senate floor yesterday, falling two votes short of passage.

Reconsideration of the bill was granted, though, so proponents of SB 810 by Mark Leno (D-San Francisco) have until Tuesday to reintroduce the bill. First they will have to come up with two big votes. The bill failed on a 19-15 vote.

"We don't want to follow the path of Europe, where the economy is in trouble, where the Euro is failing," Sen. Ted Gaines (R-Roseville) said. "It's not the example we should follow. We don't have the money. I don’t know where the money's going to come from."

Court Agrees to New Mental Health Plan for Sacramento County

Thu, 26 Jan 2012 08:00:00 GMT

A federal district judge yesterday approved the final settlement of a lawsuit that challenged a plan by Sacramento County to restructure and downsize its mental health system. Yesterday's settlement means mental health services will remain at their current levels in the county -- and, in fact, may even improve, given a number of proposals the county still hopes to adopt.

The county hopes to save money by consolidating two county-operated clinics into one, according to Mary Ann Bennett, director of the county's Division of Mental Health.

"One of them is in a leased facility," Bennett said. "So we want to get out of the leased facility, and we will get some savings there."

Judge Calls ADHC Settlement a Win-Win

Wed, 25 Jan 2012 08:00:00 GMT

A federal judge yesterday gave her official stamp of approval to last month's settlement of a lawsuit challenging the state's transition plan for adult day health care services.

"It's a good result in a challenging time," according to attorney Elissa Gerson of Disability Rights California, which brought the lawsuit.

During yesterday's hearing, U.S. District Judge Saundra Brown Armstrong said the settlement outcome was actually better than it would have been if the case went to trial and DRC eventually won it.

Senate Sends Ombudsman Bill to Assembly

Tue, 24 Jan 2012 08:00:00 GMT

The state Senate yesterday passed SB 345 by Lois Wolk (D-Davis), a bill designed to give more independence and power to the Long-Term Care Ombudsman program. It now heads to the Assembly for committee and floor approval.

"Most of the provisions in this law simply clarify state and federal law," bill author Wolk said. "What has happened in this ombudsman program is the office is not effectively being an advocate for people in long-term care and local [ombudsman] offices."

State ombudsman Joseph Rodrigues begs to differ, and has testified against the bill in committee hearings, saying that the proposed law is duplicative and establishes additional requirements without additional funding.

Appropriations Committee Moves Single Payer Toward Floor

Mon, 23 Jan 2012 08:00:00 GMT

After all the drama, controversy and heated debate over legislation to set up a single-payer health care system in years past, last week's appropriations committee approval of the measure was strikingly brief and uneventful.

Like several other bills up for approval at last week's hearing, there was no presentation on single payer -- only a vote, followed by an eight-word pronouncement from Senate Committee on Appropriations Chair Christine Kehoe (D-San Diego):

"OK," Kehoe said, "6 to 2, that measure is out."

Trigger Cuts to IHSS Care Put on Hold

Fri, 20 Jan 2012 08:00:00 GMT

Federal judge Claudia Wilken did not mince words yesterday when an attorney representing California asked her if she would issue a stay, to grant the state the right to start implementation of a proposed 20% cut in In-Home Supportive Services.

"No, I won't stay it," Wilken said of the temporary restraining order she issued last month. "The TRO is now the permanent injunction, ... but it will be modified. It is appealable, as of now. But no, I'm not going to lift it."

The injunction means that 370,000 Californians, mostly seniors, will continue to receive IHSS care, while the state appeals the decision.

Cuts, Policy Changes at Healthy Families Program

Thu, 19 Jan 2012 08:00:00 GMT

The most recent state budget proposal includes a variety of cost-saving measures in the Healthy Families program -- reduced reimbursement rates, higher premium prices, higher copays and a transition of its 877,859 children into managed care plans by the end of June 2013.

At yesterday's monthly meeting of the Managed Risk Medical Insurance Board, chief deputy director Terresa Krum broached the bad news.

"There are a number of significant budget assumptions," Krum said. "So first, the budget proposes to reduce the per-member, per-month rates paid to health plans in Healthy Families to the average Medi-Cal rate."

Lots To Do With Less Than Two Years To Go

Wed, 18 Jan 2012 08:00:00 GMT

It is an eventful month for the California Health Benefit Exchange board.

Tomorrow, it releases its final solicitation for technology to help run the exchange. Proposals are due at the end of this month for the communication, outreach, assisters and health plan management components of the exchange.

Meanwhile, Executive Director Peter Lee said at yesterday's board meeting, the exchange has continued to hire new personnel and is now negotiating for office space to lease in Sacramento to accommodate all of those new hires.

State Moving Toward Licensing Home Health Workers

Tue, 17 Jan 2012 08:00:00 GMT

Two bills have been proposed to regulate an estimated one million unlicensed home health workers in California. The big questions are, how much regulation is needed, and how much that type of program will cost. One of the bills, AB 899 by Mariko Yamada (D-Davis), has looser requirements and is currently stuck in the Assembly appropriations committee.

The one more likely to make it to the floor is SB 411 by Curren Price (D-Inglewood), which would require background checks and care instruction for all home health care workers. It is expected to be taken up for a floor vote as soon as the end of January.

SB 411 is the one up for debate and possible amendment, according to Jordan Lindsey, director of policy and public affairs for CAHSAH, the California Association for Health Services at Home.

'Road Map' Lays Out Details for Building Exchange

Fri, 13 Jan 2012 08:00:00 GMT

The Children's Partnership "blueprint for reform" released this week marks an important milestone in the formation of California's Health Benefit Exchange, according to Kristen Golden Testa, health director of the Children's Partnership.

"The [Health Benefit] Exchange board did a lot of work on the visioning process, figuring out what they wanted the exchange to be like," Golden Testa said. "This offers a road map to get to a lot of the visioning pieces."

The report was released in draft form to the exchange board in December, and some of the detail laid out in the report may have helped board staff develop that RFP, Golden Testa said.

Medical Transport Lawsuit Gets Federal Injunction

Thu, 12 Jan 2012 08:00:00 GMT

A federal judge issued a preliminary injunction Wednesday to halt a 10% Medi-Cal provider reimbursement cut to medical transportation services.

It was the third time the state has lost in court on this issue. State officials said the state will appeal. Preliminary injunction rulings at the end of December halted cuts in hospital and pharmacy services. Another lawsuit, brought by the California Medical Association and other providers, is still pending.

Marat Sheynkman, executive director of the California Medical Transportation Association, which filed the suit that triggered Wednesday's ruling, said the 10% Medi-Cal reimbursement cut would have hit medical transport providers particularly hard.

Controversy Surfaces Over Ombudsman Plan

Wed, 11 Jan 2012 08:00:00 GMT

Legislative committees started back up with a bang yesterday, when a seemingly benign measure to beef up the state's Long-Term Care Ombudsman Program was almost scuttled by its director.

Yesterday, during the first meeting in months of the Senate Committee on Human Services, Senate member Lois Wolk (D-Davis) introduced SB 345, which is designed to increase the advocacy power of the long-term care ombudsman's office.

"The idea is to strengthen the ability to advocate residents' rights," Wolk said. "There is warranted concern that the ombudsman's office has not been adequately representing residents. The ultimate goal is that the ombudsman's office will aggressively pursue advocacy for the residents of long-term care facilities."

Legislation Would Require On-Time Medicaid Payments

Tue, 10 Jan 2012 08:00:00 GMT

Sarane Baker-Collins remembers the time well. "We went for months without a [Medi-Cal] payment. We kept doing our work, and the state didn't pay us for months. It's almost criminal what the state did to us."

Baker-Collins runs three small homes for residents with developmental disabilities in Santa Rosa. In the wake of the budget impasse of 2008, California had to shut off payments to Baker-Collins and other health care providers until a budget could be agreed upon.

Some Medi-Cal providers went as long as 60 days without reimbursement. For a small not-for-profit on a thin margin like the one run by Baker-Collins, that's a cost hard to bear.