California Healthline: Medi-Cal

Survey: Medi-Cal Users Praise Program, Struggle To Obtain Primary Care

Thu, 31 May 2012 08:00:00 GMT

A new survey finds that while 90% of Medi-Cal beneficiaries have a positive perception of the program, some have trouble finding primary care physicians. According to the survey, beneficiaries use the emergency department twice as much as other insured residents. Los Angeles Times et al.

Dentist Shortage Leading to Emergencies, Tooth Decay in Rural Counties

Wed, 30 May 2012 08:00:00 GMT

As a result of dentist and specialist shortages, residents in rural California counties are experiencing high rates of tooth decay and preventable dental emergencies. Experts say clinicians face financial barriers to practicing in rural areas because reimbursement rates are lower. HealthyCal.

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."

Dental Managed Care Plan Limits Access for L.A. Children

Tue, 29 May 2012 08:00:00 GMT

Only 23% of Los Angeles County children enrolled in a Medi-Cal managed care plan visited a dentist last year, compared with 31% in Sacramento and about half of all Medi-Cal children beneficiaries statewide. Advocates say dental managed care plans -- which pay clinics and dentists a monthly fee per child, regardless of whether the child visits a dentist -- ultimately limit children's access to pediatric dentists and other specialists. Sacramento Bee.

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.

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.

Study Finds Federal Poverty Level Undercounts in Calif.

Fri, 18 May 2012 08:00:00 GMT

Many California residents are ineligible for potential safety-net programs because the current federal poverty level, at $15,130 for a couple, is too low, according to a new study by the UCLA Center for Health Policy Research. The study's authors said the FPL should be nearly three times higher in some parts of the state, noting that 40% of adults older than age 65 and 25% of non-seniors are undercounted as being poor. Payers & Providers.

Opinion: Medicaid Expansion a Costly Part of Health Reform

Fri, 18 May 2012 08:00:00 GMT

In a Payers & Providers opinion piece, Texas physician Chris Rangel argues that a provision in the federal health reform law that will expand Medicaid coverage to individuals below 133% of the federal poverty level "is more likely to raise health care costs over the next decade" than the law's individual insurance mandate. He writes, "Contrary to popular belief, the uninsured do not flood emergency rooms because they can't get care elsewhere." He notes, "They are their own best managed care system by avoiding expensive health care except for serious conditions," which they may no longer be compelled to do after the Medicaid expansion. Payers & Providers.

Senate Rejects Several Republican-Supported FY 2013 Budget Plans

Thu, 17 May 2012 08:00:00 GMT

The Senate voted down five different Republican-backed fiscal year 2013 budget resolutions yesterday. Lawmakers noted that Congress is unlikely to approve any budget proposals that include changes to Medicare and Medicaid until 2013. The Hill's "Floor Action Blog" et al.

Molina Healthcare Added to Fortune's Largest Companies

Thu, 17 May 2012 08:00:00 GMT

Molina Healthcare, a Medicaid managed care plan based in Long Beach, has been named among Fortune's 500 largest U.S. companies, debuting at number 500. The company has expanded rapidly outside of the California market, generating $4.6 billion in revenue in 2011. Molina currently has 1.8 million Medicaid managed care beneficiaries in 10 states. Payers & Providers.

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.

Revised Budget Would Affect Central Valley Health Care

Wed, 16 May 2012 08:00:00 GMT

Gov. Brown's revised fiscal year 2012-2013 budget plan includes deeper cuts to health and welfare programs than his initial proposal, some of which would affect hospitals and social service agencies in the Central Valley. For example, Kaweah Delta Medical Center would lose $16.6 million, or about 14.5% of its Medi-Cal revenue, in the next fiscal year under the revised budget plan, according to Kaweah Delta CEO Lindsay Mann. Fresno Bee.

Brown Calls for Deeper Health Program Cuts in Revised Budget

Tue, 15 May 2012 08:00:00 GMT

Gov. Brown has released his revised budget plan for the next fiscal year. The plan includes deeper Medi-Cal and In-Home Supportive Services cuts than his original plan and maintains proposed cuts to welfare and child care programs. Sacramento Bee's "Capitol Alert" et al.

Reconciliation Measure Cutting Entitlement Spending Clears House

Fri, 11 May 2012 08:00:00 GMT

The House has approved a budget reconciliation bill that would override automatic spending cuts and reduce entitlement spending. The bill would cut the federal Medicaid match to states and impose stricter eligibility standards. Washington Times et al.

Proposed Rule Would Boost Medicaid Pay for Primary Care Physicians

Thu, 10 May 2012 08:00:00 GMT

Yesterday, HHS released a proposed rule that would increase Medicaid reimbursements for primary care physicians over two years. Under the proposal, which stems from the health reform law, the federal government would cover the entire cost of the increase. Washington Post et al.

House Panel OKs Budget Plan That Includes Cuts to Health Care Spending

Tue, 08 May 2012 08:00:00 GMT

The House Budget Committee has approved a budget plan that would cut funding from Medicaid, the Children's Health Insurance Program and other health initiatives. The full House likely will pass the bill, but the Senate is expected to reject it. AP/San Francisco Chronicle et al.

Concerns Raised About Access to Primary Care in Sacramento County

Tue, 08 May 2012 08:00:00 GMT

Health care leaders in Sacramento County are concerned about the lack of primary care services available to low-income and uninsured residents. The county once operated six public clinics but now runs only one, while not-for-profit community clinics are scarce. Sacramento Bee.

Risks, Rewards Higher for Managing Dual Eligibles

Mon, 07 May 2012 08:00:00 GMT

California health plan officials say the experience of shifting seniors and persons with disabilities into Medi-Cal managed care plans over the past year will help as the state moves dual eligibles -- beneficiaries of both Medicare and Medi-Cal -- into managed care this year.

Report: Recession Fuels $70B Jump in Medicaid Spending

Mon, 07 May 2012 08:00:00 GMT

A Kaiser Family Foundation report finds that Medicaid spending increased from $330 billion in fiscal year 2007 to $400 billion in FY 2010, partly because of increased unemployment and lower incomes during the recession. Reuters.

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.

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."

Calif. To Revamp 30-Year-Old Medi-Cal Computer System

Wed, 25 Apr 2012 08:00:00 GMT

California Auditor Elaine Howle recently announced that the state is developing a new computer system to handle Medi-Cal billing. The new system -- called Health Enterprise -- will replace the 30-year-old Medicaid Management Information System that currently processes billing. Capitol Weekly.

Many Medi-Cal Caregivers Are Low-Income, Report Finds

Tue, 17 Apr 2012 08:00:00 GMT

More than 50% of California's long-term caregivers who are paid by Medi-Cal to aid low-income seniors and residents with disabilities are living in poverty or close to living in poverty, according to a new report by the UCLA Center for Health Policy Research. Capitol Public Radio's "KXJZ News."

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.

Bay Area Could Lose Millions in Medi-Cal Expansion Ruling

Thu, 05 Apr 2012 08:00:00 GMT

Bay Area counties could lose tens of millions of dollars if the U.S. Supreme Court rules that a planned Medi-Cal expansion under the federal health reform law is unconstitutional. Forty-seven California counties by the end of January had established low-income health programs to prepare for implementing the Medicaid expansion in 2014, including Alameda, Contra Costa, San Mateo and Santa Clara counties. If the expansion is ruled unconstitutional, the counties could lose out on expected federal funding. San Jose Mercury News.

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.

San Diego Seeks Ways To Manage Frequent Users of Emergency Services

Wed, 04 Apr 2012 08:00:00 GMT

San Diego officials are working to address the frequent use of emergency services by a largely homeless population. According to experts, frequent emergency service users need access to better coordinated health care and more permanent housing options. U-T San Diego.

Federal, State Officials Investigate SCAN Health Plan for Overbilling

Wed, 04 Apr 2012 08:00:00 GMT

SCAN Health Plan is being investigated by state and federal authorities for allegedly double-billing Medi-Cal and Medicare for treating the same pool of patients and intentionally hiding its actions. SCAN recently set aside $125 million for resolving the allegations. California Watch.

Calif. Top State in Recouping Funds From Medicaid Fraud

Wed, 04 Apr 2012 08:00:00 GMT

California recouped $388.26 million from Medicaid fraud and patient abuse cases in fiscal year 2011, according to an HHS Office of the Inspector General report. The amount is the most recovered by any state that year. FierceHealthcare, HHS OIG report summary.

Calif. To Announce Counties Heading Managed Care Pilot

Tue, 03 Apr 2012 08:00:00 GMT

On Wednesday, California officials will announce the four counties that will pilot a managed care program for residents eligible for both Medicare and Medi-Cal. The program is designed to streamline care and save $1 billion in fiscal year 2013-2014 by reducing unnecessary hospitalizations, emergency department visits and nursing home stays. Ten California counties -- including Alameda, Contra Costa, San Mateo and Santa Clara -- are seeking to be among the four selected to run the program. Oakland Tribune/Contra Costa Times.

House Approves Ryan's FY 2013 Budget Proposal, Axes Separate GOP Plan

Fri, 30 Mar 2012 08:00:00 GMT

Yesterday, the House approved House Budget Committee Chair Paul Ryan's fiscal year 2013 budget proposal, which would repeal the health reform law and alter Medicaid and Medicare. The House rejected a budget plan by the Republican Study Committee. Wall Street Journal et al.

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."

Calif. Aims To Have 10K Health Providers Nab EHR Incentive Payments

Wed, 28 Mar 2012 08:00:00 GMT

By June, California wants 10,000 health care providers to receive Medicaid incentive payments for implementing or upgrading to certified electronic health record technology. CMS says some states are joining with local stakeholders to help providers achieve meaningful use. Modern Healthcare.

Medi-Cal Commission Discusses Concerns With Gold Coast Health Plan

Tue, 27 Mar 2012 08:00:00 GMT

The Ventura County Medi-Cal Managed Care Commission recently discussed complaints about Gold Coast Health Plan, which administers Medi-Cal for county residents. A health care provider at the meeting said the plan is months behind on payments. Ventura County Star.

ACS Now Operating Medi-Cal Claims Management System

Tue, 27 Mar 2012 08:00:00 GMT

Last week, Xerox-subsidiary Affiliated Computer Services announced that it has fully transitioned into its role as manager of Med-Cal's claims processing system. In 2010, ACS received the 10-year, $1.6 billion contract. It began assuming operational responsibility from the former contractor -- Electronic Data Systems/Hewlett Packard -- in October 2011. Sacramento Business Journal.

HHS: Faulty Claims Data Led to Uncollected Overpayments

Mon, 26 Mar 2012 08:00:00 GMT

Medicaid Integrity Contractor audits failed to recoup millions of dollars in overpayments during the first half of 2010 because of incorrect and misinterpreted claims data, according to a new HHS Office of Inspector General report. The report found that 81% of the audits conducted between Jan. 1, 2010, and June, 30, 2010, either were unable or unlikely to identify overpayments. FierceHealthcare, Modern Healthcare.

Court Denies Request To Allow Medi-Cal Pay Cuts While Lawsuit Continues

Mon, 26 Mar 2012 08:00:00 GMT

The 9th U.S. Circuit Court of Appeals has denied California's request to allow a 10% cut to certain Medi-Cal payments until a formal ruling is made in a lawsuit challenging the cuts. A federal judge in February granted a preliminary injunction to block the cuts. Sacramento Business Journal.

Senate Panel Clears Bill Tweaking Sacramento County's Dental Plan

Fri, 23 Mar 2012 08:00:00 GMT

A state Senate panel has approved a bill -- by Senate President Pro Tempore Darrell Steinberg -- that would give Sacramento County children enrolled in Medi-Cal a choice between the current managed care dental program and a fee-for-service model. Sacramento Bee.

Judge: Calif. Violated Law by Not Disclosing Info on Medi-Cal Cuts

Thu, 22 Mar 2012 08:00:00 GMT

A superior court judge has ruled that the Department of Health Care Services violated disclosure law when it refused to provide background information on a proposed 10% cut to Medi-Cal payments. The judge ordered the state to release the information. Sacramento Bee's "Capitol Alert."

House Committee OKs Ryan's Budget Blueprint for Fiscal Year 2013

Thu, 22 Mar 2012 08:00:00 GMT

The House Budget Committee has approved Committee Chair Paul Ryan's new budget plan, which includes proposals to repeal the health reform law and alter Medicare and Medicaid. GOP leaders say they expect the full House to pass the measure. The Hill's "On the Money" et al.

California Will Not Appeal Ruling Against First 5 Funding Shift

Wed, 21 Mar 2012 08:00:00 GMT

The state will not appeal a 2011 court ruling that rejected lawmakers' plan to shift $1 billion away from First 5 commissions. The commissions are seeking reimbursement for an estimated $586,000 in legal fees. California Watch.

Study: Medicaid Enrollees Face Barriers to Primary Care

Tue, 20 Mar 2012 08:00:00 GMT

Medicaid beneficiaries nationwide are nearly twice as likely as privately insured individuals to face barriers to primary care, according to a study in the Annals of Emergency Medicine. The study also found that Medicaid beneficiaries are much more likely to visit emergency departments. The study analyzed responses of 230,258 patients who participated in the National Health Interview Surveys from 1999 to 2009. MedPage Today, UPI.

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.

Report Finds Uptick in Costs, Enrollment for Medicaid, CHIP

Mon, 19 Mar 2012 08:00:00 GMT

Medicaid and the Children's Health Insurance Program enrolled about 78 million residents and cost about $444 billion in fiscal year 2011, up from 76 million enrollees and $400 billion in costs in FY 2010, according to a report by the Medicaid and CHIP Payment and Access Commission. In the report, MACPAC also outlined recommendations to boost care quality, lower costs and improve fraud detection. Modern Healthcare.

HHS Issues Final Rule on Federal Reform Law's Medicaid Expansion

Mon, 19 Mar 2012 08:00:00 GMT

Last week, HHS released the final rule governing the Medicaid expansion mandated under the federal health reform law. HHS said it responded to stakeholder feedback by adding more consumer protections and state-level flexibility to the final rule. Modern Healthcare et al.

Calif. Families Expect State To Investigate Gold Coast Coverage Denials

Mon, 19 Mar 2012 08:00:00 GMT

California families are expecting the state to investigate Gold Coast Health Plan's denials of coverage for home care services. The health plan said the denials were for treatments that are not considered medically necessary. Ventura County Star.

CBO: Medicare Spending To Nearly Double Over Next Decade to $1.058T

Wed, 14 Mar 2012 08:00:00 GMT

The Congressional Budget Office estimates that Medicare spending will nearly double from $563.3 billion in fiscal year 2011 to $1.058 trillion in fiscal year 2022. It also estimates that Medicaid spending will jump from $275 billion in FY 2011 to $622 billion in FY 2022. Modern Healthcare.

Editorial: Brown's Managed Care Plan the 'Right' Start

Tue, 13 Mar 2012 08:00:00 GMT

State officials "want to proceed more cautiously" with Gov. Brown's plan to cut $3.6 billion from Medi-Cal spending over the next four years by shifting individuals eligible for both Medi-Cal and Medicare into managed care plans, but California's "fiscal realities cannot be ignored," a Los Angeles Times editorial states. According to the editorial, "Policymakers and health care providers must change the financial incentives in Medi-Cal and deliver more value for the dollar through better coordinated, more effective care." It concludes, "The governor's proposal may not be the complete answer, but it's the right starting point." Los Angeles Times.

Payment Delays, Personnel Issues Plague Medi-Cal Plan

Mon, 12 Mar 2012 08:00:00 GMT

Ventura County health care providers say Gold Coast Health Plan, a managed care system that administers Medi-Cal in the county, is significantly behind in processing claims. Meanwhile, the group's CEO resigned on Thursday. Last month, the plan's human resources director and interim director of operations were dismissed, and its chief financial officer resigned in January after an allegation of driving under the influence. Ventura County Star.

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.

House GOP Unveils Medicaid Reform Bill, Prepares Another

Fri, 09 Mar 2012 08:00:00 GMT

On Wednesday, Rep. Todd Rokita introduced a bill that would save an estimated $1.8 trillion by combining Medicaid and the Children's Health Insurance Program under a single block grant program and freezing federal Medicaid spending at current levels over the next decade. Meanwhile, Rep. Bill Cassidy is preparing a separate proposal that would replace the current federal matching rate system with a per-patient monthly budget that is based on the characteristics of each state's patient population. The Hill's "Healthwatch."

Hearing Examines Patient Care Under Medi-Cal Overhaul

Fri, 09 Mar 2012 08:00:00 GMT

Witnesses testified at an Assembly hearing that Medi-Cal beneficiaries switching to managed care plans face obstacles to accessing care. They said treatments have been delayed and beneficiaries have been bumped off of organ transplant lists. California Watch.

Assembly Member Stumps for Denti-Cal Benefits for Seniors

Fri, 09 Mar 2012 08:00:00 GMT

Assembly member Richard Pan said comprehensive Denti-Cal benefits should be restored for low-income seniors. The 2009 state budget eliminated most dental benefits for adult Medi-Cal beneficiaries. Capital Public Radio.

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.

Four Sacramento-Area Counties Join LIHP Ahead of Reform Law

Tue, 06 Mar 2012 08:00:00 GMT

Four counties in the Sacramento region are implementing the state's Low Income Health Program. More than 40 other counties already participate in the program, which offers health coverage to uninsured residents. Sacramento Bee.

Health Reform in California Inevitable, Health Leaders Say

Mon, 05 Mar 2012 08:00:00 GMT

Health industry officials say that health care reform will happen in California regardless of whether the federal overhaul is upheld. They note that higher costs and lower reimbursements necessitate a statewide overhaul. Sacramento Business Journal.

California Hospitals Seek To Treat Fewer Patients Under Federal Overhaul

Mon, 05 Mar 2012 08:00:00 GMT

California hospitals are trying to keep patients out of their facilities in preparation for new federal health reform law rules. The law provides higher reimbursements for hospitals with better patient outcomes and penalizes facilities for preventable readmissions. Los Angeles Times.

O.C. Board Delays CalOptima Leadership Reappointments

Fri, 02 Mar 2012 08:00:00 GMT

On Tuesday, the Orange County Board of Supervisors voted 3-2 to delay the reappointments of Ed Kacic as chair of CalOptima's board of directors and Adriana Moreno as a CalOptima director. CalOptima is Orange County's Medi-Cal managed care plan. The supervisors will wait until the completion of investigations into allegations that Kacic and Moreno used their positions to obtain funds and other cutbacks on behalf of organizations they work for. Payers & Providers.

State Controller's Office Says Medi-Cal Overpays for Hearing Aids

Thu, 01 Mar 2012 08:00:00 GMT

Medi-Cal reimburses hearing aid providers for the wholesale cost of the devices, but providers often pay a fraction of that cost because of discounts and rebates. The state controller's office found that California could save $27.3 million over three years if it reduced overpayments. Orange County Register's "OC Watchdog."

Editorial Supports Steinberg's Efforts To Fix Dental Program

Thu, 01 Mar 2012 08:00:00 GMT

Senate President Pro Tempore Darrell Steinberg "is insisting justifiably" that state health care officials act immediately to improve Sacramento County's dental care plan for low-income children, according to a Sacramento Bee editorial. It argues, "Poor kids in Sacramento should not have to put up with abysmal service, and taxpayers ought not to pay for something that is not being delivered." Sacramento Bee.

Steinberg Wants Quick Fix for Dental Plan in Sacramento County

Wed, 29 Feb 2012 08:00:00 GMT

Senate President Pro Tempore Darrell Steinberg is calling for immediate improvements to a Sacramento County dental care plan for low-income children. He also said the program should offer a choice between managed care and fee-for-service plans. Sacramento Bee.

Gov. Brown Lobbies for Medi-Cal Waiver During Washington, D.C., Visit

Mon, 27 Feb 2012 08:00:00 GMT

Gov. Brown recently met with HHS Secretary Kathleen Sebelius and requested authority to charge Medi-Cal beneficiaries copayments for visits to emergency departments, physicians and dentists. Sebelius said there are legal issues to consider regarding the proposal. Los Angeles Times et al.

Brown: High Court's Stance on Medi-Cal Lawsuit Favors State

Mon, 27 Feb 2012 08:00:00 GMT

Gov. Brown said that when the U.S. Supreme Court sent a Medi-Cal lawsuit back to the federal appeals court, it provided "clear instructions that are very favorable to the state's position." The lawsuit stems from Medi-Cal reimbursement cuts the California Legislature approved in 2008 and 2009. KPCC's "KPCC News."

DHCS Chief Promises Changes to Children's Dental Program

Fri, 24 Feb 2012 08:00:00 GMT

In a letter to Senate President Pro Tempore Darrell Steinberg, Department of Health Care Services Director Toby Douglas promised to help ensure that low-income Sacramento County children with Medi-Cal coverage have access to "high quality and timely" dental care. Douglas was responding to a letter from Steinberg calling for a review of the county's dental program. Sacramento Bee.

California Hospital News Roundup for the Week of February 24, 2012

Fri, 24 Feb 2012 08:00:00 GMT

Children's Hospital of Orange County is being investigated by the California Department of Public Health after the facility reported a surgical error. A status report on San Gorgonio Memorial Hospital shows that construction on the two-story, 37,500 square-foot facility is 80% complete.

Supreme Court Declines To Rule on Medi-Cal Reimbursement Suit

Thu, 23 Feb 2012 08:00:00 GMT

The U.S. Supreme Court has declined to rule on a lawsuit considering whether Medi-Cal beneficiaries and providers can sue over reimbursement cuts. The justices said a lower appellate court should re-examine the case. Los Angeles Times, Sacramento Bee.

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.

State Forgoes Giving Medi-Cal Patients Drug Dispensers

Wed, 22 Feb 2012 08:00:00 GMT

The California Department of Health Care Services has abandoned a pilot project that would have installed automatic medication dispensers in the homes of Medi-Cal beneficiaries following recent DHCS findings that the initiative would not generate its projected $140 million in annual savings. CHCF Center for Health Reporting.

LAO: Brown's Expansion of Managed Care Pilot Would Be 'Premature'

Wed, 22 Feb 2012 08:00:00 GMT

The Legislative Analyst's Office has reviewed Gov. Brown's plan to quickly expand a pilot program shifting residents eligible for both Medi-Cal and Medicare into managed care plans. LAO said the state should evaluate the results of the pilot program before expanding the initiative statewide. California Watch.

10 Counties Expand Access to Health Care for Low-Income Residents

Tue, 21 Feb 2012 08:00:00 GMT

A group of 10 counties has expanded access to health coverage for hundreds of thousands of low-income residents through California's Bridge to Reform program, which seeks to prepare the state for the implementation of federal health reform law provisions. Los Angeles Times.

Letter Accuses CalOptima Officials of Improprieties

Fri, 17 Feb 2012 08:00:00 GMT

On Thursday, an anonymous letter faxed to the board of directors of CalOptima -- Orange County's Medi-Cal managed care plan -- alleges that CalOptima Chair Ed Kacic uses his position to steer funds to the Irvine Health Foundation, of which he is president. The letter also alleges that CalOptima board member Mary Anne Foo "accepts pay for working for CalOptima while working on its board." Both Kacic and Foo said the allegations are false. Voice of OC.

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."

Steinberg Seeks Review of Sacramento County Dental Plan for Children

Tue, 14 Feb 2012 08:00:00 GMT

Senate President Pro Tempore Darrell Steinberg is calling for a state review of Sacramento County's dental program for children enrolled in Medi-Cal. Steinberg says the program's prevention and treatment services are "woefully inadequate." Sacramento Bee.

Enrollment in Riverside Co.'s Health Plan for the Uninsured Nears 3,000

Tue, 14 Feb 2012 08:00:00 GMT

About 2,700 low-income Riverside County residents who do not qualify for Medi-Cal have been enrolled in a new countywide health plan that emphasizes timely primary and preventive care. The program directs residents seeking care to public health clinics. HealthyCal.

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.

Obama's Budget Likely Will Not Include Major Changes to Entitlements

Fri, 10 Feb 2012 08:00:00 GMT

President Obama is not expected to propose major Medicare and Medicaid changes in his new budget proposal next week. Despite supporting program cuts, he likely will abstain from such proposals to retain the support of elderly residents in the election. Wall Street Journal.

CMS Rejects California's Plan To Require Medi-Cal Copayments

Tue, 07 Feb 2012 08:00:00 GMT

CMS has rejected California's plan to require copayments from Medi-Cal beneficiaries for certain health care services. Gov. Brown's administration said it will appeal the federal government’s decision. Sacramento Bee's "Capitol Alert," et al.

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.

State Medicaid Leaders Worried About New Tax on Premium Revenue

Thu, 02 Feb 2012 08:00:00 GMT

Many state Medicaid directors are concerned about a provision of the federal health reform law that requires insurers to pay a tax on premium revenue. Some directors hope the federal government will exempt Medicaid managed care plans from the tax. Kaiser Health News/McClatchy.

Judge Issues Injunction To Block Medi-Cal Reimbursement Cuts

Thu, 02 Feb 2012 08:00:00 GMT

On Tuesday, a federal judge issued a preliminary injunction to block California from moving forward with a 10% reduction to Medi-Cal payments. According to finance department officials, the state will appeal the ruling. Los Angeles Times' "PolitiCal" et al.

State Controller Warns California Could Run Out of Cash by Early March

Wed, 01 Feb 2012 08:00:00 GMT

State Controller John Chiang has sent a letter to budget leaders warning that California could run out of cash by early March. Brown administration officials say the spending gap stems in part from courts blocking planned cuts to health and welfare programs. Sacramento Bee et al.

Judge Tentatively Blocks 10% Cut to Medi-Cal Reimbursement Rates

Tue, 31 Jan 2012 08:00:00 GMT

A judge has issued a tentative ruling to block a 10% reduction to Medi-Cal payment rates while a lawsuit challenging the cuts continues. The judge said the state's budget issues do not outweigh the harm that the reductions could cause. AP/Sacramento Bee et al.

Government Health Care Spending To Reach $1.8T by 2022, CBO Predicts

Tue, 31 Jan 2012 08:00:00 GMT

Today, the Congressional Budget Office released an economic outlook predicting that the cost of government health care programs will more than double over the next 10 years to $1.8 trillion, representing about 7% of the U.S. economy. The Hill's "Healthwatch," Wall Street Journal.

Elderly Health Program Viewed as Model To Cut Costs, Improve Care

Thu, 26 Jan 2012 08:00:00 GMT

State and federal policymakers are looking to the Program of All-Inclusive Care for the Elderly as a potential model to save money and improve health care for the elderly and individuals with disabilities. California has five PACE organizations that operate 18 centers. San Francisco Chronicle.

Poll: Most Calif. Adults Would Pay Higher Taxes To Support Safety Net

Wed, 25 Jan 2012 08:00:00 GMT

A new poll from the Public Policy Institute of California finds that 57% of California adults would be willing to pay higher taxes to support the state's safety-net programs. The poll also finds that 68% of likely voters support Gov. Brown's tax hike proposal. HealthyCal et al.

Fresno County Preparing for Large Labor Strike Next Week

Fri, 20 Jan 2012 08:00:00 GMT

On Thursday, Fresno County officials said steps are being taken to ensure public safety and essential services are maintained during a three-day labor strike planned by the 4,100-member Service Employees International Union over a new contract that includes pay cuts of at least 9%. The strike, which is set to begin on Monday, may affect some public health and social services, such as mental health treatment and Medi-Cal benefits, according to officials. Meanwhile, the California Nurses Association might consider a similar strike after its 75 county nurses experienced similar pay cuts. Fresno Bee.

Supreme Court Cases Could Alter Federal Role in Medicaid

Thu, 19 Jan 2012 08:00:00 GMT

The outcomes of two Medicaid-related lawsuits before the U.S. Supreme Court could substantially change the federal government's role in the program. In the first case -- the multistate lawsuit challenging the federal health reform law -- the plaintiffs argue that the Medicaid expansion, scheduled for 2014, coerces states to participate in the program. In the second case, which originated in California, the Supreme Court will determine whether individual beneficiaries and health care providers can sue states that make Medicaid cuts. Some legal observers say that if the Supreme Court rules in favor of the plaintiffs in both cases, federal law no longer will have significant influence on states' Medicaid operations, such as eligibility decisions, coverage requirements and health care providers' payments. Politico.

Enrollment in Medicaid, CHIP Remained Stable in 2011, Report Finds

Thu, 19 Jan 2012 08:00:00 GMT

A report by the Kaiser Commission on Medicaid and the Uninsured and Georgetown University researchers finds that the number of residents covered under Medicaid or the Children's Health Insurance Program remained relatively steady last year. National Journal, Modern Healthcare.

It May Be Time 'To Take the Pain' on Medicaid

Wed, 18 Jan 2012 08:00:00 GMT

New Kaiser Family Foundation data illustrate the rise in Medicaid enrollment and lawmakers' continuing struggle to control costs. Budget battles in Washington state, not Washington, D.C., may show the future of the program: stark efforts to slow utilization.

What's Best Enrollment Process for Dual Eligibles?

Thu, 12 Jan 2012 08:00:00 GMT

State officials face a key decision in orchestrating a shift into managed care for more than one million Californians who are beneficiaries of both Medicare and Medi-Cal: How to enroll people in the new plans. We asked stakeholders and experts to discuss pros and cons of various enrollment options.

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.

Some States Adopting ACO Model for Medicaid Programs

Wed, 11 Jan 2012 08:00:00 GMT

A number of states are attempting to control health care spending growth by implementing Medicaid initiatives similar to accountable care organizations. Although federal and state officials do not have exact figures on how many states are experimenting with such initiatives, 13 states have submitted Medicaid amendments for medical homes to CMS, and four have received approval so far. States are taking approaches that include shared savings programs and offering bonus payments for improving patient outcomes. Modern Healthcare.

Controller: State Revenues Still Lagging Behind Budget Estimates

Wed, 11 Jan 2012 08:00:00 GMT

State Controller John Chiang reports that California's December revenues fell $1.4 billion below budget estimates and that legislative action might be needed to ensure the state can meet payment obligations. Sacramento Bee's "Capitol Alert" et al.

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.

Health Advocates Say Brown's Budget Proposal Would Hurt Underserved

Mon, 09 Jan 2012 08:00:00 GMT

Health care advocates are raising concern that Gov. Brown's fiscal year 2012-2013 budget proposal would have dire implications for underserved communities, warning that proposed cuts would affect minorities, the elderly, children and rural patients. New America Media et al.

GOP Candidates Discuss Entitlement Cuts, Health Insurance, Reform Law

Mon, 09 Jan 2012 08:00:00 GMT

Over the weekend, many GOP presidential candidates discussed health care issues in New Hampshire. Former Sen. Rick Santorum said he would shift Medicaid responsibility to the states, and Rep. Ron Paul said he would repeal the federal health reform law. AP/Washington Post et al.

Alameda County Collaborates To Expand Health Care Access

Mon, 09 Jan 2012 08:00:00 GMT

In preparation for 2014 when most of the federal health reform law's provisions are scheduled take effect, officials from several Alameda County health care agencies are working together to extend health care and wellness programs to as many county residents as possible. They hope to meet the medical needs of as many as 150,000 newly insured residents by participating in a federal waiver initiative that provides funding to Medi-Cal. Officials from the agencies -- which include the county's public health department -- meet regularly to discuss ways to integrate care for low-income residents, a process they plan to streamline with the launch of shared electronic health records by 2014. HealthyCal.

Health Programs Face Significant Cuts Under Brown's Budget Plan

Fri, 06 Jan 2012 08:00:00 GMT

Gov. Brown has released a $92.6 billion state budget proposal for the next fiscal year. Brown is seeking millions of dollars in cuts to health and human services programs, but some lawmakers are expressing opposition to the plan. San Francisco Chronicle et al.

State Starts Year Facing Multiple Lawsuits, Hearings

Thu, 05 Jan 2012 08:00:00 GMT

California health care officials are fighting a number of lawsuits in courts ranging from the U.S. Supreme Court to federal district courts. The budget crisis in California has prompted drastic cuts in health care services, triggering more than half a dozen legal challenges.

Gov't Programs Account for More of Private Insurers' Revenue

Thu, 05 Jan 2012 08:00:00 GMT

A new Bloomberg Government study finds that the top U.S. private health insurers have experienced substantial revenue growth in recent years, in part because they are playing a larger role in government health insurance programs such as Medicare and Medicaid. Washington Post.