Implementing and improving health reform...

Wednesday, April 21, 2010

HEALTH ACCESS UPDATE
Wednesday, April 20, 2010

ASSEMBLY HEALTH COMMITTEE LAYS CRUCIAL GROUNDWORK
FOR HEALTH REFORM
* CA Assembly Health Moves Several Bills to Line State Up With Federal Health Reforms
* Groundwork is Laid for a State-Run Exchange, Expanded Medi-Cal, High-Risk Pool
* AB 2244 Passes, Protects Kids from Discriminatory Pricing Based on Health Status

* Read our Blog, Join Us on Facebook! Follow Us on Twitter!

In a "deadline" week, the California Assembly Health Committee on Tuesday passed a package of health care consumer protection measures, which lay down some basics for making federal health reform real in California.

CHILDREN FIRST, PLEASE: One prominent bill was AB 2244, by Assemblyman Mike Feuer (D). The bill, sponsored by Health Access on behalf of its coalition members, "phases in several key provisions for children," Feuer told the committee.

The rollout of the Patient Protection and Affordable Care Act signed by President Obama on March 23 begins with children. Insurers will no longer be able to deny coverage to children with pre-existing conditions, and they will also have to rescind pre-existing condition exclusions for children already covered by their family policies.

AB 2244 goes beyond federal law in not just preventing denials, but limiting discriminatory charges for "pre-existing conditions" for children as well. The bill phases in "modified community rating" so that insurers are limited to charging plus or minus 20% for a child's health status. The price difference would be phased to plus or minus 10%, and then to no different charges allowed by 2014.

The bill had the support of the Congress of California Seniors, Consumers Union, the 100% Campaign, the California School Employees Association and others. Speaking out in opposition were the California Association of Health Plans and the California Association of Life and Heallth Insurance Companies, saying they believed AB 2244 was "premature."

The opposition by insurers was not a surprise. Just days after Obama signed the landmark law, insurance companies tried to interpret the new rights for children very narrowly. Not so, said the feds. This woule take the next step. In the Assembly Health Committee, the vote was pretty clear: "11 Ayes" and 6 "Nos". The measure now goes to the Assembly Appropriations Committee.

MAKING MEDI-CAL AVAILABLE TO MORE CALIFORNIANS: AB 1595, authored by Dave Jones (D) lined California's income eligibility requirements right up with the new federal law. Under federal reform by January 2014, Medi-Cal, which is administered by the Department of Health Care Services, will offer Medi-Cal coverage to all adults who earn up to 133% of the federal poverty levels -- even adults without children. The income ceiling would be $14,404 for individuals and $29,326 for a family of four.

Funding for the expansion of Medi-Cal will come from Washington, which will provide 100% of the cost of newly eligible starting in 2014 for the first three years. Then the percentage starts to taper off a bit so that, by 2020, the federal government is sending 90% of the cost of newly-eligible Medi-Cal patients. Health Access is in support of the measure, which passed out of committee with 10 votes. Also in support are the 100% Campaign, the Western Center of Law and Poverty, and the American Federation of State, County and Municipal Employees.

THE CALIFORNIA PATIENT PROTECTION AND AFFORDABLE CARE ACT: Assembly Health Committee members adopted Speaker John A. Perez's central bill, AB 1602, which is more or less the leader of the package. AB1602 "makes several sweeping changes," said Perez (D). Among them are creating the California Health Benefit Exchange, where individuals and small businesses can purchase health care coverage. The measure also prohibits group of individual health care plans from establishing lifetime or unreasonable annual limits of the dollar value of benefits. Carriers will also be required to provide preventative services, outlaws denying people coverage for pre-existing conditions and extends dependent coverage to young adults up to age 26. "Let's be clear," Perez told the committee. "Federal health reform is now the law of the land and California will implement it fully." He described the bill as "by necessity a work in progress as we still need an enormous amount of guidance" on implementation from the U.S. Department of Health and Human Services. The bill won 12 votes in its favor.

MATERNITY COVERAGE, ONCE AGAIN: California insurers have been dropping maternity coverage steadily for years now. Just four or five years ago, 82% of policies [CLARIFIATION: offered in the individual market] included maternity coverage and now only 19% do. Arguing in favor of AB 1825, Assemblywoman Bonnie Lowenthal (D) said, "We can't wait another four years to see what happens." She presented AB 1825 for her colleague, Assemblyman Hector De La Torre, who authored the bill. Health Access, the California Medical Association and many other groups supported the bill, which requires every individual or small group health insurance policy to cover maternity services. Insurers had been dropping the coverage from plans in an effort to make them more affordable and sell more policies. Several organizations, however, have criticized this practice as part of an overall trend of gender discrimination by insurance companies. AB 1825 passed with 12 "aye" votes and 6 "nos."

The Senate Health Committee is due tomorrow with more key bills on health reform. More bills to implement and improve health reform are available for review here.

Labels: Insurers, Legislation, MediCal, Updates, YearOfReform

posted by Anthony Wright | Permalink | 12:20 PM


 

Medicaid matters...

Monday, April 12, 2010

Implementation has already begun. On its health reform website, the U.S. Department of Health and Human Services has started today to request comments on key issues, from rate regulation to the setting of medical loss ratios, so that premium dollars do to patient care, rather than administration and profit.


The Obama Administration also today released guidance, through a letter from the Centers for Medicare and Medicaid Services (CMS) to the states, on early expansion of Medicaid. Themore details on the state option to implement a Medicaid program for low-income populations (up to 133% FPL). States can elect to begin covering this population effective April 1, 2010, until 2014 when the requirement for all states will begin.

That's the day when Medicaid expands: January 1, 2014. California should have a goal, that on day one, we get over a million of the newly-eligible onto coverage. With the federal government picking up the full cost for the first three years, there's every reason to maximize those federal dollars to provide the most help for the most people.

We've thought a lot about how to achieve this goal, and wrote a paper on the subject of how to make our Medicaid waiver a bridge to health reform, with a variety of streamlining, early enrollment, and pre-enrollment strategies to get Californians covered on day one.

As I wrote in two posts on The New Republic's The Treatment blog, Our philosophy is that Medicaid is a bargain, not a burden--the opportunity to get many Californians covered at little or no cost to our general fund. Medicaid can also be the centerpiece of a strategy for economic recovery, given the positive jobs impact for coverage.

How do we do it with the deficit in the state general fund? Maybe we don't it this year, but we plan for when the economy comes around between now and 2014. Maybe we look at the county dollars that are now spent on providing care to those under the poverty level, and see if there's a way to have those resources matched by these newly available federal funds.

So even given the severe budget crisis that California is under, we should look at the CMS letter, and see if there are creative ways to bring in dollars and begin to expand coverage, so we can be ready for January 1, 2014.

Labels: MediCal, YearOfReform

posted by Anthony Wright | Permalink | 6:27 PM


 

Aligning CA with federal reform...

Wednesday, April 07, 2010

HEALTH ACCESS UPDATE
Wednesday, April 7, 2010

ASSEMBLY HEALTH COMMITTEE PASSES BILLS ALIGNING STATE WITH HEALTH REFORM
* CA Assembly Health: Kids in Medi-Cal Won't Be Forced to Re-Enroll Every 6 Months
* Hospital Fee Funding Deal to Draw Down More Federal Funds Seeks an Extension
* Mental Health Parity Bill Passes in CA Assembly Health -- as It Already Has in DC


HEALTH REFORM CONTINUES IN THE STATE CAPITOL: The California Assembly Health Committee on Tuesday passed a number of measures that align the state's policies closer with provisions outlined in the landmark federal health reform law.

CONTINUOUS KIDS COVERAGE: Foremost, the committee, chaired by William Monning (D), voted to pass AB 2477 to allow children on Medi-Cal to stay covered for a year before their families would have to renew eligibility paperwork. A proposal by the Governor would have required families to renew their children's coverage every six months, with the impact that some parents would miss their deadlines and the children would no longer be covered. The proposal is one of the governor's ideas for saving the state money--at the expense of the health of Californians.

Assemblyman Dave Jones (D), sponsor of AB 2477, a bill supported by Children Now and the 100% Campaign, Health Access, and other coalition partners, wrapped up his arguments in favor of the measure by saying simply, "Vote for our kids!"

Since the historic federal law signed by President Obama requires states to maintain the same level of eligibility they had before the federal reform passed, California risked losing substantial federal funds if it adopted Schwarzenegger's proposal. Semi-annual eligibility review would have posed an unfair burden on families struggling in the recession, frequently on the move and working primarily to put food on the table, Jones said.

With the committee in agreement, AB 2477 now moves to the Assembly Appropriations Committee, where its fiscal impact on the state will be assessed.

MENTAL HEALTH PARITY: Assembly Health Committee members also voted to pass a bill by Assemblyman Jim Beall (D) to require health plans to cover mental illness as they do physical illness. Current California law dictates that only serious mental illnesses be covered, and Beall's AB 1600 extends coverage to other mental illnesses as well.

Again, the provision mirrors what President Obama signed into law. Beall argued that failing to cover mental conditions, including substance abuse and drinking alcohol to excess, cost California's health care system, government and industry too much money in lost productivity and late intervention.

Beall said the bill will also correct some of the discriminatory practices of health insurance companies, which argued that AB 1600 would cost too much money. Health Access' legislative advocate said the bill is consistent with federal health reform, which would also extend mental health parity to the small group market and the individual insurance market by 2014. AB 1600 heads next to the Assembly appropriations committee.

EXTENSION OF PROVIDER TAX ON HOSPITALS TO DRAW DOWN MORE FEDERAL FUNDS: The Assembly Health Committee also considered a measure, AB1653 (Jones), to extend for another six months a three-year deal struck with hospitals through which they pay fees in order to draw down additional matching federal funds.

Lawmakers voted in favor of the measure, which was supported by several hospital associations and is needed to help hospitals cover the voluminous cost of caring for the uninsured in emergency rooms.

The current hospital fee arrangement, which is still pending at the federal level, would collect $2.3 billion a year in order to attract $1.1 billion in matching funds from Washington. Noone spoke up in opposition to the measure, which will next go before the Assembly Appropriations Committee.

KEEP UP THE FIGHT: Many other bills are scheduled for votes in the next week, and insurance companies are already sending in their letters of opposition, on everything from rate regulation to limits on charging children with pre-existing conditions.

ALERT: SEND YOUR ORGANIZATIONAL LETTERS OF SUPPORT: These bills need organizational letters of support ASAP. Please send letters to the bill's author, the chairs of the relevant Health Committees, Senator Elaine Alquist and/or Assemblyman Bill Monning, and members of the relevant policy committee that will review the legislation.

Insurers are sharing their wish-lists with the Legislature, and so we need consumer, community, and constituency organizations to voice the people's view. Submit letters in support of these specific bills, listed on our website. Contact Health Access for sample letters on some of these bills.

Labels: Hospitals, Insurers, Legislation, MediCal, Updates

posted by Anthony Wright | Permalink | 8:18 AM


 

The Budget starts to get scrutiny...

Friday, March 26, 2010

HEALTH ACCESS UPDATE
Friday, March 25, 2010


STATE BUDGET STARTS TO GET SCRUTINIZED,
ESPECIALLY IN LIGHT OF HEALTH REFORM

* Federal Health Reform "Reconciliation" Package Passes Both Senate and House
* 2010-2011 State Budget Gets Its First Glances of Scrutiny
* Senate Budget Subcommittee Rejects Harsh Cuts That Go Against Fed Health Reform
* Assembly Budget Subcommittee Grills Adminstration on Impact of Budget Cuts

*** Read Our Health Access Blog! Join Us on Facebook! Follow Us on Twitter!


Yesterday, both the U.S. Senate and House of Representatives took final votes on the on a "reconciliation" package of important improvements to historic health reform legislation signed by the President earlier this week.

THE REFORM IMPROVEMENTS: The new changes would provide more assistance to California's families and small businesses struggling with the cost of coverage, and to the state of California and its budget as well. The changes would:

* increase the financial assistance for low- and moderate-income families to afford insurance premiums, and to protect them against excessive out-of-pocket costs--especially important in a state with a high cost-of-living like California.

* improve drug coverage for seniors by eliminating the Medicare prescription drug coverage "donut hole" that currently leaves some seniors on the hook for thousands of dollars of drug costs.

* improves the financial assistance to states like California and our health system in multiple ways:
* eliminates the special Nebraska provision and instead increases the federal assistance for any expansion of Medicaid, by covering 100% of the cost in the first three years, and at worst in the tenth year, continuing to provide a significant 9:1 federal match. (California's normal matching rate is 1:1.)
* provides resources for a significant increase in Medicaid reimbursement rates for primary care physicians for two years, especially helpful for California that has some of the lowest rates in the nation;
* delays and narrows the excise tax on high-cost health insurance plans, which were more prevalent in California due simply to our high cost-of-living;
* improves the formulas for payments to safety-net (DSH) hospitals.

Although health care for low-income Californians has traditionally been a state and county responsibility, the federal governmet, under health reform with this package of improvements, will provide California with over $70 billion between 2013 and 2019 to subsidize public and private coverage for low- and moderate- income individuals and families. In particularly, the federal government would cover approximately 97% of the costs of expanding Medi-Cal to new populations over that period.

ALERT: As our nation goes forward on coverage expansion, California should not go backward with additional health care cuts that take us and our health system in the wrong direction. California should take advantage of this opportunity to draw down billions in federal funds for our health system and our economy. While health reform helps prevent some eligibility cuts, other programs are left vulnerable to budget cutting.

* CALL YOUR LEGISLATOR to urge them to reject health care cuts, especially to Medi-Cal benefits and other key services. Click here (hyperlink to www.leginfo.ca.gov/yourleg.html) to enter your zip code and find your legislators' phone numbers.

* If you have Medi-Cal and use threatened optional benefits (see below) and are willing to tell us your story to help stop the cuts, please ALSO contact Jessica Rothhaar at jessicar@health-access.org or 510-873-8787 ext. 107 to tell us what it would mean to lose coverage for the products and services you need. Your story can make a difference!

* To join our fight against health care budget cuts, also email jessicar@health-access.org with your city & zip code. We will let you know about upcoming meetings, town halls, rallies and opportunities to meet with your local legislator. Together, we are stronger than we are apart!

BACK IN SACRAMENTO, ACTION STARTS ON 2010-2011 STATE BUDGET -- Already, federal health reform is guiding California’s lawmakers' thinking as they begin the process of considering the next round of state budget cuts to health and human services. Against the backdrop of Congressional action on the historic Patient Protection and Affordable Care Act, legislative subcommittees in both the Assembly and Senate launched their examination of the governor’s proposed 2010-2011 state budget.

SENATE HEARING: On Thursday, a state Senate Budget Subcommittee rejected the harshest of Gov. Arnold Schwarzenegger’s proposals to scale back publicly funded medical services, partially because they did not meet the standards set by the new federal health reform law, finalized by the U.S. House on Thursday.

As we begin a national effort to increase coverage, the new federal law prevents states from undercutting it's effort by reducing eligibility to existing public programs--what’s called “a maintenance of effort.”

Schwarzenegger’s proposed budget threatens to reduce access to health care for nearly 2.7 million people in need, including 875,000 children. This would raise the number of uninsured Californians to more than 10 million.
“The whole thing is nonsensical,” said Sen. Mark Leno (D), chair of the subcommittee. “The concept is to improve access to health care, not to dismantle what the federal government has just achieved.” Under Leno’s leadership, the panel rejected the most devastating cuts, the so-called trigger cuts that Schwarzenegger would “pull the trigger on” if his demands for $6.9 billion in added federal funds is not met. Rejected were:

· The wholesale elimination of the Healthy Families federal-state program that provides low-cost medical coverage to children of low-income families who pay modest premiums. About 1 million children rely on Healthy Families for their health care.

· A stiffening of eligibility requirements for Medi-Cal so that millions of Californians, including working families, children, and the aged, blind and disabled would no longer qualify for public medical care.

· Eliminating nine categories of Medi-Cal benefits – on top of 10 other medical services that Schwarzenegger eliminated last year. The nine are: hearing aids, physical therapy, occupational therapy, orthotics, access to independent rehab facilities, outpatient heroin detoxification, medical supplies, prosthetics, and durable medical equipment such as wheelchairs and oxygen tanks.

· Imposing mandatory co-pays upon Medi-Cal recipients, a move that providers said would create a barrier to access to medical care and could threaten patient flow at vulnerable community clinics. The California Primary Care Association opposed this proposal, reporting that six of its clinics have closed and others statewide suffered a loss of $70 million due to last year’s budget cuts.

· Imposing twice-yearly paperwork requirements on families with young children who receive state-funded health care. The move is designed to reduce the number of children receiving care. A representative from the Department of Health Care Services said an estimated 471,000 children would be dropped from the program because their families expected to fall behind on the twice-yearly paperwork. The subcommittee ordered this proposal rejected and replaced with only annual enrollment paperwork requirements, in keeping with the mandates of the new federal health care law.

Other aspects of the 2010-2011 health and human services budget were put off until the administration provides more detail in the governor’s May revision of his budget package. Ad important as theses votes are, No vote is final unless the entire budget if final and signed.

ASSEMBLY HEARING: Meanwhile, Californians hard-hit by the deep recession are coping with severe cuts from Schwarzenegger’s budget cuts last year. Ten core Medi-Cal services were eliminated last year: dental care, podiatry, chiropractic services, infection-preventing skincare products for the incontinent, optometry, audiology services, optician services, acupuncture, speech therapy and psychological services. In addition, the Healthy Families program was suspended for two months while funding was secured to patch the hole left by the governor’s cuts to the children’s health insurance program.
One consequence to the 2009-2010 budget cuts has been an increase in use of emergency room services, including for emergency dental care.

Another, which Assemblymember Noreen Evans (D) has vowed to reverse, is a six-month freeze of new enrollment in the Every Woman Counts breast cancer early detection and treatment program for low-income women. In addition, the governor unilaterally closed the program to women aged 40 to 50, allowing only women 50 and older to be screened. Evans, a member of the Assembly Budget Subcommittee, which met Wednesday, said the governor took the action against the Legislature’s wishes and she would work to ensure full access to the program is restored.

Other action by the Assembly Budget Subcommittee included fact-finding and questioning administration officials on how many Californians would be affected by proposed health and human services budget cuts. In a majority of cases, administration officials were unable to answer the Assemblymembers’ queries.

Assemblyman Wes Chesbro (D) chastised the administration’s representatives for proposing radical cuts without the data to measure the impact on Californians.

“Our California budget is about real lives and real families and cascading effects of many of the cuts that have occurred,” Chesbro said, stressing that one family in need may suffer multiple cutbacks in multiple health care programs.

Coming up will be an Assembly Budget Subcommittee on the governor's 2010-2011 budget proposal at which the public will be able to testify.

Labels: Budget, MediCal, Updates

posted by Anthony Wright | Permalink | 8:43 AM


 

More federal help...

Thursday, February 18, 2010

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced that states are able to claim enhanced funds for Medicare Part D drug payments. This should allow California to get $680 million additional money from the federal government.

This decision could mean an additional $160 million more if the enhanced Medicaid match--which the states get through December 2010 due to the American Recovery and Reinvestment Act--is extended by Congress for an extra six months. The House has passed such an extension in both its health reform bill and its jobs bill as well.

After some unfair and harsh statements, Governor Schwarzenegger struck an appreciative tone: “Today’s announcement shows that our bipartisan efforts for a more fair and equitable relationship with the federal government are paying off. Together, state legislative leaders and our Congressional delegation, especially Senators Feinstein and Boxer, have been working to bring California more of the federal dollars we are owed. These funds are important, and while we still have more work to do, I appreciate the commitment of the Obama Administration in responding to our requests for these much-needed funds that are owed to our state.”

This doesn't solve our state budget crisis, but it certainly helps.

Labels: Budget, Federal, MediCal, Medicare, Schwarzenegger

posted by Anthony Wright | Permalink | 6:05 PM


 

Assemblymembers on Guv's budget: "Not the wisest thing"

Friday, February 12, 2010

Gov. Arnold Schwarzenegger’s self-described “draconian” budget proposals began sounding a little less inevitable by the end of Thursday’s lengthy Assembly Budget Subcommittee hearing at the Capitol.

A strong showing of citizen-advocates opposed many of the cuts, emphasizing the benefits of threatened health programs ranging from one that provides infected jail inmates with HIV and AIDS drugs to the widely accessed Adult Day Health Care program.

Members of the subcommittee chaired by Assemblyman Jerry Hill (D) noted that if the governor’s proposals were to be adopted, the costs for alternatives would be higher in the long run.

Cases in point:
* The Office of AIDS program buying discounted HIV-AIDS drugs for county jail inmates prevents costly and hazardous outbreaks of disease. The governor would cut the entire $9.5 million portion of the program for counties – and then would also transfer more prison inmates to county jails, which cannot afford the drugs.

* The governor would eliminate vision coverage for kids whose families buy discounted health insurance through the Healthy Families SCHIP program. Lawmakers noted that this move would cost the state uncounted federal dollars by preventing better classroom performance by children who need glasses.

* A proposal to eliminate Adult Day Health Care drew one of the largest crowds of opponents, who testified that the option of long-term housing was unaffordable. Another option, for household members to quit their jobs to care for the participants 24-7 would cost California productive workers and income taxes.

* Administration spokesmen argued that Family Planning Services funded by a 9-to-1 federal match needed to be eliminated because “coming up with 10-cents on the dollar in this environment” was difficult. Legislators questioned that assessment, and suggested the Administration go find even more programs with a $9 federal match for every $1 spent by the state.

Assemblyman Jim Beall Jr. (D) noted that moving ahead with health program cuts would be short-sighted because of the likelihood of federal health reform creating opportunities to restructure delivery of health care in California.

In particular, Beall said, new federal rules about mental health care getting parity with physical health care should pave innovative paths for blending delivery of care.

The final segment of the 6-hour hearing, interrupted by the second Assembly floor vote on Sen. Abel Maldonado’s nomination for lieutenant governor, was dedicated to the last item on the agenda: a proposed shift of at least $1 billion from Proposition 63 Mental Health Services Act dollars to the general fund.

The item brought out perhaps the largest turnout of the day, with advocates from Long Beach to Sonoma lining up to tell stories of how the MHSA saved money, and lives. After a Sacramento woman tallied the cost – over $2 million -- of her mentally ill mother’s numerous hospitalizations, she made the point that early intervention through MHSA-style programs would have led to far less costly, and tragic, outcomes.

Of the proposal to shift MHSA dollars to the general fund, Assemblyman Wesley Chesbro (D) said “The impact of this will be severe if it’s allowed to go forward.”

Following the entire presentation, Hill said, “We fully understand the governor’s request,” regarding the mental health funds. “This is probably not the wisest thing to do.”

Labels: Budget, MediCal, Sacramento, SCHIPHealthyFamilies

posted by Cynthia Craft | Permalink | 4:34 PM


 

Senate bill passes to secure federal funds

Wednesday, January 13, 2010

In order to secure stimulus funds from Washington, D.C., the Senate Health Commitee, chaired by Sen. Elaine Alquist (D), voted on Wednesday to advance a bill to officially undo the state's requirement for semi-annual reporting for Medi-Cal.

As a condition of receiving enhanced federal funds, states must refrain from efforts at reducing Medicaid enrollment, such as using semi-annual reporting, which has been shown to create a barrier for people trying to access the state-and-federally funded program.

"It makes sense to support this common-sense measure to keep 174,000 kids covered with health insurance, " Elizabeth Landsberg of the Western Center on Law & Poverty told committee members.

Also speaking in favor of the bill was Beth Capell for Health Access California, the California Medical Association, Molina Health Care of California, and advocates for the disabled and children's access to health care.

The bill must pass the full Senate by the end of the month to advance to the Assembly. Committee member Sen. Dave Cox (R ), was the only one to vote against it, while Vice Chair Tony Strickland (R ) joined Democrats in voting to pass the bill.

In other action, the Senate Health Committee also voted to send SB270 (Alquist) along to the Appropriations Committee. The measure would create a health information technology advisory panel to advise the Governor and the Legislature on health information technology in California.

Labels: Legislation, MediCal

posted by Cynthia Craft | Permalink | 5:03 PM


 

You've Got to Be Kidding...

Friday, January 08, 2010

HEALTH ACCESS UPDATE
Friday, January 8, 2010

GOVERNOR ANNOUNCES BUDGET FOR MORE "MONSTER" FY10-11 CUTS
* Gov. Schwarzenegger Has Budget Proposal Similar--but More Severe--Than Last Year
* Millions of Californians Could Lose Coverage and Care; Dramatic Impacts
* Details Below on $2.9 Billion in Health and Human Services Cuts
* An Additional $3.5 Billion of HHS Cuts Would Be Triggered Without Federal Funds

* For News on the Budget, Read Our Blog! Join Us on Facebook! Follow Us on Twitter!

With California bogged down by a $19.9 billion deficit for the next 18 months, Gov. Arnold Schwarzenegger on Friday once again proposed balancing the state’s budget not with new revenues back with devastating cuts to the state’s least-fortunate -- including up to 6.4 billion dollars of cuts in health and human services. Under the cuts, over 1.5 million Californians, and likely many more, would have their coverage eliminated, other key services would be scaled back, and California would lose jobs and federal matching funds.

As he has in last year's budget cycles, Schwarzenegger proposed severe cuts to health and human service programs, the kinds of safety-net services Californians expect their government to extend to the public in times of deep need, that provide help in getting the state and its people back to work.

In some of the governor’s harshest budget scenarios threatened to shut down altogether a range of existing essential health and human services if the federal government did not respond favorably to his demand for $6.9 billion in federal tax dollars.

“Tough times still lie ahead,” Schwarzenegger proclaimed in announcing a package of budget proposals that included some “monster” cuts that would either lead to “real reform” or a continuation of “the budget roller coaster.” Schwarzenegger said he would declare a fiscal emergency and call a special session of the Legislature so lawmakers would be forced to focus on solutions to the deficit.

Afterwards, Democratic Assembly Speaker Karen Bass succinctly said of the governor’s proposals: “I call this budget a big pile of denial.” Bass said the governor’s budget plan was simply and plainly “a non-starter” because “it’s calling for the virtual elimination of the safety net.” Besides Bass’ comments, early indications were that Schwarzenegger’s plan had fallen flat with the Legislature’s Democratic leadership, whose cooperation the governor will need to adopt the state’s annual budget.

Senate President Pro Tempore Darrell Steinberg opened his statements to reporters with a blunt: “You’ve got to be kidding me.” He later noted that the governor’s budget solutions lacked “creativity.” Senator Denise Ducheny, chair of the Senate Budget Committee, said she saw in the budget “a recycling of exactly the same proposals he’s had before.” The main difference, Ducheny said, was that previously Schwarzenegger tended to blame the Legislature for a lack of fiscal solutions and, on Friday, the governor focused on blaming Washington D.C.

Indeed, Schwarzenegger did everything but identify the federal government as a foe, leaning heavily on the theme of fiscal fairness. This lead Bass to note that the governor struck a nearly inappropriate tone: “Typically he threatens the Legislature. Now he’s threatening the president of the United States.”

The governor pledged to fly to Washington D.C. with all four partisan legislative leaders to demand the $6.9 billion he said the federal government owes California. Schwarzenegger made the case that, for every $1 Californians pay in federal taxes, the state only gets an average of 78 cents back. (Ironically, his cuts would cause California to lose even more in federal matching funds.)

The governor is also seeking more reimbursement funds for Medi-Cal expenses, saying California receives only 50 cents on the dollar, while the average for states is 57 cents.
Chief among the governor’s deep cuts are those that would eliminate coverage and care to millions of Californians, ironically forgoing substantial matching federal fund dollars as a result.

The Governor plans to ask for a $2.9 billion cut in health and human services (including $1.1 billion in Medi-Cal), and an additional $3.5 billion cut in health and human services if California does not get the federal money he seeks.

But even with a massive infusion of federal funds, the Governor would still propose to eliminate coverage to hundreds of thousands of Californians, including children. Health experts say these devastating cuts would further unravel the health care system that we all rely on, where we have already seen services scaled back and full clinics close. Health Access recently released an assessment of the health cuts in the 2009-10 budget, six months in.

THE GOVERNOR'S PROPOSED "TRIGGER" CUTS

The following is a list of proposed cuts and eliminations that the governor proposes to be "triggered" if additional federal funds are not forthcoming:

* Eliminate coverage and benefits for millions in Medi-Cal ($532 million), including:
* Reduce Medi-Cal eligibility to the minimum allowed under current federal law (about 72% of the Federal Poverty Level for most adults and 133% FPL for children and pregnant women). For example, this would reduce eligibility for low-income parents from an income of up to $18,310 for a family of three to around $13,000. While this tightening of eligibility standards would not be allowed under the stimulus package until January 1, 2011, it would eliminate coverage for 250,000 Californians in the first six months, coverage for 450,000 in the year after that, and hundreds of thousands more in future years.
* Eliminate many Medi-Cal programs (including the Family PACT program for family planning services, the CHDP Gateway for transitional children's coverage, Breast and Cervical Cancer Treatment Program, and the Medically Indigent long-term care program).
* Eliminate many remaining optional benefits (including medical supplies like diabetic test strips, prosthetic limbs, orthotics, wheelchairs and other durable medical equipment, hearing aids and other benefits).

* Eliminate the Healthy Families Program, affecting all 874,762 children currently enrolled ($126 million);
* Eliminate various health services programs, (including Access for Infants and Mothers, MRMIP's high-risk pools for those denied coverage for pre-existing conditions, Every Women Counts, Asthma control program, and Expanded Access to Care Program), funded by Proposition 99 (tobacco tax) funds, subject to voter approval ($115 million);
* Eliminate mental health services funded by Proposition 63 (Mental Health Services Act), shifting the $847 million to fund existing mental health services;
* Eliminate CalWORKS, the state's welfare-to-work program ($1.044 billion); and
* Eliminate the In-Home Supportive Services programs that provides home care to those not able to assist themselves. ($495 million)


BASE BUDGET PROPOSAL
(REGARDLESS OF WHETHER FEDERAL DOLLARS ARE FORTHCOMING)

Specifically, as described below, the budget proposal makes a number of cuts to health and human services programs, redirects funding from other sources to health care programs, and relies on significant receipt of federal funds.

Cuts to Medi-Cal:
· $750 million in cuts to Medi-Cal by placing limits on services and applying utilization controls, increasing cost-sharing for Medi-Cal beneficiaries, and making “other programmatic changes,” potentially affecting the 7 million Californians on Medi-Cal;
· $118 million to eliminate Medi-Cal coverage for recent legal immigrants, effective March 1, 2010, affecting about 90,000 legal immigrants;
· $104 million to eliminate the Medi-Cal adult day health care benefit, effective March 1, 2010, affecting about 35,000 frail adults;
· $55 million to delay payment to Medi-Cal institutional providers, requiring doctors and hospitals to “float” the state;
· $26.4 million from aggressive elimination of fraud in Medi-Cal; and
· $28.7 million to rescind a rate increase for Medi-Cal family planning services.

Cuts to the Healthy Families Program:
· $85.3 million (including $10.5 million for the current fiscal year) by tightening eligibility requirements for the Healthy Families Program from 250% of the federal poverty level (FPL) to 200% of the FPL, effective May 1, 2010, affecting roughly 225,000 children, plus an additional corresponding $3.9 million cut to the California Children’s Services program for Healthy Families-eligible children;
· $21.7 million by eliminating vision coverage from the HFP benefit package and increasing monthly premiums in families 151-200% of the FPL, effective July 1, 2010, affecting 167,000 children.

Other cuts to Health and Human Services programs:
· $950.5 million in reducing eligibility, payments and services in the In-Home Support Services (IHSS) program;
· $146.1 million by reducing benefits for CalWORKS recipients;
· $306.9 million by reducing benefits for recipients of SSI/SSP;
· $60 million by eliminating the California Food Assistance Program;
· $200 million by reducing support for Regional Centers;
· $18 million by eliminating the Substance Abuse Offender Treatment Program.

A redirection of funding to avoid more health care cuts:
· Reduce $240 million from children’s health coverage to be replaced by newly enacted hospital fees;
· Reduce $36 million from Medi-Cal to be replaced by one-time Proposition 99 (tobacco tax) reserve funds;
· Reduce $25 million from the Access for Infants and Mothers (AIM) program to be replaced by one-time use Proposition 99 (tobacco tax) reserve funds;
· Reduce $550 million in General Fund expenditures on high-priority health and social programs serving children to be replaced by state and local Proposition 10 (California Children and Families Act) funding, subject to voter approval; and
· Reduce $452.3 million in General Fund expenditures on EPSDT services for children and mental health managed cared to be replaced by Prop 63 (Mental Health Services Act) funding, subject to voter approval.

A reliance on federal funding to avoid more health care cuts:
· $1 billion from federal funds owed to the state for disabled Medicare-eligible individuals and the rate of Medicare Part D coverage
· $1.8 billion from increasing the standard federal matching assistance percentage (FMAP) for Medi-Cal from 50 to 57 percent;
· $1.5 billion from continuation of an increased FMAP (through June 30, 2011) as part of ARRA, the economic recovery act.

Labels: Budget, MediCal, Schwarzenegger, Updates

posted by Anthony Wright | Permalink | 9:35 PM


 

A shocking and severe budget...

Governor Schwarzenegger released his proposed 2010-11 budget today, which includes severe cuts and no new revenues.

As part of the cuts, the Governor proposes a $2.9 billion cut in health and human services (including $1.1 billion in Medi-Cal), and an additional $3.5 billion cut in health and human services if California does not get a major infusion of federal funds.

The Governor proposes shocking cuts eliminating coverage and care for millions of Californians, which will have dramatic impacts on not just these families but on the health system on which we all rely. Even *with* a massive infusion of federal funds, the Governor would still propose to eliminate coverage to hundreds of thousands of Californians, including children.

These devastating cuts would further unravel the health care system that we all rely on, where we have already seen services scaled back and full clinics close. Health Access recently released an assessment of the health cuts in the 2009-10 budget, six months in.

This is an anti-jobs budget that not just harms California families and our healthcare system, but our economic recovery. The most effective way to create jobs is invest in Californians, and in their health and in services to help all of us get through a tough time. This proposal completely undermines our economic recovery efforts.

The economic impacts of these health and human service cuts would be multipled because we would not just lose jobs but billions in federal matching funds.

Labels: Budget, MediCal, SCHIPHealthyFamilies, Schwarzenegger

posted by Anthony Wright | Permalink | 4:50 PM


 

The week in review, awaiting the budget...

Thursday, January 07, 2010

HEALTH ACCESS UPDATE
Thursday, January 7, 2010

2010: THE NEW YEAR BRINGS MORE CUTS TO CONTEST
* Gov. Schwarzenegger To Unveil FY10-11 Budget Proposal on Friday, 11:30 a.m.
* Health Access Reveals "The Damage Already Done" Six Months Into 2009-10 Budget
* Stakeholders Meet for First Medi-Cal Waiver Committee Meeting

* 2010 Promises to be a Big Year! Join Us on Facebook! Follow Us on Twitter!

BUDGET TO BE ANNOUNCED FRIDAY: California Governor Arnold Schwarzenegger announces the release of his new FY2010-2011 budget around 11:30 a.m. on Friday. All expectations are that the budget proposal will include more painful cuts in programs vital to California's health and struggling economy. Health Access will review and report later tomorrow on the proposal's impact on health and human services, with quick reactions on our blog and on Twitter.

ASSESSING "THE DAMAGE ALREADY DONE" BY CUTS BEFORE CONTINUING: In anticipation of that announcement, Health Access California today released a new report detailing the six-month impact of nearly $2 billion in cuts already made to the state’s healthcare system in the current budget year. Entitled “The Damage Already Done: A Report on the Impacts of the 2009 Health Care Budget Cuts, Six Months In,” the report documents many of the effects these cuts have had on individual patients, families, health providers, and our economy.The finding? Just six months into the 2009 budget, hundreds of thousands of Californians have been denied care or coverage for key services, and we see indications of the health system we all rely on is crumbling, with five clinics closing. These cuts are starting to ripple through the health system and our economy, as we lose health jobs and federal matching funds, and people don’t get the help they need to get through these tough times. Six months into those cuts, families are suffering harmful impacts of being denied access to a range of critical services such as dental care, basic prevention and affordable health care options. We hope this assessment informs the discussion about whether the state can afford to cut more.

THE GOVERNOR'S ANTI-JOBS, ANTI-HEALTHCARE STATE OF THE STATE: But the indications are not positive. Yesterday, the Governor presented his State of the State address. The Governor focused on jobs, but by suggesting tax breaks and credits that would only make the deficit bigger and force additional cuts. He conveyed that the budget will include painful cuts, but did not acknowledge the lost jobs and lost federal funds that would result.

The Governor took the opportunity to oppose the health reform proposals in Congress, completely contrary to the health plan he supported merely two years ago. Health Access believes his reasoning is based on faulty assumptions, and has very different numbers of the fiscal impact of Medicaid expansions in health reform on California. Beyond that, California--with its large percentage of uninsured people and low-wage workers--is likely to disproportionately benefit from the billions of federal dollars to help families and small business, and the state, afford coverage.

MEDI-CAL WAIVER STAKEHOLDER PROCESS STARTS: In this busy week, Thursday marked the first gathering of the stakeholder committee appointed to help guide the state Department of Health Care Services in its 1115 Medi-Cal federal waiver process. The renegotiation of our state's Medi-Cal waiver with the federal government will provide challenges and opportunities regarding the Medi-Cal coverage of 7 million California children, parents, seniors, and people with disabilities. More information is at the Department of Health Care Services website.

OTHER ITEMS TO READ: The Health Access Blog has additional updates about:
* Speaker Pelosi and the House of Representatives' take on negotiating a final health reform bill.
* Rush Limbaugh's accidental endorsement of health reform and Hawaii's employer mandate.
* Health Care for America Now's marathon-themed "Let's Finish Health Reform Right" TV ad.
* Thoughts about how health advocacy has changed and stayed the same, in the past ten years.

A REQUEST FOR THE NEW YEAR: From fighting budget cuts to fulfilling the promise of health reform, 2010 will be a very busy year. We’ll need your help, so resolve to join and contribute: Consider contributing to the Health Access Foundation!

Labels: Budget, MediCal, SCHIPHealthyFamilies, Updates

posted by Anthony Wright | Permalink | 9:17 PM


 

The Damage Already Done by the 2009-10 Health Cuts...

As Governor Schwarzenegger is poised to release his proposal for next year’s state budget, the proposal is expected to include a slew of additional cuts to health and human services.

In anticipation of that announcement, Health Access California today released a new report detailing the six-month impact of nearly $2 billion in cuts already made to the state’s healthcare system in the current budget year. Entitled “The Damage Already Done: A Report on the Impacts of the 2009 Health Care Budget Cuts, Six Months In,” the report documents many of the effects these cuts have had on individual patients, families, health providers, and our economy.

The finding? Just six months into the 2009 budget, hundreds of thousands of Californians have been denied care or coverage for key services, and we see indications of the health system we all rely on is crumbling, with five clinics closing. These cuts are starting to ripple through the health system and our economy, as we lose health jobs and federal matching funds, and people don’t get the help they need to get through these tough times. We deserve a budget that supports, not undercuts, the health of our communities.

Since the Governor signed the budget in July 2009, slashing nearly $2 billion from the health care system, some cuts have been partially averted through various actions. The delay and uncertainty, however, have generated grave consequences. In many cases, cuts were made, resulting in very real human hardships and economic impacts for Californians.

Those impacts include:

* Almost three million low-income adults have lost ten important benefits, such as dental care, vision care, speech therapy, and psychological services – in the last six months, over 450,000 Californians in poverty have either had to forego or pay for dental care; another 240,000 have lost coverage for prescriptions eyeglasses;
* About 93,000 children waited uninsured for Healthy Families coverage until the cut was averted by non-government donations and higher cost sharing for 269,000 children on the program;
* Five community clinics in the state have already been forced to shut down and hundreds of workers have been laid off, an additional 10 clinics are on the brink of closure;
* Thousands of AIDS/HIV patients have been denied access to needed services and affordable medications they rely on;
* About 300,000 low-income women no longer have access to life-saving breast cancer screenings;
* Six domestic violence shelters were temporarily closed while the Legislature passed a bill to find ways to keep shelters open, and even afterwards, most have been forced to reduce services;

The ripple effects of these cuts will continue beyond these short six months, as we see more layoffs and closures of services, and the impacts of people not getting care or preventative services comes to back to haunt us.

“The Damage Already Done” will be distributed at multiple press conferences this week held to address the broader topic of health and human service cuts. Events are scheduled for San Francisco, San Bernardino, and Sacramento this Thursday morning as well as Bakersfield, San Diego, Los Angeles, Fresno, and Modesto on Friday, January 8th.

Labels: Budget, MediCal, Research

posted by Anthony Wright | Permalink | 10:10 AM


 

Waivering...

After much anticipation throughout the fall, we are finally having the first stakeholder meeting around the new Medi-Cal waiver.

As you may know, the current agreement between the state and federal government about the administration of Medi-Cal runs out in September of this year. There's lots to discuss, from areas of agreement to issues of contention. In this process, there's lots for California, for low-income patients, and for our health care system to gain, and lots for us to lose.

To start negotiations with the federal government about an extension or renewal, the Schwarzenegger Administration released a final concept paper to the federal government in mid-December.

As part of this process, the state had convened a sexily-titled "Section 1115 Comprehensive Demostration Project Waiver Stakeholder Advisory Committee (SAC)," of which I am on with 38 others in California's health policy world.

The first meeting is today, Thursday, January 7th. It is public, starting at 9:30am – 12:30pm at the Sacramento Convention Center, Room 204. All the materials for the festivities are at the Waiver Renewal website of the CA Department of Health Care Services:
http://www.dhcs.ca.gov/provgovpart/Pages/WaiverRenewal.aspx

We'll post our impressions here afterwards, and maybe even post some reactions on Twitter if time permits. Until then, here's Health Access' paper, which focuses on the opportunities to use this waiver renewal as a bridge to health reform over the next five years:
http://www.health-access.org/files/expanding/Medi-Cal%20Section%201115%20%20Waiver%2011-17-09.pdf

Labels: MediCal, Schwarzenegger

posted by Anthony Wright | Permalink | 12:16 AM


 

Christmas Eve comments...

Friday, December 25, 2009

So the U.S. Senate passes a major health reform bill on Christmas. There were lots of responses of congratulations, even from those who seek significant changes. Not so much from Governor Schwarzenegger:

“I have long supported fixing our broken health care system with comprehensive reform. But, I still believe both the House and Senate bills fall short and need additional work. Congress must ensure states are not strapped with unfunded mandates and unfair costs that will only lead to larger budget deficits with unsustainable services. I remain committed to working with Congress and the President as the two houses move forward on reforms that are balanced and focus on slowing the growth in health care costs, improving the quality of care and providing health insurance coverage for the uninsured, while ensuring states can sustain the expansion of programs like Medicaid. This is a historic opportunity and I urge members of Congress and the Obama administration to come together and work through these issues to fix our broken system.”

The Governor took the opportunity of this health reform vote to refocus attention on his letter urging "flexibility to meet current obligations within the revenues available to states." In other words, he wants more money for California, and the ability to make cuts to health programs--seeking authority to make cuts to Medi-Cal and Healthy Families eligibility, benefits and reimbursements to providers.

We're not the only ones who think such actions are very unbecoming, especially at Christmas. Assemblyman Dave Jones, chair of the Assembly Health Committee, called him on the substance of the letter seeking cuts, and on the timing:

“It’s the day before Christmas and like Ebenezzer Scrooge, Governor Schwarzenegger wants to take poor Tiny Tim’s crutch away. And deny him any healthcare. Bah humbug, Governor!

The Governor has asked Congress to allow him to make cuts in healthcare for Californians.

Here we are in the worst recession since the Great Depression. Record numbers of Californians have lost their jobs outright or had their income cut. Record numbers of Californians are without health insurance. They are not able to see a doctor or get treatment for themselves or their loved ones. And the Governor’s response is to look for ways to deprive even more Californians of healthcare, so more Californians will get sick and die.

The Governor, in writing to Congress, is not speaking for Californians or California. California needs Congress to expand healthcare coverage and to increase payments to California to help pay for it. But the answer is not, as Governor Scrooge requests, to turn our backs on those who rely on California for medical care or to cut the already too low reimbursements to our doctors, nurses, hospitals and other medical providers who provide that care.

In a word, what the Governor proposes is worthy only of Scrooge. Lets hope that the Governor is visited by several ghosts tonite who will cause him to see the error of his proposal to cut healthcare for Californians.”

Labels: Budget, MediCal, Schwarzenegger, YearOfReform

posted by Anthony Wright | Permalink | 9:48 PM


 

Talking DSH...

Wednesday, December 23, 2009

As we have written previously, the manager's amendment to the Senate bill that was adopted earlier today makes a number of changes to the Senate bill.

Our California Senator Barbara Boxer, as well as Senator Dianne Feinstein, won a significant improvement for California as well as six or seven other states, including Idaho, North Carolina and Michigan.


It is easy to figure out that Nebraska (and Hawaii) got something in the Medicaid provisions because those two states are mentioned by name.


We guessed that California met the following: "If the State is not a low DSH State described in (5) (B) and has spent more than 99.90 percent of the DSH allotments for the State on average for the period of fiscal years 2004 through 2008, as of September 30, 2009, the applicable percentage is 35 percent."


What is that and why do we care? DSH or Disproportionate Share Hospital funding is a key part of Medicaid funding for hospitals. In some states, DSH helps to make up for low Medicaid reimbursement rates. In other states, including California, DSH helps to cover the cost of care by hospitals for the uninsured as well as improving low Medicaid rates.


DSH is a big deal in California both because we are 51st in Medicaid reimbursement and because we have such a high proportion of uninsured.


So what did our Senators win for us? The earlier version of the Senate bill cut DSH funding in half once the rate of uninsurance drops. The new version would cut DSH funding by only 35%.


This moves the Senate bill much closer to the House version in terms of the DSH cut, at least for California, Idaho, North Carolina, Michigan and several other states.

Labels: Hospitals, Legislation, MediCal, YearOfReform

posted by Beth Capell | Permalink | 8:04 AM


 

A new week...

Monday, November 30, 2009

To provide the latest information about health policy and politics, from the California budget to the federal health reform debate, Health Access is piloting a new format to our regular Health Access Update, highlighting resources on our website, blog, Twitter feed, Facebook page, coalition partners, and elsewhere. Sign up by typing your E-mail address on the front page of our website. Please let us know what you think. Here's this week's update:

SENATE VOTES TO START FLOOR DEBATE ON HEALTH REFORM: The U.S. Senate will come back from Thanksgiving today and start floor debate on health reform, after a crucial vote before the break. If you follow us on Twitter, you'd have gotten the real-time updates as Senators voted affirmatively, 60-39, on a "motion to proceed" to debate health reform. The House of Representatives passed their own version of health reform three weeks ago.

Health advocates thanked California's Sen. Barbara Boxer and Sen. Dianne Feinstein for voting, with all Democrats and independents, to move health reform to the next stage.

The next day, on Sunday, Senator Feinstein went on to appear on NBC's Meet the Press, where she made strong points on the urgency of reform, the problem with our for-profit insurance industry, and the fabrication of opposition facts. Watch it and read about it on our blog.

Much more to come in the next few weeks, as Senate leadership hopes to finish debate and get the necessary 60 votes to stop debate before Christmas.

NEW BUDGET FIGURES SPARK SPECULATION ABOUT ADDITIONAL CUTS: Due to the economic downturn, things were decidedly less promising in California, where we were busy explaining, explaining, and explaining in the media that any additional budget cuts in health and human services would be beyond brutal in terms of their impact on individuals and families, on our economy, and on the health system on which we all rely. A fact sheet of the health budget cuts in the current budget is available on our website.

Governor Schwarzenegger is expected to release in January both a mid-year cuts package and a 2010-11 proposed budget. Many crucial health program are expected to be in jeopardy, as elected leaders seek to address another massive anticipated shortfall of upwards of $20 billion for the next year-and-a-half. Health Access will be actively organizing to prevent the worst of these cuts, and to advocate for the revenues that are needed prevent the cuts and sustain these programs.

MEDICAID WAIVER GETS LEGISLATIVE HEARING: Meanwhile, an administration proposal for a federal Medi-Cal waiver was given a hearing by the Senate Health Committee. This process would reshape for the next five years the Medi-Cal program, which provides coverage to seven million low-income Californians, largely children, parents, seniors and people with disabilities, and provides core funding to safety-net hospitals and other providers.

The Assembly Health Committee is expected to have its own informational hearing on Thursday, December 10th. Health Access' new paper discussed how the waiver may offer a bridge to health reform.

HOLIDAY PARTY: There's lots going on during December, but if you are in the Bay Area, take the time to join Health Access California and the California Pan-Ethnic Health Network for a holiday celebration in the Bay Area. Health Access and CPEHN are hosting our annual holiday celebration in Oakland on Wednesday, December 9.

The location is Max's of Oakland, 500 12th Street, at the Oakland City Center. (12th Street BART). Here's a map. It'll be from 4 p.m. to 7 p.m. Please RSVP to Pam Flood at pflood@cpehn.org. Hope to see you there!

Any suggestions about the new update format, or questions about its content, should be directed to Cynthia Craft at Health Access, at ccraft@health-access.org.

Labels: Budget, HealthAccessCommunity, MediCal, Updates, YearOfReform

posted by Anthony Wright | Permalink | 6:44 AM


 

Senate Health hears Medi-Cal waiver ideas...

Wednesday, November 18, 2009

The Senate Health Committee, chaired by Sen. Elaine Alquist, met Wednesday to hear panels of experts share ideas for how the state’s Medi-Cal program could be restructured through the development of a Medicaid waiver.

The waiver that California hopes to obtain from the federal government next year would allow the state to stretch the boundaries of Medicaid’s current rules. Administration officials, including David Maxwell-Jolly, Director of the CA Department of Health Care Services, argued that the proposed changes would help the state’s Medi-Cal program save money and improve coverage for California’s most vulnerable citizens. The focus of their talk, and a concept paper that was released a few weeks ago, was finding savings and in organizing and coordinating care of patients, especially those with chronic conditions.

The restructured health care delivery system would seek to do more with less, saving the state money in the long run. The informational hearing came as the Legislative Analyst’s Office predicted that California’s revenue shortfall will balloon to $20.7 billion in 2010.

Several advocates and health policy experts expressed hope that the state will pump any savings resulting from the waiver program back into health care services to prepare the state for a smooth transition into national health care reform, should federal legislation pass.

Proposed health care reform legislation in Congress would go into effect in 2013, midway into the five-year waiver period that the state hopes to begin in September of 2010.

Health Access California’s Beth Capell offered suggestions as to how the state could take advantage of the timing and dovetail into the rollout of federal reform by, for example, simplifying eligibility requirements before 2013.

“We’ll have to be ready to go from zero to sixty on January 1, 2013,” Capell told the committee, recommending that existing programs prepare auto-enrollment processes. That way, California would be poised to get as many Californians enrolled on day one, and take advantage of federal dollars for a reformed health care delivery system right from the start. These ideas were also explained in a Health Access Medi-Cal waiver paper released this week.

Several panel members fielded questions from the Health Committee members regarding the best methods of care in California.

Among those testifying about best practices and enhanced outcomes were a few administrators of a few spotlighted "medical home" and managed care systems already in place in 26 counties. They reported that their coordinated care systems led to fewer emergency room visits, greater attention to “whole body” wellness, better preventative care and more attention to co-occuring mental health and substance abuse cases. In addition, these counties were able to attract some uninsured Californians who had been putting off medical care, a practice that could lead to higher medical bills in the long run.

But Senator Alquist also raised questions to Administration officials, including whether all existing managed care plans actually did care coordination, and whether they were ready to take the responsibility to provide quality care and coordination in accordance with the special needs of seniors and people with disabilities in Medi-Cal.

Saying the hearing had proved informative, Senator Alquist said, “There’s no reason why we can’t produce a better product at a reduced cost.”

Western Center on Law and Poverty legislative advocate Elizabeth Landsberg expressed concerns about mandatory managed care, but supported a “medical home" model, as did several testifiers. The medical home model has a lot in common with managed care plans in that it serves as a hub of coordinated care for patients. Beneficiaries would have a practitioner who serve as their “medical home,” a source from which all medical and behavior care, diagnostic tests, medications -- and so on -- can be linked and coordinated.

There was some questions as to whether individual physicians would be prepared to serve as a medical home model, and if the Administration's proposal was simply to shift many seniors and people with disabilities into existing managed care plans.

The Department of Health Care Services is leading the waiver development, and plans to convene a panel of stakeholders as well as technical committees for input and feedback.

Alquist asked DHCS administrators to be prepared to report back to the committee with more details as the process progressed.

Labels: Budget, DHCS, MediCal

posted by Cynthia Craft | Permalink | 5:16 PM


 

A bridge to health reform?

Lots going on today. At 2pm Pacific, Senate Majority Leader Reid will unveil the new, combined version of a health reform proposal to his Democratic Senate colleagues, thus starting weeks of debate on the measure. The drama is whether all 60 Democratic-caucusing Senators will vote to allow such a debate to take place, in order to prevent a Republican filibuster. It's an important next step in getting health reform passed.

Back here in California, health reform will be front and center in its own way. At 1:30pm, the Senate Health Committee, chaired by Senator Elaine Alquist, will hold an informational hearing on "Redesigning California's Medi-Cal Program: Examining the Potential for Cost Savings and Program Improvements."

As we have reported before, California's Medi-Cal waiver agreement with the federal government is up for renewal next year. A new waiver would set the rules for the program, which now covers 7 million Californians, mostly low-income children, parents, seniors, and people with disabilities, for the next five years.

Those next five years would take us into the full implementation of health reform, should any of the pending proposals in Congress pass. The waiver process poses a challenge, since consumer advocates are always wary of changes that might undermine patients' rights or access to care. But it can be a significant opportunity to increase access to care and coverage and transition Medi-Cal to a newly reformed system.

We'll have a full report on the hearing later, but here's our new paper by Health Access California on a new Medi-Cal waiver for California, about what we see is the potential, and concerns, in a new waiver.

Labels: Federal, MediCal

posted by Anthony Wright | Permalink | 9:27 AM


 

The future of Medi-Cal, part 1...

Monday, November 02, 2009

The state Department of Health Care Services had its first official public forum today on a new Medi-Cal "waiver," which will determine the funding and structure of the program for the next five years. They reviewed a draft concept paper, released on October 19th, that includes at its core a shift of many Medi-Cal beneficiaries to mandatory managed health care plans or other "medical homes" as a way to slow the continued growth of Medi-Cal costs.

The plan, under which the state will seek a waiver from the federal government from certain rules guiding Medi-Cal spending, was developed by the department at the behest of the Governor and the Legislature. More information on the Medi-Cal waiver is on the Department's website, at:
http://www.dhcs.ca.gov/provgovpart/Pages/WaiverRenewal.aspx

As part of the 2009-2010 budget deal, the Legislature had passed AB xxxx 6, which Governor Schwarzenegger signed, requiring the DHCS to embark on a process for a renewed waiver from the federal government for our Medi-Cal program, with a goal to achieve long-term cost savings.

The restructuring entails securing a waiver from Washington in order to continue receiving matching federal dollars for public health care. It comes as Congress is closer than it ever has been to paving the way to national health care reform.

Department executives said a waiver would allow the Medi-Cal program to operate more efficiently to achieve long-term cost savings while continuing coverage for California’s older adults and chronically ill. This is the costliest population medically because of its ongoing need for health care.

Should health care reform emerge from Washington in a form that would expand Medi-Cal coverage to insure more Californians, an expansion likely would not occur for several years. This waiver for the next five years has the opportunity to be a bridge to that reformed health care system.

Monday’s hearing on the waiver demonstration project marked the first public hearing on the proposal. Dozens of advocates representing patients, hospitals, care providers, community clinics, the uninsured and others – including Health Access California – pressed DHCS for detailed answers to their questions about the proposal.

Stakeholders have until November 14th to submit their comments, positions and suggestions to DHCS officials. The department will convene a stakeholder committee and a panel of technical advisors to examine the waiver proposal closely and suggest any changes.

DHCS said its goal is to present proposed milestones for the waiver demonstration project to the Centers for Medicare & Medicaid Services by August 2010. Officials admitted that they did not have an exact date for when changes take place, should the waiver be approved as proposed.

Health Access will have more written materials about the substance of the draft waiver concept paper shortly.

Labels: Budget, DHCS, MediCal

posted by Cynthia Craft | Permalink | 6:29 PM


 

Will it cost much for California?

Thursday, October 29, 2009

Earlier this week the Governor sent a letter to Congress asking them to support health reform but noting that the cost of Medi-Cal expansions could be as much as $1 billion. To his credit, unlike earlier estimates, the Governor noted that this estimate did not include offsetting cost savings to California.

Health Access has done an estimate of the estimate of the Medi-Cal/Healthy Families impacts of health reform based on our best understanding of the national reform proposals that were in print until today.

We also have posted it on our website under federal health reform.

The bottom line is that we estimate that the net impact of the Senate Finance Mark for California state government would be costs of about $750 million annually plus a loss of $550 million in DSH funding while HR3200 would cost California about $200 million annually plus a loss of $330 million in DSH funding.

We will revise it again once we have read the House bill that was released this morning! Preliminary information indicates that a larger Medicaid expansion is included in the new House bill: that will be a good thing in terms of affordability and benefits for those covered though a challenge in terms of assuring adequate access to physicians.

Health Access has supported the earlier version of HR3200 for many reasons—the impact on California’s budget is on the long list of good things about the earlier House proposal.

Labels: MediCal, Schwarzenegger, YearOfReform

posted by Beth Capell | Permalink | 1:01 PM


 

He writes letters!

This week, one letter by Governor Arnold Schwarzenegger was getting a lot of focus.

But there was another letter by California's Governor, to Congress, on health reform, that also got some attention, in the Sacramento Bee, San Gabriel Valley Tribune, and elsewhere.

There wasn't much new. It wasn't even his first letter to Congress on health reform this year. Also, given that the Governor has been all over the place on health reform, being at different times both for the expansion of key health coverage programs and for their elimination, for employer mandates to provide coverage and against them, and for new regulations on insurers and against them, the question is not so much where the Governor is but where he is *now* on some of the vital health policy questions.

We'll have more to say on the substance soon...

Labels: MediCal, Schwarzenegger, YearOfReform

posted by Anthony Wright | Permalink | 1:34 AM


 

Seeing the consequences of cuts...

Monday, October 26, 2009

Courtney Perkes at the Orange County Register has a compelling story about the fall out from some of the budget cuts made just a few months ago.

Luba Taylor pressed the letter almost to her nose, close enough to read through thick glasses that she was losing her "optional" vision benefits from state Medi-Cal.

Taylor, 54, saw the words but couldn't believe them. After all, a brain tumor left her legally blind — even when wearing glasses — and unable to work. Last week, months after receiving the letter, reality set in when her glasses broke.

She called for an appointment with her low-vision specialist in Fullerton and was told she lost her coverage July 1.

"I don't understand how ruthless this society is," Taylor said. "My glasses are very expensive because I'm very low vision — 20/200. I'm going to just have to get Scotch tape and tape them up. I have no spending money."

By eliminating vision and dental coverage for most adults receiving Medi-Cal, including roughly 181,000 in Orange County, the state saved $122 million. Other health cuts in late July would follow to help close California's massive $26 billion deficit, including $86 million for AIDS prevention and services, and $28 million to reduce day care for adults with dementia and other disabilities...

The article goes on to detail other cuts, like the elimination of dental coverage for the nearly 3 million adults (mostly parents, seniors, and people with disabilities) with Medi-Cal coverage:

In Orange County, the cuts have resulted in layoffs at nonprofit community dental clinics and longer wait times as former Denti-Cal patients compete for time in the dentist's chair with the growing numbers of uninsured.

Six out of 14 nonprofits providing dental care have cut back their hours, said Isabel Becerra, executive director of the Orange County Coalition of Community Clinics. The nonprofit clinic system sees about 200,000 patients a year, with 40 percent of them needing a cavity filled or a cleaning.

"Their care is being delayed out 6 to 9 months," Becerra said. "The patients are not being turned away. That's the hallmark of the community clinics. They just won't be able to see you as quickly as they once were."...

Besides pain, lack of dental care is also associated with respiratory disease, diabetes, stroke, heart disease and premature and low birth weight deliveries.

"It's not just Orange County, but pretty much everywhere you go, the first impression is very important," said the clinic's dental director Dr. Jila Nikkhah. "If you don't have front teeth, if you don't look presentable, you probably won't get the job."

Other budget cuts--choices made rather than raising (or even restoring) revenues--were to prevention programs, which has significant consequences for both the patients directly, but our health care system as a whole:

Sariah Gonzalez isn't the condom lady anymore.

After nine years with AIDS Services Foundation Orange County, she was laid off last month and other programs were scaled back after the nonprofit lost $105,000 in prevention funds. Orange County lost about $1.8 million for AIDS services and prevention.

Gonzalez worked with Spanish-speaking Latina women — a high-risk group because their partners might have unprotected sex with men. Gonzalez said that because of cultural stigma, some men keep their bisexuality a secret, which puts their wives at risk.

Latinos represent about one-third of Orange County's population, but last year, they accounted for 52 percent of diagnosed AIDS cases, according to the county's Health Care Agency....

Some cuts that were made were avoided--either by legislative action, as with the severe cuts to Healthy Families or domestic violence shelters that were lessened, or by court order, as with the proposals on adult day health centers. But it's important to remember that many cuts continued. The article details just some of the impact in Orange County, but these are stories that are going on in every community in California.

Labels: Budget, InTheNews, MediCal

posted by Anthony Wright | Permalink | 1:32 AM


 

A Cautionary Tale for California...

Wednesday, October 21, 2009

Indiana's generally well-regarded Republican governor who formerly served as President George Bush's Director of Management and Budget, pulled the plug on October 16 on their effort to "modernize" the state's system of delivering welfare services. This was a similar result in Indiana to an effort to privatize welfare in the state of Texas which was a failure, and was cancelled in 2007 after a huge expenditure of Texas state funds.

The Indiana governor acknowledged that he continued to favor privatization of some state government functions. However, the systems changes he implemented resulted in too many errors and left too many deserving people waiting for too long for help they desperately needed. State legislators were inundated with complaints from their constituents. Eligible applicants suffered nightmarish consequences that affected their health coverage and their health status. In fact, Indiana is facing increased criticism and oversight from the federal government over their error rate. State hearings on this debacle are under consideration by the Indiana legislature.

Indiana expected significant cost savings by directing applicants to apply for benefits by calling customer service centers staffed by contractor employees or by having the public file for benefits using a computer. Now that the governor has cancelled the $1.34 billion contract, applicants will return to applying for public services as part of face-to-face interviews with state workers in local county offices. The governor admitted in his public statements that it wasn't the resources the state devoted to this endeavor or the amount of effort, but that it was "a flawed concept that simply did not work out in practice."

So, why are these experiences in Texas and Indiana so relevant to California? As my mother would say: "It is a cautionary tale." The California legislature passed, and the governor signed, AB 7 Centralized Enrollment for Public Social Services that purports to streamline and automate the process for applying for public social services like Medi-Cal, food stamps, and CalWORKS. The benefits of this law are reputed to be greater access to benefits by having the public apply over a computer, greater consistency in eligibility determinations from county to county, and significantly lower administrative costs for the state.

As the state prepares to implement this law in the coming months, it will face many of the same problems and criticisms experienced by these other states. California will doubtless incur tremendous costs (and will be unlikely to realize any savings) while exposing eligible Californians to significant delays and real adverse health consequences from what other states are calling "a failure."

The question to ask is: Can we learn from their mistakes?

Labels: Legislation, MediCal, OtherStates

posted by Elizabeth C Abbott | Permalink | 3:01 PM


 

National treasures...

Friday, October 16, 2009

Before I joined Health Access in January 2006, I worked for the federal government in a variety of jobs. I began my career when I was hired to take applications for retirement, survivor's and disability insurance benefits for the Social Security Administration and ultimately worked in 17 Social Security offices across the U.S. I also served as the Regional Administrator for the Centers for Medicare and Medicaid Services (CMS), formerly HCFA, in San Francisco. The regional office was responsible for Medicare and Medicaid in the four western states (including California) and the Pacific Territories. While these programs are complex, they remain important and are widely respected.

Government programs have many detractors. All programs have coverage gaps and other flaws because of the compromises that arise out of the legislative process. In addition, agencies can have imperfect administration, due to inadequate funding or for other reasons. However, I had the good fortune to work on those programs (Social Security, Medicare, and Medicaid) that are esteemed by Congress and the public as National Treasures to this day. They are consistently admired as having a strong programmatic purpose, an unwavering commitment to beneficiaries, and consistent, professional, and relatively low-cost administration.

So, as we approach a new chapter in the current health care reform debate, it is interesting to look back at the legislative history leading up to the passage of Social Security and Medicare/Medicaid. Since our Congressional representatives all point to those programs as hallmarks of our social fabric and essential to our financial underpinnings, it is interesting to see if those revered programs passed Congress with virtually monolithic, or at least bi-partisan support. Not so much. The Social Security Act of 1935 passed with overwhelming Democratic support, but only 16 Republicans voted for it in the Senate. The Medicare/Medicaid legislation in 1965 similarly had broad support among Democrats in the Senate, but only 13 Republican Senators voted for its passage. While these programs remain part of our foundation, and few legislators would vote for their repeal today, they had little support across the political spectrum at the time they were signed into law.

However, as we attempt to build on their foundation for health care reform, no one remembers the fierce opposition those programs encountered, and the fairly one-sided and sometimes grudging support they received in their day. These days legislators from both political parties acknowledge the critical importance of these programs to the American people. So, let's hope as we re-examine our commitment to passing health care, we continue to go about the business of building on these National Treasures.

Labels: Federal, MediCal, Medicare

posted by Elizabeth C Abbott | Permalink | 3:33 PM


 

Anthem Blue Cross withdraws rate hikes, for now......

 

The Governor embraces health reform

 

WellPoint, Blue Shield end rescissions

 

The continuing campaign in Congress...

 

Early signals on the Budget...

 

Anthem Blue Cross delays rate hike -- again

 

Bartering and exchanging...

 

Sebelius to WellPoint: Knock it Off!

 

Already, WellPoint is trying to game the system..

 

Anthem Blue Cross dumps breast cancer patients