Progress on the County Safety-Net, In LA and Fresno

Consumer, community and health advocates have been cheered by events this week that should improve access to health care in two major California counties for the remaining uninsured.

* Tomorrow, October 1, Los Angeles will launch “My Health LA,” a new program to provide primary and preventive care for the remaining uninsured, including those excluded from Medi-Cal.

* On another front, Fresno County got help this weekend when Governor Brown signed a bill to provide it budget flexibility so it can continue its indigent care program–something it voted to end just last month.

Given the new context of the Affordable Care Act (ACA), other counties are looking to adjust or extend their safety-net services in the coming year. With our success in enrollment Californians in ACA coverage, counties are appropriately looking to see how to revamp and extend their safety-net services for the remaining uninsured, including for those without options under the ACA due to immigration status. We are pleased to see progress by counties, the traditional health provider of last resort, to be innovative in meeting the ongoing needs of the remaining uninsured in their communities. In particular, immigrants are a crucial part of California’s economy and community–they should be fully included in our health system as well.

A study conducted by Health Access California last year found that California’s safety net for the remaining uninsured is uneven, with different eligibility rules on income and immigration and different services offered county-by-county.

LOS ANGELES: LA County is taking a major step forward today in launching My Health LA. Hundreds of thousands of low income people who have been denied access to health care will be able to sign up for care for the first time. We applaud Los Angeles County for My Health LA, and stepping up to provide a medical home that includes care that is primary and preventive, not just emergency and episodic. It’s inspiring to see Los Angeles, for so long ground zero of the crisis of the uninsured, work to fulfill the promise of health care reform, that everyone—regardless of income or background—could have access to basic care. When we start open enrollment in November, all Angelenos below poverty will be eligible for something–and if not Covered California or Medi-Cal, then My Health LA. We want to spotlight those counties that are stepping up to ensure access and afford basic care.

The program was approved by the Board of Supervisors last week and is slated to cover approximately 150,000 low-income uninsured Angelenos and build on the success of its precursor, Health Way LA.

Applicants must be L.A. County residents, age 6 and older, below 138% of the Federal Poverty Level, uninsured, and not eligible for Medi-Cal. My Health LA is a primary care program financed through 65 million dollars approved by the Board of Supervisors.  It covers primary and preventive care including pharmacy and in limited cases, dental services.  MHLA also covers specialty care and urgent and emergency care at DHS facilities.

Link to DHS/My Health LA Website:  http://dhs.lacounty.gov/MHLA

Link to Federal Poverty Levels:  http://file.lacounty.gov/dhs/cms1_215467.pdf

MHLA Customer Service Line:  1-844-744-6452 (MHLA)

FRESNO: While several counties look to augment or extend their services, Fresno County was the only county to take action to roll back eligibility in their indigent care, in a vote last month. But that decision had a 90-day stay, pending legislation that was signed into law by Governor Brown this weekend. AB2731(Perea) gives Fresno County the budget flexibility it says it needs to continue to provide safety-net services. We hope that with these new developments, Fresno County revisits its recent vote and commits to continue to provide safety-net health care services for the remaining uninsured. California is stronger when everyone has access to care and coverage. It’s more cost-effective to have access to primary, preventive, and specialty care than to just address the issues in the emergency room. By ensuring that Californians have that access, counties can make sure that their residents are healthy and contributing economically to their communities.”

The Health Access report from last year on the county safety-net can be accessed by visiting www.health-access.org or directly by visiting:

http://health-access.org/files/expanding/California%27s%20Uneven%20Safety%20Net%20-%20A%20Survey%20of%20County%20Health%20Care.pdf

Assembly Health Committee Delves into Medi-Cal

Last week, the Assembly Committee on Health, chaired by Assemblymember Richard Pan held an oversight hearing to delve further into selected Medi-Cal issues , some of which the committee had examined in previous informational and oversight hearings.  Here’s a report from our legislative advocate Sawait Hezchias-Seyoum:

The committee invited stakeholders and the the Department of Health Care Services (DHCS) to obtain status reports and updates on Medi-Cal related issues including, the enrollment backlog in Medi-Cal, provider directories and adequacy of networks, access to dental care and the Dashboard.

Cathy Senderling of California Welfare Directors Association and Elizabeth Landsberg of Western Center on Law & Poverty both testified on the enrollment backlog in Medi-Cal and the impact it has had on consumers throughout the state.  During their panel presentation, Assemblymember Roger Hernandez expressed his concern over the backlog, explaining that his district, which is in large part comprised of low income people and immigrants, has been disproportionately impacted.

While significant progress has been made to reduce the backlog, DHCS reported today that there are still approximately 250,000 Medi-Cal applications that have not been processed.  CalHEERS was designed to interface with various federal, state, and local information technology systems in order to facilitate the purchase of health insurance, however today’s hearing highlighted the system issues that have contributed to the backlog of applications.

Following the discussion with the California Welfare Directors Association and Western Center on Law & Poverty, Republican Assemblymember Jim Patterson asked Director of DHCS, Toby Douglas when the state expects to clear the current backlog.  Toby explained that while he is not able to provide a definitive date as to when the backlog would be cleared, he and the Department is committed to ensuring consumers have access to Medi-Cal within the 45 day period it currently takes to process Medi-Cal applications.

On the subject of provider directories and adequacy of networks, the California Association of Health Plans said that the health plans need accurate information from providers to in order to keep their directories current. Louizos also stated that an internal survey they did of their networks showed that 90% of their contracting providers accept Medi-Cal patients.  Dr. Pan indicated that there is a difference between a provider who sometime accepts Medi-Cal and a provider willing to accept additional Medi-Cal managed care patients today. The Assembly and Senate Joint Legislative Audit Committee is also working on their own audit which should be released soon.

Brett Johnson, representing the California Medical Association explained that there are many things that could be done to ensure accurate and up-to-date provided directories, including matching provider directories against the universal provider source that is widely used in the industry, requiring lists to be updated more often, requiring valid e-mail addresses for providers and utilizing other innovative technological tools that exist.  On network adequacy, Johnson explained that their Medi-Cal managed care physicians continue to experience difficulty referring out to specialists.

During the hearing, Assemblymember Patterson shared a story of a consumer who showed up at the pharmacy to pick up a prescription only to find out that he had been dropped from coverage.  Patterson explained that he continues to hear of consumers who are dropped from coverage and usually without their knowledge.  Toby explained “the buck stops here” in terms of ensuring adequate access to care in Medi-Cal, however if a consumer has been dropped from coverage without their knowledge than that person likely has coverage through Covered California and should contact Covered California for assistance.

The discussion around Dental Care centered on inadequate access to care throughout the state and especially Sacramento County.  Sutter Medical Center,  a key service provider in Sacramento  for Medi-Cal beneficiaries who need inpatient dental anesthesia because they are developmentally disabled  recently announced that it would discontinue dental anesthesia services  but has agreed to provide services through January 1, 2015.   DHCS shared that work groups have been established to help create more efficient and uniform anesthesia protocol, to identify administrative barriers and improvements for payments and also to identify other care providers who can accommodate and provide services to Medi-Cal beneficiaries.

Another highlight from the hearing was the discussion around the Medi-Cal Managed Care Performance Dashboard. Today’s hearing provided an opportunity to explore how the dashboard can be improved and leveraged to better monitor quality and access to care in Medi-Cal Managed Care.  Abbi Coursolle from National Health Law Program provided several recommendations to the committee on how the dashboard could be improved, such as breaking down the data by race and ethnicity.

Capitol Weekly’s Health Care California Conference: Highlights for Advocates

Last Tuesday’s Health Care California conference gave us a chance to pause and reflect on ACA implementation efforts to date—and where we need to go as a state—before the fun begins again with the next open enrollment season in November. If there was a general sentiment across the panel presentations it was simply that California has done well to this point, having slashed the number of uninsured in half and probably slowed the growth in premium costs, also by about half; but now comes the harder part, including the work on reducing health care costs. Many suggested that if we don’t get a handle on costs, the gains of health reform could be erased, and additional agenda items could not be addressed, from tackling longstanding issues like timely access to care, to covering the remaining uninsured.

There was only one session devoted to consumer angles in reform and featuring Health Access’ Anthony Wright–it’s worth highlighting if only to remind our colleagues in the policy community that if we want health reform 2.0 to be successful, consumers will need to be at the heart of the most critical initiatives in care delivery. One example, touched on by several panelists, is patient-centered medical homes, an important mechanism for coordinating care for people with chronic conditions. Medical homes work best when patients and families are fully engaged in their design and execution.
Financial Impacts of the Affordable Care Act in California (Opening Panel)

Those looking for weeds on the cost issue got plenty. Covered California’s robust enrollment gives the plans and Covered CA officials a better grasp of the risk we are facing in the new marketplace, says David Panush of Covered California, and this should give us a jump start on managing that risk.

There are no quick fixes for the cost issues, said several panelists—and it’s not the lack of regulatory mechanisms that’s to blame  for rising health care costs, says Micah Weinberg of Bay Area Council, and this is why we need to double down on getting better value from all of our medical spending.

Consumer Panel: “Who’s Helped, Who’s Hurt” by the ACA in CA

That California is no longer on the list of states with high uninsured numbers is reason enough to celebrate, says Carla Saporta of the Greenlining Institute. And noting that California is a majority minority state, people of color have even more reasons to celebrate. But there are still huge gaps, for example it took way too long to adopt the materials in the now 13 threshold language standard for Covered CA language access. The early enrollment surge leaves us with many in the system have not used before so need to focus on helping people better utilize the system.

That so many enrolled in spite of the barriers to enrollment reminds us of the need for reform, said Anthony Wright of Health Access, and the need to do better in the next round. We need everyone in the system–enrolled and getting good access to care—so that it works better for all of us. He pointed out the decisions by California to improve upon the ACA, such as making Covered California an active purchaser with the authority to negotiate rates and other important details with insurers. To reap the rewards from our active purchasing approach, including better management of costs, consumers should really weigh their new options. Though automatic renewal will be critical for some consumers and for marketplace stability overall, consumers in position to do so should make a point of SHOPPING AROUND. It’s a lot to ask of consumers—and advocates may be in the best position to help consumers get more engaged at these levels.

Lunch Keynote: Diana S. Dooley, HHS CA Secretary

The focus on enrollment to this point has made sense, said Dooley. But we need to start shifting attention to the other legs of the stool: cost containment and delivery system reform. With eight counties set to pilot coordinated care initiatives for ‘duals’ (individuals dually eligible for Medicare and Medi-Cal), and the state’s SIM (State Innovation Model) grant poised to begin in January if funded, we are moving into the next exciting stage of reform. We will know we are successful when consumers become healthier as a result of these and related initiatives to lower costs and improve quality of care.

Featuring “accountable care communities for health,” California’s SIM proposal is about the health of the population, Dooley said. “It asks all of us to think differently not just about health care but about health and how our community is configured to support health and reduce disparities: How can we live differently, in ways that keep us well? If, as Let’s Get Healthy California Task Force Co-Chair Don Berwick tells us, 30% of care provided is unnecessary or actually harmful—but how do you go after that safely? And with so many new people in California’s care delivery system, we know we cannot provide care the way we did in the past.

Medi-Cal Panel: looking for sunshine, beyond the enrollment backlog

Cathy Senderling-McDonald of the County Welfare Directors Association is, borrowing a football metaphor, still looking for sunshine, having trouble seeing past the Medi-Cal enrollment backlog, down to 250,000, and the pent up demand for care introduced by so many new enrollees in a time of great uncertainty about access to providers. Add to that the renewal challenges—made somewhat easier by full passage of SB18.

And supposing we do find our ‘steady state’ for these challenges, access to health care is just one factor in people being healthy…what about housing, family support—it will be important to get at these angles as we dig deeper into reform.

With responsibility for risk shifting in an already shifting landscape for care delivery as the MediCal managed care plans delegate risk to the RBOs (risk bearing provider groups), the group with the most to lose right now are the Medi-Cal enrollees, said Francisco Silva of the California Medical Association. In an even more chilling reminder of the work we have cut out for us, half of the enrollees in plans facing financial solvency issues or corrective action  plans are Medi-Cal beneficiaries.

But given that Medi-Cal enrollees and individuals with subsidized make up more than one-third of covered lives in the state means that this population should have clout, real buying power—and with that growing influence in the way care is delivered and paid for in the golden state.

The Politics and Problems: Where do we go from here?

The concluding political panel touched on several hot button topics, including the role of government and the increasing vulnerability of Medi-Cal as it covers more and more Californians. This group of 12 million and counting makes up a massive voting block, says Richard Figueroa of California Endowment. “What will it take for this group to start demanding ‘hands off my Medi-Cal!” And as time goes on lawmakers will not be able to continue ignoring the remaining uninsured.

Echoing Diana Dooley, Bruce Bronzan sees coverage as the first critical step in implementation, but the ACA includes numerous provisions and tools to tackle the remaining challenges (discussed over the course of the day): care coordination, shared medical information, and re-aligning incentives, to name just a few examples.

Our Full Update On the Governor’s Actions on Health Bills

HEALTH ACCESS UPDATE: Friday, September 26, 2014

GOVERNOR BROWN SIGNS KEY PATIENT PROTECTIONS INCLUDING SB964(HERNANDEZ) TO ENSURE TIMELY ACCESS TO CARE, BUT VETOES OTHERS

     Governor signed SB964(Hernandez) to provide more oversight over insurers, including annual reviews of Medi-Cal managed care and Covered California plans and others, even those with “narrow networks,” to ensure timely access to care for patients

*        Other bills signed include SB18(Leno/Hernandez) to accept foundation and federal funding for community groups to help Medi-Cal enrollees with renewals; SB1052(Torres) on disclosing formularies; SB1053(Mitchell) on contraceptive coverage; SB1182(Leno) on disclosing large group claims data; and AB1962(Skinner) on disclosing how much dental plans spend on care versus administration and profit.

*       Bills vetoed include SB1124(Hernandez) on limiting Medi-Cal estate recovery; and AB2088(Hernandez) on avoiding junk coverage. Consumer groups vow to continue efforts next year.

Consumer, community, and health organizations were pleased yesterday that Governor Brown signed several key health consumer bills into law, but disappointed in some of the vetoes in yesteray’s batch of bills release this evening: http://www.gov.ca.gov/news.php?id=18726

Key bills supported by Health Access California and other consumer groups that were signed today include SB18 to allow California to accept foundation and federal dollars for community groups to help those on Medi-Cal renew their coverage, SB964 to increase oversight on network adequacy and timely access to care, SB1052 to require insurers to disclose their prescription drug formularies, SB1053 to ensure coverage of contraceptive services, SB1182 to better disclose claims data, AB1962 to disclose how much dental plan premiums are spent on patient care, and others.

Consumer groups were disappointed that vetoed bills included AB2088 to limit “junk” coverage being offered by large employers to their workers, and SB1124 to limit Medi-Cal estate recovery to just long-term care.

Governor Brown has the month of September, next week, to either sign or veto the remaining bills on his desk, which include SB1094(Lara) on Attorney General oversight over hospital sales and mergers, and others.

The new law with perhaps the most direct impact on the biggest number of consumers is SB964(Hernandez) which will increase oversight of network adequacy in health plans.In this year where California was successful in enrolling people into coverage under the Affordable Care Act, new scrutiny focused on whether patients had timely access to care once enrolled in Medi-Cal managed care, which has long been criticized for lack of adequate access, or Covered California or other commercial plans offering “narrow networks.” SB964, sponsored by Health Access California would require the Department of Managed Health Care to do annual reviews for timely access and network adequacy for all plans,with reviews done separately for Medi-Cal managed care and the individual market so that consumers in Medi-Cal and Covered California have the guarantee that they can get needed care, when and where they need it.

Also signed was SB 18 (Leno/Hernandez) which would have the State accept $6 million from the California Endowment to fund Medi-Cal renewal assistance by community based organizations, drawing down federal matching funds as well. Advocates saw this as critical especially in this first-ever renewal period, when the processes and rules have changed under the ACA.

Consumer, community, senior, and low-income advocates were very disappointed by the veto of SB 1124 (Hernandez) to limit Medi-Cal estate recovery to long-term care, so those getting Medi-Cal managed care services would not find that their family home had a claim on it after death. Over 40 states follow this practice, allowing Medi-Cal to be a true safety-net for medical care without putting the family’s assets at risk. “Estate recovery,” which amounts to about $500 per month in liens for those over age 55, arbitrarily seeks assets from a small slice of lower-income families who are trying to do the right thing and get covered. Advocates vowed to continue to work to fix this policy that currently penalizes low-income families taking personal responsibility by building savings while signing up for coverage. The Governor’s veto message suggested addressing this issue in the budget process next year, which advocates will do so Californians can get the coverage they need without any fear of any financial repercussions for their family. Advocates have appreciated the testimonies from impacted Californians, and continue to seek those stories for the continued effort.

A Health Access California-sponsored bill that was vetoed was AB 2088 (Roger Hernandez), which makes, in the large group market, limited benefit plans supplemental to comprehensive coverage. This consumer protection already exists in the individual and small employer market; the bill closes a loophole for employers to possibly avoid compliance with the full intent of the ACA. Employees who accept employer coverage are barred from subsidies in Covered California even if that coverage is unaffordable or does not meet 70% minimum value: Advocates are disappointed by the AB2088 but will continue next year to work to limit this “junk” coverage and ensure employees get comprehensive coverage, with the guidance the Governor offered.

Below is a longer bill list of the key health legislation acted upon yesterday by Governor Brown:
*** 2014 HEALTH CONSUMER BILLS SIGNED BY THE GOVERNOR  

Ø  Insurance Consumer Protections

NETWORK ADEQUACY OVERSIGHT OF HEALTH PLANS: SB964 (Ed Hernandez) requires the Department of Managed Health Care (DMHC) to do annual reviews for timely access and network adequacy for all plans and to be done separately for Medi-Cal managed care and the individual market so that consumers in Medi-Cal managed care and Covered California get timely access to necessary care. Sponsored by Health Access California.

SB959 (Ed Hernandez) is the clean-up bill for the individual and small group market reform legislation to implement the ACA enacted in 2012 and 2013.

SB1052 (Torres) to require health insurers to disclose and standardize their prescription drug formularies.

SB1053 (Mitchell) to ensure health coverage includes contraception and birth control services for women.

Ø  Medi-Cal

FOUNDATION & FEDERAL FUNDS FOR MEDI-CAL RENEWAL: SB18 (Leno/Herrnandez) accepts $6 million to the State from the California Endowment–and $6 million in federal matching funds–to fund Medi-Cal renewal assistance by community groups. Sponsored by Health Access California and Western Center on Law and Poverty.

Ø  Cost/Quality Transparency

SB1182 (Leno) would provide claims data or other detailed information to large purchasers, including employers and union trust funds.

AB1962 (Skinner) would make transparent what dental-only plans spend, as a percentage of premium, on patient care. It requires specialized dental-only plans to disclose a “medical loss ratios” as for medical coverage. The bill is sponsored by the California Dental Association.

Ø  Prevention and Other

SB912 (Mitchell) would eliminate the sunset on the current requirement that vending machines in state buildings include 35% healthy food and drinks. Sponsored by California Pan-Ethnic Health Network.

 

*** BILLS THE GOVERNOR VETOED:

JUNK INSURANCE FOR LARGE EMPLOYERS: AB2088 (Roger Hernandez) while not banning limited benefit plans, makes them supplemental to comprehensive coverage. California’s Insurance Code allows the sale of “insurance” that provides very limited benefits with a minimum actuarial value of less than 60%. This bill extends this consumer protection to large employer coverage, closing a loophole for employers to possibly avoid compliance with the full intent of the ACA. Sponsored by Health Access California.

LIMIT ON MEDI-CAL ESTATE RECOVERY: SB1124 (Hernandez) limits Medi-Cal estate recovery. California is one of only ten states that impose estate recovery on more than long term care services, where the state, for those over 55, recovers the cost of all medical care from the estate of an individual after death. This has discouraged some from signing up for Medi-Cal coverage. Co-sponsored by Western Center on Law and Poverty (WCLP) and California Advocates for Nursing Home Reform.

Governor Brown Signs and Vetoes Key Health Bills

This evening, Governor Brown signed and vetoed several key health bills on his desk. Consumer, community, and health organizations were pleased that Governor Brown signed several key health consumer bill pending on his desk, but disappointed in some of the vetoes in today’s batch of bills release this evening

Perhaps the most notable bill signed was SB964(Hernandez), which would provide more oversight over insurers, including annual reviews of Medi-Cal managed care and Covered California and other plans, even those with “narrow networks,” to ensure timely access to care for patients.

Other bills signed include SB18(Leno/Hernandez) to accept foundation and federal funding to help Medi-Cal enrollees with renewals; SB1053(Mitchell) on ensuring contraceptive coverage; SB1182(Leno) on disclosing large group claims data; and AB1962(Skinner) on disclosing how much dental plan premiums are spent on patient care versus administration and profit.

Consumer groups were disappointed that vetoed bills included AB2088 (Hernandez) to limit “junk” coverage being offered by large employers, and SB1124 (Hernandez) to limit Medi-Cal estate recovery to just long-term care. Here are some highlighted bills of interest to consumers.

Here’s some of the highlights:

SIGNED:  SB964 (Ed Hernandez), sponsored by Health Access California, requires the Department of Managed Health Care (DMHC) to conduct annual reviews of managed care health plans for timely access and network adequacy. With this signature, regulators will be at the ready to respond to Californians’ concerns about access in Medi-Cal managed care or about narrow networks in some Covered California plans. Now that we have more Californians enrolled, we need to ensure than once covered, Californians can get access to the care they need when and where they need it. This bill will increase pro-active oversight of health insurers so that they keep their promises that they have a big enough network to provide all needed care in a timely manner.

SIGNED: SB18 (Leno/Hernandez), sponsored by Health Access California and Western Center on Law and Poverty, would accept California Endowment money and federal matching funds to help community enrollment counselors with the Medi-Cal renewal process this fall. We are pleased Governor Brown saw fit to accept the free foundation and federal funds offered to make Medi-Cal renewals easier.

VETOED: SB1124 (Hernandez) would have limited Medi-Cal estate recovery to long-term care. We are disappointed that California will continue to be one of only a few states that penalizes personal responsibility, by seeking to recover the home of deceased Medi-Cal recipients of families that did the right thing and saved and signed up for coverage. California should not seek to seize the assets arbitrarily of this select low-income population. We will take the Governor’s advice to vigorously pursue this issue in the budget process next year, so Californians can get the coverage they need without any fear of any financial repercussions for their family.

VETOED: SB2088 (Hernandez) would have extended consumer protections from the individual and small group markets into the large group market to ensure that “limited benefit” plans would only be offered as supplement to comprehensive coverage. We are disappointed the Governor vetoed the bill, and commit to come back next year to limit this “junk coverage,” with the guidance the Governor offered.

 

The Evolution of Medi-Cal

Nobody knew the blockbuster news of Friday that Toby Douglas deciding to step down as head of te California Department of Health Care Services and for Medi-Cal–but one day before the Medi-Cal Stakeholder Advisory Committee was still noteworthy for the news and information it did provide.

The main topics were a deeper discussion on network adequacy and timely access in the Medi-Cal program; and a broader discussion on the negotiations for a new 1115 waiver. These are both parts of a evolution of Medi-Cal–not just expanding coverage, but to a different way of providing care.

TIMELY ACCESS: With regard to timely access, it seemed after that presentation even more urgent that the Governor sign SB964 (Hernandez), to improve network adequacy, which is now on his desk.

Many of the Committee’s participants had requested this briefing. DHCS (Department of Health Care Services, which administers Medi-Cal) and DMHC (over commercial markets and  most Medi-Cal managed care) are taking additional steps to determine ongoing compliance with network adequacy and timely access requirements, including a new timely access verification study announced by DHCS, public posting (for the first time ever) of DHCS medical audits, and annual reporting of network adequacy by DMHC as well as geoaccess mapping at the plan/provider level which is being used by both departments. SB964 would provide structure and support for this increased oversight.

The promise of Medi-Cal managed care is that Californians in managed care will have the same consumer protections whether they are enrolled in Medi-Cal managed care or through coverage on the job or coverage they buy as an individual. The Brown Administration has pointed to these California consumer protections like timely access to care as they worked to expand Medi-Cal managed care, moving almost a million kids from Healthy Families to Medi-Cal, imposing mandatory enrollment of managed care on hundreds of thousands of seniors and persons with disabilities, expanding managed care into rural areas, and now embarking on a “pilot project” that will affect 800,000 Californians covered by both Medi-Cal and Medicare. But if health plans use different networks for Medi-Cal than for commercial coverage, those networks should be surveyed separately. The Administration is taking some steps to provide more effective oversight but given the decades of complaints about lack of access in Medi-Cal managed care, more needs to be done.

WAIVER: The provider access discussion set the tone and helped to frame the main topic and purpose for yesterday’s gathering: the Medi-Cal waiver renewal process, which is about to move at a very fast clip.  The state is entering into negotiations with CMS on its Medi-Cal waiver renewal: lots of new ideas about expanding access to the remaining uninsured, as well as ideas about care delivery and payment methodologies will be tested over the next five years, with everything at stake for beneficiaries.

The state can certainly take pride in the many successes of the current “Bridge to Reform” waiver: the Low Income Health Programs that were an early Medicaid expansion, Delivery System Reform Incentive Pool (DSRIP), among others.  The waiver renewal will build on these successes and on lessons from any missteps.

Lots of unknowns and pitfalls here, particularly when DHCS starts looking at shared savings models where the savings achieved through any delivery system reforms or efficiencies would be shared with the Feds. Is California poised to become the next “accountable care state?” Some advocates express concern–since in the wrong hands or under certain state fiscal conditions, large scale accountable care arrangements can easily devolve into Medicaid block grants or per capita caps that take an already starved base of funding and constrain it into the future.

Like New York’s recent waiver and consistent with California’s grant application for system transformation (CalSIM), California expects to focus its waiver to emphasize payment and delivery system reform and re-aligned incentives for providers to coordinate care more efficiently. There was some discussion about new delivery models in order to improve access though this was long on aspirational vision and short on specifics.

Other advocates continued to raise issues around increasing access to care and coverage, and ensuring that the safety net survives and thrives–most notably the public hospitals, which they note put up the money to draw down the federal matching funds.

The state hopes to submit its waiver renewal request by mid-February (!) and technical advisory groups are forming now (track the process here).

OTHER UPDATES: The state is about to transition more seniors and people with disabilities into managed care as part of the Coordinated Care Initiative—but will beneficiaries have the access to coordinated care they need to manage chronic conditions? Gary Passmore of the Congress of California Seniors notes there’s a cost to not sorting this out early on—for care delivered too late, in the wrong settings for this population the costs can add up quickly.

In related news, DHCS also announced that it may delay the implementation of the pregnancy wrap and the wrap for recent lawful immigrants who are low-income, childless adults. This is not good news for pregnant women: once the pregnancy wrap is implemented, pregnant women up to 138%FPL will be eligible for no-cost, full-scope Medi-Cal (instead of pregnancy-only coverage) and pregnant women 139%FPL-208%FPL will remain in Covered California but with zero premiums and zero cost sharing. For recent lawful immigrants who are low-income childless adults, it is better news: they stay on state-only, zero-cost Medi-Cal but once the wrap is implemented they will be covered through Covered California but with zero premiums, zero copays and continued coverage for adult dental. Implementation of these coverage “wraps” was set for January 1 but may be delayed. More to follow on this.

Big news today, as Toby Douglas, the director of the Department of Health Care Services, announced he would be leaving that post by the end of the year. For the last four years in that position, he ran Medi-Cal, which provides health care and coverage for a staggering 11 million Californians–more than a quarter of the state.

It was a surprise for many of us–we were with Toby all yesterday at an all-day Medi-Cal Stakeholders Advisory Committee, and he hid this news like a good poker player. The meeting provided updates on what will be his legacy at the Department: the shift of seniors and people with disabilities into coordinated and managed care, the budget cuts during the recession and the partial restoration of key benefits, the absorption of programs like Healthy Families, and most notably, the expansion of coverage and the other eligibility and enrollment changes under the Affordable Care Act. He talked about the need for the Department and Medi-Cal to grow and evolve, to meet a new mission and mandate.

The meeting, which we will post the notes from shortly, also delved deeply into two areas that he will start the work but leave unfinished for his successor: the work to ensure access to patients in Medi-Cal, with more rigorous reviews of network adequacy and timely access, and the discussion around a new 1115 waiver and negotiations with the federal government–the plan for Medi-Cal for the next five years, and the implementation of additional delivery system reform.

It’s hard to overstate the importance of Medi-Cal in general, of Toby’s job, and as part of the Affordable Care Act. Covered California may have been the bright shiny object, but Medi-Cal covered more people and could be seen as having greater successes (nearly 2 million enrollees, the Low-Income Health Programs and express lane enrollment) and failures (the still-pending 350,000 backlog of applications).

We are glad Toby is staying through the end of the year, to provide a good transition, and appreciate his work, and wish him well in whatever his new career offers.

BethAbbottSwearingIn

Also this week, our former colleague Beth Abbott started as the new head of the Office of the Patient Advocate. We are excited about her tenure, and were happy to see these pictures of her getting sworn in by Health and Human Services Secretary Diana Dooley. We look forward to seeing who Secretary Dooley gets to swear in for the DHCS job in the beginning of 2015.

ALERT: Your Health or Your Home?

HEALTH ACCESS ALERT: Friday, September 12, 2014

ALERT: CALL GOVERNOR BROWN TO SIGN SB1124, SO CALIFORNIA FAMILIES AREN’T FORCED TO CHOOSE BETWEEN THEIR HEALTH AND THEIR HOME

*        Key bills on the Governor’s desk–Governor Brown has month of September to sign or veto bills including SB1124(Hernandez), to limit Medi-Cal “estate recovery” to long term care–so signing up for Medi-Cal managed care doesn’t put the family home at risk.

*       CALL (916-445-2841), E-MAIL or TWEET GOVERNOR BROWN to urge signing of SB1124 and reward responsibility, so low-income families aren’t penalized for doing the right thing: meeting the mandate and signing up for coverage, saving up and buying a home.

*        COMING NEXT WEEK: Call-in Days for SB 964 (Hernandez) to ensure network adequacy and timely access to care for all managed care patients, including those in Medi-Cal and Covered California.

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Governor Brown has until September 30 to sign or veto several critical health and consumer protection bills, including SB1124 (Hernandez), a crucial bill that protects California families from having to choose between their health and their home.

SB1124 (Hernandez) would limit Medi-Cal “estate recovery” to long-term care, so the state collects only what is required under federal law, aligned with 40 other states. Current California policy places a lien on the assets of Medi-Cal managed care patients 55 and over–discouraging them for signing up for coverage, even as there is no such repayment expected of those higher-income families getting assistance in Covered California.

SB1124 rewards personal responsibility for those Californians who do the right thing by meeting the mandate to sign up for health coverage, and who save and buy a home despite limited incomes. A wide range of consumer, health, low-income, senior, and community organizations–and editorials from the Los Angeles Times and other newspapers–are urging Governor Brown to sign the bill.

CONTACT GOVERNOR BROWN

1.      Calls are best: (916) 445-2841. Give the name of the bill you are calling about first and a simple statement of support (1-2 sentences max). For example:

My name is ______ and I’m calling to ask you to please sign SB1124 (“Limit on Medi-Cal Estate Recovery”) into law. No one should have put the family home at risk just to get help with their medical costs.

2.    Email the Governor at: https://govnews.ca.gov/gov39mail/mail.php .
- Choose the right bill (ex: SB1124) under “Please choose your subject.”

- Fill out the form carefully (note that the ‘con’ button comes before the pro button!)

You can include a few sentences in this email form, but keep your statement brief, as in this example:

“Please sign SB1124 into law. My in-laws, both in their late 50s, have worked hard all of their lives, but now they have jobs that do not provide health insurance. They refuse to sign up for Medi-Cal because they don’t want to put the family home at risk. If they do end up in the E.R, doesn’t Medi-Cal have to pay that bill anyway?”

3.    Tweet today! and though the end of September. Here are a few suggestions, but make your own!

·       CA should not keep low-income Californians in poverty for having Medi-Cal. Ask @JerryBrownGov to sign SB1124 #SaveMyFamilyHome

·       Medi-Cal should be a safety net program – not a long-term loan program. @JerryBrownGov sign SB1124 #SaveMyFamilyHome

·       Reward responsibility: Don’t force CA families to choose between their health and their home. @JerryBrownGov sign SB1124 #SaveMyFamilyHome

4. Share Your Stories!

If you have been directly impacted by any of the circumstances above, please share your story with us at www.health-access.org by clicking on the “Share Your Story” icon or call (916) 497-0923.

Example

Paul and his wife, both age 62, are between jobs and uninsured. When they went to sign up for coverage on Covered California, they learned they qualify for Medi-Cal but that the  state would go after their home or other assets after their death. “We didn’t work for 30 years to pay off our mortgage, to hand it over to the state. Our home needs to go to our children. This is blatant age discrimination. The policy should have failed on this alone. Because of this I did not sign up for Medi-Cal.”

Many low-income Californians age 55 and older are reluctant to enroll in Medi-Cal because they are afraid the state will ‘recover’ their house when they die. The federal government requires states to recover against the estates of Medi-Cal beneficiaries age 55 and older, but only for long term care services such as nursing home care. Yet California is one of only ten states that collects for all medical care, including premiums paid to a health plan.

 

Thank you for your efforts in support of this important piece of legislation. Questions about the bill can be directed to Health Access, or to Linda Nguy (lnguy@wclp.org), Legislative Advocate at Western Center on Law and Poverty, a co-sponsor of SB1124(Hernandez) with California Advocates for Nursing Home Reform.

Key Health Bills On the Governor’s Desk After Legislature Adjourns

HEALTH ACCESS ALERT: Tuesday, September 2, 2014 

KEY PATIENT PROTECTIONS ON GOVERNOR’S DESK AS LEGISLATURE ADJOURNS

*        Legislature ends 2013-14 session with a flurry of activity; Governor has month of September to sign or veto bills passed, including SB 964 (Hernandez) on network adequacy and timely access to care.

*       Also pending on Governor’s desk are key Medi-Cal bills: limiting Medi-Cal estate recovery (SB1124), and allowing State to accept foundation money for Medi-Cal renewal assistance (SB18).

       Closely-fought bill to require paid sick leave passes, as does SB1094(Lara), to expand the Attorney General’s authority to enforce conditions of non-profit hospital mergers and acquisitions. Other measures on out-of-pocket costs stall, with advocates commiting to action next year.

*        POST-LEGISLATIVE SESSION RECEPTION TODAY to wish Health Access’ Beth Abbott well as she transitions to her new post as director of the revamped Office of the Patient Advocate. Please RSVP here for the reception Today, Tuesday, September 2nd, 4-7pm, Ambrosia Cafe in Sacramento.

   Be a Member of Health Access To Help CA Seize The Opportunities In Health Reform
   Read Our Health Access Blog for More Updates; Also Follow Us on Facebook!
   Read Real-Time Updates on ACA Implementation on Twitter @HealthAccess!
 
 

The Legislature ended its 2013-14 session early Saturday morning, passing a flurry of bills to the Governor’s desk for his consideration.  Some key health care consumer protections and proposals made it through the legislative process, and are now headed to the Governor for his final review. Several other measures stalled, some earlier in the year and some in the last days or even hours of the session.  Governor Brown now has the month of September to either sign or veto bills before him.

BILLS HEADED TO THE GOVERNOR:

In this year where California was successful in enrolling people into coverage under the Affordable Care Act, new scrutiny focused on whether patients had timely access to care once enrolled in Medi-Cal managed care, which has long been criticized for lack of adequate access,  or Covered California with some plans offering “narrow networks.” Passing this week was the Health Access California-sponsored bill, SB 964 (Ed Hernandez), which would require DMHC to do annual reviews for timely access and network adequacy, separately for Medi-Cal managed care and the individual market so that consumers in Medi-Cal and Covered California have the guarantee that they can get needed care, when and where they need it.

Two important Medi-Cal bills are also headed to the Governor. SB 18 (Leno/Hernandez) would have the State accept $6 million from the California Endowment to fund Medi-Cal renewal assistance by community based organizations, and drawing down federal matching funds as well.

Getting near unanimous votes in the legislature was SB 1124 (Hernandez) which would limit Medi-Cal estate recovery to long-term care, so those getting Medi-Cal managed care services would not find that their family home had a claim on it after death. Over 40 states already do this, allowing Medi-Cal to be a true safety-net for medical care without putting the family’s assets at risk. “Estate recovery,” which amounts to about $500 per month in liens for those over age 55, arbitrarily seeks assets from a small slice of lower-income families who are trying to do the right thing and get covered. While this would have a small state budget impact, enactment would be a big deal for families’ economic security: health and low-income advocates are making it a major priority to get the Governor’s signature.

Another Health Access California-sponsored bill that is headed to the Governor is AB 2088 (Roger Hernandez), which makes, in the large group market, limited benefit plans supplemental to comprehensive coverage. This consumer protection already exists in the individual and small employer market; the bill closes a loophole for employers to possibly avoid compliance with the full intent of the ACA. Employees who accept employer coverage are barred from subsidies in Covered California even if that coverage is unaffordable or does not meet 70% minimum value: AB2088 would protect those employees by assuring that they get comprehensive coverage.

Also passing, but not without major effort, was SB 1094 (Lara), which would expand the Attorney General’s authority to enforce conditions of non-profit hospital mergers and acquisitions, to assure that a nonprofit hospital will continue to serve its community after a transaction in which ownership changes. SB 1094 initially failed passage on the Assembly Floor and was granted reconsideration, passed out of the Assembly Floor Thursday evening with a vote of 43-27 thanks to the tireless work of advocates ranging from Planned Parenthood to the California Labor Federation, from SEIU to Consumers Union to Health Access California. This bill is now headed to the Governor.

A last minute bill of interest to health advocates in Fresno County was AB 2731 (Perea) which would give Fresno County the budget flexibility it says it needs to preserve safety-net services to the undocumented and indigent—the bills allows the County to defer the county’s maintenance of effort requirement for its transportation fund, with the freed-up resources required to go to indigent care. The County felt that the language in the budget passed in June was too restrictive, and had voted to nearly eliminate its medically indigent program a few weeks ago—but put a 90-day stay in anticipation of a legislative fix such as AB2731, which now heads to the Governor.

While not about health insurance or treatment, the health-related bill that got the most attention was AB 1522 (Gonzalez), the requirement on employers to offer at least 3 days of paid sick leave to their workers. While major cities across the country have adopted similar policies, California would be only the second state to require paid sick leave—but with a major and problematic exemption of home care workers, a carve-out requested by Governor Brown, but actively opposed by the unions representing in-home supportive services caregivers.

There were also a few bills that were held in the Legislature, some with commitments from the Administration to address the issue at hand in the next legislative session and others with commitments from the State to address the issue at hand via changes in regulations.

BILLS HELD:

Three bills on trying to make out-of-pocket costs manageable were held—but health advocates hope to revisit these issues in the year ahead.

AB 1917 (Gordon) which would have capped prescription drug co-pays at 1/12 of the annual out-of-pocket limit so that patients with HIV/AIDS, cancer, MS, and other diseases will not be forced to pay high upfront costs for their medication was held due to insurer and Administration opposition. Assemblyman Gordon, sponsoring organization Health Access California, and others are committed to continuing the effort and conversation with the Administration to address this issue in the next legislative session.

Another bill that has been held is SB 1176 (Steinberg), which would have made a health plan or insurer responsible for tracking out-of-pocket costs for in-network providers, and reimbursing the consumer when they exceed their out-of-pocket limit. The Department of Managed Health Care has committed to developing regulations that will require health plans and insurers responsible for tracking out-of-pocket costs for in-network providers and responsible for reimbursing consumers when they exceed their out-of-pocket limit.

Also not proceeding was AB 2533 (Ammiano) which would have ensured that if a patient can’t get timely access to care, the health insurer must arrange for needed care out-of-network, but with in-network cost sharing. This is now the practice with plans regulated at the Department of Managed Health Care, but not the Department of Insurance.

Finally, a late push to extend the July 2015 sunset for the California Health Benefits Review Program, which provides University of California analysis of benefit mandate proposals, AB 1578 (Pan), stalled in literally the last moments of the legislative session.

Below is a full bill list of all the key health legislation on the Governor’s desk.

 

RECEPTION TODAY: This afternoon/evening, Health Access California is hosting a reception to recognize our director of administrative advocacy, Beth Abbott, as she is about to start working as the Governor’s appointment to direct a revamped Office of the Patient Advocate. The reception will take place Tuesday, September 2nd, from 4-7pm, at Ambrosia Cafe in Sacramento. Please RSVP at this link to join our advocates and colleagues to wish her well.

 

*** 2014 HEALTH CONSUMER BILLS ON THE GOVERNOR’S DESK  

Ø  Insurance Consumer Protections

NETWORK ADEQUACY OVERSIGHT OF HEALTH PLANS: SB964 (Ed Hernandez) requires the Department of Managed Health Care (DMHC) to do annual reviews for timely access and network adequacy to be done separately for Medi-Cal managed care and the individual market so that consumers in Medi-Cal managed care and Covered California get timely access to necessary care. Sponsored by Health Access California.

JUNK INSURANCE FOR LARGE EMPLOYERS: AB2088 (Roger Hernandez) while not banning limited benefit plans, makes them supplemental to comprehensive coverage. California’s Insurance Code allows the sale of “insurance” that provides very limited benefits with a minimum actuarial value of less than 60%. This bill extends this consumer protection to large employer coverage, closing a loophole for employers to possibly avoid compliance with the full intent of the ACA. Sponsored by Health Access California.

SB959 (Ed Hernandez) is the clean-up bill for the individual and small group market reform legislation to implement the ACA enacted in 2012 and 2013. SUPPORT.

Ø  Medi-Cal

FOUNDATION & FEDERAL FUNDS FOR MEDI-CAL RENEWAL: SB18 (Leno/Herrnandez) provides $6 million to the State from the California Endowment to fund Medi-Cal renewal assistance Sponsored by Health Access California.

LIMIT ON MEDI-CAL ESTATE RECOVERY: SB1124 (Hernandez) limits Medi-Cal estate recovery. California is one of only ten states that impose estate recovery on more than long term care services, where the state, for those over 55, recovers the cost of all medical care from the estate of an individual after death. This has discouraged some from signing up for Medi-Cal coverage. Co-sponsored by Western Center on Law and Poverty (WCLP) and California Advocates for Nursing Home Reform. SUPPORT.

AB2325 (Speaker Perez) would create a Medi-Cal medical interpreter program. The bill was vetoed last year: this is a re-introduction of that measure. SUPPORT.

Ø  Cost/Quality Transparency

SB1182 (Leno) would provide claims data or other detailed information to large purchasers.  SUPPORT.

AB1962 (Skinner) would make transparent what dental-only plans spend, as a percentage of premium, on patient care. It requires specialized dental-only plans to disclose a “medical loss ratios” as for medical coverage. The bill is sponsored by the California Dental Association. SUPPORT.

Ø  Hospital Oversight and Consumer Protections.

SB1094 (Lara) amends existing law on Attorney General oversight of nonprofit hospital mergers and acquisitions. It extends the review period from 60 days to 90 days. It also gives the Attorney General authority to enforce conditions of hospital transactions. This bill is sponsored by the Attorney General. SUPPORT.

SB1276 (Ed Hernandez) updates the Hospital Fair Pricing law (which Health Access California sponsored in 2006) by: defining a reasonable payment plan as monthly payments that are no more than 10% of income after essential living expenses; allowing underinsured individuals with high health costs (over 10% of income) to receive the hospital fair pricing discount even if they receive a discounted rate on their cost sharing from their health plan or insurer. It is being sponsored by Western Center on Law and Poverty based on their experience assisting consumers. SUPPORT.

Ø  Prevention and Other

SB912 (Mitchell) would eliminate the sunset on the current requirement that vending machines in state buildings include 35% healthy food and drinks. Sponsored by California Pan-Ethnic Health Network. SUPPORT

AB 2731 (Perea) would allow Fresno County budget flexibility in their county budget to spend $5.5 million for indigent healthcare by deferring the county’s maintenance of effort requirement into a Proposition 42 transportation fund. SUPPORT.

Legislative Update

HEALTH ACCESS ALERT: Tuesday, August 25, 2014 

KEY PATIENT PROTECTIONS UP IN LAST WEEK OF LEGISLATIVE SESSION

*        Key health bills, including SB 964 (Hernandez) on network adequacy and timely access to care, are among hundreds of bills Legislature must pass by Sunday; If approved, Governor Brown would have September to sign or veto.

*       Also pending: key Medi-Cal bills: limiting Medi-Cal estate recovery (SB1124), and allowing State to accept foundation money for Medi-Cal renewal assistance (SB18).

*        Most closely-fought health bill SB1094(Lara), to expand the Attorney General’s authority to enforce conditions of non-profit hospital mergers and acquisitions, to assure that a nonprofit hospital will continue to serve its community after a transaction in which ownership changes. Advocates urged to call in support.

*        POST-LEGISLATIVE SESSION RECEPTION to wish Health Access’ Beth Abbott well as she transitions to her new post as director of the revamped Office of the Patient Advocate. Please RSVP here for the reception Tuesday, September 2nd, 4-7pm, Ambrosia Cafe in Sacramento.

   Be a Member of Health Access To Help CA Seize The Opportunities In Health Reform

   Read Our Health Access Blog for More Updates; Also Follow Us on Facebook!

   Read Real-Time Updates on ACA Implementation on Twitter @HealthAccess!

In this last week of the 2013-14 legislative session, the Assembly and Senate will voted on hundreds of bills by Sunday, including those of strong interest to California patients and health consumers. Bills must pass out of the Legislature by the end of the week and if passed, the Governor has the month of September to decide their ultimate fate.

Below is a list of specific bill pending in this crucial week. On the Assembly floor for a vote as early as today is a key bill to ensure network adequacy and timely access to care, SB 964 (Ed Hernandez), a Health Access California-sponsored bill which would require DMHC to do annual reviews for timely access and network adequacy, separately for Medi-Cal managed care and the individual market so that consumers in Medi-Cal and Covered California get timely access to necessary care. Consumer groups are actively working to get this bill passed.

Two important Medi-Cal bills are also up for a vote on the Senate floor: SB 18 (Leno/Hernandez) would have the State accept $6 million from the California Endowment to fund Medi-Cal renewal assistance, and drawing down federal matching funds as well; SB 1124 (Hernandez) would limit Medi-Cal estate recovery to long-term care, so those getting Medi-Cal managed care services would not find that their family home had a claim on it after death. Advocates are gearing up to generate calls and letters to the Governor’s office on these important bills.

A new bill that is advancing in the Legislature, AB 1578 (Pan), would extend until June 30, 2016, the operative date of the California Health Benefit Review Program (CHBRP) and further expand its role to include an assessment of legislation that impacts health insurance benefit design, cost sharing, premiums, and other health insurance topics. This short-term extension will give the Legislature and other stakeholders the opportunity to consider how the role of CHBRP should be revised post-ACA. This bill requires bipartisan support because it requires a two-thirds vote to extend funding.

The most contested health bill this week seems to be SB 1094 (Lara), which would expand the Attorney General’s authority to enforce conditions of non-profit hospital mergers and acquisitions, to assure that a nonprofit hospital will continue to serve its community after a transaction in which ownership changes. SB 1094 failed passage on the Assembly Floor in a vote last week, but has been granted reconsideration, and advocates ranging from Consumers Union to Planned Parenthood to the California Labor Federation to Health Access California are making a strong push for passage. The debate on the Floor was contentious, with Republicans and some Democrats siding with hospitals in opposition. Democrats in support, like Assemblymember Holden expressed “this is about protecting the interests of consumers.” Consumer and community groups are urged to support this key measure in this crucial week.

Other key bills are listed below.

RECEPTION: We hope to celebrate next week, after the legislative session ends, as Health Access California will host a reception to recognize our director of administrative advocacy, Beth Abbott, as she is about to start working as the Governor’s appointment to direct a revamped Office of the Patient Advocate. The reception will take place Tuesday, September 2nd, from 4-7pm, at Ambrosia Cafe in Sacramento. Please RSVP at this link to join our advocates and colleagues to wish her well.

BILL LIST

Here’s a broader list of the bills of interest to health care advocates, pending floor votes in the state legislature this week. It’s the last week for consumer and community groups to weigh in to the Legislature:

NETWORK ADEQUACY OVERSIGHT OF HEALTH PLANS: SB964 (Ed Hernandez) requires the Department of Managed Health Care (DMHC) to do annual reviews for timely access and network adequacy to be done separately for Medi-Cal managed care and the individual market so that consumers in Medi-Cal managed care and Covered California get timely access to necessary care. Sponsored by Health Access California.

PRESCRIPTION DRUG COST SHARING: AB1917 (Gordon): would cap prescription drug co-pays at 1/12 of the annual out-of-pocket limit so that patients with HIV/AIDS, cancer, MS, and other diseases will not be forced to pay high upfront costs for their medication. Sponsored by Health Access California.

JUNK INSURANCE FOR LARGE EMPLOYERS: AB2088 (Roger Hernandez) while not banning limited benefit plans, makes them supplemental to comprehensive coverage. California law allows the sale of “insurance” that provides very limited benefits with a minimum actuarial value of less than 60%. This bill extends this consumer protection to large employer coverage, closing a loophole for some large employers to avoid offering comprehensive coverage to their employees. Sponsored by Health Access California.

SB1176 (Steinberg) makes the health plan or insurer responsible for tracking out-of-pocket costs for in-network providers, and reimbursing the consumer when they exceed their out-of-pocket limit. SUPPORT.

SB959 (Ed Hernandez) is the clean-up bill for the individual and small group market reform legislation to implement the ACA enacted in 2012 and 2013. SUPPORT.

AB 2533 (Ammiano) would seek to ensure timely access to necessary care at in-network cost sharing. SUPPORT.

Ø  Cost/Quality Transparency

SB1182 (Leno) would provide claims data or other detailed data to large purchasers.  SUPPORT.

AB1962 (Skinner) would make transparent what dental-only plans spend, as a percentage of premium, on patient care. It requires specialized dental-only plans to disclose a “medical loss ratios” as for medical coverage. The bill is sponsored by the California Dental Association. SUPPORT.

AB 1578 (Pan) would extend until June 30, 2016, the operative date of the California Health Benefit Review Program and further expand its role to include an assessment of legislation that impacts health insurance benefit design, cost sharing, premiums, and other health insurance topics. SUPPORT.

Ø  Hospital Oversight and Consumer Protections.

SB1094 (Lara) amends existing law on Attorney General oversight of nonprofit hospital mergers and acquisitions. It extends the review period from 60 days to 90 days. It also gives the Attorney General authority to enforce conditions of hospital transactions. This bill is sponsored by the Attorney General. SUPPORT.

SB1276 (Ed Hernandez) updates the Hospital Fair Pricing law (which Health Access California sponsored in 2006) by: defining a reasonable payment plan as monthly payments that are no more than 10% of income after essential living expenses; allowing underinsured individuals with high health costs (over 10% of income) to receive the hospital fair pricing discount even if they receive a discounted rate on their cost sharing from their health plan or insurer. It is being sponsored by Western Center on Law and Poverty based on their experience assisting consumers. SUPPORT.

Ø  Medi-Cal

SB18 (Leno) provides $6 million to the State from the California Endowment to fund Medi-Cal renewal assistance Sponsored by Health Access California.

SB1124 (Hernandez) limits Medi-Cal estate recovery. California is one of only ten states that impose estate recovery on more than long term care services, where the state, for those over 55, recovers the cost of all medical care from the estate of an individual after death. This has discouraged some from signing up for Medi-Cal coverage. Co-sponsored by Western Center on Law and Poverty (WCLP) and California Advocates for Nursing Home Reform. SUPPORT.

AB2325 (Speaker Perez) would create a Medi-Cal medical interpreter program. The bill was vetoed last year: this is a re-introduction of that measure. SUPPORT.

Ø  Prevention

SB912 (Mitchell) would eliminate the sunset on the current requirement that vending machines in state buildings include 35% healthy food and drinks. Sponsored by California Pan-Ethnic Health Network. SUPPORT