Office of the Patient Advocate Releases 2014-2015 Health Care Quality Report Cards

The much anticipated 2014-2015 edition of the OPA’s Health Care Quality Report Cards comes months ahead of the usual release date so that the information can be of use to consumers in the coming open enrollment season. The OPA release actually includes three different report cards: one for the health plans (HMOs); one for Preferred Provider Organizations (PPOs); and one for the Medical Groups. All told, the findings will of interest to more than 16 million Californians, most enrolled in job-based coverage but also those enrolled in the individual marketplace through Covered California.

There’s good news and bad on these tools. Historically, the tools have not been all that well utilized by consumers or employers. While many Californians not in position to make their own plan selection—their employer typically picks it for them—the report card is useful for those who have choices in “open enrollment” period coming this fall, including potentially for those in Covered California. Purchasers and employers have been clamoring for better tools, and indeed the tools seem to be getting better (learn more here).

Health Access is honored to feature OPA Director Beth Abbott (former Director of Administrative Advocacy at Health Access) in a Q & A about the new report cards…

Health Access: What’s new or different about the 2014-15 Report Card Release?

Beth Abbott of the OPA: This year’s release provides one point of entry to the most recent quality information on all commercial plans in the state: www.opa.ca.gov . The release features a few new measures, including the percentage of readmissions to hospitals that are preventable.  This is important because if the readmission to the hospital shouldn’t have been necessary, it both increases the cost of the care and can have an adverse impact on health outcomes. 

HA: Why release the report card now?

BA: We are releasing the Report Cards to coincide with open enrollment periods for both employer-sponsored health coverage [for people who get their insurance through their job) and for people who are making selections of plans through our state-based marketplace at www.CoveredCA.com.  This means that this easy to use tool is available at the precise time when many Californians will be making selections and they will be able to evaluate health plans, PPOs (Preferred Provider Organizations), and medical groups, not only based on costs, but also with the most up-to-date quality information at their disposal. 

HA: What is your long range vision for the report card and related transparency tools?

BA: We want to have consumers select health plans based on value, which is the intersection between cost and quality.  Getting the cheapest plan based on the monthly premium is not always the best choice, since there are also out-of-pocket expenses that should be considered when you use the plan (deductibles, co-payments and the like.)  Also, if a plan is low cost, but does not deliver good quality, it is not a good choice.  Using the OPA Report Cards to evaluate the plans enables the consumer to consider quality metrics in easy-to-understand terms.  In addition to having consumers use the Report Cards to evaluate health plans as a matter of routine, we would like to see employers and unions who contract with health plans factor those quality measures into their contracting decisions.  In other words, when they are deciding which plans to offer to their employees, they offer them a selection based not only on costs, but what kind of results they get for their patients based on accepted clinical standards and patient experience. 

HA: What can the report card do to help advance the goals of health reform?

BA: One of the chief goals of the Affordable Care Act is to promote the integration of health care for the patient and to help lower the costs of providing health care.  These cost and quality measures go hand in hand.  If health care achieves a high degree of integration, patients don’t have to undergo duplicate tests and procedures, and their clinical data can be easily shared among the team that is treating them so that all information is available.  A well-integrated approach to care means, for example, that simple things can be handled by email between the patient and the doctor or pharmacist. This gets answers to the patient more quickly without having to wait for a formal appointment to be scheduled.  All of these kinds of things mean that the cost of health care is going down and the quality of health care is much more coordinated and responsive to patients’ needs. 

HA: What can groups like Health Access go do to help promote use of the report card?

BA: Health Access and its allies, friends, and relations can help by publicizing the Reports Cards.  It continues to amaze me how few people actually are familiar with these important quality tools.  I have come to refer to the Office of the Patient Advocate that I now work for as the “best undiscovered gem in CA state government.”  People should share our website with their employer, their union, their PTA group, their church or synagogue organization, their neighborhood association, and all of their friends.  I want this to be second nature for everyone who is making a health plan choice to get the right plan for them. 

The OPA has provided the following tools for community partners to use in getting the word out about the Report Cards.

  • A web badge designed for other organizations to place on their websites that will link people directly to the Health Care Quality Report Cards. The html code needed for the web badge placement can be found on this webpage: www.opa.ca.gov/Pages/PartnersBadges.aspx.  There also are general OPA web badges available in additional languages and sizes that link to OPA’s home page instead of the Report Cards.
  •  OPA’s social media accounts and links:
    Facebook -  Office of the Patient Advocate
    Twitter – @CAPatientAdv
    YouTube – CAPatientAdvocate
  • Last but not least, OPA has a “California Health Care Report Card” Mobile App available for free download through iTunes and Google Play. An overview about the Mobile App and the links to the two online stores can be found here: www.opa.ca.gov/Pages/MobileApplications.aspx.

HA: Anything else we should know about the report card and the OPA?

BA: If you think you want to stay with the plan you have now, you might want to look at our Report Cards, and click on your plan name.  It will give you your “plan profile” with all the details.  You can also click on any other plan you have under active consideration for a comparison.  And if you have particular health concerns in your family, e.g. diabetes or a heart condition, you can compare plans clinical measures of that treatment to make sure you’ve selected a plan that excels in that kind of care. 

Legislative Wrap-Up: 2014 Bills Signed/Vetoed by the Governor

HEALTH ACCESS UPDATE: Friday, October 10, 2014

2014 LEGISLATIVE WRAP-UP: GOVERNOR BROWN SIGNS KEY PATIENT PROTECTIONS INCLUDING SB964(HERNANDEZ) ON TIMELY ACCESS TO CARE
* Other bills of note 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 more.

* Key bills vetoed include SB1124(Hernandez) on limiting Medi-Cal estate recovery; AB2088(Hernandez) on avoiding junk coverage; and SB1094(Lara) on hospital merger oversight. Consumer groups vow to continue efforts next year.

* Full bill list below of fate of 2014 legislation that made it to the Governor’s desk.

The 2014 legislative session came to an end last week. The Governor’s deadline to sign or veto bills has come and gone; Governor Jerry Brown had until September 30th to sign or veto bills presented to him by the legislature.

After several years of significant legislative work to pass dozens of bills to put in place the key component of the Affordable Care Act in California law, it was the administrative work to implement and improve health reform that took center stage. That said, several key health consumer bills of note were passed and signed into law by Governor, even as some priority bills were vetoed as well.

The new law SB964(Hernandez) has perhaps most direct impact on the biggest number of consumers on one of the highest-profile issues of the year–the question of whether Californians, once covered, can get care. SB964 will increase oversight of timely access and network adequacy of all health plans, thus benefitting over 21 million Californians. In this year where California was successful in enrolling millions 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 requires 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 they need it.

The Governor also signed two other bills to help access to care for those insured. SB 1052(Torres) requires the development of a standard drug formulary template which health plans and insurers must use to display their drug formularies and to post their formularies on their Internet Web sites. This bill also requires the California Health Benefit Exchange (Covered California) to provide links to the formularies. SB1053(Mitchell) was also signed and willeliminate cost sharing for FDA approved female contraceptives that are generic or preferred brands and allows substitution of non-preferred contraceptives, unless a therapeutic equivalent contraceptive is provided by the plan with no cost sharing.

To help consumers keep their coverage, SB 18 (Leno/Hernandez) provides the State $6 million from the California Endowment to fund Medi-Cal renewal assistance by community based organizations, drawing down $6 million in matching federal funds as well. This is the first ever renewal period since the process and rules changed under the ACA. Consumer advocates worked hard to pass this bill to ensure people eligible for Medi-Cal – many who have never had Medi-Cal before – got the necessary help to renew and maintain their health coverage. Thanks to the California Endowment and the Governor for his signature of SB 18, the State now has the necessary resources to ensure people who are eligible for Medi-Cal are able to successfully renew and maintain health care coverage.

On cost, quality and transparency, the Governor signed SB1182 (Leno), which requireshealth plans and insurers to share claims data or other detailed data to very large purchasers that have 1,000 or more enrollees or that are multiemployer trusts with at least 500 members. AB1962(Skinner) was also signed and would make transparent what dental-only plans spend, as a percentage of premium, on patient care by requiring specialized dental-only plans to disclose a “medical loss ratios” as for medical coverage.

For the remaining uninsured, SB 1276(Hernandez) by Western Center on Law and Poverty updates the Hospital Fair Pricing law enacted in 2006 after a five battle and sponsored by Health Access California. SB1276 defines a reasonable payment plan as monthly payments that are no more than 10% of income after essential living expenses and allows 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.

To help the remaining uninsured in Fresno, the Governor signed AB 2731(Perea) which will allow Fresno County to spend $5.5 million for indigent healthcare by deferring their county maintenance of effort requirement for local streets and roads. The Fresno County Board of Supervisors must now take action to reverse a decision to undo their safety-net program.

Consumer, community, senior, and low-income advocates were very disappointed in some key vetoes, but vowed to continue the work next year, and saw hope for progress in the Governor’s veto messages.

SB 1124 (Hernandez) would have limited 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” amounts to about $500 per month in liens for those over age 55. It arbitrarily seeks assets from a small slice of lower-income families who are trying to do the right thing by getting covered and owning a home. Advocates vowed to continue to work to fix this policy that 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.

Health Access California-sponsored bill AB 2088 (Roger Hernandez), which would have made limited benefit policies supplemental to comprehensive coverage sold to large employers was also vetoed. This consumer protection already exists in the individual and small employer market; the bill closes a loophole for larger 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 provides less than 60% 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.

The veto of SB 1094(Lara) on Attorney General oversight over hospital sales and mergers was also a disappointment to consumer groups, labor, and Planned Parenthood alike. SB 1094 would have enhanced the Attorney General’s oversight of nonprofit hospital mergers and acquisitions. It sought to extend the review period from 60 days to 90 days. It also would have given the Attorney General authority to enforce conditions of hospital transactions. This bill was sponsored by the Attorney General.

Below (and on our website) is a longer bill list of the key health legislation (all supported by consumer groups including Health Access California) acted upon by Governor Brown in the past month:

BILLS SIGNED BY THE GOVERNOR

Ø Insurance Consumer Protections

OVERSIGHT OF HEALTH PLAN NETWORK ADEQUACY: SB964 (Ed Hernandez) requires the Department of Managed Health Care (DMHC) to do annual reviews of all health plans for timely access and network adequacy and that reviews 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) would standardize plan formularies so that consumers know which plans cover which drugs at what costs. This measure applies to the individual and employer coverage markets.

SB1053 (Mitchell) eliminates cost sharing for FDA approved female contraceptives that are generic or preferred brands and allows substitution of non-preferred contraceptives, unless a therapeutic equivalent contraceptive is provided by the plan with no cost sharing.

Ø Medi-Cal

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

SB1089 (Mitchell) is a clean-up measure to AB 396 (Chapter 394, Statutes of 2011) which established a voluntary program to allow the State, on behalf of counties and the California Department of Corrections and Rehabilitation, to draw down Federal Medicaid funding for hospital inpatient and inpatient psychiatric services for Medicaid eligible detained juveniles at no cost to the State.

SB1341 (Mitchell) would require that the Statewide Automated Welfare System (SAWS) has the ability to make use of the Medi-Cal rules housed in the IT system, CalHEERS, jointly operated by the California Health Benefits Exchange and the Medi-Cal program.

Ø Cost/Quality Transparency

SB1182 (Leno) requires health plans and insurers to share claims data or other detailed data with very large purchasers that have 1,000 or more enrollees or that are multiemployer trusts.

SB1340 (Hernandez) would eliminate gag clauses in contracts between types of health care providers and health plans or insurers.

AB1792 (Gomez) would require the Department of Finance to report on the cost of public assistance received by employees of California employers.

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 Hospital Oversight and Consumer Protections.

SB1276 (Ed Hernandez) updates the Hospital Fair Pricing law which Health Access California sponsored in 2006 and which says that low-income uninsured and underinsured cannot be charged more than the higher of Medicare or Medi-Cal. SB1276 defines a reasonable payment plan as monthly payments that are no more than 10% of income after essential living expenses and allows 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. Sponsored by Western Center on Law and Poverty.

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.

Ø Other Bills

SB20 (Hernandez) would revise the open enrollment dates for the individual market to conform to current federal guidance, which is November 15-February 15. SUPPORT.

SB1004 (Hernandez) would change the definition of hospices to eliminate the requirement that patients forego curative treatment. SUPPORT.

SB1034 (Monning) would eliminate waiting periods due to pre-existing conditions, conforming California law to federal law with respect to waiting periods for health insurance. SUPPORT.

AB2731 (Perea) would allow Fresno County to spend $5.5 million for indigent healthcare by deferring the county’s maintenance of effort requirement necessary to receive state funding for local streets and roads.

BILLS VETOED BY THE GOVERNOR

Ø Insurance Consumer Protections

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.

Ø Medi-Cal

LIMIT ON MEDI-CAL ESTATE RECOVERY: SB1124 (Hernandez) would have limited Medi-Cal estate recovery to long-term care. 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.

SB1002 (De Leon) would have better aligned Medi-Cal and CalFresh reporting periods in order to streamline benefit delivery and improve low-income Californians’ access to federally funded health and nutrition benefits.

AB2325 (Speaker Perez) would have created a Medi-Cal medical interpreter program.

Ø Hospital Oversight and Consumer Protections.

SB1094 (Lara) would have enhanced 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.

SB204 (Corbett) would have required the Board of Pharmacy to survey pharmacists and electronic health record vendors to determine utilization of standardized prescription directions for use adopted pursuant to Board regulations.

Better Know a New Law: SB964 on Timely Access to Care

One of the most far-reaching and consumer-friendly health care bills enacted this year by Governor Jerry Brown was SB 964 by Senate Health Committee chairman Dr. Ed Hernandez, and sponsored by Health Access California.

Addressing two pressing issues for consumers, network adequacy and timely access to health care, SB 964 was a natural progression of decades of policy work going back to 1975 when then Governor Jerry Brown signed the Knox-Keene Act to assure that consumers in managed care receive the care they need when they need it, at in-network cost sharing. Over the decades since additional consumer protections have been put in place to make meaningful the bedrock principle for managed care: patients accept limited networks and the health plans in return guarantee that the network is adequate enough to provide timely access to care, including primary care in their geographic region, and access to medically necessary care at in-network cost sharing.

Over seven million Californians are or will be enrolled in Medi-Cal managed care: almost 3 million of them will be new to Medi-Cal managed care, either as a result of transitions from fee-for-service and Healthy Families or due to the ACA changes. This is more than a quarter of the population of California.  At a time when we are shifting an unprecedented number of people into Medi-Cal managed care plans and with the consumer concerns about the “narrow networks” in Covered California plans, it becomes   even more important that we fulfill the promise of the law and ensure that consumers can get the care they need, when they need it.

SB 964 builds on decades of policy work around consumer protections, and the work of the Department of Managed Health Care (DMHC), by enforcing the timely access and network adequacy standards in law and assuring that consumers have timely access to necessary care.

History

When the Knox-Keene Act was first implemented, DMHC’s predecessor) reviewed network adequacy whenever a health plan was initially licensed or moved into a new area (for instance, when Kaiser Permanente opened a new facility in Bakersfield) or whenever there were sufficient complaints to raise an alarm.  In 1975, this probably seemed sufficient.  However, this meant that there were health plans that had been operating for decades without a careful look at whether the networks were adequate and care was provided in a timely manner. .

The timely access statute adopted in 2003 required annual review of timely access compliance.  Unfortunately, the prior Administration bungled the compliance procedures for timely access, allowing different health plans to use different metrics and approaches for determining compliance and thus making enforcement quite difficult.  Under the current Brown administration the DMHC has taken a number of steps to encourage more standardized reporting on timely access and to improve the information collected on network adequacy.

SB 964 standardizes the data to be annually reported by health plans regarding network adequacy and allows the further development of standardized annual reporting on timely access.

Medi-Cal Managed Care

A fundamental promise of Medi-Cal managed care is that Medi-Cal managed care enrollees will receive the same consumer protections as other Californians enrolled in managed care.

SB964 takes a number of steps to assure that consumers in Medi-Cal managed care have the same protections as other Californians in managed care:

  • It requires that if a health plan uses a different network for Medi-Cal managed care than for other lines of business, the annual review for timely access and network adequacy be done separately for the separate Medi-Cal network.
  • It repeals the existing exemption of Medi-Cal managed care plans from medical surveys done every three years, building on  the Brown Administration’s current practice.
  • It requires health plans to submit to DMHC the same information on networks and network changes that is already submitted to DHCS so that the departments may check for inconsistencies.
  • In the only provisions affecting DHCS, it requires DHCS to post on its website completed medical audits. DMHC already posts completed medical surveys: DHCS does not. This furthers transparency for Medi-Cal managed care plans.

Covered California and the Individual Market

California has led the way in implementing the Affordable Care Act. Not only have the number of uninsured been cut in half, the rate of increase in premiums in the individual market has also been cut in half. In driving down the increase in premiums in the individual market, health plans have made numerous changes, including shifting to narrow networks. The Department of Managed Health Care  will soon release two targeted investigations arising out of these changes in the market for coverage sold directly to individuals, inside and outside Covered California.

SB964 takes a critical step to assure that in future years, networks in the individual market are adequate by requiring that if a health plan uses a different network for the individual market than for the small employer market, then the annual reporting on timely access and network adequacy shall be done separately for the different networks.

SB 964 will help people like Charlie who recently was unable to get routine medical care for more than six months:

CharlieSpiegelPhoto_SB964NetworkAccess

Though Charlie has an Obamacare Platinum Plan, he was unable to get routine medical care for more than six months. “I chose the Platinum level “Premier Direct Access” plan offered by Anthem Blue Cross Plan,” says Charlie, “because my Sutter primary care doctor was in that network.”  “But before I could get in for an initial appointment, Anthem cancelled their contract without notice, leaving me with $640 of not covered expenses!”

“At the same time I had to postpone a scheduled colonoscopy, I also continue to be unable to schedule a required sleep study for potential apnea, which my brother has and which led to a coronary event for him.  And Anthem will not even say if my requested provider is In Network or not.”

SB964: Adequate Networks and Timely Access to Managed Care

Almost twenty million Californians rely on coverage regulated by the Department of Managed Health Care. Stories from consumers like Charlie and recent enforcement actions and investigations by the DMHC indicate a need to further strengthen enforcement and oversight of timely access and network adequacy.

For these reasons, we are pleased that Governor Brown has signed SB 964 into law. and Health Access and other consumer advocates are already working with DMHC to begin implementing the new law. The bill takes effect on January 1.

Wal-Mart Drops Part-Time Coverage, As Anticipated for a Decade

Wal-Mart’s decision to drop health coverage for part-time workers is not a shock–it’s a move anticipated for years, especially here in California, which has been debating policy proposals on this issues for over a decade.

The important news is that thanks to the Affordable Care Act, workers will still have health care coverage options available, through Medi-Cal or Covered California. After decades of employers dropping health benefits, it’s so critical that the ACA is now offering affordable options for working families.

But while workers health care options are protected under the ACA, it’s unfair and unsustainable to allow Wal-Mart and other companies to shift health costs onto taxpayers. We need the employer responsibility provision in the ACA implemented and enhanced to ensure our health system is sustainable in the long-term, to protect taxpayers, and to provide a level playing field for employers who do offer coverage to their workers.

For years, California has had one of the worst rates in the nation of employers offering health coverage to their workers and families. As a result, California voters and policymakers have actively considered proposals to employer-based coverage, including Proposition 166 in 1992 and Proposition 72 in 2004; SB2(Burton) in 2003; and AB880(Gomez) in 2013. The ACA’s employer responsibility philosophy was reflected in the AB1x1(Nunez/Schwarzenegger) proposal in 2007 and in the currently operating Healthy San Francisco. California has had a decade-long debate anticipating this moment when Wal-Mart drops coverage–the question now is if our policymakers can finally act to protect taxpayers and our health system.

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.