There were lots of predictions about the end of Obamacare:
In tribute to today’s Supreme Court ruling in favor of full marriage equality for LGBT Americans, Health Access presents this report from Kate Burch, Network Director for the California LGBT HHS Network. Health Access joins with many others in celebrating today’s historic ruling, even as we are mindful of the work still needed to ensure better and more equitable health and health care for all LGBT Americans.
Last Friday, June 19, Health and Human Services Secretary Sylvia Burwell met with about 25 LGBT health advocates in Washington, DC to hear about the health care needs of LGBT communities around the country. After brief mention of the Affordable Care Act and the importance of addressing transgender health inequalities, Secretary Burwell opened up the floor. Advocates raised a number of issues and recommendations for HHS to consider. Underlying everything was the urgency to accomplish as much as we can during the Obama administration, and to put lasting measures in place that will continue, no matter what happens in the 2016 election.
Affordable Care Act
Nondiscrimination remains a huge issue when it comes to LGBT communities and the Affordable Care Act. Transgender “young invincibles” in many states aren’t signing up because their health care needs, including transition-related treatments, aren’t covered by the insurance they can get through the marketplaces.
Section 1557 of the Affordable Care Act prohibits discrimination, and advocates are eagerly awaiting the regulations that will explain how that section should be implemented. The regulations should soon be open for public comment. Advocates hope that the regulations will address these areas, among others:
- The prohibition against discrimination based on sex and gender should include gender identity and sexual orientation.
- The regulations should include concrete examples of discriminatory practices that should be prohibited, such as benefit design that excludes care for transgender people based on gender identity, and prescription drug tiering that places HIV medicines on the most expensive tier, consequently steering HIV+ patients away from choosing those plans.
- And the regulations should include definitive statement that transgender patients need to be able to access medically necessary services that are available to non-transgender people.
California is ahead of the curve on health care for transgender patients. The Department of Managed Health Care and the Department of Insurance affirmed in 2013 that insurance plans have to cover medically necessary care for transgender people and are not permitted to have transgender-specific exclusions. This applies to all plans sold through Covered California, as well as to those sold outside of the marketplace.
California is also leading the way on protecting consumers from discriminatory benefit design by regulating prescription drug costs. AB339 (Gordon), which is currently awaiting a vote by the Senate Health Committee, would make high-cost prescription drugs much more affordable to consumers, and would prohibit plans from placing all of the drugs available to treat a condition on the highest cost tier. In a separate process, Covered California took action in May to place a monthly cap on individual prescription costs.
Comprehensive data collection about sexual orientation and gender identity (SOGI) is critical to a systematic approach to improving LGBT health. The ability to count LGBT people, document the disparities that exist, and identify successful interventions will allow for high-impact strategies to improve LGBT health.
- The federal health insurance marketplace should begin to collect SOGI data on all their applications. Advocates recently sent a letter to CMS asking to add SOGI questions to the application, and will meet with CMS soon to discuss the issue.
- CMS should allow states with a state-based marketplace to add SOGI questions to their applications if they want to, and include those questions with other demographic questions that are already on the application. Advocates will meet with CMS soon to discuss the issue.
- As the federal government urges more providers to move towards using Electronic Health Records (EHR) and as EHR platforms and protocols are developed, it is important to include SOGI data collection in electronic health records and to ensure meaningful use of these data over time. To this end, advocates recommend that sexual orientation and gender identity be standard data fields included in the EHR, while it remains optional to put any data in those fields. Currently most EHR vendors don’t include data fields for SOGI, so providers don’t even have the option of including that data.
- The National Health Interview Survey has taken steps towards including a sexual orientation question. Advocates would like to see questions about gender identity included on national surveys as well.
FDA Blood Ban
The Food and Drug Administration released draft regulations in May that lifts the blanket ban on blood donation by any man who has had sex with a man since 1977. The draft regulations would allow men who have sex with men to donate blood if they are healthy and haven’t had sex with a man in the last year. While this is a huge improvement, it is still a practical ban on any sexually active gay man. The proposed regulations don’t go far enough and don’t adhere to what studies have shown about HIV transmission. HHS will get numerous comments from advocates expressing this during the open comment period. Comments are due July 14, and can be submitted here.
Medicare and Medicaid
- Medicare cards still have a sex marker on them, which is completely unnecessary. This forces many transgender people to be “out” every time they use their Medicare card, including with a receptionist at the doctor’s office or at the pharmacy when they pick up medication. There is no need for the sex marker on the Medicare card, and advocates would like the marker removed when new Medicare cards are issued.
- While it is fantastic that Medicare has done away with the categorical exclusions of gender affirming surgeries, people still aren’t able to actually get these surgeries. There are network adequacy problems, as well as foot-dragging by Medicare contractors who simply aren’t following the World Professional Association for Transgender Health standards of care.
- In Medicaid, around 40 states still have categorical bans on providing such necessary care to transgender people, either in practice or written into the law. A letter to state Medicaid directors clarifying that section 1557 of the ACA prohibits categorical exclusions would go a long way towards improving health care for transgender people. Medi-Cal, California’s Medicaid program, does cover transition-related health care for transgender people.
- Given that 20% of LGBT Americans live below the poverty level (compared to 17% of non-LGBT people living alone) and that transgender people arefour times more likely to have incomes under $10,000 per year, the fact that many states still haven’t expanded Medicaid is a huge problem for LGBT communities.
- Coverage for HIV medications needs to be improved; the current copays are too high and many plans simply don’t include important HIV medications on their formularies—indirectly avoiding risk.
- There are plans that include PrEP or PEP (the only two medications effective at preventing HIV infections) on their formularies, but too many routinely deny coverage when the medication is prescribed. While this can be appealed, delay of PEP coverage is particularly problematic because it needs to be taken within 72 hours to be effective. Guidance to plans from HHS would be helpful in addressing this issue.
- Not enough health funders are putting money into LGBT health – they need encouragement to put money into LGBT health work.
- The Model States Vital Statistics Act of 1992 went through the beginnings of a revision process in 2011. This model act provides guidance to states as they consider revising their own Vital Statistics Acts. The proposed revision included great steps forward on how to properly respect transgender identities on birth certificates and death certificates. The revision has been held up somewhere for reasons unrelated to identity markers and respecting transgender identities, and it would be great to get that moving again.
- Our nation’s foster care and adoption systems need to be fundamentally reformed. Currently, there are no protections in place federally for LGBTQ youth, so youth often stay in the closet or are mistreated based on sexual orientation or gender identity. Additionally, many states don’t have nondiscrimination requirements for their foster and adoption agencies. This results in some agencies turning away prospective parents (same sex couples, single people, and gender non-conforming people) even if state law allows them to be adoptive parents.
Photo credit: Transequality
Here’s President Obama’s statement on the Supreme Court’s upholding of the Affordable Care Act:
For another more exuberant reaction, here’s a tweet that shows, from the steps of the Supreme Court, the response of our colleague Ron Pollack, executive director of Families USA. While California would not have been impacted, we are relieved for the millions of Americans who have continued coverage because of the Affordable Care Act, with even more security that such coverage and financial assistance won’t be taken away.
Once again, the Supreme Court ruled this morning to uphold the Affordable Care Act (ACA) on a 6-3 vote in the King v. Burwell case, which challenged the subsidies available in the states that have federally facilitated marketplaces under the five-year old federal law. The case was based on four words of Section 1311 of the ACA, which argues (contrary to any literal and contextual reading of the law) that subsidies are only available to people in state-based exchanges.
ACA IS HERE TO STAY: Now that the Supreme Court has upheld the Affordable Care Act once again, we hope we can stop debating a five-year old law and discuss additional ways to reduce health costs and provide more health and financial security for American families. Californians never needed to worry, since our exchange is state-based, even as we were concerned about the impact on millions of Americans in other states. This ridiculous challenge should have never been taken, since it was based on a hyper-literal willful misreading of four words of the Affordable Care Act, going against virtually all evidence of Congressional intent and judicial precedents.
CALIFORNIA MOVING FORWARD: While this case attempted to rewrite history, California has been looking to the future in implementing and improving health reform. Previously the epicenter for the uninsured crisis in America, California have already cut our uninsured rate in half, and provided new consumer protections for million. In one of many efforts to not just implement and improve upon the Affordable Care Act, California just committed to cover all children regardless of immigration status. Pending bills would use the ACA as a platform to provide additional consumer protections against unfair out-of-pocket costs. California shows how we need to be discussing additional steps to provide health and financial security for all Americans, and not re-debating a five-year old law.
Today, the Senate Health Committee heard AB 248 (R. Hernández) and passed it out on a 6-1 vote, with Senator Nielsen voting no and Senator Nguyen abstaining. Sponsored by Health Access, AB 248 would close a loophole created by federal guidance that allows insurers and health plans to sell subminimum coverage to large employers.
Specifically, AB248 protects California workers by holding health insurance sold to large employers to a minimum standard in terms of value. Federal and state law already hold insurance sold to small employers and individuals to a basic standard (60% actuarial value), but insurers are free to sell large employers “junk” plans. When large employers offer such plans employees are stuck between a rock and hard place: with unmanageable costs for benefits that are not covered or thousands of dollars in out-of-pocket costs (see Health Access’s fact sheet for details).
Here’s the rub: if an employee accepts an employer’s coverage, even if it is subminimum coverage, the employee is automatically ineligible for premium subsidies through Covered California—and the employer gets off the hook on the employer responsibility penalty.
Speaking in opposition to the bill in in today’s robust committee discussion were California Association of Health Underwriters and the California Association of Small Employer Health Plans. Both groups opposed the bill, arguing that it would make health care premiums even more expensive for large employers if there was a requirement for employer-plans to hit the 60% minimum value threshold before other products can be added.
Health Access and consumer advocates argue that subminimum plans don’t reduce health costs, but simply shift those costs onto workers. They pointed to the deleterious consequences of current loophole for consumers: Consumers may not know or even be told the cost implications of whatever offer of coverage they are accepting–much less what it’s actuarial value is (how many of us can explain what that is?), which leaves them vulnerable to medical debt or bankruptcy from a single visit to the emergency room.
Other bills were also considered: AB 635 (Atkins), a bill that would provide for interpretive services in Medi-Cal was also heard in committee today and passed out successfully. AB 1114 (Bonilla) which clarifies that Medi-Cal and Covered California renewal forms and notices be translated into the thirteen Medi-Cal threshold languages, was on consent and will be moving to Appropriations along with AB 248 (Hernández) and AB 635 (Atkins).
California Healthline this week is hosting a discussion on our bill, SB248(Hernandez) to prohibit subminimum coverage. We sponsored this bill to close a loophole in the ACA that allows such coverage–prohibited in the individual and small group markets–to be offered by large employers, and if taken up could prohibit workers from getting subsidies for comprehensive coverage in Covered California. This bill is up in Senate Health Committee today.
We appreciate the contributions from Julie Silas of Consumers Union and Gerald Kominski of UCLA Center for Health Policy Research. Here’s the full un-excerpted contribution from our policy advocate Beth Capell:
Some of the success that California has had implementing the Affordable Care Act could be undone if the state doesn’t close a loophole that, if exploited by some employers and insurers, could deny workers access to care and subsidies for coverage.
Health Access is proud to sponsor AB248 by Assemblymember Roger Hernandez, to close this loophole, and ensure workers get the care and coverage they need, rather than subminimum “junk” coverage.
Ask yourself if your employer offered you, in Spanish, a brochure on “Freedomcare” which covers:
- Unlimited eye exams: but not glasses or treatment
- Diabetes “counseling” but not insulin or other treatment
- Cancer testing but not surgery, radiation, chemotherapy or other cancer treatment
- Oral health evaluations but not dental care: no cleanings, no fillings, no root canals
- Diabetes testing but not treatment
- Cholesterol tests but not treatment
- Supplements but not prescription drugs
This so-called coverage actually doesn’t actually cover much at all. This “prevention-only” coverage does NOT cover:
- Emergency room
- Prescription drugs
- Lab tests (except as specified)
- X-Rays, MRIs, other imaging
The ACA set minimum standards for health plans, so patients who need care won’t get stunned with huge bills because of exclusions in their coverage. But for employer-based coverage, there’s a loophole. If a worker takes this plan, it gets the employer off the hook for the employer responsibility penalty.
Your employer, and the insurance broker, tells you this coverage gets you out of the individual mandate. They do not tell you that if you take this, you cannot go to Covered California and get tax subsidies. They do not tell you that you might be eligible for free Medi-Cal if your income is low enough.
Right now, an employer who offers such coverage faces no penalty for offering such subminimum coverage. What kinds of businesses this coverage marketed to? Those with low-income workers like agriculture corporations, staffing companies, janitorial services, resorts, golf courses, call centers, landscaping companies, and security firms.
Most health plans do not offer such subminimum coverage in California: not Anthem, not Blue Shield, not Kaiser, not HealthNet, not any of the plans that contract with Medi-Cal managed care or Covered California or that dominate the employer market in California. But we should address this practice before it becomes widespread to the detriment of workers and our whole health system.
The Internal Revenue Service could close this loophole nationally, but until they do, California needs AB248(Hernandez) to put a stop to such subminimum coverage.
Following a presentation by Executive Director Peter Lee on Covered California’s “story” of success and need to transition from start up mode to a mature operation with sustainable financing, Thursday’s Board meeting had exactly one action item: approval of the Covered California budget for fiscal year 2015-2016.
Comings and Goings
Director Lee announced the retirement from 35 years of state service of David Panush, after three years as Covered California’s Director of External Affairs and previously many years in the California State Senate. We at Health Access wish David Panush well in his future efforts, which likely will include playing music in a band.
Executive Director Report: Building on Covered California’s Story of Success
As an active purchaser exchange, Covered California has made the promise of reform real for millions of Californians, not just cutting the uninsured rate almost by half, but also delivering on the triple aim: better care, healthier people, and lower costs. Those with coverage have better coverage—and as the largest purchaser in the state with 1.3 million covered lives (“Sorry, CALPERS”), Covered CA has real clout to extend its impact even further and in all insurance markets.
Going forward, Covered California will be leveraging its role as an “active purchaser” to ensure enrollees are getting the right care at the right time through delivery system reform. As a condition for offering products on Covered CA, all plans will…
- participate in payment reform and quality collaborative;
- develop programs to chart progress in reducing disparities;
- determine the health status of adults and use that information to improve health;
- encourage consumers to use their benefits and seek preventive care;
- help consumers select a PCP or team-based care or clinic;
- help those with chronic conditions manage their health;
- Provide and update information showing total costs and out of pocket costs for the most used services.
In their comments advocates heartily applauded Lee’s plans to “raise the bar” on these efforts and others addressing health equity. Speaking for Health Access, Beth Capell urged Covered California to meet the quadruple aim (the triple aim + equity), especially given the populations covered in Covered CA. Betsy Imholz of Consumers Union and Cary Sanders of CPEHN (California Pan-Ethnic Health Network), too, welcome the opportunity to address disparities through delivery system reforms. To ensure that equity goals are “baked into the mission,” Covered California has a new Disparities Officer assigned to these issues, Jonathan Tran, though Lee made a point of clarifying that it is the job of all on the staff to address disparities.
Covered CA is in the top seven states in enrolling the subsidy-eligible population. Special enrollment numbers showed that since the last open enrollment 129,800 have enrolled, with lost insurance as the number one reason (53,303). The second highest category of SEP enrollees (42,413) enrolled thanks to the special SEP circumstance created earlier this year: informed of tax penalty. Enrollment by ethnic groups has been closer to projections, though a significant number (30%) still don’t disclose their ethnicity when they enroll.
Covered California’s $335 million budget reflects the transition away from federal exchange establishment funds toward exclusive reliance on health plan assessments. As presented by Finance Director Jim Lombard, the 2015-16 budget also reflects:
- a continued focus on enrollment and retention
- an investment in analytics and a data warehouse to understand enrollees’ experience with health care and to help them get the right care and the right time, through delivery system reforms.
The new budget also puts the focus on helping people understand their benefits and making sure they have information they need, in the right formats, to make informed choices.
To those ends, consumer advocates had hoped to see a stronger commitment to navigators and consumer assistance in the 2015-16 budget.
Elizabeth Landsberg of Western Center on Law and Poverty described the calls she gets from a number of groups, including the California Hospital Association—very often, if their caseworkers encounter complex problems, they call HCA (Health Consumer Alliance)—but the new budget reduces their funding to $1.3 million.
Earlier in the week some of the consumer and legal assistance and navigator groups that work with the most vulnerable populations met with Lee to challenge recommendations to reduce funding for navigators (see Asians Advancing Justice Coalition letter). In response Lee pointed out Covered CA’s history of responsiveness to feedback from advocates recommendations along these lines. After meeting with navigators and advocates, Lee agreed to set aside $3 million for navigator tied to meeting precise performance criteria.
Overall, despite arguments by Obamacare opponents, Covered California has shown itself to be sustainable, said Anthony Wright of Health Access, who urged that Covered California invest more in marketing, outreach, and enrollment, given that would contribute to the exchange’s long-term sustainability. He suggested an evidence-based trigger to use Covered California’s substantial reserves to make the investments necessary to meet or exceed the enrollment targets.
The budget as proposed was adopted unanimously by the Board. With no meeting in July, the Board is set to reconvene in August.
This afternoon, the Senate Budget Committee met to review details of the budget deal announced on Tuesday by Governor Brown, Assembly Speaker Toni Atkins, and Senate President Pro Tempore Kevin de León. Most notably, the agreed upon 2015-16 state budget includes a historic expansion of full-scope Medi-Cal for low-income children regardless of immigration status. While this major victory brings us one step closer to #Health4All Californians, the final budget included few other investments sought by health and human service advocates, including restorations to Medi-Cal benefits and rates.
Beyond coverage for all California children, other health augmentations included restoration of Denti-Cal reimbursement rates, and investments in public health programs around HIV and hepatitis C prevention.
The budget agreement announced on June 16 outlines broad areas of consensus between the Governor and the Legislature, including which big ticket items will be funded and, implicitly, which will not. The fine details of the FY 2015-16 budget—the exact funding levels, effective dates, and programmatic scope of programs—are set forth in the omnibus health budget trailer bills, AB 94 and SB 75. While this agreement is already in place, the Legislature has to formally pass the main budget bill and trailer bills, and the Governor is expected to sign them prior to the start of the budget year on July 1. Here are highlights of budget priorities for health care consumers, starting with the good news.
*Health4All: The budget allocates $40 million to enroll undocumented low-income children in full-scope Medi-Cal. This effort is projected to enroll 170,000 children in Medicaid managed care and cost $132 million/year under full implementation for a full year. The budget deal includes language directing DHCS to seek federal matching funds for this expansion; if federal funds are not available, then state-only funds will be used to provide coverage. Coverage for kids will be available no later than May 1, 2016, which is five months later than what the Legislature initially proposed. As noted in the press conference announcing the budget deal, the delayed start date resolved the disagreement between the Governor and Legislature about how many children would actually enroll. Unfortunately, language requiring the state to research the feasibility of capped enrollment for undocumented adults was not included in the final budget deal. Senator Lara has committed to continue pursuing a path for adults to be covered in SB 4.
*Eliminate Rate Reductions for Dental Providers: The final budget eliminates the 10% rate reduction adopted in 2011 for Medi-Cal dental providers effective July 1, 2015. A recent state audit of the Denti-Cal program revealed extreme access issues because of low reimbursement rates for dental providers.
*Investments in Public Health Programs: Though exact amounts are not known at this time, the budget deal includes funding for Hepatitis C (HCV) Linkage to Care Projects; the Syringe Exchange Program, which helps prevent HIV and Hep C and other infectious diseases; and Pre-Exposure Prophylaxis (PrEP) Access and Outreach Program, which will help develop protocols for outreach to targeted at-risk populations.
OTHER CHANGES FOR HEALTH CARE CONSUMERS
The budget is notable in terms of what’s missing: long-sought restorations to Medi-Cal benefits and rates cut during the recession. There may be opportunity to look at these issues, though in the larger context of Medi-Cal financing in the special session Gov. Brown called (see his Resolution). The health care special session, which will run concurrently with the regular legislative session, will address Medi-Cal financing and a revamping and expansion of the MCO (managed care organization, or health plan) tax. This existing tax on managed care plans helps draw down federal funds and provides about $1 billion of funding to the Medi-Cal program. Now it needs to be reconfigured to conform to federal guidelines. A revamped MCO tax or any other tax considered to fund Medi-Cal would still require a 2/3 vote, meaning support from Republicans as well as Democrats, but a special session allows more flexibility in terms of legislative deadlines, and measures passed in special session and signed by the Governor go into effect immediately. Health consumer advocates plan to actively participate in this effort.
The budget trailer bills also includes the following policy changes or initiatives:
*Eliminating language on Medi-Cal co-pays for non-emergency visits to the ER(a violation of federal law): The budget trailer bill eliminates statutory language adopted during the recession that directs the state to implement a copay for emergency room usage for non-emergencies. While this copay has never been implemented, as it has not been approved by the federal government, legislators sought to take this out of California law, so it isn’t misused in the future.
*Information on how to apply for insurance affordability programs like Covered CA or Medi-Cal. Enrolling providers who participate in Limited Benefit and Special Population Programs (Every Woman Counts, Family Planning Access Care and Treatment or FPACT and IMProving Access, Counseling, and Treatment for Californians with Prostate Cancer (IMPACT)) will be required to provide individuals with information on how to apply for programs such as Medi-Cal and Covered California.
*LifeLong Community Clinic: The budget allocates $2 million to support an urgent care clinic operated by the LifeLong Community Clinic that will serve communities affected by the closure of Doctors Medical Center in West Contra Costa County.
*Child Health and Disability Prevention Program Dental Referral. Requires public health programs and providers to refer all Medi-Cal-eligible children aged one year or older to a dentist participating in the Medi-Cal program.
*ADAP Modernization. This budget updates financial eligibility for AIDS Drug Assistance Program (ADAP) and the Office of AIDS Health Insurance Premium Payment program to consider family size and increase the income limit for these programs.
The Senate and Assembly will vote on the budget bill and trailer bills tomorrow.
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Details on #CABudget health priorities from Health Access http://bit.ly/1J6PwaH
Today, the Sacramento County Board of Supervisors voted 5-0 approving a budget for the coming fiscal year which includes a staff recommendation to provide indigent care services to undocumented residents. It’s a historic day for Sacramento: the Sacramento Board of Supervisors has made a important start in addressing undocumented Sacramentans’ need for quality, comprehensive health care.
The proposal approved by the Board today came out of a workshop held by the Board last March on healthcare services for undocumented immigrants. During the course of that hearing, Sacramento County Department of Health and Human Services staff presented potential options for covering undocumented immigrants along with cost estimates for each option. Health Access joined several dozen advocate organizations and a handful of elected officials, including Sacramento Mayor Kevin Johnson, State Senator Richard Pan, and Assemblymember Kevin McCarty in support of providing healthcare services to undocumented immigrants.
The proposal approved by the Board today provides for primary care, preventative care, some specialty care and limited pharmacy benefits to approximately 3,000 undocumented immigrants in Sacramento County. Not unlike other county safety-net programs in the state, eligibility is restricted to adults between the age of 19-64 and income levels up to 138% FPL. The total cost of the program is estimated to be $6.7 million, which includes county and partner resources, with total new General Fund cost estimated at $1.9 million. While there are some limitations to the proposal that was approved today, including limitations around geographic points of access and services, today’s decision is a step in the right direction and provides momentum for other counties to reorient their safety-net programs to better serve the remaining uninsured. We expect other counties to follow suit soon, to be more inclusive and to improve their safety-nets. Our health system works best when everyone is included.
Pictured above: Sawait Hezchias-Seyoum, Health Policy Advocate with Health Access, testifying before the Sacramento Board of Supervisors at the June 16, 2015 hearing.
Pictured above: Beth Capell for Health Access, Senator Ricardo Lara (author of SB 4), and Ronald Coleman of the California Immigrant Policy Center.
Big Step Forward on #Health4All
Today in a joint press conference with California Assembly Speaker Toni Atkins and Senate President Pro Tempore Kevin de León, Governor Brown announced a budget deal that includes $40 million for a Medi-Cal expansion for low-income children regardless of immigration status. The expansion would be effective May 1, 2016 (four month later than the Legislature’s proposed start date). The proposal would eventually cover 170,000 children and cost $132 million when fully implemented and the full number of children expected to actually enroll.
This expansion of coverage to all children regardless of immigration status would make California’s children healthier, our health system stronger, and our families and communities more financially secure. Ensuring all California children, regardless of immigration status, have access to primary and preventive care, advances the effort to improve the quality and reduce the cost of the health system on which we all rely. We thank the Governor and legislative leaders for taking this next step for a health system that works for all Californians. While Washington continues to see gridlock on immigration and health issues, this proposal would continue California’s leadership in both health reform and immigrant inclusion. California will be the largest state to make this commitment to cover all its children (along with NY, IL, WA, MA and DC), regardless of where they were born, and we expect additional steps in short order.
A related bill SB4 would make California the first state in the nation to expand Medi-Cal to undocumented immigrants (up to a capped amount set in the California budget), and allow undocumented immigrants above those income levels to use their own money to buy a health plan in Covered California. This bill will soon be heard in the Assembly Health Committee.
Key Health and Human Service Cuts Not Restored In Budget Deal
The budget deal did not fully restore Denti-Cal or other recession-era cuts to medically necessary Medi-Cal benefits like audiology, speech therapy, or podiatry. The Legislature’s budget sought to restore these benefits, as well as to begin the restoration of Medi-Cal provider rate reimbursements which were cut by 10% several years ago.
We still have more to do to restore the health and human services cut during the recession. The cuts made during the recession were penny-wise but pound-foolish, cutting services like dental and podiatry, and access to primary and preventive care. California needs to continue to work on these restorations to provide more efficient and cost-effective care overall.
There may be opportunity to look at these issues, though in the much larger context of Medi-Cal financing. The Governor used his press conference to call for a special session to address financing of the Medi-Cal program in general and in light of both regulatory changes in allowable uses of federal matching funds and the dramatic increase in enrollment from the Affordable Care Act (see the Governor’s special session resolution on this topic). The special session may be an opportunity to revisit these restorations of Medi-Cal rates and benefits and to address access issues in general.
The budget deal came on the same day as a state audit of Medi-Cal showing there is still significant work to ensure that the 12 million Californians with Medi-Cal coverage have access to needed services and care. Specifically, the audit finds that DHCS did not verify that the provider network data that it received from the plans were accurate, which means that DHCS cannot ensure adequate access to providers for Medi-Cal beneficiaries. These findings provide momentum for pending reforms, including implementation of annual surveys of network adequacy through SB 964 (Hernandez), which passed last year, and consideration of SB137 (Hernandez), which is pending in the California Assembly. SB137, co-sponsored by Health Access, Consumers Union, and CPEHN, addresses the problem of inaccurate, out-of-date, and misleading provider directories.
See Health Access’s Press Statements on:
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