Key Bill Pass Health Committees, Capping a Productive Half-Year of Progress

Earlier this week, the Assembly and Senate Health Committees passed a series of key patient protection bills to increase transparency and protect consumers from unfair health care costs. Sponsored by Health Access California, these measures would prevent patients from facing surprise out-of-network medical bills and mid-year cost-sharing increases, and provide notice of unjustified premium rate hikes, rising prescription drugs costs, and patients’ rights to timely appointments and medical interpreters.

This was the culmination of a busy first half of 2016, which saw significant progress not just on this consumer protection agenda, but also on the state budget and restorations and investments in health and human services; on winning key conditions to health insurance mega-mergers; on public health and the enactment of the most sweeping smoking prevention legislation in a generation; and in advancing the goal of #Health4All at the state and county level, to expand coverage to all Californians regardless of immigration status.

Even with these advances that we further detail below, more work is required to solidify these gains. Health Access California needs your help to bank these victories and take advantage of the other opportunities for progress in 2016. We invite your membership so that Health Access can be stronger as a coalition organization when we seek to win new benefits on behalf of California consumers and communities–from patient protection legislation to new revenues on the ballot to allowing the state to invest in health and other vital services.

Below are just some of the successes we’ve acheived already this year. With your membership and contribution, we can acheive many more victories to come.

Patients’ Rights and Other Key Legislation

Even with the passage of the Affordable Care Act, Californians continue to complain about unfair health care costs. Some relief is on the way with a package of patient protection bills sponsored by Health Access California:

Four of these bills passed the Senate Health Committee in the last two weeks. They include:

·       SB908 (Hernandez) would notify patients of “unreasonable” rate increases and provide a new opportunity to shop around.

·       SB932 (Hernandez) would prevent insurers from raising co-pays and cost-sharing mid-year.

·       SB1010 (Hernandez), co-sponsored with the California Labor Federation, would provide notice and disclosure on rising prescription drug costs.

·       SB1135 (Monning) to provide patients more information about their rights to timely access to care and language access.

Yesterday, the Assembly Health Committee also approved AB72 (Bonta, Bonilla, Dahle, Gonzalez, Maienchein, Santiago, & Wood), new and improved bipartisan legislation to resolve the issue of surprise medical bills, so a patient visiting an in-network hospital or facility doesn’t get a bill of hundreds or thousands of dollars from an out-of-network physician during that visit. Co-sponsored with the California Labor Federation, now with seven joint authors including two Republicans and four members who didn’t support last year’s effort. We are hopeful this will break the logjam we faced last year with AB533, while providing even stronger consumer protection. Read the fact sheet here.

You can also visit our legislative action webpage to find fact sheets and sample letters on these bills. All of the patients’ rights legislation are now in the Appropriations Committee and we expect a vote there and on the legislative floors in August.

For more information on where the bills stand, please see our full bill matrix.

The matrix doesn’t include the bills already signed, such as the budget and the MCO tax as well as the #Health4All bill to open up Covered California. Health Access was also proud to support a package of the most significant tobacco control legislation in decades that included raising the age to purchase tobacco to 21 and regulating e-cigarettes.

Progress to #Health4All 

This past year saw historic progress on the goal of expanding health care coverage to all Californians, regardless of immigration status.

·       In May, we helped launch the expansion of Medi-Cal to cover all children, regardless of immigration status—which means every California child, in every classroom and every playground, now has access to affordable coverage. We have been working to ensure easy transition of children into full-scope Medi-Cal from existing programs like emergency Medi-Cal, county initiatives and Kaiser charity care coverage.

·       Last month, we also highlighted the expansion of a new primary care benefit to many rural Californians, without regard to immigration status, through the 35 counties in CMSP. While a year ago, only 9 counties provided non-emergency care to the undocumented, today that number is 47, with new pilot programs in Contra Costa, Monterey, Sacramento, and elsewhere. This dramatic expansion of county care is spotlighted in Health Access’ new report, “Profiles of Progress: California Counties Taking Steps to a More Inclusive and Smarter Safety Net.”

·       In the last few weeks, the Governor signed SB10 (Lara), which the California Legislature passed—on a bipartisan, supermajority 2/3 vote—to authorize the state to seek a first-in-the-nation federal waiver to allow all Californians, regardless of immigration status, to buy health insurance through Covered California. We have already been meeting with HHS, Treasury and White House officials in Washington, DC in order to smooth the application and consideration process.

Budget and Investing in a Healthier California

A new state budget has passed, and we were pleased that the budget included some investments to key health and human services priorities, including child care, housing, and repealing the maximum family grant policy in CalWORKS. In health care, the budget will limit estate recovery in Medi-Cal to long-term care, undoing a counterproductive and inequitable policy that threatened the family home of low-income Californians in Medi-Cal managed care.

Our Budget Scorecard details the health investments that were included in the state budget—from the restoration of acupuncture as a Medi-Cal benefit to investments in public health programs—as well as what was not included which we will continue to fight for.

This budget included two victories secured earlier this year that brought significant federal money into California to support our health system. One was a new Medicaid waiver, which draws down new federal dollars to spur new innovations in our health system. Health Access worked hard in the development and pursuit of this “Medi-Cal 2020” waiver, which is encouraging delivery system reforms in our public hospitals, improved dental care, smarter and more inclusive safety-net care for the remaining uninsured, and new county efforts to provide integrated “whole person” care.

Health Access also supports the new revamped managed care organization (MCO) tax, which prevented a loss of over a billion dollars in Medi-Cal funding, and allowed for additional investments in home care and services for Californians with developmental disabilities.

This fall, Californians will get to vote on key ballot measures to ensure that resources are available for further investment and restoration in health and other vital services. Health Access is actively working to extend the existing upper-income taxes to prevent new cuts, and strongly supporting the tobacco tax measure, which would not just prevent youth smoking and save lives, but also raise revenues for needed investments in Medi-Cal.

Join Us! Become a Member of Health Access California

Please consider becoming a Health Access California member. Your partnership, and the modest membership contribution, goes a long way, and allows us to be even more active in helping your organization and others be as effective as possible on health policy issues on behalf of your community and constituency.

If you want to donate as an individual, we would welcome that support as well.

With your support, as an organization and/or as an individual, we can work to pass these bills and ballot measures for a healthier California.

Assembly Health Committee Passes Key Bills on Rx Costs, Unjustified Premiums

Today, the California Assembly Health Committee passed three key patient protection measures to protect patients from unfair health care costs, most notably the heavily lobbied SB1010 (Hernandez) to provide notice and disclosure on prescription drug costs. After a very long hearing, the bill passed with 12 votes, with all Democrats in support.

The committee also voted to pass two other bills: SB908 (Hernandez) would inform Californians if the health plan they are in is charging a premium hike that is determined to be “unreasonable” or “unjustified,” and give consumers time to shop for another plan, and SB1135 (Monning), which would inform consumers of their right to a timely appointment and care in the language they speak.

Legislators today appropriately voted for SB1010 (Hernandez), co-sponsored by Health Access California and the California Labor Federation, to provide some notice and disclosure to address the surprise and unexplained prescription drug price hikes that Californians have been facing. Despite the over-the-top scare tactics from the drug companies, this modest transparency effort lives to fight another day.California law requires similar transparency for almost every other part of the health system–this bill would simply asks that health care purchasers and patients get the same notice and disclosure from the prescription drug companies.

Legislators also agreed today, by passing SB908 (Hernandez) that when insurers decide to move forward with unjustified rate increases, patients should be notified so they can potentially shop around and let the market work.

In all, the transparency legislation passed by Assembly Health Committee today would better inform California consumers about the rising cost of prescription drugs and their choices when charged with an unreasonable premium hike, as well as their rights to get a timely appointment or a medical interpreter. We hope in floor votes to come, California legislators continue to put patients first and provide real relief from these unfair health costs.

Senate Health Committee to Vote on Legislation to Stop Surprise Medical Bills

By Tam Ma, Policy Counsel, Health Access California

AB 72 (Bonta, Bonilla, Dahle, Gonzalez, Maienschein, Santiago, Wood) is being heard in the Senate Health Committee Wednesday, June 29, 2016.

Patients know they have to follow their health plan or insurer’s rules and go to in-network providers and facilities to keep their out-of-pocket costs low. Unfortunately, many patients end up getting a surprise medical bill for hundreds or thousands of dollars from an anesthesiologist, radiologist, pathologist or other specialist who turns out to be an out-of-network provider; one the patient probably never met, did not choose, and often had no control over selecting.

Health Access and Consumers Union have heard from hundreds of consumers who have received surprise medical bills in spite of doing their homework and making sure they were getting care at an in-network facility:

Cassie R.

Cassie R. was diagnosed with breast cancer a year ago and needed a minor surgery after a mastectomy. Although she made sure the outpatient clinic was in network, she ended up getting a $600 surprise bill from an anesthesiologist. Watch this CBS news story about Cassie’s surprise bill and how it affected her finances.

Sarah R.

When Sarah had a baby in June 2015, she researched her options and chose an in-network hospital. She ended up having an unplanned C-section and was surprised when she received a $1,050 bill for the out-of-network anesthesiologist.

“I’m grateful that my baby girl is healthy and that my delivery went well, but I had no idea the anesthesiologist would be out-of-network and not covered by my insurance. That unexpected additional $1,050 bill was a burden on our budget.”

Jen C. 

Jen has a hereditary blood vessel disease that can cause brain damage or a stroke. In 2015, Jen had a stroke that required brain surgery, which she had at an in-network hospital with an in-network brain surgeon. However, after the surgery, they received $808 in bills from an out-of-network neurologist.

“We had no idea this was going to happen—and Jen’s husband was there the whole time,” shared Becca, Jen’s mother-in-law. “It’s frustrating and unfair that she never had the chance to be seen by an in-network neurologist in the first place. We just don’t have the money to pay for this. All our money has been spent on premiums, which are supposed to cover this. And when you go in for major surgery, you don’t have resources to deal with surprises like this.”

Surprise Medical Bills Burden California Consumers

Each year, thousands of Californians like Cassie, Sarah, and Jen receive surprise out-of-network bills despite following their health plan or insurer’s rules. In 2015, a Consumer Reports National Research Center survey found that 1-in-4 privately insured Californians face surprise medical bills, which wreak havoc on people’s finances and their ability to pay for basic necessities. A recent Kaiser Family Foundation survey found that 61% of those with medical bill problems say they have difficulty paying other bills as a result of their medical debt and more than a third (35%) were unable to pay for basic necessities like food or housing. Just last month, the Federal Reserve said that nearly half of U.S. households reported they would have trouble meeting emergency expenses of just $400.

AB 72 Protects Consumers from Surprise Out-of-Network Bills.

AB 72 ensures that consumers are not on the hook for surprise bills from out-of-network charges that were outside of their control. Specifically, among other consumer protections, the bill:

Requires health plans to let consumers pay the same co-pays and other cost sharing that they would pay for in-network care when they end up being treated by an out-of-network provider at an in-network facility.
Protects consumers from having their credit adversely affected, wages garnished, or liens placed on their primary residence.
Allows a consumer to voluntarily consent to an out-of-network provider if the consumer is enrolled in a PPO with out-of-network benefit and specified procedures are followed.

AB 72 keeps our health care costs under control.

Insurers must reimburse out-of-network doctors a fair rate for their services: 125% of Medicare or the insurer’s average contracted rate, whichever is greater. As a result, doctors are assured a minimum payment in statute, and they can appeal to the state’s Independent Dispute Resolution Process (IDRP) if they want a higher payment.

Key Patient Rights Legislation Up Next Week

 

Yesterday, the Assembly Health Committee passed one consumer protection measure, SB 923 (Hernandez) on a vote of 17-0, to prevent mid-year increases in co-payments and other cost-sharing by a health plan. Other key legislation also authored by Senate Health Committee Chair Dr. Ed Hernandez and sponsored by Health Access California to protect patients from unfair health care costs, including unjustified premium increases (SB908) and prescription drug price hikes (SB1010), was rescheduled from this week to next Tuesday in Assembly Health Committee. Letters of support are due today.

These bills are part of a package of patients rights bills–including some of the most lobbied legislation this session–to help prevent unfair and unreasonable bills, premiums, and cost-sharing, inform consumers of their rights and options, and increase transparency to address the rising cost of care. Consumer advocates are urging California legislators to put patients first and provide real relief from these unfair health costs with their votes next week.

While most of these patients rights bills are in Assembly Health Committee next Tuesday, one measure up in Senate Health Committee on Wednesday is a new and improved effort to address the issue of surprise medical bills. AB 72 (Bonta, Bonilla, Dahle, Gonzalez, Maienschein, and Wood) is a revamped and bipartisan proposal to protect patients from surprise medical bills when they go to in-network hospitals and facilities, so they don’t get unexpected and unfair out-of-network bills from doctors and other providers from that visit. Co-sponsored by Health Access California and the California Labor Federation, the new version includes seeks to resolve the legislative logjam that stalled last year’s AB533 (Bonta), which fell short on the last day of session by just three votes. Since the failure of the legislature to act, California consumers have continued to receive surprise medical bills of hundreds or thousands of dollars from out-of-network providers after using in-network medical facilities. After months of negotiations between lawmakers, advocates, insurers, and business, the revised legislation will include even stronger consumer protections to stop these surprise bills while also ensuring that health professionals are fairly reimbursed for their work. AB72 is slated to be heard in Senate Health Committee on Wednesday, June 29th.

The most contested consumer protection bill next week is in Assembly Health Committee with SB 1010 (Hernandez) to provide transparency to soaring prescription drug prices for both public and private purchasers, as well as greater disclosure of prescription drug cost trends. In particular, the bill would require 60-day notice for prescription drug price hikes. California law requires such notice and disclosure for almost every player in the health system in order to reduce costs and improve quality. Last Tuesday, Health Access California and the California Labor Federation launched a digital campaign to call out Big Pharma in their attempts to operate behind a veil of secrecy, asking #WhatsPharmaHiding.

“Every dollar that goes to rising premiums is a dollar that does not go into workers’ pockets or to employers to expand their business and create more jobs,” said Steve Smith, Communications Director for the California Labor Federation. “Drug costs are increasing faster than other parts of the health care industry, driving up the cost of coverage for workers, employers and taxpayers. SB 1010 is an important first step to opening up the black box of prescription drug price increases, arming workers and employers with tools to help contain health care costs. AB 72 will protect workers from surprise medical bills that take money out of workers’ pockets, even when they do the right thing and go to an in-network provider.” He continued, “The California Labor Federation is proud to stand with Health Access and other groups today in support of this package of bills.”

Betsy Imholz, Special Projects Director for Consumers Union, the policy and advocacy arm of Consumer Reports noted that, “Consumer Reports’ survey results and the hundreds of California stories we have collected vividly illustrate that a significant number of insured Californians, through no fault of their own, are stuck with unexpected medical bills and drug price increases.” Imholz continued, “Families spending their hard earned dollars on health insurance premiums each month deserve the protection AB 72 will provide from these unfair, surprise out-of-network extra charges. SB 1010 provides the transparency on prescription drug prices essential to creating a competitive marketplace and fair negotiating landscape to contain costs for the state and all purchasers, workers and consumers.”

Also rescheduled for next week’s Assembly Health Committee is SB 908 (Hernandez) that would inform Californians if the health plan they are in is charging a premium hike that is determined to be “unreasonable” or “unjustified”, and give consumers time to shop for another plan.

“It is unacceptable so many consumers have been stuck with health insurance rate hikes that are unreasonable and unjustified. SB 908 will ensure consumers are notified if their rate isn’t justified and given the option to find a better deal for their dollar,” said Emily Rusch, Executive Director of CALPIRG. “Californians expect and should have assurance that their insurance co-pays and deductibles will not unexpectedly increase mid-year.”

The Assembly Health Committee will also hear next Tuesday SB 1135 (Monning), which would better inform patients of their right to timely care and language access, in the packets of mail they already send.

“With more low-income and communities of color now in the health system under the Affordable Care Act, it now more crucial than ever to prevent these unfair costs that could be destabilizing for the family’s finances,” said Sara de Guia, executive director of the California Pan Ethnic Health Network. “Patients should be informed of their rights and options. We strongly support SB1135, so Californians know they can get the care they need, and also have the right to a medical interpreter and a timely appointment.”

Health Access California would greatly appreciate any help to support on our package of patients’ rights legislation, much of which will be up next week in committee, including SB908, SB1010, SB1135 on Tuesday in Assembly Health Committee, and AB72 on Wednesday June 29th in Senate Health Committee.Our website has a fact sheet on the five bills of the 2016 PATIENTS’ RIGHTS LEGISLATION PACKAGE.

Here’s our legislative action webpage, with fact sheets and sample letters—many of which are due today: http://www.health-access.org/legislation-budget/legislation/legislation-2016.html Our website has fact sheets on all the bills, including SB1010(Hernandez) on prescription drug price notice and disclosure  and AB72, the new and improved bipartisan legislation to resolve the issue of surprise medical bills.

SB10 Signed! A Step Closer to #Health4All!

Last week, Governor Brown signed a bipartisan bill to remove a critical barrier to Covered California and allow all Californians to access the state health insurance marketplace, regardless of immigration status. SB 10 (Lara) authorizes the state to apply for a federal waiver that would allow undocumented immigrants to buy unsubsidized health coverage through Covered California. Currently, undocumented immigrants are barred from using the state marketplace under the Affordable Care Act even when using their own money and instead must go directly to a broker or health plan to purchase health insurance.

Governor Brown’s signature of this bipartisan bill is an appropriate recognition that our health system is stronger when everyone is included. We now look forward to California moving quickly to submit the application to remove this counterproductive exclusion, and a quick approval from the federal government. This proposal is not just a benefit for working immigrant families to more easily sign up for coverage, but helps the health and financial vitality of the entire community

We recognize that without subsidies, there will still be a significant affordability issue for many undocumented immigrants. But beyond the important symbolism of inclusion, this waiver application will provide a practical benefit for many California families with mixed immigration status, who will be able to buy coverage together easily, even if some family members are eligible for financial assistance and others are not.

California would make history as one of the first states to use the 1332 waiver process under the ACA, and the first state to pursue such a waiver for this purpose. Under “1332 waivers,” the federal government can allow states to change certain aspects of the Affordable Care Act, as long as the state can show it will meet the same goals of number of people covered, affordability, comprehensiveness of coverage, and cost to the federal government.

Budget Deal Reached!

The Legislature and the Governor have reached a budget deal! The Budget Conference Committee convened on Thursday night to take final action on budget issues in Conference Committee, which is described below. See how health priorities fared in our budget scorecard.

The revised budget includes several limited but important investments in health and human services, including in child care, housing, and other areas. In particular, the budget including the long-sought repeal of the Maximum Family Grant Rule in CalWORKS. The budget deal repeals the Maximum Family Grant rule in CalWORKS, a racist and punitive policy that puts families deeper into poverty. Health Access congratulates our allies in the health and human services community for this long overdue victory!

On health care items, details are still trickling out about the final budget deal, but we do understand it includes the following:

Medi-Cal Estate Recovery: We understand the budget deal includes funds ($26M GF) to limit Medi-Cal estate recovery to long-term care services, consistent with federal requirements. The federal government requires states to recoup certain medical costs – mostly related to nursing home care – from the estates of some Medi-Cal patients after they die. Current California policy, however, seeks repayment beyond the federal minimum and a patient’s estate is expected to pay back the value of ALL coverage, including premiums for managed care plans, received after a patient turns 55. This policy unfairly targets older Medi-Cal recipients (higher income Covered California patients don’t have to repay their subsidies), and discourages enrollment and home ownership. Health advocates have made this a top priority and are pleased the California budget is limiting estate recovery to the minimum required by federal law, aligning California with 40 other states.

Restoration of Acupuncture Benefit in Medi-Cal: The Conference Committee took action to allocate $3.7 million GF in 2016-17 (and $4.4 million ongoing) to restore the acupuncture optional benefit in the Medi-Cal program. This is a positive step toward restoring the non-federally mandated Medi-Cal benefits that were eliminated in 2009 for fiscal, not policy reasons. Denti-Cal was only partially restored in 2013. The remaining benefits that continue to be excluded in Medi-Cal coverage are: audiology, chiropractic, incontinence creams & washes, optician/optical labs, podiatry, vision, and speech therapy. Health Access will continue to advocate for full restoration these benefits, along with full adult dental benefits.

Medi-Cal Interpreters for Medi-Cal: The Senate and Assembly previously approved $15 million for in-person interpreters to assist Medi-Cal patients who do not speak English well. The Conference Committee reduced this amount to a one-time $3M GF allocation to establish a multi-county pilot project. These funds are contingent upon enactment of legislation authorizing the project. Both federal and state law require that all patients who need an interpreter should have access to one. About 40% of California residents regularly speak a language other than English, and many of the newly insured have language access needs. Language barriers can cause patients to be misdiagnosed, not get appropriate or timely treatment, and cause medical errors that jeopardize safety.

Hepatitis Initiatives: The Conference Committee allocated a one-time $1.4M GF allocation for Hepatitis Initiatives that increase Hepatitis B vaccinations for high-risk adults and provide resources for rapid Hepatitis C and HIV test kits. The Senate had provided on-going support for these initiatives.

Children’s Dental Disease Prevention Program (CDDPP): Both the Assembly and Senate restored $3.2M GF funding for CDDPP, which provided school-based oral health prevention services to 300,000 low-income school children in 32 counties for nearly three decades before it was eliminated during the recession. 

Delay of the Newly Qualified Immigrant (NQI) Wrap: Both houses approved the Administration’s May Revision proposal to delay implementation of the NQI wrap program for one year. The program would transition Medi-Cal expansion adults who have less than five years in a “qualified immigration status” to Covered California with wraparound services. Advocates, including Health Access, Western Center on Law and Poverty, and California Pan Ethnic Health Network had raised concerns about the transition given its complexity and workability.

Both houses acted to improve access and affordability for individuals living with HIV or AIDS by eliminating cost-sharing for individuals enrolled in the AIDS Drug Assistance Program (ADAP) with annual incomes between 400 and 500 percent of the Federal poverty level, making it more affordable and accessible to patients, which will result in savings to the state. The Legislature also approved the development of a Pre-Exposure Prophylaxis (PrEP) Affordability Program to cover PrEP-related copays, coinsurance, and deductibles incurred by all individuals accessing PrEP in California with annual incomes below 500 percent of the federal poverty level. Finally, both houses proposed $8.6 million (federal funds and ADAP rebate funds) for the Office of AIDS’ Health Insurance Premium Payment (OA-HIPP) Program, which covers premiums, copays, coinsurance, and deductibles incurred by all eligible people living with HIV/AIDS in California.

The conference budget deal also includes $33 million/year for three years for medical residency programs, including clinic-based Teaching Health Centers, to increase to primary care workforce.

Finally, the deal includes budget trailer language to allow Covered California limited authority to issue emergency regulations.

HEALTH ITEMS NOT FUNDED IN CONFERENCE COMMITTEE: 

Medi-Cal Data Collection: The Conference Committee ultimately did not allocate any funds to align Medi-Cal’s health plan data collection and reporting requirements for race/ethnicity, language, and sexual orientation and gender identity (SOGI) data with Covered California’s proposed 2017 qualified health plan standards. The Assembly had approved $200,000 GF and trailer bill language to accomplish this task. Health Access will continue to pursue this goal is other venues.

Aged & Disabled Eligibility Level Increase: The Conference Committee also declined to increase the amount of income that is disregarded in calculating eligibility for the Medi-Cal aged and disabled (A&D) program. When the A&D program was enacted in 2000, it had an income eligibility standard of 199% federal poverty level (FPL) plus income disregards, making the eligibility criteria equivalent to 133% of the FPL. However, the disregards lose real value every year, with the resulting income standard today at only 123% of the FPL. The Assembly previously allocated $30M GF to increase the eligibility level.

Health and community advocates will continue to pursue the restoration of Medi-Cal rates and benefits, and the #Health4All expansion of Medi-Cal to all adults regardless of immigration status, even if they are not included in either legislative body’s budget. Thanks to actions taken in last year’s budget, all California kids became eligible for full-scope Medi-Cal this month. The work to expand Medi-Cal to cover adults regardless of immigration status, continues in Senator Lara’s SB 1418. Those Californians currently enrolled in Medi-Cal coverage continue to experience the cuts made during the Great Recession to Medi-Cal rates and benefits, which need to be restored. This includes less access to doctors due to a 10% cut to provide reimbursement rates. We are pleased the budget restores acupuncture services, a number of other non-federally mandated benefits, including full adult dental ($98M), audiology ($2.4M), chiropractic ($3M), incontinence creams & washes ($5.6M), optician/optical labs ($5.9M), podiatry ($13.5M), optician/optical lab ($5.9M), and speech therapy ($160K), were also eliminated during the Great Recession and have not been restored. Adult dental benefits were partially restored in the 2013-14 budget, but still left uncovered are gum treatments, rear root canals, and partial dentures.

NEXT STEPS: The Senate and Assembly Budget Committees plan to hold hearings on the budget deal early next week, and the Legislature is expected to pass the budget by June 15.

#CABudget Conference Committee Conferees Announced

Assembly Speaker Rendon and Senate President Pro Tem Kevin de León have announced their appointments to the 10-member Budget Conference Committee, which reconciles differences between the budgets passed by the two houses. Assemblymember Ting will serve as chair of the Conference Committee this year, and he will be joined by Assemblymembers Richard Bloom, Lorena Gonzalez, Jay Obernolte, and Kristin Olsen. The Senate Conferees are Senators Mark Leno, Patricia Bates, Loni Hancock, Ricardo Lara, and Jim Nielsen. The budget conference committee begins its work this week. The Legislature must pass the budget bill by June 15.

  • Read our previous blog post on important actions the budget subcommittees took as well as issues that will be addressed in conference committee.
  • Read Health Access’ letter on health issues in budget conference committee.
  • Keep track of important health issues through the Conference Committee process with our Budget Scorecard.

Budget Update: Health Priorities for California Consumers

This post was written by Tam Ma, Policy Counsel. 

The Assembly and Senate budget committees completed their review of the Governor’s May Revision and finalized their respective versions of the 2016-17 budget. The budget conference committee will begin meeting next week to reconcile the differences between actions taken by the two houses. The Legislature must pass the budget bill by June 15. This post highlights some important actions the budget subcommittees took as well as issues that will be addressed in conference committee. You can also view our 2016 Budget Scorecard.

ITEMS AGREED TO BY BOTH LEGISLATIVE HOUSES: The following items have been included in both the Senate and Assembly budgets, meaning it is likely these proposals will be in the combined Legislative state budget. However, that proposal still is the subject of a negotiation with Governor Brown and may or may not be included in the final budget passed in June.

Medi-Cal Estate Recovery: Both the Senate and Assembly approved funds ($26M GF) to limit Medi-Cal estate recovery to long-term care services, consistent with federal requirements. The federal government requires states to recoup certain medical costs – mostly related to nursing home care – from the estates of some Medi-Cal patients after they die. California, however, seeks repayment beyond the federal minimum and a patient’s estate is expected to pay back the value of ALL coverage, including premiums for managed care plans, received after a patient turns 55. This policy unfairly targets older Medi-Cal recipients (higher income Covered California patients don’t have to repay their subsidies), and discourages enrollment and home ownership. Health advocates have made this a top priority and are pleased the Legislature has prioritized limiting estate recovery to the minimum required by federal law, aligned with 40 other states.

Interpreters for Medi-Cal: The Senate and Assembly approved $15 million for in-person interpreters to assist Medi-Cal patients who do not speak English well. Both federal and state law give all patients access to a medical interpreter who need one. About 40% of California residents regularly speak a language other than English, and many of the newly insured have language access needs. Language barriers can cause patients to be misdiagnosed, not get appropriate or timely treatment, and cause medical errors that jeopardize safety.

Delay of the Newly Qualified Immigrant (NQI) Wrap: Both houses approved the Administration’s May Revision proposal to delay implementation of the NQI wrap program for one year. The program would transition Medi-Cal expansion adults who have less than five years in a “qualified immigration status” to Covered California with wraparound services. Advocates, including Health Access, Western Center on Law and Poverty, and California Pan Ethnic Health Network had raised concerns about the transition given its complexity and workability.

Children’s Dental Disease Prevention Program (CDDPP): Both the Assembly and Senate restored $3.2M GF funding for CDDPP, which provided school-based oral health prevention services to 300,000 low-income school children in 32 counties for nearly three decades before it was eliminated during the recession.

Both houses acted to improve access and affordability for individuals living with HIV or AIDS by eliminating cost-sharing for individuals enrolled in the AIDS Drug Assistance Program (ADAP) with annual incomes between 400 and 500 percent of the Federal poverty level, making it more affordable and accessible to patients, which will result in savings to the state. The Legislature also approved the development of a Pre-Exposure Prophylaxis (PrEP) Affordability Program affordability program to cover PrEP-related copays, coinsurance, and deductibles incurred by all individuals accessing PrEP in California with annual incomes below 500 percent of the federal poverty level. Finally, both houses proposed $8.6 million (federal funds and ADAP rebate funds) for the Office of AIDS’ Health Insurance Premium Payment (OA-HIPP) Program, which covers premiums, copays, coinsurance, and deductibles incurred by all eligible people living with HIV/AIDS in California.

ITEMS IN CONFERENCE COMMITTEE: Other proposals are included in the budget proposal for just one legislative house. In these cases, the Budget Conference Committee, which guidance from legislative leadership, decides how to reconcile differences between the two proposals from the Assembly and Senate.

Restoration of Acupuncture Benefit in Medi-Cal: The Assembly allocated $3.7 million GF in 2016-17 (and $4.4 million ongoing) to restore the acupuncture optional benefit in the Medi-Cal program.

Medi-Cal Data Collection: The Assembly approved $200,000 GF and trailer bill language to align Medi-Cal’s health plan data collection and reporting requirements for race/ethnicity, language, and sexual orientation and gender identity (SOGI) data with Covered California’s proposed 2017 qualified health plan standards.

Aged & Disabled Eligibility Level Increase: The Assembly approved $30M GF to increase the amount of income that is disregarded in calculating eligibility for the Medi-Cal aged and disabled (A&D) program. When the A&D program was enacted in 2000, it had an income eligibility standard of 199% federal poverty level (FPL) plus income disregards, making the eligibility criteria equivalent to 133% of the FPL. However, the disregards lose real value every year, with the resulting income standard today at only 123% of the FPL.

Hepatitis Initiatives: The Senate included $1.4 million in funding for Hepatitis Initiatives that increase Hepatitis B vaccinations for high-risk adults and provide resources for rapid Hepatitis C and HIV test kits.

ITEMS NOT IN LEGISLATIVE BUDGET PROPOSALS: Health and community advocates will continue to pursue additional restorations and investments, even if they are not included in this year’s budget.

#Health4All adults: Thanks to actions taken in last year’s budget, all California kids became eligible for full-scope Medi-Cal this month. Remaining work needs to be done to expand Medi-Cal to cover adults regardless of immigration status. Senator Lara’s SB 1418 would accomplish this goal.

Medi-Cal rates and benefits: Californians enrolled in Medi-Cal coverage continue to experience the cuts made during the Great Recession to Medi-Cal rates and benefits. This includes less access to doctors due to a 10% cut to provide reimbursement rates. A number of other non-federally mandated benefits, including full adult dental ($98M), audiology ($2.4M), chiropractic ($3M), incontinence creams & washes ($5.6M), optician/optical labs ($5.9M), podiatry ($13.5M), optician/optical lab ($5.9M), and speech therapy ($160K), were also eliminated during the Great Recession and have not been restored. Adult dental benefits were partially restored in the 2013-14 budget, but still left uncovered are gum treatments, rear root canals, and partial dentures.

New Health Access Report Details Dramatic Expansions in California’s County Health Care Safety-Net

Today, Health Access released a new report detailing the dramatic changes to California’s health care safety net programs at the county level. As the Affordable Care Act implementation has cut the number of uninsured Californians in half and the state has taken additional steps to cover all children, many California counties have extended their health care safety net programs to better serve the remaining uninsured. Counties have responded in various ways, from expanding coverage options to undocumented immigrants to providing new benefits to those already covered. A year ago, less than ten counties served undocumented Californians outside of the emergency room; on Monday, that number will expand to 47 counties.

On Monday, more Californians in 35 of the state’s most rural counties will be able to benefit from the latest expansion of the County Medical Services Program (CMSP) which includes virtually all the counties north of the Bay Area and Sacramento to the Oregon border and many in the Sierra Nevada mountains and in the Central Valley. CMSP is expanding eligibility in its main indigent care program, including raising the income level from 200% to 300% of the federal poverty level ($60,480 for a family of three). CMSP is also offering a new limited primary care benefit of three doctor visits and some pharmacy coverage to those in its program, as well as to residents (138-300% FPL) regardless of immigration status. Potentially thousands of Californians will benefit from these expansions, as well as those of other counties that have launched similar pilot programs in the last year.

Health Access’ new report, “Profiles of Progress: California Counties Taking Steps to a More Inclusive and Smarter Safety-Net,” examines the expansion in the County Medical Services Program (CMSP) along with an in-depth analyses of how six other counties adjusted their safety net programs in response to changes in need and funding. These counties include: Contra Costa, Los Angeles, Monterey, Sacramento, Santa Clara, and Fresno.

While the Affordable Care Act has gone a long way to provide new coverage options, it has been left to California and its counties to figure out how to provide care for the remaining uninsured, including those explicitly excluded from federal help due to immigration status. Taking their responsibility seriously to provide health care to the remaining uninsured, more and more California counties are thankfully taking steps to a more inclusive and smarter safety-net. This month’s expansion in 35 rural counties of primary and preventive care is another step forward to a healthier California. Thousands of Californians are benefitting from these new pilot programs, but there’s more work to do in many counties and statewide to further expand and strengthen our health system on which we all rely.

Speaking on a press conference call today were county leaders, advocates and individuals, including County Supervisors that recognized the broader benefits and policy rationale for these expansions. The report and the press conference call also highlighted the grassroots advocacy that helped bring about this rapid change.

The report predicts that additional California counties will also launch similar efforts in the near future, especially under new financial structures under both state law and the new federal Medicaid waiver and its Global Payment Program, which has incentives to offer preventive care and other treatments prior to the need for emergency or episodic care. In turn, these actions at the county level also provide additional momentum at the state level for inclusive health policies.

Budget Focus at Covered California Board Meeting

This post was written by Kate Burch

The Covered California board meeting on May 12 addressed several controversial issues. You can find a recording of the board meeting, links to the presentations, reports, proposed regulations, attachments, and other materials here.

Market Analysis

Covered California contracted with PwC for an in-depth analysis of the direction of the health insurance market over the next 6 years. The presentation to the board included information about enrollment projections with different scenarios (major changes to the economy, change in subsidies, change in minimum wage, etc.). Covered California used the projections and scenarios from this research to make their enrollment and income projections for the coming years. These projections are an important part of how Covered California budgets for future years.

Budget Proposal

Covered California staff presented a proposed budget to the Board. The coming fiscal year will be the first year that Covered California is operating without any federal funding, relying solely on their reserves and the fees assessed from participating health plans for their funding. The proposed 2016-2017 budget is $308 million, which is $25 million lower than the 2015-2016 budget. These are some of the changes expected in the 2016-2017 budget.

  • Previously, health plans were paying a flat per member per month fee. Beginning in 2017, plans will pay 4% of the premium for the individual market.
  • 2016-2017 will be the last year that Covered CA has a call center in Contra Costa County; in future years they will rely on two call centers rather than three.
  • Covered California proposes ending their relationship with the Health Consumer Alliance, and instead instituting an ombudsman program to help resolve consumer issues independent of the service center.
  • Funding for the Navigator Program was cut to $5 million, down from both the $13 million approved in the 2015-2016 budget and the $10 million actually awarded to Navigator Grantees.

Consumer advocates provided extensive comments. The two main areas of interest were the relationship with Health Consumer Alliance and the reduced Navigator Program. Advocates emphasized the importance of an outside entity providing consumer assistance in certain complicated cases, which will no longer happen if Covered California ends their relationship with Health Consumer Alliance. Establishing an ombudsman program within Covered California will be insufficient to replace the work of the Health Consumer Alliance.

Consumer advocates also spoke strongly in support of the Navigator Program. Certified Enrollment Counselors called in to the board meeting to express the importance of the individual assistance they are able to provide. Advocates spoke in favor of funding the Navigator Program at the same level as last year, if not higher, and strongly opposed cutting the funding in half.

The budget was presented for discussion; Covered California staff will present a final version of the budget for board approval in June.

Navigator Program

Covered California staff provided an update on the success of the Navigator Program this year. Navigators provide outreach, education, enrollment assistance, renewal assistance, and post-enrollment support, and specialize in reaching and supporting some of the hardest to reach populations.

During Open Enrollment 3, Certified Enrollment Counselors in the Navigator Program enrolled, renewed, and retained 77,154 people.

Covered California staff recommends inviting 46 of the current 68 Navigator Grantees to renew their Navigator contract for 2016-2017. The 46 organizations that Covered California wants to continue as Navigators had an average cost of $166 per enrollment/renewal, and the organizations that will not be invited to renew their contracts had an average cost of $575 per person assisted.

Covered California recommends a target of $200 per person assisted. With a recommended funding level of $5 million, Covered California anticipates the Navigator Program helping 25,000 people in 2016-2017, which is 50,000 fewer people than in 2015-2016.

Special Enrollment

The Covered California Board approved the Individual Eligibility and Enrollment Regulations for re-adoption that were presented at the April board meeting. Within those regulations, the Board approved making changes to the Special Enrollment policy.

For the remainder of 2016, Covered California will require that a statistically significant random sample of people enrolling during the Special Enrollment Period provide documentation to prove the qualifying life event (QLE) that they attested to. If Covered California can’t verify the QLE, the individual will be ineligible to enroll during the Special Enrollment Period. Covered California will evaluate the results of their random sample to get a clearer picture of what is actually happening with the population that enrolls outside of Open Enrollment.

The changes adopted do not reflect the new federal interim final rule issued on May 6 that imposes new requirements on people who are eligible because of a permanent move. We can expect to see further updates to the eligibility and enrollment regulations in future months to align with the new federal regulation.

Language on the application will more strongly explain consumers’ financial liability for incorrectly attesting to a qualifying life event, and will require that consumers acknowledge that they might be asked to verify their qualifying life event.