The Senate Budget Subcommittee on Health and Human Services held its first hearing of the year on March 5, 2015. Programs within the California Health and Human Services Agency (CHHS) were on the committee’s agenda. The Senate Budget Subcommittee #3’s hearing agendas can be found here.
Office of Systems Integration – CalHEERS Oversight
First on the agenda for CHHS programs was the Office of Systems Integration, which manages the CalHEERS (California Healthcare Eligibility, Enrollment, and Retention System), an IT system that supports the application process for insurance affordability programs (Medi-Cal and Covered California). It is jointly sponsored by DHCS and Covered CA.
CalHEERS has had a number of problems, resulting in key populations not being able to access the coverage they need. For example, under the ACA, former foster youth qualify for Medi-Cal coverage until age 26 regardless of their income. This law has been in effect since January 1, 2014 but has not been programmed accurately into CalHEERS, resulting in enrollment delays, enrollment in the wrong affordability program, or denial of Medi-Cal for former foster youth. Similar issues arise with the Medi-Cal Access Program (formerly known as Access for Infants and Mothers – AIM).
Our colleagues at Western Center on Law and Poverty testified about the lack of transparency and stakeholder engagement in setting the policies and priorities for CalHEERS, contrary to the requirements of AB 1296 (Bonilla, 2011). Specifically, stakeholders have received limited updates regarding CalHEERS changes but have not had an opportunity to give input on those priorities. Health Access echoed the concerns raised by WCLP and other consumer advocates and urged the subcommittee to maintain oversight over this issue.
Senator Holly Mitchell, Chair of the Budget Subcommittee, expects further conversations on CalHEERS at the March 19 hearing, when the DHCS programs and budget will be on the agenda. The subcommittee held this item open for further discussion and information gathering.
Office of the Patient Advocate
Beth Abbott, former Director of Administrative Advocacy at Health Access and new Director of the Office of the Patient Advocate (OPA), was “pleased as punch” to present her office’s budget change proposal to the committee.
Last year, the OPA was revamped and its responsibilities include producing health care quality report cards with clinical performance and patient experience data for the state’s largest health plans and over 200 affiliated medical groups; compiling and reporting on how state health consumer assistance call centers are (or are not) helping patients, from the Department of Managed Health Care, Department of Insurance, Department of Health Care Services, and Covered California; and the development of model protocols for these call center agencies.
OPA has requested $206,000 in 2015-16 and $182,000 ongoing to support the implementation of the Complaint Data Reporting Project. Health Access testified in strong support of OPA’s funding request. Health Access has a long history of working to strengthen consumer assistance hotlines to help Californians navigate the system, exercise their rights, and make informed health care choices. We have sponsored and supported legislation to revamp the OPA and give it the new responsibility of collecting, tracking and reporting on data from state health consumer assistance agencies. Having this information will help the state know whether its call centers are (or are not) helping patients. We also expressed our hope that OPA will, in the future, include reporting on call center metrics such as call wait times and dropped calls because call center performance is an important element of consumer complaint handling. Our colleagues at Western Center on Law and Poverty, CPEHN, and Congress of California Seniors also spoke in support. The Subcommittee held this item open for additional discussion.
High Cost Drug Proposal
The Governor’s budget includes $300M set aside to pay for new breakthrough drugs, such as those used to treat Hepatitis C. The budget does not allocate this funding to specific departments at this time. Individuals enrolled in Medi-Cal, the AIDS Drug Assistance Program (ADAP), patients in state hospitals, and inmates in state prisons are among those who may potentially be treated with the new Hepatitis C drugs. The Administration is convening a workgroup to address the state’s approach regarding high-cost drug utilization policies and payment structures. Right now, the workgroup only includes state departments and county representatives.
Health Access and other consumer advocates urged the inclusion of consumer and patient advocates in the workgroup. Advocates also requested that this process look at all high-cost drugs and not just those for Hepatitis C. Concerns about access and affordability will apply to all high-cost drugs coming to market.
Health Access will continue providing updates about the budget subcommittee process throughout the spring.