Author: Ashley Cohen


Health-Related Bills Signed into Law Before Deadline

October 9 was Governor Brown’s deadline to sign pending legislation into law. This past week, the following bills were signed.

SB 51 (Alquist): Implements MLRs by requiring insurers to spend 80-85% of premium dollars on health care. Removes annual and lifetime caps on benefits. Supports provisions in ACA.

AB 922 (Monning): Improves Office of Patient Advocate (OPA) by providing a center to handle questions and complaints. Moves the Department of Managed Healthcare and OPA under HHSA.

AB 1296 (Bonilla): Requires HHSA to establish a standardized application for Medi-Cal, the Exchange, and county programs.

SB 222 (Evans) and AB 210 (Hernandez): Require small group and individual health plans to include maternity coverage beginning July 2012. Since 1975, California law has required HMOs and large group plans to include maternity coverage. Federal law requires employers who have 15+ employees and offer coverage to cover maternity services. New laws could increase premiums by an average of $6.92. ACA requires this provision in 2014.

SB 299 (Evans): Requires employers with group plans to maintain and pay for coverage for women who take maternity leave.

SB 946 (Steinberg): Requires private health plans to cover treatment for children with autism. Exempts Medi-Cal and Healthy Families.

Read more from the Sacramento Bee, California Healthline and Health Access.

Prior to last week, Brown signed the following bills.

SB 335 (Hernandez) extends a hospital fee to increase funding for Medi-Cal through 2013 and ABX 1 21 (Blumenfeld) extends a fee on Medi-Cal managed care plans for another year. SB 335 is estimated to generate $2.2B in fee revenue paid by private hospitals, $320M of which will be used for children’s coverage. The remaining $1.9B will be matched by federal dollars, generating approximately $3.7B in new payments to private hospitals. ABX1 21 is estimated to raise $207M in 2011-2012. Approximately half will be used to help fill a $130M funding gap in the Healthy Families Program caused by state budget cuts. Read more about SB 335 and ABX1 21 here.

 

Southern California Beach Cities Plan to Get Healthy

A cluster of cities in the South Bay (including Manhattan Beach, Redondo Beach and Hermosa Beach) were recently selected as the nations first “Vitality City.” With $5M in federal and local grants, the region is implementing initiatives to encourage healthy eating and exercise. The goal is to reduce rates of obesity of the region over three years by altering resident lifestyles at home, at work, and in school. The incentive is simple: keep people out of doctors’ offices.

The region was selected because of its motivated leadership. Already, restaurant owners are offering healthy alternatives to calorie-rich foods, planners are working to create bike lanes, and schools have begun “walking school busses.” A similar initiative in Alberta Lea, Minnesota led to an average weight loss of 2.6lbs per resident and an increase in life expectancy by three years.

To read more about the South Bay’s plans for the new grant, visit the LA Times.

Results from Recent LTSS Study

Last week, the SCAN Foundation hosted the Summit on Transforming California’s Long-Term Services and Supports (LTSS). Gretchen Alkema, Vice President of Policy and Communications, presented data from the first State LTSS Scorecard sponsored by the AARP Foundation, The Commonwealth Fund and the SCAN Foundation. The purpose of the Scorecard is to help states improve LTSS so that the elderly and disabled can exercise choice and independence.

The Scorecard measures performance across four dimensions:

  1. Affordability and access;
  2. Choice of setting and provider;
  3. Quality of life and quality of care; and
  4. Support for family caregivers

Using this multidimensional approach, California ranked 17th (second quartile) overall, landing in the top quartile for affordability and access (7th) and choice of setting in provider (9th), bottom quartile for quality of life and quality of care (39th), and third quartile (30th) for support for family caregivers. Minnesota grabbed the #1 spot, landing in the top quartile for all four dimensions and Mississippi ranked last, landing in the bottom quartile for the first three dimensions and in the second quartile for family caregiver support.

Above: Data By State (see interactive map)

Some major findings from the study include:

  • Public policy decisions made in leading states result in higher performance systems;
  • Many lagging states are in the South, have the lowest median incomes and highest rates of poverty and disability;
  • In many cases, low performing states have not adopted public policies that increase access or allow choice and control. This leads to wide variation between high performing and low performing states within all dimensions;
  • Consumer choice and affordability are largely affected by Medicaid policies;
  • The cost of services is not “affordable” in any state;
  • High state scores on access, affordability and choice also put an emphasis on caregivers; and
  • Data on these issues are limited.

California ranked in the top five for the following indicators:

  • State rates of consumer direction of services for adults with disabilities – Number of people receiving consumer-directed services per 1,000 adults age 18+ with disabilities (Rank: 1)
  • Reach of Medicaid safety net – Medicaid LTSS participant years per 100 adults age 21+ with ADL disability in nursing home or at/below 250% of poverty in the community (Rank: 2)
  • Measures of Medicaid LTSS balance – Percent of new Medicaid LTSS users first receiving services in the community (Rank: 5)

Read the full report to see California’s rankings in 25 indicators across four dimensions.

September Exchange Board Meeting: Level I Establishment Grant, Legislative Update, IT Design Options

On Tuesday, the Exchange Board held their September meeting (agenda) in Sacramento. Both the attendees and the Board were pleased to welcome Peter Lee as the first Executive Director of the Exchange. Lee said a few words about his excitement to be back in California (after a 1.5 year gig with the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services in Washington, DC) and his view of California as the leader in implementing an Exchange. He officially begins on October 17.

Pat Powers, Acting Administrative Officer for the Exchange, will remain active until the end of the year on a part-time contract.

The Board approved the updated Conflict of Interest Policy, the proposed 2012 calendar, and the requirement to selectively contract with CO-OPS (despite the NPRMs proposed construct to automatically deem CO-OPS eligible to participate in the Exchange).

Exchange Staff

Joe Munso, Retired Annuitant at HHSA, provided an update on Exchange recruitment as a part of the $39M Level I Establishment Grant recently received from the federal government. In August, the Board authorized $300,000 for one or more contracts for recruitment of remaining executive-level management positions. They have narrowed the candidates down to two firms and plan on making one or more awards. Munso presented three other solicitation approvals for procurement of IT consulting ($494,000), program integration ($580,000), and stakeholder consultation ($400,000) firms.  Munso explained that they have also entered into final negotiations with a vendor to create a business and operations plan (approved at the August meeting). The vendor has been involved in the Massachusetts connector and also has experience with IT systems. They will provide stakeholders with a presentation to share their plans for the Exchange once negotiations are finalized.

Legislative Update

As for the relevant legislation discussed at the July meeting, only one bill (AB 1296) remains on the Governor’s desk. AB 1296 (Bonilla) sets standards for streamlining eligibility and enrollment by creating a single application form for multiple entities.

Program Integration

Katie Marcellus, Assistant Secretary for HHSA, explained that the Board is working with state partners, including DHCS, DOI, DMHC, HHSA and MRMIB, on the eligibility and enrollment issues. They recently drafted a list of priorities (i.e. defining navigators) during one of their regular convenings.

Design Options

Pat Powers presented design options created as a result of internal meetings and stakeholder meetings. Priorities from stakeholder input were building confidence, consumer control, considering all perspectives, enabling live contact, providing status updates, ensuring consistent rules regardless of application method, and ensuring that the SHOP brings value to the marketplace. The goals of the program is a “no wrong door” service, cultural and linguistic appropriateness, and seamless transitions between programs. They hope to provide real-time eligibility determination that is accurate, private, and enables consumers to make informed choices.

The presentation included 3-4 options for the ITs design infrastructure. Each option had different visions for the Exchange’s relationship with current county systems, the MRMIB/Maximus System, and Qualified Health Plans. They propose who would be responsible for eligibility functions, plan enrollment, case maintenance and updating client indexes for the Exchange, MAGI Medi-Cal, non MAGI Medi-Cal and CHIP enrollees. These options include: Option 1 – Distributive, Option 2 – Partially Integrated, and Option 3 – Fully Integrated. Bill Obernessor, the Exchange’s IT consultant, cited Option #1 as making the most of current systems. A handout was provided with a fourth option, Integrated Partnership.

Strategic Visioning

Bobbie Wunsch, Pacific Health Consulting, presented the two options for the Exchange vision mission and values that they have been developing since July. The goal is to adopt a vision by the October Board meeting. The general consensus was that elements from each vision mission should be combined to create one strong, clear mission.

Comments on the Federal NPRM

The Board presented their consolidated letter from all state agencies to submit with their comments on the first set of proposed rulemaking (establishment of Exchanges and Qualified Health Plans and reinsurance, risk corridors and risk adjustments). There was only one discrepancy in feedback from the Insurance Commissioner (technical issues related to risk). The deadline to submit comments was extended from September 28 to October 31. Many groups stated that they would still like to submit comments.

CaliforniACA September Newsletter Now Available!

Update on Health-Related Legislation
Approved Bills
Governor Brown has signed two bills into law since the legislative session ended on September 9. SB 335 (Hernandez) extends a hospital fee to increase funding for Medi-Cal through 2013 and ABX 1 21 (Blumenfeld) extends a fee on Medi-Cal managed care plans for another year. SB 335 is estimated to generate $2.2B in annual fee revenue paid by private hospitals, $320M of which will be used for children’s coverage. The remaining $1.9B will be matched by new federal dollars, generating approximately $3.7B in new payments to private hospitals. ABX1 21 is estimated to raise $207M in 2011-2012. Approximately half will be used to help fill a $130M funding gap in the Healthy Families Program caused by state budget cuts. Read more about SB 335 and ABX1 21 here.

Bills Pending
Many health-related bills remain on the Governor’s desk, including bills related to autism coverage (SB 946), Medical Loss Ratios (SB 51), maternity care as a basic benefit in individual plans (SB 222), and establishing a standardized application for individual public and private coverage (AB 1296). Governor Brown has until October 9 to sign or veto these bills.

Two-Year Bills
The rate regulation bill, AB 52 (Feuer), and Basic Health Plan bill SB 703 (Hernandez) have been put over for consideration in next year’s legislative session.

Medi-Cal
California Receives Grants to Boost Medi-Cal and CHIP Enrollment
California received grants from HHS to coordinate the enrollment and renewal processes of the Medi-Cal and CHIP programs. Five California entities received grants worth $4.9M, including the Fresno Healthy Communities Access Partners ($1.3M), the Los Angeles Unified School District ($982,170), the Alameda Health Consortium ($850,000), and the Mendocino County Office of Education ($769,313). The entities plan to use funding to enhance outreach and enrollment efforts within their respective county. The fifth grant went to the American Association of School Administrators ($1M). For more information, see this post on California Healthline.

Cuts in Provider Rates
In its June application, the state sought federal approval to cut Medi-Cal provider rates by 10% across the board. CMS and federal courts have blocked Medi-Cal rate cuts, but DHCS said it would study the effects of cuts on access to care. In October, the Supreme Court will hear California’s appeal of the 9th Circuit’s decision to uphold the injunction against the across-the-board rate cuts. DHCS has yet to report their findings, and rejected a Public Records Act request by the Sacramento Bee to obtain access to the study.

The California Health Benefit Exchange
Executive Director Selected
Peter Lee, the current Deputy Director for the Center for Medicare and Medicaid Innovation at CMS, has been appointed by the Board as the first Executive Director of the Exchange.  He will oversee planning, development and ongoing administration/evaluation of the HBEX beginning October 17, 2011.

CHCF’s Options for the Exchange
The California HealthCare Foundation (CHCF) has outlined three visions for how the Exchange could purchase coverage. These include: 1) Price Leader – The Exchange as a negotiator of lowered premiums; 2) Service Center – The Exchange as a consumer destination; and 3) Change Agent – The Exchange as a catalyst of payment and delivery system reform. Read more about these visions from CHCF.

Notice of Proposed Rulemaking
On July 11, HHS released the first set of proposed regulations  for state-based health insurance exchanges. The California Health Benefit Exchange board accepted stakeholder input through August 18. The Board has produced summaries of proposed rules for establishment of exchanges and qualified health plans and reinsurance, risk corridors and risk adjustment.  Comments are due to the federal government by September 28.

Basic Health Program
SB 703 (Hernandez), which would establish a Basic Health Program in CA, has been carried over to next year. The BHP could insure as many as one million low-income Californians with family incomes between 134-200% of FPL. Read more about BHP’s implications from a recent Urban Institute study, including the 23% federal funding increase a BHP could generate for states and the drastic subscriber savings, here.

§1115 Waiver
Blue Shield Grant
Blue Shield of California Foundation (BSCF) is seeking grant proposals to support California counties to implement their Low Income Health Programs (LIHPs). Proposals are due Tuesday, September 27, 2011 by 5:00 pm. A LIHP may enroll adults not otherwise eligible for Medi-Cal or Medicare in a coverage program transitioning to Medi-Cal. Interested applicants are invited to submit proposals through BSCF’s online application system.

ADAP/Ryan White and the LIHP
As a part of the waiver, the federal government will finance half the cost of LIHP beneficiaries, including those with HIV or AIDS, while counties will finance the other half. This also means that eligibility for the county and federal funded LIHP program takes precedence over the federal and state funded Ryan White program. Some counties are considering paring back LIHP eligibility due to the shift in cost of caring for AIDS patients from the state to the counties. Three sets of guidance/FAQs have been released on this issue.

Fresno Rejects LIHP
Fresno County’s LIHP application originally stated that it would put up $56M ($28M/year) to cover 12,000 Medically Indigent Adults (MIAs) under 114% FPL for two years, starting January 1, 2012. Yesterday, the Fresno County Board of Supervisors voted against drawing down a federal match. The reason stated was due to a 30-year contract with Community Medical Centers (CMC) to manage the Medically Indigent Services Program (MISP), their current program for MIAs. The contract is in its 15th year. Read more here.

Adult Day Health Centers
The California Legislature appropriated $85M for a scaled down version of the ADHC program through December 1. On December 1, up to 300 ADHC centers will close, affecting approximately 35,000 seniors and persons with disabilities. About half of the $85M will fund the transition of these beneficiaries into managed care health plans, while the other half is being used to keep the centers alive from September 1 to December 1. Plans will receive a $60 per person incentive to take on the ADHC patients. DHCS recently sent out letters to patients notifying them of their plan options. Read more here.

Healthy Families
A web-based application (Health-e-App) is now available to help families apply for children’s coverage through Medi-Cal and Healthy Families.  This online-app was developed by CHCF with MRMIB and DHCS.

Pre-Existing Condition Insurance Plan
As of September 1, enrollment for California’s high-risk pool reached 4,000. Read about last month’s eased eligibility requirements here.

Young Adults
A new health survey finds that nearly 1M more young adults (19-25) gained insurance in the first three months of 2011. Gallup reports that the uninsured rate among adults 18-25 dropped from 28% to 24.2% between Fall 2010 and Summer 2011. Credit is being attributed to the ACA provision that allows young adults to stay on their parents coverage until age 26.

Mental Health
Budget Cut Risks
News reports show the use of overstretched hospital emergency rooms has increased for patients with serious mental illness due to reductions in state and local mental health services.

Parity Laws
The US Court of Appeals for the Ninth Circuit has ruled that a woman’s treatment for anorexia was medically necessary and must be covered by her healthcare plan as stipulated by the federal parity laws. The treatment for anorexia at issue included an extended inpatient stay. The ruling may not have immediate effect, because Blue Shield could petition the court for a rehearing of the case or request a review from the US Supreme Court.

Grants
Prevention
The California Department of Public Health received four funding installments totaling $1.7B from HHS to help improve local health programs. The funding included $756,000 to increase public health immunizations, $381,103 to monitor the effectiveness of vaccines, $340,245 for tobacco cessation hotlines, and $216,151 for an emerging infections program. The grants were a part of $137M of federal funding, allocated from the Prevention and Public Health Fund and the Substance Abuse and Mental Health Services Administration, to improve public health infrastructure nationwide.

Rate Review
California received two grants, each worth $2.16M, for the California Department of Insurance and the Department of Managed Health Care. The grants are meant to help the state review health insurance premium increases. California does not currently have authority to reject increases, but AB 52 (Feuer) would give California prior approval authority. The bill will be considered next year.

Home Visitation
On September 22, HHS announced $224M to support evidence-based home visiting programs to help parents and children. California received an $11.5M formula award and a $9.4M competitive expansion award for maternal, infant and early childhood home visitation programs.

Data
Uninsurance and Poverty
According to Census data, 7.2 million Californians (19.4% of residents) lacked insurance in 2010, ranking eighth among all states for the highest rate of uninsured.  The poverty rate also rose to 16.3% last year, the highest level in more than 10 years, while household incomes fell by 5%.

Long-Term Care
A study by AARP’s Public Policy Institute, the Commonwealth Fund and the SCAN Foundation shows that CA ranks 15th best in the US for providing long term care to Seniors and Persons with Disabilities.  Rankings take into consideration affordability, access, patient choice, quality of life/care, and support for family caregivers.

Well-Being Index
The Gallup-Healthways 2010 Well-Being Index shows that California ranks highly in self-reported healthy behaviors (top quintile), well-being, life evaluation, and physical health (second quintile).  The state ranked in the fourth quintile in basic access.  Cities such as San Jose, San Francisco and San Diego ranked highly overall, while Modesto, Bakersfield, Stockton and Redding ranked in the lowest quintile with respect to basic access.

A New Script for LA’s Community Clinics

Today’s guest blogger is Louise McCarthy, MPP, President and CEO of the Community Clinic Association of LA County (CCALAC). 

Tonight CBS will debut a new show, “A Gifted Man,” which features the struggles of a doctor trying to keep a community clinic afloat amidst a host of clinical, operational, and personal issues. Is this reality television? While the show itself is fiction, it is rooted in the painful and promising drama in which LA’s community clinics and health centers now find themselves.

LA’s clinics are at a pivotal hour in their own personal drama—they have suffered Medicaid (Medi-Cal) cutbacks, celebrated healthcare reform and struggled to meet the demands of the newly uninsured. Now, clinics restlessly await the recommendations of the Federal Debt Reduction Supercommittee along with the annual Federal Appropriations process. All the while, they must enhance their operations in order to survive and thrive in the evolving health care marketplace.

For the television clinic, survival involves delivering a quality show, building a dedicated viewer base, earning strong ratings and studio support. For real-life clinics, survival is rooted in delivering quality care, building a strong patient base, transforming delivery systems, and maintaining public support for their programs. The challenge is great, but LA’s clinics are making progress:

· Delivering Quality Care: With the advent of health care reform, and the move toward transparency in health care systems, it will be critical for providers in any system to demonstrate the results they achieve for their patients. For over ten years, LA’s clinics have participated in a statewide quality improvement initiative, tracking data on diabetes, hypertension and adult preventive measures and gauging their patient outcomes against national benchmarks, such as the US Preventive Services Task Force. CCALAC Member clinics have demonstrated that despite serving a sicker population, they can meet, and sometimes exceed, the benchmarks. This year, we will begin publicly reporting this quality data at a statewide level.

· Building a strong patient base: CCALAC represents 46 nonprofit community clinics and health centers, serving nearly one million patients each year at over 140 sites across LA County. The vast majority, 87%, of LA clinic patients are under 200% of the Federal Poverty Level, and 62% of the patients are uninsured. We know that community clinics and health centers cannot serve solely an uninsured population: a 2008 regression analysis found that a clinic can sustain no more than 34.5% uninsured visits. To serve the uninsured, clinics in LA County must seek additional support through fundraising, grant writing, and county indigent care programs. With the expansion of Medicaid in 2014, over 550,000 Angelenos will become eligible for Medicaid, and 800,000 will remain uninsured. LA’s clinics have the capacity to serve the remaining uninsured, but as the regression indicates, that is not a sustainable proposition. They must be able to retain and attract the newly insured in order to keep services available to those who remain without coverage. Luckily, clinics are up to this challenge: through secret shoppers, patient satisfaction surveys, and involvement of patients in clinic governance, clinics across LA County are seeking patient input on their experience, and using this information to inform how they adjust their programs and services. These efforts will help clinics become providers of choice in the evolving health care system, ensuring their sustainability.

· Transforming Health Systems: Primary care does not exist within a vacuum. Clinics must transform their primary care practices in the context of the hospitals, specialists, and other providers that also care for their patients. Through partnerships with LA’s Departments of Health Services, Public Health and Mental Health, as well as key funders such as Kaiser Permanente and L.A. Care Health Plan, clinics in LA are working to reengineer our delivery system so that patients get better access to more comprehensive and appropriate care. Current efforts, such as LA County’s Healthy Way LA program, aim to strengthen the partnership between our public and private systems to better improve access and patient outcomes. Additionally, various telemedicine and tele‐mental health initiatives promise innovative approaches to specialty care access that will transform the patient experience.

· Maintaining Public Support: The above efforts will dramatically transform the ability of community clinics and health centers to meet the needs and desires of their patient population; however, we cannot ignore that the success of these efforts hinges in large part on Federal and State investments that are currently in jeopardy. The current budget debates in Sacramento and Washington threaten to fundamentally change funding for community clinics and health centers and the communities they serve: Federal support for the Medicaid program and the rules which currently prevent states from reducing eligibility, annual appropriations for Federally Qualified Health Centers, the National Health Service Corps, and many other key programs that encourage innovation and expand capacity to serve the underserved are all currently at risk. Clinics will advocate to strengthen our system to remain viable in the context of health care reform, yet they cannot do this alone. We ask that our partners join us in these efforts and advocate to maintain public support for these important programs (click HERE to sign up for CCALAC’s Action E-List).

Clearly, LA’s clinics are working mightily to build the foundation for the future; yet, every moment is pivotal in ensuring their survival. And so, like their prime-time counterpart, clinics are hoping that their performance today will get them “renewed” for another season.

 

CCALAC is the largest regional association of nonprofit community and free clinics in California.  Founded in 1994, CCALAC has 46 members that operate more than 140 clinics throughout the county.  These clinics serve nearly one million patients per year, the majority of whom are uninsured or underinsured.  CCALAC is dedicated to serving and representing the interests of its member clinics as providers of quality health care, including medical, dental and pharmacy services. For more information about CCALAC, visit www.ccalac.org or call (213) 201-6500.

Implications of Establishing Basic Health Programs

Earlier today, Stan Dorn (Urban Institute) gave a presentation on the implications on a basic health program based on his recent research study, “Using the Basic Health Program to Make Coverage More Affordable to Low-Income Households: A Promising Approach for Many States.”

Under ACA, states have the option to implement a Basic Health Program for low-income adults between 138% and 200% FPL and lawfully present immigrants under 138% who do not qualify for Medicaid based on the less-than-five-year ban. States with BHP contracts would receive annual grants from the federal government in the amount equal to 95% of what they would have spent on health insurance tax credits for the eligible consumers in the Exchange. These dollars go into a state trust fund and may only be used on BHP subscribers.

The cost of coverage through the Exchange for low-income individuals, although subsidized, will still be significant. The chart below shows the monthly premiums expected of individuals in the Exchange who earn below 250% FPL. An individual who earns 150% FPL has a pre-taxed income of $1,354 and would have to spend $54.15 on monthly premiums. They would also pay $20 copays for office visits and $250 copays for inpatient hospital. Though these premiums are much lower than what people have to pay now, research has indicated that low-income consumers will be deterred from using these services due to cost. In addition, because subsidies are based on tax credits, individuals purchasing coverage through the Exchange could owe money to the IRS if they underestimated their income. 

ACA mandates that coverage through BHP be less than what subscribers would pay after receiving subsidies in the Exchange.

Using the Health Insurance Policy Simulation Model (HIPSM)*, Dorn and his team discovered that implementing a BHP would lead to annual savings of approximately $1500 among single adults compared to receiving subsidies in the Exchange. A BHP would generate an average of 23% more funding for the state compared to current funding. (He suggested this funding be used to raise provider rates above the Medicaid baseline). California would receive $5.6M compared to the current $4.6M (19.8% increase in funding) if it implemented a BHP.

If all states implemented a BHP, the estimated uninsured rate after 2014 would decrease by 600,000 and 34/50 states would have a statistically significant coverage increase. Overall, states would save $1.3B a year by moving people from Medicaid to BHP ($286M saved in California). Moving this population into the Exchange would save the state the same amount of money, however costs would be shifted to consumers in the form of copays and premiums.

Although it would lower consumer costs, the tradeoff to implementing a BHP is that provider payments, even with increased reimbursement rates, would be lower than commercial plans offered in the Exchange. This would lead to a smaller provider network. States must decide which is a more significant barrier to access.

Dorn and his team concluded that although implementing a BHP would take people out of exchanges, they would still be large enough for viability and attracting good plans. Unfortunately, the fixed administrative costs of running the exchanges would be spread across a smaller population. In addition, BHPs may not increase premiums due to tobacco use, so the cost to care for tobacco-related illnesses might increase costs.

About half a dozen states have legislation surrounding BHP, but no state has implemented it yet. California recently made its BHP bill, SB 703 (Hernandez) into a two-year bill. In addition, HHS has not yet issued federal regulations or guidance.

To learn more about Dorn’s study on the BHP, visit the Association for Community Affiliated Plans’ website.

*Models behaviors based on policy change.

Fresno Rejects a Federal Match Under the Low Income Health Program

Fresno County’s Low Income Health Program (LIHP) application stated that it would put up $56M ($28M/year) to cover 12,000 Medically Indigent Adults (MIAs) under 114% FPL for two years, starting January 1, 2012. Yesterday, the Fresno County Board of Supervisors voted against drawing down a federal match. The reason, they stated, was due to a 30-year contract with Community Medical Centers (CMC) to manage the Medically Indigent Services Program (MISP), their current program for MIAs. The contract is in its 15th year.

Under the contract, Fresno County pays CMC $20M annually to care for uninsured residents. This care does not include primary care and care is restricted to CMC facilities. Drawing down federal funds would require the County to commit $18M of the $20M currently provided to CMC each year to LIHP (in addition to $10M from mental health realignment for a total of $28M/year).CMC currently provides care for 18,000 MIAs, approximately 6,000 of whom are undocumented.

Fresno County concluded that they could not support their current contract with CMC while also providing funding for LIHP. The refusal to participate in LIHP could jeopardize the county’s ability to enroll newly eligible individuals into Medi-Cal when care for that particular population is fully funded by the federal government in 2014.

Fresno is the only county in California to turn down the matching funds under the §1115 Waiver. Some counties might limit enrollment due to high anticipated treatment costs. The waiver requires counties to offer a core set of benefits, including mental health, physician services, and prescription drugs. It also sets strict timely access standards, such as offering primary care appointments within 20 days, urgent care within 48 days, and specialty care within 30 business days, and geographic access standards, such as ensuring that a primary care provider is within a maximum of 30 miles or 60 minutes from the subscriber.

If fully implemented, LIHP could offer coverage to approximately 500,000 low-income Californians.

Read more here.

Brown Signs Two Bills

Governor Brown has signed two bills into law. SB 335 (Hernandez) extends a hospital fee to increase funding for Medi-Cal through 2013 and ABX 1 21 (Blumenfeld) extends a fee on Medi-Cal managed care plans for another year. SB 335 is estimated to generate $2.2B in fee revenue paid by private hospitals, $320M of which will be used for children’s coverage. The remaining $1.9B will be matched by federal dollars, generating approximately $3.7B in new payments to private hospitals. ABX1 21 is estimated to raise $207M in 2011-2012. Approximately half will be used to help fill a $130M funding gap in the Healthy Families Program caused by state budget cuts. Read more about SB 335 and ABX1 21 here.

End of Legislative Session: Some Bills Make it to Governor’s Desk, Others Become Two-Year Bills

The legislative session ended on September 9. Lawmakers passed various health-related bills which are now on the Governor’s desk. The Governor has until October 9 to either veto or sign these bills.

SB 946 (Steinberg): Requires private health plans to cover treatment for children with autism. Exempts Medi-Cal and Healthy Families.

SB 51 (Alquist): Implements MLRs by requiring insurers to spend 80-85% of premium dollars on health care. Removes annual and lifetime caps on benefits. Supports provisions in ACA.

SB 222 (Evans): Requires individual health plans to provide maternity-related care as a basic benefit starting July 2012. ACA does not require this until January 2014.

SB 335 (Hernandez): Enacts Medi-Cal hospital provider Quality Assurance Fee (QAF). Provides grants to public hospitals.

SB 866 (Hernandez): Requires insurers to use standardized authorization forms for treatments, transmit forms electronically and respond to requests within two days.

AB 922 (Monning): Improves Office of Patient Advocate by providing a center to handle questions and complaints. Moves DMHC and OPA under HHSA.

AB 1296 (Bonilla): Requires HHSA to establish a standardized application for Medi-Cal, the Exchange, and county programs.

The following bills did not move forward and will be considered next year (i.e. “two-year bills”).

AB 52 (Feuer): Gives state regulators, the Department of Insurance and the Department of Managed Health Care authority to reject unjustified rate increase by insurers.

AB 714 (Atkins) & AB 792 (Bonilla): Would notify and pre-enroll eligible individuals into available coverage in 2014.

AB 1083 (Monning): Adopts small group insurance reforms.

SB 703 (Hernandez): Would create an alternate health plan (Basic Health Plan) for low-income individuals between 133% and 200% FPL.

For more information, visit the Health Access Blog or California Healthline’s recent article.