Author: Deborah Kelch


ITUP Remains Focused on Covering the Uninsured and Improving the Health of Californians

The unexpected results of the 2016 Presidential election triggered uncertainty and anxiety around the future of health reform in California and across the country.  While we do not yet know the full-breadth of legislative and regulatory changes that President Trump and the Republican-led Congress will pursue, we do know that California potentially has the most to lose from any federal repeal, rollback or decrease in the federal commitment to health reform.

Importantly, California has the most to lose precisely because the state wholeheartedly embraced and successfully implemented ACA coverage expansions and health system reforms.  This also means that California is the state best prepared to showcase the benefits of reform, contributing what we have learned to the federal debate. We are well-positioned to creatively respond regardless of what challenges are presented. (more…)

2016 Legislative Wrap-Up

At the end of August, the California Legislature adjourned the 2015-2016 legislative session.  The Governor had until September 30 to review and consider all bills the Legislature passed and sent to him.  This summary highlights key health care bills signed by the Governor, vetoed and those that failed in the Legislature.

Bills Signed Into Law

AB 72 (Bonta) – Payment for out-of-network providers

Starting July 1, 2017, limits consumer cost sharing, in the event a health plan enrollee receives services from a non-contracted provider when they have at a contracting health facility, to no more than what the consumer would pay for an in-network, contracted provider.  Requires health plans to pay non-contracted providers in these instances the greater of either the health plan’s contracted rate for the same or similar service, or 125% of the amount Medicare pays for the same or similar service.  (Chapter 492, Statutes of 2016)

AB 1568 (Bonta/Atkins) – Federal §1115 Medicaid Waiver

Implements specified components of California’s newly approved §1115 federal Medicaid waiver, Medi-Cal 2020. The waiver allocates more than $6.2 billion to specific pilot and demonstration programs aimed at redirecting Medi-Cal beneficiaries from costly inpatient and emergency room services to coordinated outpatient primary, preventive and specialty care services.  (Chapter 42, Statutes of 2016)

AB 2024 (Wood) – Critical Access Hospitals

Permits, until January 2024, federally certified critical access hospitals in rural areas to employ physicians and charge for professional services rendered by those physicians. With certain limited exceptions in law, California prohibits hospitals from employing physicians.  (Chapter 496, Statutes of 2016)

AB 2308 (Hernandez, R.) – Health Care Coverage: Information to Students

Requires California State University and California Community College campuses to provide students with information about insurance affordability programs, including how to apply for Medi-Cal and Covered California. Extends until January 1, 2021 the requirement that California public schools provide parents and guardians with information about health care coverage options and assistance.  (Chapter 570, Statutes of 2016)

SB 10 (Lara) – Coverage for Undocumented Immigrants: Federal Waiver

Requires Covered California, California’s state-based ACA exchange, to apply for a federal ACA §1332 waiver allowing undocumented immigrants to buy coverage through the Exchange.   Federal funds would not be available to subsidize the coverage.  (Chapter 22, Statutes of 2016)

SB 586 (Hernandez) – California Children’s Services: Whole Child Model

Authorizes the Department of Health Care Services to establish a “Whole Child Model” for the California Children’s Services (CCS) program in 21 counties; four county organized health system plans would provide both CCS and Medi-Cal services to children enrolled in Medi-Cal and CCS.  Under current arrangements in most counties, CCS services are “carved out” (excluded) from Medi-Cal managed care contracts.  (Chapter 625, Statutes of 2016)

SB 815 (Hernandez) – Federal §1115 Medicaid Waiver

Implements specified components of California’s newly approved §1115 federal Medicaid waiver, Medi-Cal 2020. The waiver allocates more than $6.2 billion to specific pilot and demonstration programs aimed at redirecting Medi-Cal beneficiaries from costly inpatient and emergency room services to coordinated outpatient primary, preventive and specialty care services.  (Chapter 111, Statutes of 2016)

SB 833 (Committee on Budget and Fiscal Review) – Health

Limits estate recovery in the Medi-Cal program to only those health care services required to be collected under federal law.  California currently implements several federal options to collect from Medi-Cal beneficiaries beyond what is required under federal law.  (Chapter 30, Statutes of 2016)

SB 908 (Hernandez) – Health Insurance Premiums: Consumer Notice

Requires health plans to notify individuals or small businesses in advance of any premium increase if state regulators find the proposed premium rate “unreasonable” or “unjustified.” Advance notice of the regulator findings allows individuals and businesses to shop for other coverage options prior to the renewal date of their existing plan.  The Department of Managed Health Care and California Department of Insurance conduct mandatory premium rate reviews for health plans under their jurisdiction according to ACA rules and implementing California law.  (Chapter 498, Statutes of 2016)

SB 1135 (Monning) – Timely Access to Care

Requires health plans, health insurers and Medi-Cal managed care plans to notify enrollees and contracted providers about California’s timely access to care standards and provide information about access to interpreter services, at least annually.  (Chapter 500, Statutes of 2016)

SB 1139 (Lara) – Health Professions Grants and Loans

Deems undocumented students eligible for admission to a medical school or medical residency program.  Prohibits grant and loan repayment and forgiveness program applications from being denied based on citizenship and immigration status.  (Chapter 786, Statutes of 2016)

SB 1159 (Hernandez) – Health Care Cost and Quality Data Atlas

Requires the Health and Human Services Agency to research the options for developing a cost, quality, and equity transparency database.  (Chapter 727, Statutes of 2016)

Vetoed Bills and Bills That Failed Passage

AB 1300 (Ridley-Thomas) – Mental Health: Involuntary Commitment

Authorizes an emergency physician or psychiatric professional, that work in a facility that has not been designated by the county for mental health treatment, to place an individual on an up to 72-hour involuntary hold for purposes of obtaining mental health evaluation and treatment. California law currently authorizes individuals to temporarily be held against their will for assessment if certain professionals believe that, due to a mental disorder, that individual is a danger to himself, a danger to others, or gravely disabled.  (Held in Senate Rules Committee)

AB 2077 (Burke/Bonilla) – Health Coverage Transitions: Medi-Cal and Covered California

Enacts eligibility, administrative and notice requirements to ensure that individuals whose eligibility fluctuates between Medi-Cal, Covered California and other health care coverage programs do not experience a break in coverage. Establishes a 20-day grace period after an individual is no longer eligible for Medi-Cal so they can apply for and enroll in Covered California or other health coverage without a coverage break.  (Vetoed by Governor)

AB 2216 (Bonta) – Teaching Health Center Program

Establishes the Teaching Health Center Primary Care Graduate Medical Education Fund to support primary care residency programs. Modeled after a limited federal program included in the federal Affordable Care Act (ACA).  (Held in Assembly Appropriations Committee)

AB 2436 (Hernandez, R.) – Prescription Drug Cost Transparency

Requires health plans in California to provide consumers with specified information on the costs of prescription drugs, including the consumer’s potential out-of-pocket costs.  (Failed Passage on Assembly Floor)

SB 932 (Hernandez) – Oversight of Mergers and Acquisitions

Requires prior approval by the Department of Managed Health Care for mergers between health plans and other organizations and prohibits specified provisions in health plan provider contracts.  (Held in Senate Appropriations Committee)

SB 997 (Lara) – Coverage for Undocumented Children

Authorizes undocumented children eligible for full-scope Medi-Cal coverage, who are enrolled in low-cost coverage through Kaiser Permanente or another Medi-Cal managed care plan, to be enrolled in full-scope Medi-Cal with the same health plan.  (Final bill text no longer relevant)

SB 1010 (Hernandez) – Prescription Drugs: Transparency

Requires health plans to provide regulators reviewing health care premium filings with specified information relating to prescription drug spending. In addition, this bill requires drug manufacturers to notify state purchasers of health care services when drug prices increase during any 12-month period by more than 25%, or when manufacturers introduce new drugs to the market costing more than $10,000 annually or per course of treatment.  (Held on the Assembly Floor)

SB 1418 (Lara) – Medi-Cal Coverage for All

Extends eligibility for full-scope Medi-Cal to all individuals 19 years of age and older, regardless of immigration status.  (Held in Senate Health Committee)

President Obama Takes Stock of Reform

In a nontraditional role for a sitting President, “Barack Obama, JD” entered a Special Communication in the Journal of the American Medical Association (JAMA) reflecting on the passage and impact of his signature legislative endeavor, the federal Affordable Care Act (ACA). (more…)

Governor Signs SB 10 — Legislation Aimed at Allowing Undocumented Californians to Buy Coverage in the State Exchange

Governor Jerry Brown signed SB 10 (Lara) which requires Covered California to seek federal approval allowing undocumented Californians to buy health coverage through the exchange. The Affordable Care Act (ACA) prohibits undocumented persons from buying coverage or receiving subsidies through state exchanges, but does not prohibit them from buying unsubsidized coverage in the private individual market. (more…)

May 2016 Legislative Summary

Dozens of health care bills have been moving through the California Legislature in the second half of the 2015-16 legislative session. As of this writing, many of the bills are on temporary hold in the Suspense files of the Senate and Assembly Appropriations Committee pending further action. The two fiscal committees tag bills with state costs above a certain level and then consider all the bills at one hearing to better assess the combined cost implications. The fiscal committees will consider Suspense items this Friday, May 27, 2016.

Assembly bills

AB 1568 (Bonta/Atkins) – Federal §1115 Medicaid Waiver

Implements California’s newly approved §1115 federal Medicaid waiver, Medi-Cal 2020. The waiver allocates more than $6.2 billion to specific pilot and demonstration programs aimed at redirecting Medi-Cal beneficiaries from costly inpatient and emergency room services to coordinated outpatient primary, preventive and specialty care services. (Status: Assembly Appropriations Committee)

AB 2024 (Wood) – Critical Access Hospitals

Permits federally certified critical access hospitals in rural areas to employ physicians and charge for professional services rendered by those physicians. With certain limited exceptions in law, California prohibits hospitals from employing physicians. (Status: Pending referral in Senate)

AB 2077 (Burke) – Health Coverage Transitions: Medi-Cal and Covered California

Enacts eligibility, administrative and notice requirements to ensure that individuals whose eligibility fluctuates between Medi-Cal, Covered California and other health care coverage programs do not experience a break in coverage. Establishes a 30-day grace period after an individual is no longer eligible for Medi-Cal so they can apply for and enroll in Covered California or other health coverage without a coverage break. (Status: Assembly Appropriations Committee)

AB 2216 (Bonta) – Teaching Health Center Program

Establishes the Teaching Health Center Primary Care Graduate Medical Education Fund to support primary care residency programs. Modeled after a limited federal program included in the federal Affordable Care Act (ACA). (Status: Assembly Appropriations)

AB 2308 (Hernandez, R.) – Health Care Enrollment Assistance

Requires the California State University and California Community College campuses to screen every student for health insurance and offer enrollment assistance through partnerships with local organizations. Extends until January 1, 2024 the requirement that California public schools provide parents and guardians with information about health care coverage options and assistance. (Status: Assembly Appropriations)

AB 2436 (Hernandez, R.) – Prescription Drug Cost Transparency

Requires health plans in California to provide consumers with specified information on the costs of prescription drugs, including the consumer’s potential out-of-pocket costs. (Status: Assembly floor)

Senate Bills

SB 10 (Lara) – Coverage for Undocumented Immigrants: Federal Waiver

Requires the Secretary of Health and Human Services to apply for a federal ACA §1332 waiver allowing undocumented immigrants to buy coverage through Covered California, California’s state-based ACA exchange. Federal funds would not be available to subsidize the coverage. (Status: Assembly floor)

SB 815 (Hernandez) – Federal §1115 Medicaid Waiver

Implements California’s newly approved §1115 federal Medicaid waiver, Medi-Cal 2020. The waiver allocates more than $6.2 billion to specific pilot and demonstration programs aimed at redirecting Medi-Cal beneficiaries from costly inpatient and emergency room services to coordinated outpatient primary, preventive and specialty care services. (Status: Senate Appropriations)

SB 908 (Hernandez) – Health Insurance Premiums: Consumer Notice

Requires health plans to notify individuals or small businesses if state regulators find a proposed premium rate “unreasonable” or “unjustified.” Department of Managed Health Care and California Department of Insurance conduct mandatory premium rate reviews for health plans under their jurisdiction according to ACA rules and implementing California law. (Status: Senate Appropriations)

SB 993 (Hernandez) – Oversight of Mergers and Acquisitions

Requires prior approval by the Department of Managed Health Care for mergers between health plans and other organizations and prohibits specified provisions in health plan provider contracts. (Status: Senate Appropriations)

SB 997 (Lara) – Coverage for Undocumented Children

Authorizes undocumented children eligible for full-scope Medi-Cal coverage, who are enrolled in low-cost coverage through Kaiser Permanente or another Medi-Cal managed care plan, to be enrolled in full-scope Medi-Cal with the same health plan. (Status: Senate Appropriations)

SB 1010 (Hernandez) – Prescription Drugs: Transparency

Requires health plans to provide regulators reviewing health care premium filings with specified information relating to prescription drug spending. In addition, this bill requires drug manufacturers to notify state purchasers of health care services when drug prices increase by more than 10% or when manufacturers introduce new drugs costing more than $10,000 per course of treatment to the market. (Status: Senate Appropriations)

SB 1139 (Lara) – Health Professions Grants and Loans

Provides educational grants and loans to undocumented students seeking training as a health professional. (Status: Senate Appropriations)

SB 1159 (Hernandez) – Health Care Cost and Quality

Requires the Secretary of Health and Human Services to convene an advisory committee and develop the parameters for a health care cost and quality database. Enacts related reporting and regulatory authority requiring health plans to provide health care utilization and cost information to the Secretary. (Status: Senate Appropriations)

SB 1418 (Lara) – Medi-Cal Coverage for All

Extends eligibility for full-scope Medi-Cal to all individuals 19 years of age and older, regardless of immigration status. (Held in Senate Health Committee)

 

 

Medi-Cal For All Children Goes Live Today

On Friday May 13, 2016, the state Department of Health Care Services (DHCS) notified the Department of Finance that all systems are go to implement SB 75 (Medi-Cal for All Children) today.

The Medi-Cal for All Children Expansion means that low-income undocumented children will, for the first time, be eligible for full-scope Medi-Cal. Approximately 185,000 newly eligible children who do not have satisfactory immigration status will now be able to enroll in comprehensive coverage, including preventive services, specialty health and mental health services, and dental and vision care. Read more on the details of the expansion and transition of eligible children here.

Today’s milestone is the culmination of decades of state and local efforts to ensure coverage for all California children as the timeline at the bottom of this post illustrates.

California first began to emphasize covering children by allocating revenues from Proposition 99, the Cigarette and Tobacco Products Surtax ballot initiative of 1988, to a new program for middle-income pregnant women and their children not eligible for other coverage, the Access for Infants and Mothers Program (AIM).

Local and state leaders continued to move the needle on children’s coverage by implementing the landmark federal State Children’s Health Insurance Program (S-CHIP), creating the Healthy Families Program in California. California communities stepped forward starting in 2001 with the first county-based Children’s Health Initiative (CHI) to provide coverage for children regardless of immigration status. By 2007, there were 25 CHIs operating in 30 counties.

California’s commitment to cover children continued, despite setbacks when the state faced a dramatic fiscal crisis starting with the 2007 recession. During the lean years, families faced waiting lists, benefit reductions and increased out-of-pocket costs. Policymakers ultimately avoided further declines by passing the Medi-Cal managed care tax in 2009. With implementation of the Affordable Care Act, California expanded and simplified eligibility for children.

All these efforts have had an impact. Among all income levels, the percent of uninsured children in California declined from 10.3% in 2001 to 4.5% by 2014 (California Health Interview Survey). Among low-income children under 200% of the Federal Poverty Level (FPL), the rate declined from 13.4% in 1995 to 7.4% in 2012. An additional 45 million children enrolled in Medi-Cal between 2004 and 2013. Click here to see more on these stats.

The Next Challenge

The State, counties, health plans, providers, advocates and community-based organizations have been gearing up for the transition of undocumented children to Medi-Cal. It remains to be seen how successful and smooth the transition will be.

DHCS is planning to track specific indicators of the transition process but it will take vigilance and the same focus that brought California to this historic moment to ensure children have access to the care they need and deserve. ITUP will continue to reach out to its advisors and stakeholders to capture the experiences in the field as California adds nearly 200,000 children to Medi-Cal. ITUP will check in with local communities during our regional work groups in the fall. It is critical to consistently and regularly evaluate the impacts on the system as Medi-Cal continues to grow and expand to cover nearly 14 million Californians.

In addition, as remains true for the overall implementation of health reform, enrollment in coverage is just one step on the path to ensuring families have access to the health care resources needed to preserve and improve health.

Families must have access to health care services in their communities through an adequate supply of providers in all categories. Services must be timely and accessible regardless of the physical, cultural or language barriers children and families face. Services must be affordable at the point of care. We must collectively ensure that families do not encounter financial, language, literacy or cultural barriers to using the services and getting the care they need. Children and families should receive services that are appropriate for the individual and the community they live in. Services must be coordinated and integrated to meet the complexity of individual and family needs.

There is no doubt that we collectively have a lot of work to do in delivering on the promise of coverage, especially for disenfranchised children and families.

That said, putting in place the programs and systems to enroll all children in coverage is a long-awaited and essential step that we can all celebrate! Congratulations to all those who persisted in helping to realize the vision of coverage for all California children!

This blog post was co-authored by Lyndsey Nolan.

Medi-Cal for All Children

Children’s Coverage in California

 

Reflections on the 6th Anniversary of the Affordable Care Act

ITUP’s Executive Director, Deborah Kelch, reflects on the 6th Anniversary of the Affordable Care Act.

Reflections on the 6th Anniversary of the Affordable Care Act

Today we mark six years since passage of the landmark federal Affordable Care Act (ACA). This is an important opportunity to take time and acknowledge our collective efforts to embrace and fully implement the ACA and its coverage expansions.

ACA implementation has essentially cut in half the number of uninsured Californians. More than 13 million Californians are enrolled in Medi-Cal, up from just 7.9 million in the 2012-13 fiscal year. Another 1.6 million Californians have comprehensive coverage through Covered California, the state’s newly formed ACA marketplace. The state continues to move toward health care for all. This year, all eligible children regardless of immigration status will have access to full scope Medi-Cal with medical and dental coverage. Proposals are under consideration to reach and extend coverage to adults left out of the expansions to date.

Still, the ACA is more than just getting people covered and is also about reforming the health insurance market. Individuals are eligible for private coverage regardless of health status or pre-existing conditions. California adopted comprehensive benefits as the standard for individual and small employer coverage, eliminating low benefit plans which often resulted in delayed care and consumer debt. The state, counties, health plans and providers are implementing expanded mental health and substance abuse treatment benefits. California’s ACA marketplace, Covered California, is financially sustainable, increases competition among health plans inside and outside the exchange, and leads the nation in standardizing benefit designs to facilitate consumer comparison. Covered California is working with its health plans and stakeholders to measure and improve the quality of the care delivered. California’s Section 1115 federal Medi-Cal waiver offers unprecedented opportunities to improve and enhance coordination of care and services for Medi-Cal beneficiaries. Counties, health plans, providers and community-based organizations are conceiving and implementing innovative approaches to engage consumers in securing coverage and accessing needed health care. New partnerships are emerging aimed at improving collaboration and integration across the silos of care.

At the same time, we recognize that there is still a lot to do before we realize the vision of all Californians having access to affordable, quality health care. More than 3 million California residents remain uninsured. Many of our neighbors struggle to afford health care premiums or to pay out-of-pocket costs when they seek health care services. Many communities lack sufficient numbers of primary and specialty providers, with some regions missing entire categories of providers and services. Individuals with health coverage, including many newly covered persons, experience an array of barriers to accessing care including financial, language, literacy, geographic distance, physical accessibility and cultural challenges. Health care costs, pricing and utilization vary widely across regions of the state with no connection to quality. Health plans, providers, counties and affiliated agencies may yet have inadequate capacity to effectively monitor quality and make the adjustments necessary to improve care delivery and reduce costs.

We also understand that health is about more than access to health care services. Diverse stakeholders around the state are actively working in communities to ensure residents of the state have safe and healthy environments in which to flourish and grow.

Going forward, ITUP will continue to speak out on behalf of those left out and left behind. ITUP will engage state and regional partners, highlighting and promoting strategies and innovations to improve health and health care across the state. The dramatic successes to date give us the confidence to continue making progress toward our shared goals.