This issue of ACA Watch highlights program and population changes that re-shaped Medi-Cal under ACA. In addition to expanding coverage for some of the state’s most disenfranchised residents, the ACA dramatically altered the demographic profile and scope of the Medi-Cal program.
|May 25, 2017||Posted by ITUP under Latest ITUP News|
|April 14, 2017||Posted by ITUP under Blog|
On March 14, 2017, the Covered California Board convened its monthly Board meeting. The Board Meeting Agenda included Closed Session, an Executive Director’s Report, and Covered California Policy and Action Items. (more…)
|January 13, 2016||Posted by ITUP under Blog, Latest ITUP News||
Below, please find a message from our Executive Director, Lucien Wulsin.
ITUP’s goals for 2014-15 were to build on and accelerate the first year’s successes in Affordable Care Act (ACA) enrollment and to begin building consensus on the necessary next steps in the health reform process to improve health status and lower the costs of care. These included: integrating behavioral and physical health (whole person care), developing the health workforce in medically underserved communities, refining the performance of Medi-Cal managed care, improving the affordability of Covered California and delivery system reforms, and exploring the opportunities of e-medicine.
We were deeply engaged over the past year in the care and financing of the remaining uninsured in Southern California counties, the development of the §1115 waiver renewal concepts, and the transformation of local safety net systems. Many of the concepts developed, discussed, and recommended in our interviews and convenings with Southern California stakeholders were incorporated in the state’s concepts for the waiver renewal.
We updated our ObamaCare educational materials and trained Southern California clinics and community groups through webinars, convenings, and presentations to help consumers enroll in the newly available coverage. We monitor, analyze, and report annually on the trends and impacts of the ACA on usage of hospital inpatient, outpatient, and emergency room services, as well as community clinics. Covered California continued to grow to 1.3 million newly enrolled; Medi-Cal managed care enrollment grew by over 55% and reached over 12 million beneficiaries in July of 2015. Meanwhile, clinics have reported an increase in visits by patients with Medi-Cal and private coverage, accompanied by a 28% decrease in uninsured. In fact, California’s uninsured rate is about half of what it was prior to the ACA, and California is among the top five states most successful in reducing the numbers of uninsured.
There is an emerging need to better explain the new coverage to those newly eligible, and to educate the newly enrolled on the importance of prevention and primary care, rather than waiting for their health to deteriorate to the point of requiring emergency services. We worked with clinics, plans, and community-based organizations through our regional workgroups to identify and to begin addressing these educational needs.
In some communities, the supply of health care professionals is simply insufficient to meet the community’s needs. We prepared a report and convened a workgroup to discuss how to improve participation by solo and small group practices in Medi-Cal managed care. We discussed the potential of e-medicine to help alleviate shortages and highlighted its potential at our annual conference. We also emphasized these workforce needs as an issue to be addressed in the state’s §1115 waiver renewal.
Those with mental illness and substance use disorders receive treatment in three separated programs, with patient confidentiality protections that prohibit information sharing by their providers. Better-integrated and coordinated care has enormous potential and demonstrated capacity to improve their patient outcomes and reduce health costs. We prepared reports, held an issue workgroup, convened Los Angeles stakeholders, and discussed these challenges in our regional workgroups as well as at the annual conference. California has expanded mental health, and recently sought and secured federal approval to expand substance use disorder treatments over the past year. Our workgroups and reports have helped to educate our networks on these developments.
At this year’s annual conference, we featured two well-attended and much appreciated sessions on payment and delivery system reforms in the public and private sectors. In addition, we prepared a report and organized an issue workgroup on payment reforms in Medi-Cal managed care programs.
We also prepared a report and held an issue workgroup on local and state opportunities to improve affordability of Covered California premiums through augmented premium assistance. Healthy San Francisco is the first community to embrace this opportunity.
Our staff has been unstinting in their efforts to support our networks in their efforts to increase care and coverage for California’s remaining uninsured and newly insured. California could not be a leader without the efforts of all of you.
We deeply appreciate and are enormously grateful for the generous support of our funders: Blue Shield of California Foundation, The California Endowment, Kaiser Permanente, The California Wellness Foundation, California Community Foundation, California HealthCare Foundation, and L.A. Care Health Plan.
Best wishes for the New Year and thank you all for the extraordinary opportunity to work with each of you.
Lucien Wulsin Jr.
|January 5, 2016||Posted by ITUP under Latest ITUP News||
Through expanding Medi-Cal and subsidizing private insurance through Covered California for 1.3 million Californians, the Affordable Care Act (ACA) launched the triple of aim of better access, improved care, and reduced costs. As the ACA enters its third year of implementation, California will need to look beyond coverage expansion and evaluate strategies and policies that advance the triple aim framework for employment based health insurance. California’s policymakers and the employer community will need to work together to address needs and challenges that include:
- Improving coverage and affordability within the different employer markets (small, midsize, and large)
- Implementing payment and delivery system reforms that reward value
- Preparing for the impacts of the Cadillac tax
- Considering the merits of insurance market mergers.
This report provides background history and key findings from the literature and the latest available survey data on employer health benefits, describes the California context, and outlines issues for policymakers and employers to consider in advancing the triple aim for employer-based health insurance.
|July 28, 2014||Posted by ITUP under Uncategorized||
ITUP hosted a series of educational trainings entitled ObamaCare 201: Essential Updates Before Open Enrollment, the second set of sessions on the Affordable Care Act (ACA). This series of trainings explained everything there is to know about insurance and coverage under the ACA, discussed immigration status and health coverage, addressed upcoming changes in Covered California and Medi-Cal, and provided a host of resources for enrollment workers, providers, and community leaders. The trainings were held around Los Angeles County for community clinic staff, other medical providers, and community based organizations. This page is a resource for those who attended the trainings and others who find it useful.
Our Fall trainings are now complete. If you are interested in contracting with ITUP for training or have questions, please email email@example.com.
The following materials help you understand and explain ObamaCare. Please distribute widely.
Materials from the 2013 trainings can be found on the ObamaCare 101 page.
These educational trainings are provided with generous support from the California Community Foundation and L.A. Care Health Plan in partnership with the Community Clinic Association of Los Angeles County and Visión y Compromiso
|November 18, 2013||Posted by ITUP under Behavioral Health||
Posted below are materials from ITUP’s monthly Drug Medi-Cal workgroup.
Agenda from October 2, 2013 Behavioral Health Issue Workgroup
Behavioral Health Workgroup Agenda.pdf
Materials from the CalMHSA Integrated Behavioral Health Project
Stigma and Attitudes Toward Working in Integrated Care.pdf
Health Reform and the Transformation of the Delivery of Care.pdf
Trainings Needs in Integrated Care.pdf
An Update on Integrated Behavioral Health Projects in California Counties.pdf
An Update on Integrated Primary Care and Behavioral Health Services in California Community Clinics and Health Centers.pdf
IBHP New Resources, Fall 2013.pdf
|May 20, 2013||Posted by ITUP under Blog||
On May 14, 2013, Covered California announced it will be awarding $37 million in grants to 48 organizations for outreach and education efforts to individuals and small businesses. “Together, we can significantly strengthen our effort to ensure as many Californians as possible are aware of and are enrolled in the new health insurance options this fall for coverage beginning January 1, 2014.” said Executive Director Peter Lee. According to the press release, this will be accomplished through the development of educational partnerships that support outreach and education in communities where likely enrollees are located.
Outreach and Education
Covered California aims to reach Californians through outreach and education, to ensure that access to affordable health care is available for individuals and small businesses. With the awarded grants, Covered California’s goal is to increase awareness of new benefits, educate targeted populations about available subsidy programs, and encourage individuals and small businesses to participate in the health insurance exchange.
The number of Californians eligible for individual insurance is projected to be 5.3 million, with half identified as eligible for financial assistance with their premiums. Grant recipients will reach an estimated 9 million individuals and more than 200,000 small businesses. The largest group potentially eligible for federal subsidies is California’s Latino community, which is the target of 37 outreach and education grants. Caucasians are the next largest group, with 24 grants; African Americans, 24 grants; Middle-Eastern, 11 grants; and Asian-Pacific Islander communities with 20 grants. A detailed list is available at www.hbex.ca.gov.
Organizations that were not awarded grants, may apply to Covered California’s Assisters Program to become Assister Enrollment Entities. Interested organizations can also become part of Covered California’s Community Outreach Network.
See the full press release here
|Individual Funding: Access California Services
Anaheim Health Medical Center Foundation
Asian Pacific American Legal Center
Bienestar Human Services, Inc.
Cal State LA University Auxiliary Services, Inc.
California Black Health Network
California Council of Churches
California Health Collaborative
California Rural Indian Health Board, Inc.
California School Health Centers Association
Catholic Charities of California, Inc.
Central Valley Health Network
Coalition for Humane Immigrant Rights of Los Angeles
Community Health Councils
Council of Community Clinics
East Bay Agency for Children
Fresno Health Communities Access Partners
Infoline of San Diego (2-1-1 San Diego)
John Wesley Community Health (JWCH) Institute
Loma Linda University Medical Center
Los Angeles County Federation of Labor
Los Angeles Unified School District
Planned Parenthood Mar Monte, Inc.
Redwood Community Health Coalition
Sacramento Employment and Training Agency
San Bernardino Employment and Training Agency
|Santa Cruz County Human Services DepartmentSEIU Local 521
SEIU United Long Term Care Workers
Social Advocates for Youth (SAY), San Diego
Solano Coalition for Better Health
St. Francis Medical Center of Lynwood Foundation
The Actors Fund
The East Los Angeles Community Union
The Los Angeles Gay and Lesbian Community Services Center
The Regents of the University of California
UC Davis, Center for Reducing Health Disparities
United Ways of California
University of Southern California
Valley Community Clinic
Ventura County Public Health
Visión y Compromiso
Small Business Funding:
California Asian Pacific Chamber of Commerce
California Association of Non-Profits
California Hispanic Chambers of commerce Foundation
California Small Business Education Foundation
Small Business Majority
|May 1, 2012||Posted by ITUP under Conference||
See below for resources from the 16th Annual Statewide Conference California’s March to 2014: Paving the Road to Health Reform.
Photos from the Conference!
Conference Audio Sessions
Opening Remarks By Funders
California Health Benefit Exchange 1/2
California Health Benefit Exchange 2/2
§1115 Waiver 1/2
§1115 Waiver 2/2
Breakout Sessions: Implementation of the §1115 Waiver 1/2
Breakout Sessions: Implementation of the §1115 Waiver 2/2
Breakout Sessions: Purchasing Strategies 1/2
Breakout Sessions: Purchasing Strategies 2/2
Breakout Sessions: Outreach and Enrollment 1/2
Breakout Sessions: Outreach and Enrollment 2/2
Honoring- E. Richard Brown
Essential Health Benefits 1/2
Essential Health Benefits 2/2
The Future of Medi-Cal
Discussion Panel 1/2
Discussion Panel 2/2
Future of Medi-Cal Plenary - Andy Schneider.pdf
Exchange Plenary - Peter Lee.pdf
Waiver Breakout - Alex Briscoe.pdf
Waiver Breakout - Lee Kemper.pdf
Waiver Breakout - Srija Srinavasan.pdf
Essential Health Benefits Plenary - Marjorie Ginsburg.pdf
Essential Health Benefits Plenary - Susan Philip.pdf
The conference binder is password protected for copyright purposes. All conference attendees will be emailed this password.
ITUP Conference Agenda.pdf
Creating the California Health Benefits Exchange: Progress to Date.pdf
Outreach and Enrollment Breakout.pdf
Insurance Regulation Plenary.pdf
Essential Health Benefits Plenary.pdf
Future of Medi-Cal Plenary.pdf
Medi-Cal Discussion Panel.pdf
Alex Briscoe, Director Alameda County Health Care Services Agency
Dan Castillo, CEO, Children’s Hospitals of Orange County Health Alliance
Richard Chambers, CEO, CalOptima
Toby Douglas, Director, California Department of Health Care Services
Peter Long, CEO, Blue Shield of California Foundation
Mitchell Katz, Director of Health Services, Los Angeles County Department of Health Services
Lee Kemper, Executive Director, County Medical Services Program
John Arensmeyer, Founder and CEO, Small Business Majority
Kim Belshe, Board Member, California Health Benefit Exchange
Anthony Wright, Executive Director, Health Access
E. Richard Brown, Director, UCLA Center for Health Policy Research
Andy Schneider, Consultant
Burt Margolin, CEO, The Margolin Group
Srija Srinivasan, Director of Strategic Operations, San Mateo County Health System
Elizabeth McNeil, Vice President, California Medical Association
Elizabeth Landsberg, Director of Legislative Advocacy, Western Center on Law and Poverty
Howard Kahn, CEO, L.A. Care Health Plan
Marian Mulkey, Director of Health Reform and Public Programs Initiative, California HealthCare Foundation
Daniel Zingale, Senior Vice President, Policy, Communications, and Public Affairs, The California Endowment
Kaiser Permanente Community Benefits Program
Peter Lee, Executive Director, California Health Benefits Exchange
Paul Fearer, Board Member, California Health Benefit Exchange
Sharon Levine, Associate Executive Medical Director, Permanente Medical Group
Christopher Perrone, Deputy Director, CA Healthcare Foundation
Lucien Wulsin, Executive Director, Insure the Uninsured Project
Katie Marcellus, California Health Benefit Exchange
Rick Kronick, Deputy Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services
Marjorie Ginsburg, Executive Director, Center for Healthcare Decisions
Hermann Spetzler, CEO, Open Door Community Health Centers
Tangerine Brigham, Director, Healthy San Francisco
|August 3, 2011||Posted by ITUP under Blog||
[The following post was written by Micah Weinberg, Senior Policy Advisor for the Bay Area Council.]
Today the Pacific Business Group on Health (PBGH) issued a paper I wrote with Bill Kramer which reviewed the “lessons” from California’s experience for those setting up the new small employer (SHOP) exchanges in federal healthcare reform. PBGH was the administrator of California’s own small employer exchange from 1999-2006. This exchange, PacAdvantage, ultimately had to close due to a number of factors including its attracting a relatively unhealthy pool of enrollees. If we learn from its experience, though, SHOP exchanges may succeed where PacAdvantage failed.
Part of that success will be understanding the key value proposition of these new marketplaces. The main thing of value that these exchanges offer is choice. But, as we write in the paper, the experience of PacAdvantage shows that choice can come in many forms. The two main types are “employer choice,” in which management selects among a number of health plans for their workers and “employee choice,” in which management provides a certain level of financial assistance and leaves the selection of health plans up to the workers entirely. The most commercially successful product offered through this purchasing pool was a hybrid that combined employer and employee choice. The “PairedChoice” product allowed an employer to select among a number of different PPOs, one of which would be paired with an HMO from the large integrated delivery system, Kaiser Permanente. Employees then chose between the PPO and the HMO paying higher premiums if they wanted lower point-of-service costs.
PacAdvantage developed this product after determining that although employers who participated in this pool were allowed to offer a wide range of employee choices, few actually did, and most that did so utilized a “paired PPO/HMO” structure. Many employers offered a more limited version of employee choice because they found that the administrative burden was higher when their employees selected from among a large number of health plans. In theory, the administrative burden of employee choice can be outsourced to the exchange or to a broker. Since there is a single bill, the administrative demands on small businesses should be the same whether their employees select among two plans or twelve. In reality, however, employers are often expected to handle employee concerns about access to doctors or coverage decisions of insurers; therefore, the actual administrative hassle is higher when employees select from among a wider range of insurance plans.
PairedChoice split this difference by providing a highly structured set of choices that were attractive to employers while providing some autonomy to employees. Through incorporating elements of cost-conscious consumer choice, it may have helped to encourage price competition among the health plans. We suggest in the paper that SHOP exchanges should consider offering hybrid choice options to employers in addition to unrestricted employee choice. The appeal of the PairedChoice product was also based, in part, on the price advantage of the Kaiser Permanente HMO. In the past ten years, though, other HMOs in California and throughout the nation have developed differentiated networks that allow them to become more price competitive. Hence a small group exchange may be able to offer a broader range of choices for a similar “paired” product.
|April 18, 2011||Posted by ITUP under Blog||
Led by Jonathan Freedman of the L.A. County Department of Public Health, the meeting will focus on county decisions about designing Low Income Health Programs (LIHPs) and other waiver infrastructure to draw down federal reimbursement funds using Inter-Governmental Transfers (IGTs) or Certified Public Expenditures (CPEo).
This training will be held LIVE in Los Angeles (location TBA) in Tuesday, May 10 from 1 – 3 p.m. and simultaneously webcast for those who are unable to attend in person. For more details, contact Kim Lewis at firstname.lastname@example.org.