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CPAC Host Capitol Briefing in Sacramento

The California Program on Access to Care (CPAC) hosted a policy briefing yesterday in Sacramento titled Laying the Groundwork for Health Reform: Challenges and Opportunities. The meeting included four presentations on subsidy repayment, engaging communities of color in the ACA, pent-up demand in California, and the integration of substance use disorder treatments. Key findings and policy recommendations from each presentation are summarized below:

Ken Jacobs from the UC Berkeley Center for Labor Research and Education presented on minimizing families health care subsidy repayments under the ACA. 1.75 to 2.15 million Californians are expected to receive premium and cost-sharing subsidies through the California Health Benefit Exchange (HBEX) in 2019. The California Simulation of Insurance Markets (CalSIM) model allowed the researchers to assess the impact subsidy repayment could have on individuals in HBEX. According to the study,

  • Significant income volatility and churning are expected in the subsidized Exchange and repayments will be appreciable if subsidies are not adjusted as income changes.
  • Reporting income changes and adjusting subsidies could significantly reduce repayment for individuals in the HBEX.

Researchers of the study recommend educating navigators, assisters, brokers, and recipients of subsidies on the possibility of repayment and the appropriate subsidy contribution.

Ying-Ying Meng from the UCLA Center for Health Policy Research and Ruben Cantu from the California Pan Ethic Health Network presented on engaging communities of color to maximize enrollment in health coverage in 2014. The study used the Community-Based Participatory Research approach and conducted six group interviews with low-income, racially diverse adults. Findings indicate that

  • Individuals are concerned about the affordability of coverage and suggested employing multiple forms of engagement, including language-specific newspapers and television, trusted Internet websites, schools, etc. for outreach.

Researchers recommend the state ensure adequate funding for community-based application assistance programs and be cautious in devoting resources to traditional outreach and enrollment approaches.

Dylan Roby from UCLA Center for Health Policy Research presented on the pent-up demand in California’s uninsured population. The study used HCCI data from five counties (Contra Costa, Orange, San Francisco, San Mateo, and Kern) to assess the use of health services before and after individuals received coverage.  The study found that:

  • 26.2% of Year 1 enrollees had previously used health services in county safety net facilities.
  • Long-term enrollees tended to be older and more likely to be chronically ill.
  • Despite chronic illness and age, a high level of utilization at initial enrollment was replaced with lower levels of use in subsequent years.

The data suggest that while there will be an increased use of services for the newly insured, there will also be a reduction in use over time, so the pent-up demand will be short-lived.

Darren Urada from the UCLA Integrated Substance Abuse Programs presented on integrating substance use disorder (SUD) treatments with primary care in preparation for Health Reform. The study used a web-based survey to assess SUD practices in five counties and rate the extent of integration between SUD services and primary care. Findings indicate that:

  • 43% of FQHCs do not have an electronic medical record system that integrates physical and mental health and SUD.
  • FQHCs do not provide SUD services on the same day as a primary care referral.
  • Most FQHCs have individual SUD counseling available, but the use of group counseling and prescription medications is less frequent.

Researchers recommend expanding the billable SUD workforce (i.e. MFTs) and allowing for same-day billing for two services. It was also recommended that the state stabilize funding for these services.

 

Detailed findings for each of the presentations can be found below.

Minimizing Families’ Health Care Subsidy Repayments Due to Income Volatility Minimizing Families’ Health Care Subsidy Repayments Due to Income Volatility.pdf
Ensuring Access: Engaging Communities of Color in ACA Ensuring Access: Engaging Communities of Color in ACA.pdf
Assessing Pent-Up Demand in California’s Uninsured Population: Preliminary Findings Assessing Pent-Up Demand in California’s Uninsured Population: Preliminary Findings.pdf
Integration of Substance Use Disorder Treatment with Primary Care in Preparation for Health Care Reform Integration of Substance Use Disorder Treatment with Primary Care in Preparation for Health Care Reform.pdf

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