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Los Angeles County Health Care Providers Divided Over Healthy Way L.A. Matched Payments

A recent Payers and Providers article depicts L.A. County public and private providers divided over claims payments for a pre-reform expansion program, Healthy Way LA Matched.  The program is L.A. County’s Low Income Health Program (LIHP) as part of the state’s §1115 “Bridge to Reform” waiver, providing access to services for eligible low-income adults up to 133% FPL.  The L.A. County Department of Health Services (LADHS), which administers the program, and its contracted community clinic network enrolled over 200,000 patients across L.A. County.  These patients will be eligible for the Medi-Cal expansion once it takes effect in 2014.

Clinics and hospital officials across L.A. County have been encountering trouble in getting their claims paid for HWLA patients in a timely manner by LADHS. Venice Family Clinic, one of the largest free clinics in the county, is facing insolvency due to awaiting payment on up to $1.6 million in outstanding claims from Healthy Way LA Matched since the program’s start in July 2011. The clinic has used up much of its line of credit to maintain operations. Louise McCarthy, CEO of Community Clinic Association of Los Angeles County stated the current enrollment and claims systems used by LADHS are not nimble as they should be.  Hospitals have experienced similar problems receiving payments and verifying enrollment, but unlike clinics, they have other sources of funding.  However, other clinics such as Northeast Valley Health Corporation mentioned that the LADHS payment process has improved over the last few months, while a more significant source of strain is caused by Medi-Cal cuts and payment delays.

Amy Luftig Viste speaking on behalf of LADHS stated that the department pays every legitimate Healthy Way LA Matched claim within four to six weeks of submission. However, 60% of claims lack complete program applications leading to enrollment delays, are incorrectly coded, or are resubmissions of claims that have already been paid.  Luftig Viste says the challenges may be exacerbated by high staff turnover rates in clinics.  The Community Clinic Association of Los Angeles County credits LADHS for the progress made in cleaning up claims adjudication.  However, in preparation for the Medicaid expansion, more should be done to address these ongoing issues.

For more information or to access the Payers and Providers article, please click here.

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