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ITUP’s February Newsletter


Proposal to Transition Healthy Families Children into Medi-Cal
On February 9, DHCS hosted a stakeholder meeting on the proposed transition of Healthy Families (HFP) into Medi-Cal. A recently proposed trailer bill would require all HFP enrollees with family incomes up to 250% FPL to transition to Medi-Cal over a three-phase 9-month period, beginning either October 1, 2012 or 90 days after the bill is enacted (whichever date is later).  There are currently 875,000 eligible beneficiaries who would be affected. Read more here.

Supreme Court Sends Medi-Cal Case Back to Lower Court
In a 5-4 decision, the U.S. Supreme Court sent Douglas v Independent Living Center of Southern CA back to a lower appeals court, which allows medical providers to continue suing to stop Medi-Cal reimbursement cuts. The four dissenters wanted to block all lawsuits brought against cuts in Medicaid; CA will continue paying the higher rate for now. Read more here.

§1115 WAIVER

Ten Counties Expand Access
Ten California counties have expanded health insurance coverage to more than 250,000 residents who previously were uninsured as part of efforts to implement provisions of the federal health reform law ahead of schedule. Jane Ogle — deputy director of health care delivery systems for the state DHCS — said, “The 10 counties have done a fabulous job reaching out to people who otherwise would not have access to health care coverage.” Read more here.

State Requests Amendments to §1115 Waiver
A February 6 update on CMS’ status report showed that the state is requesting multiple amendments: to allow providers to deny access/services to beneficiaries who are unable to pay or have outstanding balances; to reallocate unspent funds from the HCCI and Designated State Health Programs to DY6 of SNCP funds; to move adult day health care from the state into the demonstration based on a lawsuit settlement with the state; and to create an HIV Transition Incentive Program with SNCP funds to develop a program to serve Ryan White patients.


LAO Calls Shift “Premature”
Gov. Jerry Brown’s (D) plan to rapidly expand a four-county pilot program that shifts individuals eligible for both Medi-Cal and Medicare into managed care plans is “premature,” according to a report from the non-partisan Legislative Analyst’s Office. Medi-Cal is California’s Medicaid program. According to LAO estimates, the state has about 1.9 million dual eligibles. Read why here.


Summary of the February Board Meeting
The February Exchange Board meeting (agenda) was full of fast-paced and exciting updates, followed by expert panels intended to give framework for qualified health plan (QHP) requirement determinations. During his Executive Director update, Peter Lee noted that the Small Business Health Options Program (SHOP) solicitation has been released, the Board is in the process of reviewing applications for outreach and enrollment/assisters, and have finished final amendments for the QHP’s solicitation. Also, on February 23, it was announced that the QHP grant was awarded to PricewaterhouseCooper. Read more here.

Essential Health Benefits FAQs Released
HHS released a list of FAQs as a follow-up to the Bulletin on Essential Health Benefits (EHBs) released in December. Key points include: states must use the same benchmark plans for its individual and small group markets; the state may use a different EHB for purposes of the Medi-Cal benchmark benefit for newly eligibles; and in either case, the EHB must cover the 10 statutory benefits categories.  Read more here.

Milliman Finds Little Variation in 10 Benchmark Plan Benefits
The first round of a Milliman study contracted by the Exchange found that there are relatively few benefit differences among the 10 potential benchmark products; when translated into costs, the differences are between 2-4%. The big driver for determining premium costs will likely lie in cost-sharing variations.  Read more here.

RFP for Navigators Released
On December 27, 2011, California’s Exchange Board released a Request for Proposals (RFP) for “Communications Support for the Outreach and education Campaign Plan and Assisters Program.” The RFP states that “assisters” can include Navigators and individuals/entities who already assist with coverage enrollment (i.e. agents, brokers, representatives of providers, community-based organization, county eligibility workers and many others). The RFP also contemplates the development of a compensation plan. Read more from a recent meeting hosted by the Kids Coverage Coalition.


Breaking Down Barriers
UC Berkeley hosted a conference on the barriers to creating safety net accountable care organizations (ACOs) in California. Stephen Shortell, Dean of the UC Berkeley School of Public Health, presented findings from his recent BSCF study that assesses safety net ACO readiness in two counties (Alameda and Orange) and examines legal and regulatory issues associated with forming safety net ACOs. During preliminary interviews, researchers found that safety net providers expressed concerns about scarce capital, complicated health issues of safety net patients, and the lack of information technology and infrastructure. Read more here.


Proposed Rule on Stage 2 Released
Federal officials released a proposed rule outlining requirements for health care providers pursuant to Stage 2 of the meaningful use program. Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments. Officials plan to soon release a proposed rule on the certification criteria for EHRs that support Stage 2 requirements. Read more here.


California Health Interview Survey Reports an Increase in the State’s Uninsured
The UCLA Center for Health Policy Research’s new report, The State of Health Insurance in California: Findings from the 2009 California Health Interview Survey, sheds light on the effects of the recession on insurance coverage and access to care to millions of Californians. The study finds that 7.1 million Californians were uninsured in 2009, amounting to 21.1% of nonelderly Californians who had no health insurance coverage for all or some of 2009. This is up nearly 2 percentage points from 2007. The loss of employment-sponsored insurance due to lay-offs and job losses increased uninsurance, which fell 3.5 percentage points from 2007, when 55.6% had coverage from their own or a family member’s job, to 52.1% in 2009. Read more here.

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