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CaliforniACA March Newsletter

Supreme Court Challenge
The Department of Health and Human Services v. Florida
Days after the 2nd anniversary of the ACA, the Supreme Court heard 3 days of oral arguments over the constitutionality of the ACA.  The first day was on whether or not the Court had the authority to hear the case under the 1867 Anti-Injunction Act, the second was on the constitutionality of the individual mandate, and the third was on Medicaid expansion and severability.  Read an ITUP guide to the constitutional challenges; a summary, as well as links to transcripts and audio of the hearings, is available as well.

March Exchange Board Meeting: Outreach and Enrollment
The March meeting was held in Fresno and provided an extensive overview of outreach and enrollment strategies with three panel discussions composed of representatives from Ogilvy Public Relations, health plans (Blue Shield of CA, Kaiser, Anthem), and assisters/navigators.  David Panush also summarized new federal regulations, and Ken Jacobs of UC Berkeley presented data on their California Simulation of Insurance Markets (CalSIM), which projects take-up and insurance coverage under two scenarios.  Read more here.

Board Seeks Stakeholder Input on Qualified Health Plan and Benefit Design Process
The Exchange is seeking input on QHP contracting and delivery system reform strategies to foster better value and quality with a series of stakeholder questions.  Comments are due April 1, 2012.

Circuit Court Denies State Request for Medi-Cal Cuts During Lawsuit
The 9th Circuit Court of Appeals denied CA’s 2011 request to allow proposed Medi-Cal cuts to take effect while a lawsuit involving the cuts is litigated.  In October 2011 subsequent to the Court of Appeals’ decision, CMS approved the state’s plan to reduce certain Medi-Cal payments by 10% to save the state $623 million.  In February 2012, the U.S. Supreme Court had sent the case back to the lower court for reconsideration in light of CMS’ decision.  U.S. District Court Judge Christina Snyder then granted a preliminary injunction to block the rate cuts because they could cause irreparable harm.

Details Ironed Out for Managed Care for Dual-Eligibles
After state officials met with stakeholders in late March to work out the final details of the duals demonstration project, DHCS plans to announce 10 demonstration counties in early April.  The goal is to enroll an estimated 700,000 dual-eligibles (Medi-Cal and Medicare) into Medi-Cal managed care; these projects will be operational starting January 2013.

Disability Advocates File Contempt Motion Against DHCS
Disability Rights California has filed a contempt motion stating that DHCS officials have not followed the terms of agreement regarding the transition of adult day health care to the newly created Community Based Adult Services Program (CBAS) after Adult Day Health Care (ADHC) was eliminated as a Medi-Cal benefit.  DRC officials claim that the state has illegally limited the eligibility status of many who were approved for the CBAS program.

Healthy Families
Health-e-App Led to Spike in Healthy Families Enrollment
According to a Mathematica Policy Research study, the online application tool, Health-e-App, could be responsible for boosting enrollment for the Healthy Families Program, where it was used by 50,425 applicants in 56 of the state’s 58 counties.  The online enrollment process was used for 42% of all applications last year, and use of the Health-e-App was associated with a 14% increase in total applications from 2010 to 2011.

§1115 Waiver
Four More Counties Preparing to Launch LIHP
Four Sacramento area counties (Sacramento, Yolo, Placer and El Dorado) are preparing to provide Low Income Health Programs to their county residents.  More than 40 other CA counties already participate in the program.

Small Business
Majority of CA Small Businesses Unaware of Federal Tax Credits, Exchange
According to a survey from Small Business California, 83% of polled CA small business owners are concerned about rising health care costs.  However, 77% said they were unaware of small business tax credits included in the ACA to help pay for health benefits, and 75% were unaware that they will be able to choose and purchase health plans through the Health Benefits Exchange.

Hospitals Prepare for Patient Outcome Based Reimbursement
The LA Times reported that CA hospitals are reframing their financial models and are seeking to treat fewer patients to prepare for reimbursement changes under the ACA, which align hospital payments with patient outcomes and penalize hospitals for preventable readmissions and hospital-acquired infections.

Teen Birth Rates Hit All-Time Low
The CA Department of Public Health released data showing that CA teen birth rates decreased to a record low in 2010 to 29 births for every 1,000 girls ages 15 to 19.  Despite being the highest among ethnic groups, the Hispanic teen birth rate dropped from 50.8 births per 1,000 teens to 45/1,000.  Black teen birth rates dropped from 37/1,000 to 34/1,000.

Nursing Home Investigations Inadequate
DPH may not be adequately following up on nursing home investigations, according to a federal report by HHS’ Office of the Inspector General.  In 178 deficiencies at 3 nursing homes with high rates of patients requiring hospital care for bedsores and severe infections, nursing home inspectors underestimated the severity of problems 13% of the time, and in 77% of cases that required homes to follow corrective-action plans, the state accepted plans that did not met federal standards.

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