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CaliforniACA: April 2013 Newsletter

Legislature Passes First Set of Special Session Bills
The Senate and Assembly voted to approve ABX1 2 (Pan, D-Sacramento) and SBX1 2 (Hernandez, D-West Covina) respectively, which would reform the individual and small employer health insurance markets and ban pre-existing conditions as a reason for insurance denial.  The bills are headed to the Governor’s desk; both are expected to be signed into law. An ITUP summary of the legislation is available online.

Governor Signs Legislation to Disarm Individuals Convicted of Felonies and Individuals with Court Determinations of Mental Illness
Governor Brown has signed into law SB 140 (Leno, D-San Francisco), which would allocate $24 million to help disarm 19,700 individuals with court determinations of mental illnesses or felony convictions.  State law enforcement officials have the authority to seize weapons from individuals not permitted by law to own them, but funding limitations have led to delays.  The bill would allow the state Dept of Justice to hire 36 additional agents, doubling the size of the Armed Prohibited Persons System staff.  The funds will come from surplus fees paid by gun purchasers.

Legislation to Repeal Medi-Cal Provider Cuts Sees Progress
The Senate and Assembly Committees on Health respectively passed SB 640 (Lara; D-Long Beach) and AB 900 (Alejo; D-Watsonville), which would reverse the Medi-Cal provider rate cuts imposed in 2011.  The cuts have yet to be implemented due to a pending federal court decision in a lawsuit challenging the cuts.  After passing with unanimous bipartisan votes, the bills head to appropriations committees in their respective houses.

Covered California
April Exchange Board Meeting: Supplemental Benefits, QHP Contracting, Eligibility and Enrollment 
During the April meeting, Covered CA board members and staff discussed a variety of issues, including qualified health plan contracting,supplemental benefits (adult vision/dental), and eligibility and enrollment; action was not taken on these items.  Rancho Cordova, Fresno and Concord were announced as the three service center sites, which will provide toll-free telephone application assistance.  Staff also noted that the Outreach and Education grant awardee announcement would be delayed from late April to mid May, with contracts beginning in July.

An additional, abbreviated meeting will be held in Sacramento on May 7 for the board to take action on model plan contracting; a second May meeting will be held on the 23rd.  A series of town hall meetings will be convened across the state, which will allow community members and stakeholders to provide feedback to Covered California: San Jose (May 10), San Diego (May 17).  All meeting materials are available online.

Access to Dental Care Improving for Medi-Cal Children
report by DHCS found that dental managed care plans in Sacramento and Los Angeles have significantly improved access to dental care for children enrolled in Medi-Cal.  The rate of Sacramento children receiving treatment from a dentist increased from 32.3% in 2011 to 43.7% in 2012, with similar increases for Los Angeles children with Medi-Cal coverage (24.6% in 2011 to 36.8% in 2012).

§1115 Waiver
Lawmakers Seeking to Leverage LIHP Infrastructure for Care to the Remaining Uninsured
Some state lawmakers are considering a plan that would use an estimated $700 million in county savings from Medi-Cal expansion to offer basic health care to the remaining uninsured.  When Low Income Health Program beneficiaries are transitioned into the Medi-Cal program in 2014, their health care will be fully paid for by the federal government for three years, saving counties about $1.4 billion.  This proposed plan would use part of the county savings to open county LIHPs to 1 million undocumented residents and 2 million legal residents who cannot afford to purchase health insurance next year.

Mental Health
LA, SF Investigate Alleged Patient Dumping by Nevada Mental Health Hospital
The Joint Commission, a non-profit firm that accredits hospitals, and city attorneys in San Francisco and Los Angeles, is investigating a Nevada mental health hospital that allegedly bussed hundreds of mentally ill patients to cities in CA and other states.  A Sacramento Bee investigation of bus receipts kept by the Nevada Division of Mental Health and Developmental Services revealed that the Rawson-Neal Psychiatric Hospital has sent more than 1,500 patients to other cities since July 2008.  A third of these patients were sent to CA, including 200 to LA County, 70 to San Diego County, and 19 to Sacramento.  CMS is also reviewing the hospital’s discharge practices; if violations are found, the hospital could lose federal funding.

Two employees at the Rawson-Neal Psychiatric Hospital have been firedand another three will be disciplined as a result of an internal investigation.

Provider Capacity
UCLA Program to Help Foreign-Born Physicians Practice in US
To reduce the state’s primary care shortage, the UCLA International Medical Graduate Program will offer foreign-born physicians a stipend, board preparation classes, mentorship and references to help them find primary care residencies.  The program specializes in helping Latino immigrants who are seeking a medical license, which is a costly and time-consuming process; in return, enrollees must agree to work in an underserved area for 2-3 years after obtaining their license.  The program has already placed 54 Hispanic physicians into family medicine training programs.

Payment Reform
Care Based Incentive Shows Early Pay-for-Performance Success
The non-profit health plan Central California Alliance for Health’s pay-for-performance initiative has demonstrated some successes.  The Care Based Initiative, which contracts with physicians and non-profit community and county clinics in Merced, Monterey and Santa Cruz, offers significant financial incentives for meeting criteria, such as minimizing preventable hospitalizations, extending office hours, and submitting claims electronically.

Prison Health
Judge Denies Governor’s Request to End Federal Oversight of Prison Health Care
A federal judge rejected Governor Brown’s request to end federal oversight of CA’s prison health care system.  Due to unacceptable medical malpractice or neglect, oversight of the prison’s health care system was transferred to the federal government in 2006.  In January, the Administration filed a request that would transfer oversight to the state; this request was denied in early April due to remaining “ongoing constitutional violations” and “deliberate indifference” to ongoing mental health issues.  Additionally, a panel of 3 federal judges rejected the governor’s request to end a court-mandated reduction to the state’s prison population.  The judges ruled that court-ordered prison population caps are necessary to curb unconstitutionally poor inmate care.

First 5 L.A. Awards $11M to UCLA for Improved Dental Care
First 5 L.A. awarded the UCLA School of Dentistry $11 million to improve community dental clinics in underserved areas of LA County.  The funds will be used to establish the UCLA-First 5 L.A. Children’s Dental Care Program (CDCP), which will provide dental care for children up to age five and pregnant women for the next five years.

Over 300,000 Large-Firm Employees Projected to be Medi-Cal Enrollees in 2014
In a recent study by the UC Berkeley Labor Center, the CalSIM modelpredicts over 310,000 Californians working for large firms will be enrolled in Medi-Cal in 2014.  Currently, 250,000 Californians working in firms with 500+ employees are enrolled in Medi-Cal, with 44% in the retail/restaurant industries.  In 2014, this number is expected to rise by 60,000 to 100,000 due to Medi-Cal expansions.  The recently introduced AB 880 (Gomez, D-Los Angeles) would impose a penalty on private employers with 500+ employees who have non-disabled, non-elderly employees that enroll in Medi-Cal; public employers would be exempt.

Nine CA Hospitals Among 100 Best in US
In the 2013 edition of Becker’s Hospital Review’s 100 Great Hospitals in America, nine CA hospitals were included in the list: Cedars-Sinai Medical Center (Los Angeles), Hoag Memorial Hospital Presbyterian (Newport Beach), John Muir Medical Center (Walnut Creek), Scripps Green Hospital (La Jolla), Stanford Hospital & Clinics (Palo Alto), Tri-City Medical Center (Oceanside), UC-San Diego Medical Center and UCSF Medical Center.  The Becker’s review is a compilation of hospital ranking data from several sources, such as Healthgrades, the American Nurses Credentialing Center, the Studer Group, the Malcom Baldrige National Quality Award, and U.S. News & World Report.

Fewer CA Employers Offering Health Insurance
According to a survey by the California HealthCare Foundation, the proportion of employers offering health coverage to employees declinedfrom 71% in 2002 to 60% in 2012.  During that time period, the cost of health insurance has increased almost 170%, which is five times the state’s overall inflation rate of 31.5%.  Additionally, 21% of employers said they increased workers’ share of premium costs in 2012, with 17% reducing benefits or absorbing increases.

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