Rural Managed Care Expansion Postponed Until September 1

The Department of Health Care Services (DHCS) notified stakeholders last week that the anticipated start date for the rural managed care expansion has been moved from June 1 to September 1, 2013. The later implementation date applies to all 28 counties in the proposed expansion. 

As reported in March, DHCS had announced the selection of health plans that will provide Medi-Cal Managed Care services to the residents of 28 rural counties. Eight northern counties (see list below) will offer Partnership Health Plan of California, a County-Organized Health System (COHS) that currently already serves Solano, Sonoma, Napa and Yolo Counties. Eighteen other counties (see list below) will be covered by Anthem Blue Cross and the California Health and Wellness Plan, run by CSAC Corporate Partner Centene Corporation. San Benito County will join the Central Alliance for Health – which is another COHS already serving Merced, Monterey, and Santa Cruz Counties – and the state is considering allowing Imperial County to follow the Local Initiative model, in which the county will develop partnerships with safety-net providers, traditional Medi-Cal providers, and local communities. The Imperial County decision is expected by June 1. 

The expansion of Medi-Cal Managed Care to the 28 fee-for-service rural counties was authorized last year via AB 1467 (Chapter Number 23, Statutes of 2012). For a map of the counties and plans, plus additional resources and information, please visit the DHCS Rural Expansion page. 

Partnership Health Plan Counties: Del Norte, Humboldt, Lake, Lassen, Modoc, Shasta, Siskiyou and Trinity. 

Anthem Blue Cross Counties: Alpine, Amador, Butte, Calaveras, Colusa, El Dorado, Glenn, Inyo, Mariposa, Mono, Nevada, Placer, Plumas, Sierra, Sutter, Tehama, Tuolumne and Yuba. 

Human Services

AB 197 (Stone) – Support
As Introduced on January 29, 2013

AB 197, by Assembly Member Mark Stone, would allow California Work Opportunities and Responsibility to Kids (CalWORKs) program applicants and recipients to own reliable cars. 

AB 197 would specifically delete the requirement that counties assess the value of a motor vehicle when determining or redetermining CalWORKs eligibility. AB 197 will decrease the administrative workload required of counties to verify the value of applicants’ vehicles. Counties also believe that the success of CalWORKs participants is often dependent on reliable transportation, along with key employment supports and services.

AB 197 was heard by the Assembly Appropriations Committee on April 17 and placed on that Committee’s Suspense File. 

AB 260 (Gordon) – Support
As Introduced on February 7, 2013

AB 260, by Assembly Member Richard Gordon, would remove the sunset date for the Child Care Subsidy Pilot projects in San Francisco City and County and San Mateo County. The Assembly Human Services Committee passed AB 260 on April 16, and it now goes to the Assembly Appropriations Committee. 

AB 720 (Skinner) – Support
As Proposed to Be Amended

AB 720, by Assembly Member Nancy Skinner, would help reduce recidivism and assist counties in our responsibility for post release community supervision of individuals in county jails by enrolling them in the federally funded Medi-Cal program before their release.

Assembly Bill 720 will give counties an important tool to reduce repeat crime and recidivism by allowing newly released inmates to access critical health care and substance use disorder services through Medi-Cal, or, if they qualify, through a qualified health plan in the state’s health benefits exchange. By pre-enrolling incarcerated individuals, counties can get a jump on providing wrap-around services to the most high-risk inmates to ensure adequate supervision and successful and sustainable reentry in our communities. Amendments will clarify that the county may designate which agency and staff is assigned to the jail to make eligibility determinations. 

CSAC supports efforts to increase local flexibility and innovation in serving the AB 109 and county jail population because the benefits of successful reintegration of incarcerated individuals accrue to a variety of stakeholders, including counties, the state, our local communities and families. It is for these reasons that CSAC supports AB 720 as proposed to be amended. The author is working with the California State Sheriffs Association on timing issues within the bill, and the County Welfare Directors Association on eligibility methods issues. The measure was passed by the Assembly Public Safety Committee on April 16 and next goes to the Assembly Appropriations Committee.

Public Health

AB 506 (Mitchell) – Support
As Introduced on February 20, 2013

AB 506, by Assembly Member Holly Mitchell, would authorize social workers and health care providers to consent to an HIV test for a child under the age of one year who is in temporary custody or is a dependent child of the court. The measure is sponsored by Los Angeles County and may be amended to clarify issues raised during this week’s Assembly Human Services Committee hearing. The measure was passed by that Committee and will be heard next in the Assembly Judiciary Committee.

Mental Health

SB 664 (Yee) – Oppose Unless Amended
As Amended on April 11, 2013

SB 664, by Senator Leland Yee, would remove the authority of county Boards of Supervisors to determine whether the implementation of Assisted Outpatient Treatment (AOT) services, commonly known as Laura’s Law, is appropriate in their communities. The measure had also sought to clarify that Mental Health Services Act funds may be used for AOT services in those counties that have authorized implementation. However, this provision, which CSAC supported, was amended out of the measure on April 11. 

As amended, the measure removes the authority of county Boards of Supervisors to choose to implement Laura’s Law. However, the Laura’s Law demonstration project was specifically constructed to allow county Boards of Supervisors to consider the needs and priorities of their local communities, as well as the fiscal ramifications, of implementing AOT services. It is critical that county Boards of Supervisors retain the authority and flexibility to determine whether implementing Laura’s Law AOT services in their communities is appropriate. 

It is for these reasons that CSAC had taken an Oppose Unless Amended position on SB 664. With the new amendments, CSAC may change to a straight Oppose position. The Senate Health Committee will hear SB 664 on April 24.

Medical Care

AB 361 (Mitchell) – Support
As Amended on April 4 , 2013

AB 361, by Assembly Member Holly Mitchell, would allow the state and counties to work together to leverage significant federal funding and create a patient-centered “health home” program for Medi-Cal beneficiaries who are frequent hospital users. 

Specifically, the measure would allow California to utilize a 90 percent federal funding match for two years under the Affordable Care Act to create a comprehensive program for frequent hospital users. The funding can be used to implement comprehensive engagement and case management services to high-risk populations and will help promote an integrated approach (“health home”) to health care and wellbeing for the most chronically ill people in our communities. The program goal is to stabilize – and even increase – the health of frequent hospital users while reducing their utilization of costly medical care. 

Currently, a dozen counties fund or manage health home integrated programs for frequent hospital users, and have realized medical cost savings as a result. Further, Assembly Member Mitchell has secured private funding from the California Endowment for the non-federal costs associated with the first two years of the program. Counties, many of which are working to implement the integrated health model, welcome an opportunity to opt into the health home services funding offered through the Affordable Care Act. We believe counties and the state can achieve significant cost savings for the sickest and most expensive users of hospital care – all without incurring state costs for erecting a health home program.

For these reasons, CSAC supports AB 361. The Assembly Appropriations Committee heard the measure on April 17 and placed it on their Suspense File. 

AB 900 (Alejo) – Support
As Introduced February 22, 2013

AB 900, by Assembly Member Luis Alejo, would restore significant cuts to the reimbursement rate for Medi-Cal services provided by distinct part skilled nursing facilities (DP/SNFs). These significant rate cuts were passed in 2011at the height of the Great Recession and during a time when California’s legislators were grappling with a $25 billion budget deficit. Compounding the devastating effects of the cuts is the fact that DP/SNFs must retroactively reimburse the state for more than two years of the rates paid to them before the cuts were declared legal. 

Many small urban and rural hospitals with skilled nursing facilities cannot pay the large retroactive amounts due for the rate cuts, which run into the hundreds of thousands of dollars. Further, many individual facilities cannot absorb the rate cut for this fiscal year, as health care costs have continued to rise. These small facilities are struggling financially, and their ability to continue to provide medically necessary services in communities throughout the state hangs in the balance. 

This is why CSAC has joined with hospital representatives, county affiliates, health advocates and legislators from both sides of the aisle to support the elimination of the AB 97 rate cuts to distinct part skilled nursing facilities and the retroactive payments associated with those cuts. AB 900 will allow these facilities to continue to provide critical post-hospital care. The Assembly Health Committee will hear AB 900 on April 30.