The marathon Senate Budget and Fiscal Review Committee, chaired by Senators Denise Ducheny, on Wednesday started at 10:30 a.m. and didn’t finish until around 8 p.m., with only a 45 minute lunch break.
HEALTHY FAMILIES: Various cuts under the Managed Risk Medical Insurance Board (MRMIB) were considered. MRMIB executive director Lesley Cummings stated in her summary that the Governor had left some good news in his May Revise regarding MRMIB and Healthy Families, but Senator Ducheny commented that for once, the “Governor chose to comply with the law for a change.” She was referring to health reform and its “maintenance of effort” requirements that prevent cuts in eligibility or enrollment.
One of the proposals was an increase to copayments for children in the Healthy Families program. Last November, copayments were increased by 100% for those children from 150-250% of the poverty level. The new proposal increases copayments again for ER visits and certain non-emergency services, including to all children enrolled. Republican Senator Roy Ashburn commented that these increases were not “relevant when we’re talking about small dollars.” But Senator Ducheny was quick to point out that for a family making less than $25,000 a year with 2-3 children, who then had to pay $250 a year in copayments was significant.
The committee also voted to reject the eliminate of vision care in Healthy Families, as well as premiums increases. One 10-3 vote was to reject premium increases, cuts to Healthy Families copayments and cuts to vision care, all in one swoop.
MEDI-CAL: In Medi-Cal and the broader Department of Health Care Services, the big news is that all of the major cuts to services were rejected and the proposed trailer bill accompanying the 1115 waiver was moved to policy committee, but the $337 million in savings from mandatory enrollment of seniors and persons with disabilities into managed care in a twelve month period was adopted.
The committee also rejected a hospital inpatient rate freeze by 8-2, and the elimination of providing assistance for the premiums of Medicare Part B by a 8-1 vote. They also packaged a range of the worst of the cuts to Medi-Cal.
The following issues were all voted on at once to deny. The proposals were rejected together in one swoup with a vote of 6-2:
* Elimination of selected over-the-counter drugs
* Hard Cap: six prescription outpatient drugs
* Hard Cap: durable medical equipment
* Hard Hap: Certain medical supplies
* Hard Cap: hearing aid expenditures
* Hard Cap: 10 visits for outpatient primary and specialty care provided under physicians
* Mandatory copayments for physicians & FQHC/RHC office visits
* Mandatory copayments: Dental office
* Mandatory copayments for hospital inpatient days
* Mandatory copayments for emergency room visits
* Mandatory copayments for non-emergency room visits
* Mandatory copayments: pharmacy copayments
* Limit internal nutrition to tube feeding
The committee asked many questions surrounding these issues, such as how much a hearing aid costs these days, and how is there really savings associated in capping people at 10 office visits per year. Senator Leno asked how 10 visits would be tracked to which he was told that no more claims would be paid after a patient had filed 10 visits to the doctor.
Chair Ducheny was very skeptical of the mandatory copayments, asking “How do you make it mandatory? There is still a Hippocratic oath, isn’t there? What doctor is going to deny seeing someone over $5?” She also added that it seemed awkward and that she didn’t think the federal waiver would approve such mandatory payments.
A proposal to make changes to Medi-Cal Program eligibility processing was rejected, with an understanding to find an alternative that achieves half of the savings. Another proposed cut was a fund shift around Expanded Access to Primary Care Clinics, that was denied 8-1.
After health and many other issues, the committee adjourned for the *night* and Chair Ducheny thanked everyone, stating they would pick up tomorrow for the rest of the budget issues (transportation, finance) after Appropriations and then again Friday on the floor. She added, “You didn’t really think you’d be going home, did you?”
Thank you to Nellie Price for her report from the committee…