The Governor’s office came out with a new publicity document today extolling the “reforms” that they won.
It’s kind of shocking that the first thing on that list of “reforms” is stopping cost-of-living adjustments (COLAs) indefinitely, for low-income children and families on CalWORKS, higher education, the judiciary, corrections, etc. As if there’s no such thing as inflation. How is that “reform?”
On health care issues, here’s what the Governor says is in the agreement:
Better Care Coordination in Medi-Cal and Centralizing Eligibility
Due to greater utilization of services, increased costs in the health care system and more individuals becoming eligible for services, Medi-Cal has been growing at a rate of approximately 8 percent per year. Since 2004, the Governor has been clear that without fundamental reforms, Medi-Cal is not sustainable. The Governor’s reforms will modernize the enrollment system and improve care coordination so that Medi-Cal will be better grounded to continue serving low-income, vulnerable Californians.
Reforms to Medi-Cal:
o Better care coordination for reduced costs. Slow the Medi-Cal growth rate by providing better care coordination for the various populations receiving Medi-Cal services. Authority would include mandatory enrollment into an organized system of care like a medical home model, enhanced primary care case management or managed care for seniors and persons with disabilities, those covered by both Medicare and Medi-Cal, children with significant medical needs, and a better integration of physical and behavioral health services.
o Centralized and modernized eligibility: Centralize and competitively procure enrollment functions instead of having each county make determinations. This would take an antiquated pen-and-paper system with 27,000 employees scattered through 58 counties and bring it into the 21st century. This proposal would include the eligibility process for CalWORKs, Medi-Cal and Food Stamps.
Savings: $1.8 billion in 2012-13.
Both issues are dubious in terms of the savings that can be achieved, and whether it will improve the situation for Medi-Cal patients. There are long-standing concerns about mandatory managed care for seniors and people with disabilities on Medi-Cal, both for the patients and for the health system. The privatization of eligibility work has generally been a failed experiment in other states, costing more and making it harder for people to get the coverage and services they need.
Maybe the proposals look better when we get more information. Maybe not.