Monday, April 12, 2004


* Enrollment Caps Rejected Again, by Assembly Subcommittee

* New Scrutiny and Information on Medi-Cal Redesign

Earlier today, both the Assembly and Senate Budget Subcommittees on Health

considered a range of health care cuts, and heard testimony from numerous

organizations representing consumers, providers, and communities throughout

the state. ATTACHED is an UPDATED Health Cuts Budget Scorecard indicating

the actions to date on the proposed cuts.


on Health, chaired by Assemblyman Mervyn Dymally, followed the lead of its

Senate counterpart in rejecting the full range of proposed enrollment caps.

The committee rejected proposals to deny coverage to children applying to

get Healthy Families coverage; children with disabilities applying to get

into California Children’s Services (CCS); recent legal immigrants applying

to get Medi-Cal; undocumented pregnant women and infants, as well as

long-term care to undocumented seniors, applying to get Medi-Cal; immigrants

with cancer applying to get into the Breast and Cervical Cancer Treatment

Program in Medi-Cal; and hemophelia patients and others applying to get into

the Genetically Handicapped Persons Program.

The Assembly Subcommittee heard a large amount of testimony on both the

enrollment caps, provide rate reductions, and the proposal Medi-Cal

redesign, from a full range of organizations, including people that packed

both the small hearing room and the overflow area. The Subcommittee decided

to hold the provider rate cut proposal open, and did not take a formal


NEW INFO ON MEDI-CAL REDESIGN: Both subcommittees heard testimony regarding

concerns about the Medi-Cal redesign process and proposals, and new

information came out about the proposals. In both subcommittees, Director of

Health Services Sandra Shewry described the workgroups and processes, and

hinted at the proposal that is expected to be submitted to the legislature

by the May Revise.

She passed out documents that will be used for discussion at the April 14th

and 15th Medi-Cal redesign workgroups in Los Angeles. (For more information,

go to While she stressed that these were

not official proposals by the state and only for discussion, it was clear

that they represented the current thinking of what a potential Medi-Cal

waiver and proposal would look like.

One proposal was entitled “a conceptual framework for a tiered approach to

benefits and cost sharing,” and also included charts indicating who got what

benefits and cost-sharing in each of the three tiers, but also the fiscal

analysis that presumes such changes would generate savings of over $111

million. This includes eliminating acupuncture and chiropractic services and

requiring co-payments for all Medi-Cal patients (and allowing providers to

refuse coverage if the co-pay is not paid.) It also includes higher co-pays,

premiums, and other cost-sharing for certain adult populations, including

paying 20% of the cost of benefits such as medical supplies and equipment,

nursing facility services, and many treatments. The documents are at:

Another proposal under discussion is to geographically expand the reach of

Medi-Cal managed care, even though many of these counties have not proven to

be able to sustain managed care plans in either the private or Medicare

markets. The slide show of the discussion proposal is at: The Assembly

Subcommittee explicitly rejected the notion to require aged, blind and

disabled populations to be enrolled in managed care. This was in response to

a Medi-Cal redesign discussion proposal to force seniors and people with

disabilities into managed care plans that may or may not include the

providers that they currently depend on.

SENATE EXAMINES OTHER COST SAVINGS: The Senate Subcommittee focused on a

range of proposals that had been enacted in past years to yield savings, but

seem not to have been implemented by the Department of Health Services. The

details are in the agenda, at:

Anthony E. Wright

Executive Director

Health Access

1127 11th St., #234, Sacramento, CA 95814

Ph: 916-442-2308, Fx: 916-497-0921

Health Access California promotes quality, affordable health care for all Californians.
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