Senate Health hears Medi-Cal waiver ideas…

The Senate Health Committee, chaired by Sen. Elaine Alquist, met Wednesday to hear panels of experts share ideas for how the state’s Medi-Cal program could be restructured through the development of a Medicaid waiver.

The waiver that California hopes to obtain from the federal government next year would allow the state to stretch the boundaries of Medicaid’s current rules. Administration officials, including David Maxwell-Jolly, Director of the CA Department of Health Care Services, argued that the proposed changes would help the state’s Medi-Cal program save money and improve coverage for California’s most vulnerable citizens. The focus of their talk, and a concept paper that was released a few weeks ago, was finding savings and in organizing and coordinating care of patients, especially those with chronic conditions.

The restructured health care delivery system would seek to do more with less, saving the state money in the long run. The informational hearing came as the Legislative Analyst’s Office predicted that California’s revenue shortfall will balloon to $20.7 billion in 2010.

Several advocates and health policy experts expressed hope that the state will pump any savings resulting from the waiver program back into health care services to prepare the state for a smooth transition into national health care reform, should federal legislation pass.

Proposed health care reform legislation in Congress would go into effect in 2013, midway into the five-year waiver period that the state hopes to begin in September of 2010.

Health Access California’s Beth Capell offered suggestions as to how the state could take advantage of the timing and dovetail into the rollout of federal reform by, for example, simplifying eligibility requirements before 2013.

“We’ll have to be ready to go from zero to sixty on January 1, 2013,” Capell told the committee, recommending that existing programs prepare auto-enrollment processes. That way, California would be poised to get as many Californians enrolled on day one, and take advantage of federal dollars for a reformed health care delivery system right from the start. These ideas were also explained in a Health Access Medi-Cal waiver paper released this week.

Several panel members fielded questions from the Health Committee members regarding the best methods of care in California.

Among those testifying about best practices and enhanced outcomes were a few administrators of a few spotlighted “medical home” and managed care systems already in place in 26 counties. They reported that their coordinated care systems led to fewer emergency room visits, greater attention to “whole body” wellness, better preventative care and more attention to co-occuring mental health and substance abuse cases. In addition, these counties were able to attract some uninsured Californians who had been putting off medical care, a practice that could lead to higher medical bills in the long run.

But Senator Alquist also raised questions to Administration officials, including whether all existing managed care plans actually did care coordination, and whether they were ready to take the responsibility to provide quality care and coordination in accordance with the special needs of seniors and people with disabilities in Medi-Cal.

Saying the hearing had proved informative, Senator Alquist said, “There’s no reason why we can’t produce a better product at a reduced cost.”

Western Center on Law and Poverty legislative advocate Elizabeth Landsberg expressed concerns about mandatory managed care, but supported a “medical home” model, as did several testifiers. The medical home model has a lot in common with managed care plans in that it serves as a hub of coordinated care for patients. Beneficiaries would have a practitioner who serve as their “medical home,” a source from which all medical and behavior care, diagnostic tests, medications — and so on — can be linked and coordinated.

There was some questions as to whether individual physicians would be prepared to serve as a medical home model, and if the Administration’s proposal was simply to shift many seniors and people with disabilities into existing managed care plans.

The Department of Health Care Services is leading the waiver development, and plans to convene a panel of stakeholders as well as technical committees for input and feedback.

Alquist asked DHCS administrators to be prepared to report back to the committee with more details as the process progressed.

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

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