Assembly Health Committee Delves into Medi-Cal

Last week, the Assembly Committee on Health, chaired by Assemblymember Richard Pan held an oversight hearing to delve further into selected Medi-Cal issues , some of which the committee had examined in previous informational and oversight hearings.  Here’s a report from our legislative advocate Sawait Hezchias-Seyoum:

The committee invited stakeholders and the the Department of Health Care Services (DHCS) to obtain status reports and updates on Medi-Cal related issues including, the enrollment backlog in Medi-Cal, provider directories and adequacy of networks, access to dental care and the Dashboard.

Cathy Senderling of California Welfare Directors Association and Elizabeth Landsberg of Western Center on Law & Poverty both testified on the enrollment backlog in Medi-Cal and the impact it has had on consumers throughout the state.  During their panel presentation, Assemblymember Roger Hernandez expressed his concern over the backlog, explaining that his district, which is in large part comprised of low income people and immigrants, has been disproportionately impacted.

While significant progress has been made to reduce the backlog, DHCS reported today that there are still approximately 250,000 Medi-Cal applications that have not been processed.  CalHEERS was designed to interface with various federal, state, and local information technology systems in order to facilitate the purchase of health insurance, however today’s hearing highlighted the system issues that have contributed to the backlog of applications.

Following the discussion with the California Welfare Directors Association and Western Center on Law & Poverty, Republican Assemblymember Jim Patterson asked Director of DHCS, Toby Douglas when the state expects to clear the current backlog.  Toby explained that while he is not able to provide a definitive date as to when the backlog would be cleared, he and the Department is committed to ensuring consumers have access to Medi-Cal within the 45 day period it currently takes to process Medi-Cal applications.

On the subject of provider directories and adequacy of networks, the California Association of Health Plans said that the health plans need accurate information from providers to in order to keep their directories current. Louizos also stated that an internal survey they did of their networks showed that 90% of their contracting providers accept Medi-Cal patients.  Dr. Pan indicated that there is a difference between a provider who sometime accepts Medi-Cal and a provider willing to accept additional Medi-Cal managed care patients today. The Assembly and Senate Joint Legislative Audit Committee is also working on their own audit which should be released soon.

Brett Johnson, representing the California Medical Association explained that there are many things that could be done to ensure accurate and up-to-date provided directories, including matching provider directories against the universal provider source that is widely used in the industry, requiring lists to be updated more often, requiring valid e-mail addresses for providers and utilizing other innovative technological tools that exist.  On network adequacy, Johnson explained that their Medi-Cal managed care physicians continue to experience difficulty referring out to specialists.

During the hearing, Assemblymember Patterson shared a story of a consumer who showed up at the pharmacy to pick up a prescription only to find out that he had been dropped from coverage.  Patterson explained that he continues to hear of consumers who are dropped from coverage and usually without their knowledge.  Toby explained “the buck stops here” in terms of ensuring adequate access to care in Medi-Cal, however if a consumer has been dropped from coverage without their knowledge than that person likely has coverage through Covered California and should contact Covered California for assistance.

The discussion around Dental Care centered on inadequate access to care throughout the state and especially Sacramento County.  Sutter Medical Center,  a key service provider in Sacramento  for Medi-Cal beneficiaries who need inpatient dental anesthesia because they are developmentally disabled  recently announced that it would discontinue dental anesthesia services  but has agreed to provide services through January 1, 2015.   DHCS shared that work groups have been established to help create more efficient and uniform anesthesia protocol, to identify administrative barriers and improvements for payments and also to identify other care providers who can accommodate and provide services to Medi-Cal beneficiaries.

Another highlight from the hearing was the discussion around the Medi-Cal Managed Care Performance Dashboard. Today’s hearing provided an opportunity to explore how the dashboard can be improved and leveraged to better monitor quality and access to care in Medi-Cal Managed Care.  Abbi Coursolle from National Health Law Program provided several recommendations to the committee on how the dashboard could be improved, such as breaking down the data by race and ethnicity.