Crosspost: Why I’m speaking out on the pending Catholic Hospital Mergers

This week on the Health Access blog, we are cross-posting an important and personal story from our colleague Dannie Ceseña, Program Coordinator for the California LGBTQ Health and Human Services Network (a project of Health Access). For over 30 years, Health Access has advocated for policies that protect patients when the health industry proposes to merge; whether that be health plans, hospitals, doctor groups, and more. Right now, the Attorney General of California is holding public hearings across the state to evaluate a proposed hospital system merger between Dignity Health Care and Catholic Hospital Initiatives. If approved, this merger would create one of the largest not-for-profit hospital systems in the country. Catholic hospitals have a long history of denying patients […] Read More

DHCS Stakeholder Advisory Committee Digs Deeper into Medi-Cal 2020 Waiver, SB 75 Implementation (Health4Kids), and Other Care Transformation Initiatives

This blog was written by Tam M. Ma (Policy Counsel) and Judi Hilman (Director of Special Projects) DHCS held its quarterly Stakeholder Advisory Committee today, the first time since California’s Medi-Cal 2020 waiver was approved at the end of December, covering a range of topics, including the waiver renewal, SB 75 implementation of Health for Kids, and other Medi-Cal care transformation initiatives. Medi-Cal 2020 Waiver Details from the Special Terms and Conditions Medi-Cal Director Mari Cantwell provided an overview of the new waiver (See our earlier blog overview of the new waiver) and an update on implementation efforts. The Medi-Cal 2020 waiver provides more than $6.2 billion in new federal funding through programs that shift the focus away from hospital-based […] Read More

Covered CA Board Takes Big Steps on Standardized Benefit Design and Quality/Equity Measures; Considers New Barriers to Special Enrollment

Thursday’s Covered California Board meeting, the first since the last day of open enrollment 2013, offered a deep dive on the standardized benefit designs and the quality/equity framework that will guide contracting with insurers for the next 3-year cycle (2017-2019), and a heated discussion about the new documentation requirements that insurers are calling for to qualify as a SEP enrollment. Executive Director Report Covered CA Peter Lee shared observations about OE3 and the second renewal period: With 440,000 new enrollees and a decent number choosing new plans in renewal, competition and shopping tools seem to be working. Take up by diverse and subsidy-eligible populations affirms Covered CA’s more targeted approach to marketing and outreach. Even better for the risk mix and therefore […] Read More

Attorney General Approves Daughters of Charity Hospital Deal, with Key Conditions

Yesterday afternoon, California Attorney General Kamala Harris approved the restructuring and support agreement between six Daughters of Charity Health System hospitals and BlueMountain Capital Management. The Attorney General’s approval includes significant conditions that keep key services open for 10 years, ensuring charity care levels at historical levels, and $180 million in capital improvements. Health Access asked the Attorney General to include these conditions, which will help ensure that patients and communities served by these hospitals will continue to have access to critical services, for at least a decade if not more. The AG’s conditions are similar to the ones that she imposed on the previous proposal to sell to Prime Healthcare. Health Access California and other consumer, community, and health […] Read More

Contra Costa Cares: Board of Supervisors Vote 4-1 to Create Primary Care Program for Remaining Uninsured

Earlier today the Contra Costa Board of Supervisors voted 4-1 to authorize a new $1 million pilot program to extend primary health care services for an estimated 3,000 adult immigrants, including undocumented Contra Costa residents. The care will be provided through county-based clinics, serving approximately one-fifth of uninsured adults in need of the services. The Contra Costa Cares program is a modest start, focusing on primary care rather than specialty care. Nonetheless it will provide real help for individual patients and real momentum for the notion that our health system is stronger when everyone is included. Under the program, enrollees would receive an insurance card and be assigned into a primary care medical home for care that includes immunizations, lab work, prescription […] Read More

Monterey Board of Supervisors Unanimously Approves $500K Pilot Program of Targeted Specialty Care Services for Remaining Uninsured

Building on recent victories for the #Health4All movement throughout California and at the county levels, yesterday the Monterey Board of Supervisors voted on a 5-0 vote to authorize a new $500,000 pilot program to extend limited specialty health care services to the remaining uninsured, including undocumented Monterey residents. The program will cover the cost of specified pharmacy, laboratory, and radiology services for eligible uninsured residents. Although the Monterey pilot program is a modest start, it’s a powerful signal that we can no longer exclude entire segments of our community from our health care system—and that counties are well positioned to ensure a coherent system of care that includes primary, preventive and specialty care on the front end rather than expensive […] Read More

End of Session Recap: Legislation to Stop Surprise Medical Bills Stalls in California Assembly; Other Key Patient Protection Measures Advance to Governor’s Desk

The California Assembly adjourned Saturday morning without passing legislation to prevent patients from facing surprise out-of-network bills after they get care in in-networks hospitals or other facilities. AB533 (Bonta), sponsored by Health Access California, would have held consumers harmless for surprise bills reflecting out-of-network charges that were outside of their control (See separate AB533 fact sheet). A broad coalition of consumer groups, insurers, the California Labor Federation and the California Chamber of Commerce) actively supported the measure, but the California Medical Association and related physician groups pulled out all the stops in a vigorous day of lobbying. The bill was “on call” throughout the day, with the vote total building each time the vote was called, but never making to the 41 votes needed […] Read More

Close-up on AB 533 (Bonta): Protecting Consumers from Surprise Medical Bills

Consumers know they can save money and limit their out-of-pocket costs by going to an in-network provider.  Too often, however, consumers who do the right thing by going to an in-network hospital or facility end up getting a surprise bill by a doctor who turns out not to be in-network. According to a recent survey by Consumers Union, nearly one in four Californians have received a surprise medical bill after a hospital visit or surgery with the price they are asked to pay an out‐of‐network rate when they thought the provider was in‐network. These surprise or “gotcha” bills can add up to hundreds, even thousands of dollars, driving some patients into medical debt. The consumer is stuck paying the bill […] Read More

Covered California Board Meeting on 2015-16 Budget: Highlights from June 18, 2015

Following a presentation by Executive Director Peter Lee on Covered California’s “story” of success and need to transition from start up mode to a mature operation with sustainable financing, Thursday’s Board meeting had exactly one action item: approval of the Covered California budget for fiscal year 2015-2016. Comings and Goings Director Lee announced the retirement from 35 years of state service of David Panush, after three years as Covered California’s Director of External Affairs and previously many years in the California State Senate. We at Health Access wish David Panush well in his future efforts, which likely will include playing music in a band. Executive Director Report: Building on Covered California’s Story of Success As an active purchaser exchange, Covered California […] Read More

Medi-Cal Stakeholder Advisory Committee: Highlights from May 20, 2015

With the state still awaiting initial feedback from CMS (Centers for Medicare and Medicaid Services) on its pending “Medi-Cal 2020” waiver renewal, most of the meeting was devoted to Medi-Cal programs with significant transformation initiatives.  Today’s blog covers these topics: Governor’s May Budget Revision Update on Medi-Cal and Covered California Enrollment 1115 Waiver Renewal Concept and Application Governor’s May Budget Revision (Mari Cantwell) In her brief review of the Governor’s May 14 Budget Revision (see our preliminary analysis), Medi-Cal Director Mari Cantwell pointed out that most of the $6.7 billion in additional revenues since the Governor’s January budget proposal went directly to education due to Proposition 98’s constitutional funding guarantee or to the “rainy day” reserve thanks to Prop 2. This, the […] Read More