Quality

Federal Officials Approve New “Medi-Cal 2020” Waiver Renewal

Earlier today the U.S. Centers for Medicaid and Medicare Services (CMS) officially approved California’s “Medi-Cal 2020” waiver renewal for the next five years, providing new resources and new flexibility to deliver better care for the millions of low-income Californians who rely on Medi-Cal for their health coverage. The new waiver also includes support for a “smarter safety net” and innovative care solutions for the uninsured. The announcement comes one day before the extended deadline for final renewal. A waiver is a formal request by a state to the Secretary of Health and Human Services to waive specific Medicaid program requirements in order to test new ways to deliver care without spending more federal dollars than would otherwise be spent. Since […] Read More

Covered CA Board Meeting November 19, 2015: Highlights for Consumer Advocates

This week’s Covered California Board meeting, the last for 2015, focused on the Covered CA bus tour and related OE3 campaigns; early results from Open Enrollment 3 or OE3; how the Section 1332 waiver (an option within the Affordable Care Act to waive certain ACA provisions to demonstrate a new principle or model at the state level for how to achieve the same goals but through different means) stakeholder process will work and parameters for proposals; and the certification process and priorities for 2017 Qualified Health Plans (QHPs). Covered CA Bus Tour and Related OE3 Campaigns As noted by Covered CA director Peter Lee in his opening remarks, Covered CA’s marketing and advertising strategies are heavily guided by research and analytics—and […] Read More

Obamacare in the Ballot Box: Quick Take on Kentucky Governor’s Race from California

Heading into last Tuesday’s mid-term election, there was plenty at stake for the future of health reform (HBO’s John Oliver tried to warn us), particularly in states that have refused or have yet to decide whether to implement the optional Medicaid expansion—or had decided, like Kentucky, to opt in, not because the political winds were blowing in that direction, but thanks to Governor Steve Beshear’s bold executive order. In view of Kentucky’s many successes on the ACA—the second largest drop in uninsured residents, a robust state-based exchange, and its distinction as the only southeastern state to opt in to Medicaid expansion—Tea Party Republican Matt Bevin’s gubernatorial win last Tuesday on an anti-Obamacare, anti-Medicaid expansion platform came as something of a shock, […] Read More

DHCS & CMS Agree to Medi-Cal 2020 Waiver Framework!

This past Saturday (Halloween), the California Department of Health Care Services announced it had reached a new “conceptual agreement” with the federal Centers for Medicaid and Medicare Services (CMS) on the general framework of “Medi-Cal 2020,” the renewal of the 2010-2015 Medi-Cal waiver. Toplines With details to be specified in the coming months, the framework is likely to spur innovation in California counties with respect to delivery system reforms, care for the uninsured, and “whole person care” or integration of health care services with other human services. The current five-year “Bridge to Reform” waiver, which expired on Halloween, is extended through December 31, 2015. Once the new waiver is finalized, it would start in January 2016, and consumer groups should be ready […] Read More

Q & A with the California Office of the Patient Advocate OPA: 2015-16 Report Cards Release

Background Last week the California Office of the Patient Advocate released the newest edition of its 2015/16 Quality Report Cards. The Report Cards provide a tool to assist Californians in comparing quality scores for health plans and medical groups in order to make fully informed health care decisions based on the latest quality data and not just costs.  The information includes more than 2,000 clinical data points and patient experience information to help inform their choices. It is available on their website (www.opa.ca.gov) in English, Spanish, and Chinese, and as a downloadable app for smartphone, IPAD, and tablets:  (http://www.opa.ca.gov/Pages/MobileApplications.aspx) The Report Card ratings are based on care that more than 16 million commercially insured consumers received from the state’s ten largest […] Read More

DHCS Stakeholder Advisory Committee October 14, 2015: Highlights for Consumer Advocates

Update on MCO (Managed Care Organization) Tax DHCS Director Jennifer Kent opened with an update on the MCO tax and the need to revise it to meet new federal guidelines to broaden the base to all health plans (learn more here).  Last Spring, the Governor called a special session to resolve this and related Medicaid financing issues—but the Legislature was not able during the regular session to strike a deal, as many had hoped. The Special Session will continue through the winter. Elizabeth Landsberg of Western Center on Law and Poverty noted the handful of Medi-Cal bills vetoed by Gov. Brown, as “collateral damage for the MCO tax.” “It’s poor people who pay the price” for delayed action on the MCO tax,” added […] Read More

Covered California Board Meeting Highlights from October 8, 2015

With less than one month before open enrollment (November 1 – January 31), the Board focused mainly on this year’s research-driven “no wrong door” approach to maximizing enrollment and facilitating thoughtful plan selection using shop and compare tools, quality ratings, and reaching out to enrollees who look like they could benefit from enhanced silver plans with lower cost sharing. A press conference held earlier in the day provided a glimpse of the data on current or recent enrollees and what they tell us about Covered CA’s place in the insurance landscape. Most of the individuals surveyed (85%) are staying insured, even if they move into job-based coverage or Medi-Cal. As a source of quality affordable coverage for 1.3 million currently enrolled […] 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

Covered California Board Meeting: Highlights from August 20, 2015

This Covered California board meeting featured a discussion of a vision benefit proposal and agents’ payments and responsibilities, both for action next month; the release of rates for 2016, an update on the redesigned navigator program; and a hearty welcome to new Board member and former Senator and Democratic Party Chair Art Torres (see his bio). Executive Director’s Report New rates for 2016 calendar year: Preliminary rate filings show an average rate increase of around 4%, which is lower than historical norms. Where there is greater market competition, as in Los Angeles, we find a smaller increase in rates (1.8%).  Covered CA Executive Director Peter Lee urged consumers to shop for better rates and network access in 2016–folks switching to […] Read More

Office of Health Equity Releases Plan to Promote Health & Mental Health Equity

This blog was written by Kate Burch, Director of the California LGBT HHS Network. Last week the Office of Health Equity (OHE) released Portrait of Promise: The California Statewide Plan to Promote Health and Mental Health Equity, a demographic report and strategic plan addressing how socioeconomic factors impact the health of California’s diverse communities. One of the offices within the California Department of Public Health (CDPH), the OHE was established in 2012 to align state resources to “achieve the highest level of health and mental health for all people, with special attention focused on those who have experienced socioeconomic disadvantage and historical injustice.” This report is the result of thousands of hours of research and analysis, input from community leaders and […] Read More