Timely Access

Covered California Open Enrollment Started Sunday!

Yesterday marked the official start of Covered CA open enrollment, which will run through January 31, 2016. For coverage effective January 1, people must enroll by December 31, 2015. As always, Medi-Cal enrollment is open year-round and individuals experiencing any life transitions (losing a job or moving, among many qualifying events for Special Enrollment) may enroll anytime, even after January 31, 2016. For health care advocates and other consumer groups, it’s worth clicking around the much improved Covered CA website to explore the various tools available to maximize enrollment and target those eligible but not yet enrolled. Here are a few highlights:  The Shop and Compare Tool is more useful than ever—showing options for plans by county with estimates of consumer […] 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

Key Health Care Consumer Protections to Prevent Unfair Out-of-Pocket Costs Advance to Final Floor Votes

SB137 (Ed Hernandez), to require updated, standardized & accurate health plan provider network directories, passed out of Assembly Appropriations Committee. AB533 (Bonta), to stop “surprise” billing from out-of-network doctors; AB339 (Gordon) to prevent unfair cost-sharing for specialty drugs, and AB1305 (Bonta) to limit out-of-pocket costs for individuals in family plans, passed out of Senate Appropriations Committee. SB248 (Roger Hernández), a bill to prevent large employers from offering “junk insurance,” fixing an ACA loophole,  passed the full Assembly and is now heading to the Governor’s desk. #Health4All Update: SB4 (Lara), to allow undocumented California to shop for health coverage in Covered California, seeking a Section 1332 federal waiver to remedy their exclusion in the ACA, also passed out of Assembly Appropriations. Yesterday, the Appropriations Committees of the California Senate and Assembly met […] Read More

Special Session on Healthcare – Informational Hearings

This week, the Legislature held two informational hearings as part of the 2015-16 Second Extraordinary Session on healthcare. These hearings were convened to help lawmakers, and the public, understand approaches to structuring a Managed Care Organization (MCO) tax and the state of Medi-Cal funding more broadly. The current MCO tax only applies to health plans that participate in Medi-Cal and these plans largely get their money back, with federal matching funds, through their capitated payments. New federal rules require the MCO tax to be broad-based, meaning it needs to apply to all health plans and not just those that participate in Medi-Cal. Senate Hearing on the MCO Tax Yesterday, the Senate Committee on Public Health and Developmental Services Committee held […] Read More

Medi-Cal and Medicare Turn 50–With Much To Celebrate & Room for Improvement

As we celebrate how much help Americans have gotten from Medicare and Medicaid after 50 years, including the many improvements to both programs from the Affordable Care Act, we are reminded of the work left to do. In particular, we need to close the gaps in both programs to cover the remaining uninsured. Building on the success of Medicaid, Medicare, and the ACA, California can make more progress toward the goal of health for all with bills like SB4 and SB10, while strengthening the health care system on which we all rely. Medi-Cal’s Central Role in California Covering more than 12 million Californians, nearly one-third of the state population, Medi-Cal is a critical pillar of California’s health care system.  Thanks to the Affordable Care Act, […] Read More

Assembly Health Committee Gives Green Light to Key Consumer Health Bills

Earlier today the Assembly Health Committee voted on several priority bills impacting health care consumers and the remaining uninsured, including SB 4 (Lara) For those who keep score, here’s how key consumer protection bills came out in today’s vote: SB 4 (Lara) Health Care Coverage, Immigration Status: 10-6 SB 137 (Hernandez) Accurate Provider Directories 16-2 SB 43 (Hernandez) Essential Health Benefits 16-1 SB 4 (Lara): Allowing Broader Access to Covered California  As amended, SB 4 (Lara) seeks to allow all Californians, regardless of immigration status, to purchase coverage through Covered California, using their own money. While the Affordable Care Act limits participation in health insurance exchanges to citizens and legal permanent residents, SB 4 directs the administration to seek a […] Read More

DMHC Hearing on Blue Shield Acquisition of Care1st Gets at Larger Questions on Nonprofit Obligations

Yesterday’s hearing (covered today in the LA Times) on nonprofit Blue Shield of California and its bid to acquire for-profit Medicaid managed care plan Care1st provided better clarity on the issues at stake in the $1.25 billion transaction, and little reason to doubt whether the assets Blue Shield proposes to use should be subject to charitable trust obligations. The comment period is open through this Friday, June 12 (details below), for the public to raise their issues and concerns. Health Access submitted comments with Consumers Union and other consumer groups on the charitable trust issues, and also published a recent issue brief/discussion draft on the obligations of a non-profit insurer in a post-ACA world. Requested by Consumers Union, Western Center on Law and poverty, CALPIRG, and Health Access, […] Read More

Kaiser Family Foundation Survey Findings Affirm Results of State Reform Efforts to Date and Consumer Advocates’ Legislative Focus Two Years into Affordable Care Act

Findings from a recent Kaiser Family Foundation survey of low and moderate income California residents, released yesterday, suggest the state is generally on the right track in ACA implementation, specifically in its choice to build a robust “active purchaser” exchange and to target communities with the largest coverage gaps. Those and other priorities of Covered California are paying off—starting with dramatic reductions in the state uninsured rate, the fact that enrollment of communities of color are very close to academic estimates, and in the slower rate of growth in premium costs. Survey findings further suggest the need to build on the state’s reform efforts through legislation and targeted appropriations that consumer advocates are seeking.  Though it may be purely coincidental, it’s fitting […] Read More

Another troubling stat…

As many as 20% of patients at California’s emergency departments leave without being seen, according to a new study published in the Annals of Emergency Medicine, HealthDay reports. For the study, researchers analyzed information from a database run by the Office of Statewide Health Planning and Development. The database contained information on 9.2 million ED visits that occurred at 262 nonfederal hospitals in California during 2007. We’ve focused on regulations to ensure timely access to care as a way to reduce the burden on emergency rooms–getting people care before they need to show up at an ER. But it’s especially troubling when patients can’t get timely access at an ER, and for whatever reason simply can’t get seen. Health Access […] Read More

A timely salute to a public servant…

As part of the transition to the new Brown Administration, Cindy Ehnes is stepping down as the head of the Department of Managed Health Care (DMHC). I was pleased to speak last night at Cindy’s farewell party, alongside the head of the HMO Association. Cindy had previously served as a consumer representative in Colorado, and we have appreciated her accessibility and availability for consumer and constituency groups over her tenure. We’ve often supported the DMHC’s work, but when we haven’t, she’s been always willing to talk and meet. On one contentious issue, I recalled one conference call with her on the awkward date of December 23rd. It was good of her to have the meeting–and yes, she remembered it was […] Read More