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 administration says, leaves little room for Medi-Cal investments beyond the minimum required managed care rate increases. The Governor has allocated funding for Medi-Cal coverage of those newly eligible because of the President’s executive order on immigration.

When asked about the rationale for no increases in rates beyond the required minimum, Ms. Cantwell explained that any increases in this area would need to be linked to measurably improved access (like taking more patients or engaging more providers) and that the budget revision process does not leave room to make such a determination.

To the group discussion about access and how/when to measure it or the need for related infrastructure investments, DHCS Director Jennifer Kent clarified that the first thing that DHCS wants plans to do is meet the terms of their contract. To the extent they can negotiate favorable rates that leave any wiggle room for local infrastructure or community investments, DHCS is fine with that…as long as this does not diminish access.

The May Budget Revision also includes $150 million for counties’ increased eligibility determination workload. To Gary Passmore’s (Congress of California Seniors and Health Access CA Board member) question about how disruptive the renewal process might be to the care process, particularly for patients with chronic conditions, Kent explained that DHCS has been engaging the counties in pro-actively anticipating the need for renewal so as to minimize disruption to patients. Cathy Senderling (County Welfare Directors Association) confirmed this, adding that as more Californians have moved into managed care, the counties have been more involved in the renewal process.

Churn (where people move on and off programs) has been quite disruptive to care, says Steve Melody of Anthem Blue Cross. To the extent plans can be engaged in eligibility renewal, this can help mitigate churn. Speaking for the California Primary Care Association, Marty Lynch of Lifelong Medical added that community health centers have enrollment assistors specifically trained and funded to help with renewal. The counties ought therefore to engage them more.

Update on Medi-Cal and Covered California Enrollment

Reports from Covered CA’s second open enrollment show 495,073 new enrollments for coverage effective sometime in 2015, a little lower than anticipated. Latino and African American share of total enrollment (37% and 4%, respectively) moved closer to Cal SIM estimates (38% and 5%, respectively)  New and more specific data and more will be posted in time for Covered CA Board Meeting today (May 21). The renewal rate of 92%, with younger mix of new enrollees, and increased use of enrollment assistance (a deliberate goal of Covered CA for year 2 to help people make more informed choices about plans and metal levels).

The new data show slight migration from gold and platinum metal levels to bronze and silver plans, with that migration more pronounced for the 90% of enrollees receiving a subsidy. In response to concerns raised about whether folks are making informed decisions when they choose the bronze plans Covered California’s Katie Ravel said that Covered CA is working on analytics to sort this out.

On the Medi-Cal side open enrollment 2015 shows 1,094,791 enrolled (with 87.1% found eligible) for the MAGI population (under the new ACA eligibility rules) and 90,602 for non-MAGI (they still have have an asset test and are typically using Medi-Cal for long term care services, and supports). Of the 2.4 million cases due for renewal in 2015, 80% have been processed, and so far of these 80%, 82% continued their Medi-Cal coverage.  DHCS is working with Covered CA to smooth out the transition from Covered CA to Medi-Cal for those experiencing a change in circumstances (see “transition flows” documents here).

Find complete Medi-Cal enrollment and renewal data here:

1115 Waiver Renewal Concept and Application

With the state’s application for a Medi-Cal 2020 renewal submitted and comments letters in, DHCS anticipates receiving initial feedback from CMS any day now. In the meantime, DHCS expects most of the initial dialogue with CMS will be about budget neutrality assumptions and the state’s case for shared savings. The state’s case rests on the notion that if a state (and the largest one at that) does something that saves the federal government a lot of money, the state should be able to participate in those savings.

Addressing Cantwell’s concern that CMS may want to base budget neutrality on managed care rates, rather than the current fee-for-service rates, effectively lowering the amount of funding available, Erica Murray of the California Association of Public Hospitals pointed out that the public hospitals would simply not be able to continue what they are doing on delivery system reforms. The public hospitals and other key stakeholders were encouraged to be fully engaged around the waiver negotiations. To this point, echoed by many in the room, Kent said that as soon as they have something to share, DHCS will be as open and transparent as possible. At a minimum stakeholders can expect a webinar or conference call following the first round of feedback from CMS.

For complete meeting minutes on all topics (when ready), click here.