The Governor’s Proposal on the Remaining Uninsured, and Ours…

The $1.4 billion dollars that goes to fund public hospitals, clinics, county low-income health programs, and public health in general is the subject of serious negotiations in the last few months. The Governor’s May Revise says that “the state has an interest in maintaining a strong safety-net to ensure access to health care services,” but the Governor also wanted to claim savings, and argues for “a mechanism will be established to determine the level of county savings” that the state could take back.

The Remaining Uninsured LIHP proposal aligns with the Governor’s “mechanism” in several ways:

* Rather than an “all or nothing” programmatic realignment, they both offer a more flexible framework for negotiations

* They both works off a formula & variable that is based on actual experience on the ground in the counties, as we see the impact of ACA implementation.

* They both treats counties in different situations differently, where they face different levels of demands, different pace of enrollment, and different.

* The Governor stated principle was that he didn’t want to pay for the same person twice. The Remaining Uninsured LIHP proposal embraces this–funding is tied to LIHP enrollment, requiring counties to document the people they serve that aren’t on Medi-Cal or private coverage.

* The Governor’s budget says it wants to prioritize and maximize coverage (and federal funds). The LIHP proposal does that, requiring that all who come into a county health system are screened for Medi-Cal/Covered CA, and only after are left to the countyLIHP. Our proposal would utilize opportunities to use federal funds for emergency Medi-Cal before augmenting with these state safety-net dollars.

* The Governor’s budget says it wants the mechanism to encourage efficiency and cap costs. The LIHP proposal does this, encouraging a capitated medical home model that offers primary and preventative care that is more efficient and effective, not just expensive episodic and emergency room care.

However, there are major differences between the Governor’s approach and that outlined in our Remaining Uninsured LIHP proposal.

* The Governor’s proposal takes too much, too soon. It takes from safety-net funds $300 million in year one, $900 million in year two, and $1.3 billion (more than 75%) in year three–at a time of peak demand for the health system.

      * The Remaining Uninsured LIHP proposal would maintain safety-net funding for three years–when less state savings is needed because the newly-eligible in Medi-Cal are 100% federal funded.

* The Governor’s proposal says it recognizes the costs of public health, a strong safety-net, and serving the remaining uninsured–but the aggressive estimates only leave less than 25% for such purposes.

      * The Remaining Uninsured LIHP proposal guarantees 50% for public health and basic health functions even after three years, but then ties the rest to LIHP enrollment.

* The Governor’s proposal would take savings first, and offer a “true-up” later. This is backwards, short-changing county health system at a time of peak demand, with uncertainty leading to decisions to downgrade care.

      * The Remaining Uninsured LIHP proposal allows a period of full funding first, giving time for the LIHPs to grow enrollment, and then to have allotment by based on actual enrollment and experience.

* The Governor’s proposal does not encourage a medical home, primary or preventative care.

      * The Remaining Uninsured LIHP proposal is built on primary and preventative care, not just episodic and emergency room care, just like California is doing in Medi-Cal and the private sector.

* The Governor’s proposal would allow the Low-Income Health Programs to expire at the end of this year, leaving counties on their own, and many going backwards in what they provide the uninsured.

      * The Remaining Uninsured LIHP proposal continues explicit state support for the LIHPs, as the state has done through two waivers over multiple years;

* The Governor’s proposal would shift money out of health care to backfill existing programs in other areas.

      * The Remaining Uninsured LIHP, to the extent there are savings, helps keeps the money to its original purpose of serving the uninsured to the extent it is warranted, to make sure *all* Californians are covered and included.

For these reasons, because it aligns with the Governor’s principles but solves the problems in the mechanism he has proposed, we are urging legislators to continue to support extending the LIHPs for the remaining uninsured.

Health Access California promotes quality, affordable health care for all Californians.