Update on Recent Budget Subcommittee Hearings

Senate Budget Subcommittee #3 – Thursday, April 23
Last week, Senate Budget Subcommittee #3 reviewed budget proposals for programs under the Department of Health Care Services, including Medi-Cal.The Committee’s agenda can be found here.

Limited Benefit and Special Population Programs Eligibility Requirements

Genetically Handicapped Persons Program (GHPP): The Administration has proposed trailer bill language (TBL) that would require individuals in GHPP to enroll in other forms of coverage, including qualified plans through Covered California, and receive specialized services in GHPP not provided by other coverage. Health Access joined the Hemophilia Council in opposing the proposal because it would limit access to affordable health care for GHPP participants. For example, for consumers who rely on expensive biological drugs, the required cost-sharing for prescription drugs in some Covered CA plans will be too expensive for these individuals to absorb. While we support getting people covered through comprehensive programs, we also believe access to continuous and affordable care needs to be prioritized for the hemophilia community.

The Subcommittee adopted the staff recommendation to delete provisions relating to GHPP from the trailer bill language. Health Access appreciates the Subcommittee’s action because it will ensure that medically vulnerable individuals in this program have continuity of care.

Modification of Major Risk Medical Insurance Program
Health Access testified that we support the intent of the administration’s proposal to maintain MRMIP for people with Medicare-ESRD (end stage renal disease) individuals can purchase supplemental coverage, and maintain MRMIP as an option for non-ESRD people who are in MRMIP today. MRMIP was originally set up to provide health insurance to Californians who were unable to get affordable coverage due to a pre-existing condition. The need for this high-risk pool has been greatly reduced due to the ACA, which bans denying coverage to people due to a pre-existing condition. While this program now serves only about 2,000 Californians, including some with ESRD, the services are important and should be maintained. The Administration previously proposed to eliminate the MRMIP program in its entirety. The Subcommittee held this issue open for additional conversations. 

Medi-Cal: Managed Care Office of the Ombudsman
Health Access supported DHCS’ request for resources to support the Office of the Ombudsman. We are concerned about the office’s capacity to answer calls and help beneficiaries resolve problems with their managed care plans, particularly with complex problems that have not been able to be resolved elsewhere. Several years ago, Health Access did a secret shopper survey to evaluate customer service at all of the state call centers that help health care consumers. The survey showed that DHCS’ call center had the highest wait times and dropped calls, among other issues. We hope the additional funding will improve services and provide data that will allow the Office of the Patient Advocate to do its work analyzing and reporting heath care consumer complaint data from all the state’s call centers, including the Managed Care Office of the Ombudsman. The Subcommittee voted to approve this budget item as budgeted.

Medi-Cal: Impact of the President’s Executive Order
The Administration acknowledged that persons eligible for deferred action under the President’s order are also eligible for Medi-Cal–and that the Governor was not proposing any changes to eligibility. Health Access and other health and immigrant rights advocates expressed optimism that deferred action status could be granted in the current budget year, and that the population impacted by the President’s Executive Order should be included in Medi-Cal estimates. In addition, advocates emphasized that we still need to address the need to cover the remaining uninsured, including undocumented immigrants not covered by executive action. Advocates from the Children’s Health Coverage Coalition noted that the remaining uninsured includes an estimated 170,000 children who would remain uninsured due to their immigration status. In addition, not all older Californians have access to Medicare. The Subcommittee held this item open for additional conversation.

Medi-Cal: Continuation of 1115 Waiver Workload
DHCS requested additional staffing resources for workload associated with the 1115 waiver and the waiver that’s in the pipeline. Health Access supports this budget request and was pleased to be part of 3 of the stakeholder advisory committees DHCS convened to inform the development of the waiver. We think the waiver is essential to California’s on-going implementation of the Affordable Care Act, and are excited by some of the concepts included to make Medi-Cal more responsive to the needs of beneficiaries and be more financially sustainable. We hope the final waiver will move California toward the “quadruple aim” of better care, better health, lower cost and reduced disparities, through both delivery system reform and population health approaches that integrate health care with other human services and community supports. The Subcommittee approved this budget request as budgeted.

Assembly Budget Subcommittee #1 – April 27, 2015
Today, the Assembly Budget Subcommittee #1 heard some budget requests from the California Health and Human Services Agency. The Committee agenda can be found here.

CalHEERS and Medi-Cal Eligibility Determinations
The IT system used to determine eligibility for people applying for Medi-Cal has been plagued with a number of IT challenges that have resulted in people erroneously being denied benefits or facing long delays before they are deemed eligible. The Committee received an update from DHCS on the status of addressing these issues. Director Kent expressed optimism that these problems can be fixed. DHCS has been working closely with county staff, and recently started including advocates in conversations about changes to the system. A number of county workers testified about the challenges and frustrations they face dealing with the IT system and described how it affects beneficiaries who need care but can’t get it because of these problems. The Department said we should expect to see details about what resources are needed to help make CalHEERS more fully functional in the May Revise. Health Access joined Western Center in Law and Poverty in acknowledging the significant problems with the interface, the significant work the counties have put forth, and the recent inclusion of advocates in discussions on how to address these problems. The Subcommittee held this item open for additional discussion.

Staffing Resources for the Office of the Patient Advocate
Health Access strongly supported the OPA’s funding request to implement the Complaint Data Reporting Project. We have had a long history of working to strengthen consumer assistance hotlines to help Californians navigate the system, exercise their rights, and make informed health care choices. Health Access has sponsored and supported legislation to revamp the OPA and give it the new responsibility of collecting, tracking and reporting on data from state health consumer assistance agencies. Having this information will help the state know whether its call centers are (or are not) helping patients. The Subcommittee approved this funding request as budgeted.