Medi-Cal is California's Medicaid program — a public health insurance program that provides needed health care services for low-income families with children, seniors, people with disabilities, foster caregivers, pregnant women and low-income people with specific diseases, such as tuberculosis, breast cancer or HIV/AIDS. Medi-Cal is financed equally by the state and federal governments.
Medi-Cal is California’s Medicaid program — a public health insurance program that provides needed health care services for low-income families with children, seniors, people with disabilities, foster caregivers, pregnant women and low-income people with specific diseases, such as tuberculosis, breast cancer or HIV/AIDS. Medi-Cal is financed equally by the state and federal governments.
A new report from the California Health Care Foundation (CHCF) examines physician participation in Medi-Cal and whether supply is meeting demand. According to CHCF, the report’s findings support the conclusion that Medi-Cal provides a vital safety net to low-income Californians — and that further investments and improvements are needed to ensure adequate access to care for all beneficiaries. Based on self-reported data from physicians, findings include:
Primary care physicians in California were more likely to serve Medi-Cal patients than uninsured patients, but less likely to have Medi-Cal patients in their practices than patients with private health insurance.
Non-primary care physicians were more likely to serve Medi-Cal patients than uninsured patients, but less likely to have Medi-Cal patients in their practices than patients with either Medicare or private insurance.
Rates at which physicians accept new Medi-Cal patients and uninsured patients varied across specialties, practice settings, and regions.
The California Department of Health Care Services (DHCS) has issued an analysis of the Better Care Reconciliation Act (BCRA) that found a drastic shift in responsibilities and health care costs from the federal government to the state. The analysis found that the BCRA would add nearly $3 billion in costs to the state in 2020, with the annual cost growing to $30.3 billion by 2027. The cumulative cost to the state from 2020 through 2027 would total an estimated $114.6 billion, with a $92.4 billion impact to the state’s General Fund. The report notes that increased costs would require the state to consider reductions in services and coverage to the Medi-Cal population. The full analysis is available on DHCS’ website.
The California Health Care Foundation and UC Berkeley’s Institute of Governmental Studies have conducted a statewide survey to assess Californians’ attitude about the Affordable Care Act (ACA), Medi-Cal, and health insurance coverage of treatment for mental health and substance use disorders. The data are broken down by region, age, race, gender and income. Overall findings include:
More than half (56 percent) of Californians worry that they or a family member will lose coverage if the ACA is repealed and replaced.
Support for the ACA is at a record-high 65 percent.
Medi-Cal is recognized as an important program by 88 percent of Californians, spanning the state’s regions and political parties.
Three in four Californians believe that coverage for mental health and substance use disorder services is very important, and that this treatment can help people lead healthy and productive lives.
The Kaiser Family Foundation has released the attached issue brief analyzing which states are most at risk from the American Health Care Act (AHCA) proposal to end enhanced federal matching funds for Medicaid expansion, established as part of the Affordable Care Act (ACA). The proposal would cap – and significantly reduce – the amount of federal funding states receive for Medicaid through a per capita cap or block grant. According to the Congressional Budget Office, the AHCA as passed by the House would reduce federal Medicaid spending by $834 billion from 2017-26, and reduce enrollment by 14 million by 2026; the Trump Administration’s proposed budget would further reduce Medicaid spending. While all states would face challenges related to these cuts, states with limited Medicaid programs, poor health status, high cost markets or low state fiscal capacity would have the most difficulty responding to per capita cap or block grant policies. The brief finds that in states that expanded Medicaid coverage post-ACA, such as California, a scaling back or elimination of expansion coverage is likely.
Earlier this month, the Centers for Medicare & Medicaid Services (CMS) approved 15 applications for Whole Person Care (WPC) pilot projects, authorizing seven new pilots and expanding eight that were previously approved. The WPC pilot program — developed under California’s section 1115(a) demonstration waiver, titled “California’s Medi-Cal 2020 Demonstration” — is intended to provide locally based comprehensive care to particularly vulnerable Medi-Cal members. The pilots aim to coordinate physical health, behavioral health and social services in a patient-centered manner, improving the health and well-being of Medi-Cal members who are high users of multiple health systems and continue to have poor health outcomes. For a list of CMS’ approved WPC pilot projects for the first and second rounds, and for more information about the program, please visit the Department of Health Care Services website.
The California Budget & Policy Center has released a new fact sheet that offers updated and in-depth data on Medi-Cal coverage in every California county. Using California Department of Health Care Services data, the analysis provides Medi-Cal enrollment by age, enrollment as a share of the total statewide population and each county’s ranking by Medi-Cal enrollment. Medi-Cal provides health care services to more than 13 million low-income Californians who live in all 58 counties. Of the 10 counties with the highest share of residents enrolled in Medi-Cal, six are in the San Joaquin Valley: Tulare (54.8 percent), Merced (50.9 percent), Fresno (49.9 percent), Kern (45.9 percent), Stanislaus (45.1 percent) and Madera (45.1 percent).
The California Department of Health Care Services (DHCS) has released the attached All Plan Letter providing guidance to Medi-Cal managed care health plans on non-emergency medical transportation (NEMT) and non-medical transportation (NMT) services, pursuant to AB 2394 (Chapter 615, Statutes of 2016). AB 2394 provides that, effective July 1, 2017, NMT for a Medi-Cal managed care plan member seeking Medi-Cal medical, dental, mental health or substance use disorder services is covered, subject to utilization controls and permissible time and distance standards. The APL outlines the requirements for NEMT, NEMT physician certification forms, NMT, conditions for NMT services, NMT private vehicle authorization requirements, NMT authorization, and the NMT and NEMT access standards. The full All Plan Letter is attached. All DHCS All Plan Letters are available on the DHCS website.
The Kaiser Family Foundation has released an issue brief highlighting 10 facts about Medicaid, the public health insurance program that covers one in five Americans – including many with complex and costly needs for medical care and long-term services. The program is designed to support low-income children, adults, seniors and people with disabilities, many of whom would be underinsured or uninsured without it. The report examines Medicaid’s cost-effectiveness in providing health care coverage at a lower per-person cost than private insurance could. The report acknowledges that Medicaid keeps coverage and care affordable for low-income Americans – and in effect bolsters the private insurance market by acting as a high-risk pool. The report notes that more data on Medicaid’s impact on health outcomes are becoming available, and initial results indicate that not only does Medicaid improve access to care for both children and adults with low income, but it also may be associated with significant reductions in mortality.
The Centers for Medicare & Medicaid Services (CMS) has extended the deadline for program year 2016 attestations for the Medi-Cal Electronic Health Record Incentive Program to May 23. Because CMS’ website is non-operational as of April 28, expected to continue through May 2, the California Department of Health Care Services (DHCS) requested an extension for all providers. According to DHCS, hundreds of providers in California have yet to attest for 2016. Providers wishing to attest for program year 2017 must wait until 2016 attestations close; 2017 attestation may not be available until May 24. Questions should be directed to firstname.lastname@example.org or (916) 552-9181.
CHA participated on a panel addressing the barriers that prevent access to care for Medi-Cal beneficiaries during yesterday’s Senate Budget Subcommittee on Health hearing. Other panelists included representatives from the California Medical Association, California Primary Care Association, California Dental Association and UC Health. Amber Kemp, CHA vice president, health care coverage, testified on CHA’s behalf and discussed the following:
The Medi-Cal expansion and reduced payments to primary care physicians enacted during the economic downturn are driving increased demand for hospital services
Medi-Cal members often seek preventive and other non-urgent care in hospital emergency rooms when they do not have access to primary care providers or specialists
Many Medi-Cal patients still lack appropriate access to mental health and substance use disorder treatment services, although the Affordable Care Act expanded coverage for these services
Many hospitals face significant difficulty securing needed post-acute care for Medi-Cal patients
Hospitals can play an important role in reducing the number of uninsured through the Hospital Presumptive Eligibility (HPE) program. The HPE program will allow all hospital Medi-Cal providers — including any clinic on a hospital’s license — to provide potentially-eligible individuals with temporary, full-scope Medi-Cal benefits.