medi-cal update

California Partnership of Healthcare AdvocatesConference 2010

Medi-Cal Update

Rene Mollow, MSN, RN, Chief

Medi-Cal Eligibility Division

2“Preserve and Improve the Health Status of all Californians”

Medi-Cal Year In Review

• Child Health Insurance Program Reauthorization Act (CHIPRA) of 2009

• American Recovery and Reinvestment Act (ARRA) of 2009

• Federal Health Care Reform

• State Budget– Elimination of optional benefits

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CHIPRA Medicaid Provisions

• Ability to waive the five year bar on covering immigrant children and pregnant women residing lawfully in the US.

• Provides alternative means for verifying citizenship status.

• Provides bonus payments for increased enrollments into Medicaid and CHIP programs when certain conditions are met.

• Provides funding for outreach and enrollment strategies to increase enrollments in Medicaid and CHIP programs.

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• Temporary Federal Medical Assistance Percentage (FMAP) Increase

• Temporary Increase In Disproportionate Share Hospital (DSH) Allotment

• Extension of Moratoria on Certain Medicaid Regulations • Extension of Transitional Medical Assistance (TMA)

Program• Extension of the Qualifying Individual (QI) Program • Protections for Indians under Medicaid and CHIP• Health Information Technology Incentives for Medicaid

Providers • Income Disregards for Select Populations

ARRA Medicaid Provisions

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Federal Health Care Reform

• House Bill?

• Senate Bill?

• Medicaid Impacts

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State Budget Deficit and Medi-Cal Impacts

• Originally estimated $42 billion deficit; by May Revise, total deficit for SFY 2009-10 to $60 billion.

• The $60 billion gap was closed by the following actions:

Dollars in chart are in millions

Budget Act 2009 Enacted in February

Budget Act 2009 Amendments

Enacted in July

Total Solutions

Cuts $14,893 $16,125 $31,018 Taxes $12,513 - $12,513

Federal Stimulus

$8,016 - $8,016

Other $402 $8,034 $8,436 Total $35,824 $24,159 $59,983

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State Budget Deficit and Medi-Cal Impacts (cont.)

• May Revise - Medi-Cal program reductions amounted to an additional $1.4 billion including the following: Reductions in payments to private hospitals – $47.9 million which is

commensurate with the 10 percent reduction public hospitals received

Expansion of anti-fraud efforts - $46.4 million in savings to combat fraud waste and abuse in the Medi-Cal program

Improvements in health care coordination and controlling long-term Medi-Cal costs - $400 million in savings estimated to be achieved by 2012-13 in program reforms under a demonstration project or waiver, to utilize managed care and other specialized delivery systems of care for vulnerable populations including seniors, persons with disabilities, children with significant health care needs and individuals with behavioral health problems.

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Medi-Cal Optional Benefit Elimination

• Effective July 1, 2009, the following optional benefits were excluded from coverage under the Medi-Cal program (both fee-for-service and managed care): ‒ Adult dental services (with exceptions)

‒ Acupuncture services

‒ Audiology and Speech Therapy services

‒ Chiropractic services

‒ Optometric and optician services, including services provided by a fabricating optical laboratory

‒ Podiatric services

‒ Psychology services

‒ Incontinence creams and washes

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Medi-Cal Year in Progress

• Ongoing State Budget Deficit• ARRA Extension?• Federal Section 1115 Demonstration

– The hospital financing waiver expires August 31, 2010

– The program growth curve of Medi-Cal needs to be slowed to ensure long term sustainability

– Medi-Cal needs to be ready for national health reform

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DHCS 2010-2011 Proposed Budget

• General Fund: $9.15 billion• Federal Funds: $27 billion• Special Funds and Reimbursements: $3.5

billion• Total Funds: $40.55 billion

‒ State operations: $438.9 million; balance is Local Assistance

• Serves approximately 7.5 million beneficiaries.– 3.4 million are children/youth age 19 or younger– 1.4 million are eligible for Medicare and Medi-Cal

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State Budget Deficit and Medi-Cal Impacts

• Statewide deficit estimated at $20 billion • Medi-Cal solutions include:

– Cost containment strategies for a savings of $750 million

– Elimination of full scope Medi-Cal for certain immigrants

– Eliminate Optional Adult Day Health Care Benefits

• Federal Funding• Triggers

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ARRA Federal Funding Extension

• Length of time

• Impacts for California– Maintenance of eligibility effort

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Federal Section 1115 Goals

• Strengthen California’s health care safety net. • Maximize opportunities to reduce the number of

uninsured individuals. • Optimize opportunities to increase federal financial

participation and maximize financial resources to address uncompensated care.

• Promote long-term, efficient, and effective use of state and local funds.

• Improve health care quality and outcomes. • Promote home-and community-based care.

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Federal Section 1115 Initiatives

• Promote organized delivery systems

• Strengthen and expand the health care safety net

• Implement value-based purchasing strategies

• Enhance the delivery system for the uninsured to prepare for national reform

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Waiver Stakeholder Efforts

• Waiver stakeholder committee – Will advise on the preparation of the waiver

implementation plan and for ongoing advice during term of waiver

• Four technical workgroups– Behavioral Health– Seniors and Persons with Disabilities– California Children Services– Health Care Coverage Initiative

http://www.dhcs.ca.gov/provgovpart/Pages/WaiverRenewal.aspx

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So what does all of this mean for you?

• Need to maintain presence in communities of need

• Important to be aware of public program changes and impacts to those you assist on a daily basis

• Essential to maintain current efforts to help individuals navigate a dwindling health care safety net delivery system

• Serve as a critical link to helping people access services

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Questions and Answers