California Transition To Affordable Care Act Prompts Concerns From Health Plans

This story comes courtesy of California Watch.

By Christina Jewett

Under a budget-paring plan crafted by Gov. Jerry Brown and approved by lawmakers, 870,000 children who were covered by the Healthy Families program will be moved to Medi-Cal in phases starting Jan. 1. But it remains unclear whether a health plan serving Sacramento, Fresno, San Diego and Los Angeles counties will have enough doctors to accept the children.

Health Net, which covers about 86,000 children, notified the state that it can?t say how many of its doctors will continue to see children after they are moved from the better-paying Healthy Families program to Medi-Cal, a Medicaid program that pays some of the nation?s lowest reimbursement rates.

CalViva, a plan that contracts with Health Net to provide care to nearly 15,000 clients in Fresno, Kings and Madera counties, also reported similar concerns.

?That?s a lot of children who would be affected if there are problems in the health plans,? said Michele Stillwell-Parvensky, a policy and communications associate with the Children's Defense Fund ? California.

In a report published Nov. 1, Health Net said it could not determine its doctors' willingness to take on Medi-Cal clients without seeing rates under the emerging plan.

After hearing the concerns, state authorities moved the transition date for Health Net and CalViva clients covered by Healthy Families from Jan. 1 to March 1. The coverage transition is expected to roll out in four phases through August.

State Department of Health Care Services spokesman Norman Williams said the state provided rate information to Health Net on Nov. 5 and is continuing to collect data on whether doctors will accept Medi-Cal clients. The change comes as the state attempts to cut about $64 million from children?s coverage in the fiscal year ending next summer.

Health Net reported to the state that it has a low ?overlap? in its network, meaning that many doctors who served Healthy Families clients do not accept Medi-Cal.

?Our focus is to help Health Net increase the overlap of providers in its Medi-Cal model so that it can ensure a seamless transition into a network that is adequate for the transition,? Williams said in an email.

Health Net spokesman Brad Kieffer said the firm ?continues working closely with the state and we will be providing an update by the deadlines that are required.?

Federal health reform is expected to limit rate cuts for doctors who see children covered by Medi-Cal starting in January. At that time, federal funds will boost Medi-Cal rates for primary care doctors to the same level as Medicare rates, which are roughly 50 percent higher. The change is expected to last through 2015.

Still, whether doctors will take on the influx of Medi-Cal clients goes to the heart of children's advocates' concerns.

?Our worry is that there seems to be an intention to proceed with these transitions without that certainty that the doctors will be there to meet all these kids,? said Kathleen Hamilton, director of governmental affairs with the Children?s Partnership.

Hamilton said she?s also concerned that pediatricians will be caught off guard by the changes. She said she recently spoke to doctors in Los Angeles about the changes and found they were ?anxious for information.?

Twenty-two members of California?s congressional delegation signed a Nov. 16 letter urging caution during the transition.

The letter to state Health and Human Services Secretary Diana Dooley notes that the changes come as the state moves 470,000 elderly and disabled Medi-Cal clients into managed care plans.

?When large numbers of persons are moving into managed care plans, plan capacity and access to providers must be addressed carefully,? the letter says. ?The potential for children to lose access to care is of great concern to us.?

Authorities with the state?s Medi-Cal agency say they are ?working diligently to ensure that this transition is conducted appropriately.?

Christina Jewett is an investigative reporter focusing on health and welfare for California Watch and the Center for Investigative Reporting. To read more California Watch stories, click here.

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Source: http://www.huffingtonpost.com/2012/11/29/affordable-healthcare-act-california_n_2215098.html

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