Transitioning from "Healthy Families" to Medi-Cal: Too Much, Too Soon?
By Linda Leu
Last week, two California Senate Committees, the Committee on Budget and Fiscal Review and the Committee on Health, held a joint oversight hearing on the transition of the Healthy Families Program to Medi-Cal. Despite the assurances of Administration officials charged with implementing the transition, legislators' questions demonstrated serious concerns with whether the state will really be ready to move forward on the proposed timeline. The California Department of Health Care Services (DHCS) has proposed that the transition begin on January 1, 2013, with "general notices" going out to families imminently, even though many important details remain undecided.
Specific concerns expressed by legislators and advocates revolve around network adequacy - will there be enough providers that will see these children at a lower Medi-Cal payment rate? There was concern over whether the certification of network adequacy for the health plans will be complete in time, in order to ensure that children who are transitioned will continue to have seamless access to the care they need.
Additionally, concern was expressed over the lack of transparency about what criteria is being used in the assessment of network adequacy, and what enforcement mechanisms might be employed if plans cannot demonstrate adequate networks. Advocates concerned with dental and mental health services also expressed concerns about whether those issues are adequately addressed.
Generally, there is a great deal of concern with the January 1, 2013 start date, which is not required by the legislation that authorizes the transition. Advocates referenced the report from the California Health Care Foundation report that highlights some lessons learned from the transition of Seniors and People with Disabilities, which urges a more cautious and carefully planned approach to such transitions.
In his closing remarks, Senator Leno, who chaired the hearing, encouraged DHCS to take enough time to ensure that the transition is done correctly.
Linda Leu is a health care policy analyst for Health Access California, a statewide health care consumer advocacy coalition of over 200 groups.