Medi-Cal beneficiaries being transitioned to managed care plans are encountering life-threatening obstacles to needed treatments, according to patient advocates who testified at a legislative hearing on Wednesday, California Watch reports.
Medi-Cal is California's Medicaid program.
Background
In June 2011, California began moving certain Medi-Cal beneficiaries into managed care plans as part of a plan to improve care and reduce health costs within the program. The state plans to extend the initiative to include about 1.2 million seniors who are covered by both Medicare and Medi-Cal, known as dual-eligibles.
Norman Williams, spokesperson for the Department of Health Care Services, said that as of January, 170,000 beneficiaries had been moved to managed care plans. He said at total of 380,000 seniors who are not covered by Medicare and individuals with disabilities are expected to be moved to managed care plans by June.
The shift also is intended to prepare the state for a Medi-Cal expansion in 2014 -- required by the federal health reform law -- which will allow an additional 2 million residents to qualify for the program.
Hearing Details
Members of an Assembly budget subcommittee and the Committee on Aging and Long-Term Care held a hearing on the transition's effect on patient care.
Witnesses at the hearing included:
- Michael Arnold, a legislative advocate for the California Dialysis Council;
- Katie Murphy, supervising attorney for Neighborhood Legal Services of Los Angeles County; and
- Patricia Samuelson, a Sacramento physician who testified on behalf of the California Medical Association.
The witnesses said the transition has prevented some patients from keeping chronic diseases under control and removed other patients from organ transplant waiting lists.
Samuelson said that a patient with hepatitis C symptoms had her medications delayed for weeks after she was moved to a managed care plan. Samuelson said, "She may have lost her chance to be cured of this illness."
Arnold said patients who were on a list for kidney transplants had to start the process again when they switched health providers. He said, "Such delays could mean that the patient will die prior to receiving the transplant."
Discussion of Exemptions
Speakers at the hearing also discussed exemptions that would allow patients more time to transition to managed care plans.
According to DHCS estimates, 12,800 Medi-Cal beneficiaries requested exemptions between June 2011 and December 2011. About 1,900 -- or 15% of those requests -- were approved. However, 7,500 requests were considered incomplete and sent back to care providers, while about 3,400 requests were denied, according to Williams.
At the hearing, Assembly member Bill Monning (D-Carmel) said that he has introduced legislation (AB 1553) that would strengthen the current managed care exemption process by making it less subject to interpretation.
State Response
Toby Douglas, director of DHCS, told Assembly members at the hearing that the department "can always improve" its oversight of the transition and that DHCS has launched seven work groups to address challenges associated with the shift to managed care plans.
However, he said that a recent poll of 460 Medi-Cal beneficiaries found that 87% said their ability to make medical appointments was the same or better under managed care plans (Jewett, California Watch, 3/9).