There were several major developments in California's health policy world yesterday, with the release of Gov. Jerry Brown's (D) May budget revise.
It started with an almost offhand comment from Brown:
"We are eliminating the Department of Mental Health," Brown said. Then later he added, "We want to eliminate 43 boards and commissions in California." One of those boards facing elimination is the Managed Risk Medical Insurance Board (MRMIB).
Mental health services and health care commissions aren't the only things on the chopping block. Brown's May revise also targets Healthy Families, and the state's plan for adult day health care centers could be changing.
Two of the higher-profile strategies in Brown's May revise are to phase out the Department of Mental Health and create a state hospitals department.
Responsibility for many mental health services already has been shifted over time to the counties, so it's not quite as big a task as it sounds. Some aspects of the department, such as enforcement and oversight, would be taken over by the Department of Health Care Services.
The state hospital system -- the main mental health component still run by California -- would be operated by its own agency, the Department of State Hospitals, rather than the DMH.
"This moves community health programs to the local level," Diana Dooley, secretary of the California Health and Human Services Agency, said. "What's left is the state hospitals. And, we need to address the longstanding problems of our state hospitals."
Pat Ryan is executive director of the California Mental Health Directors Association. She said that shifting mental health services to counties could be a good thing, since that's where the care is provided in the first place.
"The question is: What is left that the state does and needs to continue to do?" Ryan asked. She continued, "Has the administration identified role and functions the state needs to play in terms of oversight and compliance?"
Under Brown's plan, oversight and compliance would be handled by DHCS, Dooley said. She added that filling that role is one of the fundamental tenets of realignment: "As we facilitate this shift to the counties, the role of state government in all of that is a fundamental shift."
Health Care Boards, Commissions
Brown's May revise calls for shutting down several health-related boards and commissions, including the:
- California Health Policy and Data Advisory Commission;
- California Medical Assistance Commission;
- Commission on Emergency Medical Services;
- Continuing Care Advisory Commission;
- Health Care Quality Improvement and Cost Containment Commission;
- Healthcare Workforce Policy Commission;
- Public Health Advisory Committee; and
- Rural Health Policy Council.
MRMIB took the unusual step of posting an open letter on its website.
"MRMIB has grave concerns about the proposal and its impact on the almost 900,000 children and adults served by its programs," the letter states, adding, "We request that the administration delay action and work with MRMIB to address ... significant issues."
Another major proposal is the May revise is to move the 870,000 children in the Healthy Families program to Medi-Cal managed care plans.
"Medi-Cal and Healthy Families are on [the] same plans, with one exception," Toby Douglas, director of DHCS, said. "So we want to work with those kids to transition to Medi-Cal managed care plans, starting in January."
The only difference, he said, is that the service delivery mechanism is being changed. The exception to plan compatibility is Blue Shield, which has about 37,000 kids on its Healthy Families plans, about 4% of the patients that would be switched over to Medi-Cal.
That could create an access-to-providers problem, with so many children making the switch to a network that already has some access issues, according to Anthony Wright of Health Access California.
"There's some positive things, some things that could be good," Wright said, "But it seems to be clear that most of the question is around access to providers."
For instance, he said, if you're a child using Anthem Blue Cross in Healthy Families, you might have a little more trouble finding a health care provider who takes Anthem Blue Cross for Medi-Cal.
Those access issues could be balanced by efficiencies of the new arrangement, Kelly Hardy of Children Now said.
"We view it as a fairly positive move," Hardy said, adding, "It's not an uncomplicated proposal. So there are a lot of questions to think through."
Adult Day Health Care
There is also concern that the state's direction in regard to its adult day health care program is shifting.
The program was expected to be eliminated and then reborn as a new program with half its budget. The state in March allocated $25 million to help it transition into a new program, but now advocates say that the state wants that $25 million dedicated to a new kind of transition -- toward elimination.
"The governor's office has made it clear in conversations that the $25 million should go toward elimination, not toward transitioning into another program," Wright said, adding, "Basically the message to adult day health [organizers] was, 'don't close your doors, we'll work something out.' But that's not really the case now."
The fate of ADHC now is tied to passage of AB 96, by Bob Blumenfield (D-Woodland Hills), which would establish a new program and work out a waiver for it with the federal government.