Healthy Families Notices Sent, Now Federal Approval Needed

by David Gorn

TOPIC ALERT:

The state late last week sent 415,000 notices to inform Healthy Families participants they will need to switch to Medi-Cal managed care plans on Jan. 1.

At the same time, almost two dozen organizations, including the California Medical Association, sent a letter to lawmakers and state health officials asking for a delay in the conversion for 880,000 children in California.

The 60-day notices went out on Thursday and Friday last week, according to officials at the Department of Health Care Services. That officially starts the clock ticking on the Healthy Families transition.

On Thursday last week, the state submitted its network adequacy assessment for the conversion to the Legislature. That's the next step toward approval of the plan by CMS, which is necessary before the transition can begin.

The organizations asking the state to slow down do not object to the transition, only to the timetable.

"What we've offered [in the request for a slower transition] are seven key elements in order to press 'Go,' " said Wendy Lazarus, the founder and co-president of The Children's Partnership, a national not-for-profit children's advocacy group based in Santa Monica. "We're saying we want to work with [the state] to get this right. Once we have those elements in place, that is what should set a start date."

A written statement from Norman Williams, director of public affairs for DHCS, said the state is ready for the transition and is proceeding carefully.

"This is an important step. It creates one health care program for all children in California families who meet the eligibility requirements (0 to 250% of poverty).  The children will continue to get comprehensive care, but now it will be provided solely through Medi-Cal. There are important benefits to the transition that will improve our ability to provide high quality care in the most efficient manner," Williams wrote. "The transition simplifies coverage options, provides additional benefits, and lowers costs for the families of these children at certain income levels. It helps us achieve administrative efficiencies and saves the state's General Fund $72 million annually. It also allows us to hold plans more accountable and develop an improved and more consistent health plan contracting process, while helping the state prepare for implementation of the ACA."

Lazarus said stakeholders are not against the transition, but are concerned about the speed at which changes take place. When so many providers and consumers are forming opinions about Medi-Cal managed care and about health care reform in general, it's important this transition does not cause undue concern, Lazarus said.

The letter from stakeholders voices a similar sentiment, saying the state is not yet ready for the Jan. 1 start date. The letter contends it's not necessary to adhere to that date.

"We are also deeply concerned that the timetable for transition implementation is being driven unnecessarily by an arbitrary Jan. 1, 2013 start date. We strongly urge CHHS to reconsider …  and instead adopt a realistic timeframe that will ensure a smooth transition and guarantee children access to a provider, without jeopardizing the care of children currently in Medi-Cal," the letter said.

"With a little more due diligence, it can be done better," Lazarus said. "If it's premature at the start of it, that could plant questions in the minds of the public to implement health reform. It just needs a little more time to make it right."

"DHCS is prepared to implement this transition," Williams wrote. "We will do so carefully, taking all of next year to transition the 880,000 children to Medi-Cal. Medi-Cal currently contracts with almost all of the HFP plans and providers, so children will be able to continue to receive the same high level of access to quality primary and specialty care. The goal is to help ensure that children are able to stay in the same plan and see the same provider." 


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