State Gets Resistance to Moving All Healthy Families' Kids

by David Gorn

TOPIC ALERT:

A coalition of not-for-profit children's groups yesterday sent a letter to California officials asking them to scale back the state's ambitious plan to move 875,000 children out of the Healthy Families program and into a new Medi-Cal managed care program.

"We do not support the governor's proposal," Suzie Shupe of California Coverage and Health Initiatives said. "We have some very serious concerns about it. It’s a very rapid timeline, for one, and in our view does not detail the kind of safeguards that need to be in place, and the monitoring of access to that care, to make sure kids do get access to quality health care."

Yesterday's letter was a joint effort from Children Now, The Children's Partnership, PICO California, the Children's Defense Fund California and United Ways of California, as well as CCHI. It calls for a scaled-back version of the governor's proposal.

"This is a huge undertaking, to transition this many people from one coverage into another, so quickly," Shupe said. "We think people could be really confused by it."

The state plans to move all of those 875,000 Healthy Families children into a managed care plan by 2014, in several phases. To Shupe, that could make sense for the so-called "bright line" children -- those at or below 133% of poverty -- since the Affordable Care Act is designed to serve those children in 2014.

The rest should stay in Healthy Families -- California's version of the federal State Children's Health Insurance Program -- for at least another year beyond that, Shupe said. There is currently no estimate of how many Healthy Families children are below that bright line, she said. "We think it's in the vicinity of 130,000 to 320,000 kids who are below 133% of the federal poverty rate," Shupe said.

Department of Health Care Services officials released a written statement on the transition proposal:

"Per the proposed 2012-13 budget, Healthy Families Program (HFP) children will transition to DHCS as part of the broader Medi-Cal program over a nine-month period beginning in October 2012. DHCS has developed a thoughtful approach to transition all 875,000 HFP children to Medi-Cal, while minimizing any disruption in coverage. This transition will create benefits for children, families, health plans, and providers by simplifying eligibility and coverage for children and families; improve coverage through retroactive benefits, increased access to vaccines, and expanded mental health coverage; and eliminate premiums for low-income beneficiaries."

The Healthy Families transition was the focus of this letter from the coalition of children's groups, but it's not the only budget proposal that could have a sizable negative effect on California's children, Shupe said.

"The concern with the budget in general is with the enormity of the number of proposals," she said. "There are so many changes so quickly. And so many could have a significant impact on children's care." She cited higher premium costs and higher copays proposed for Healthy Families along with reduced reimbursement rates to providers.  

"What's really important is that the needs of the kids are the highest priority," Shupe said. "The biggest risk is whether the system you're moving them into is prepared to absorb them, and ready to provide the care."

A federal judge this week ordered the state to stop its plan to lower Medi-Cal provider reimbursement rates by 10%, and legal actions have also halted other proposed cuts.

"All of those issues feed the concern about the adequacy of the provider network," Shupe said. "There is already strain on the system, and a huge influx of new children into the system will cause additional strain. It's better to go slower."


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