Managed Risk Medical Insurance Board officials yesterday expressed reluctance and worry over the state's plan to move 415,000 children out of the Healthy Families program and into Medi-Cal managed care plans on a single day -- Jan. 1, 2013.
Because notices of the change would need to be sent 90 days prior to the big shift, letters would need to be mailed to beneficiaries in a little more than a week, by Oct. 1.
That plan moves too many children too quickly, said board member Richard Figueroa.
"As I understand it, the Jan. 1 date is just a beginning date," Figueroa said. "We don't want to lose thousands of children in the process."
The MRMIB staff yesterday proposed a more phased-in version of the move, with about 144,000 children switching to Medi-Cal managed care plans on Jan. 1. Figueroa and several other board members liked that idea.
"This is exactly what we need to be moving toward," board member Samuel Garrison said. "The folks I've talked to, the consensus is, doing this all at once is a terrible idea."
Figueroa added that CMS officials need to sign off on the whole transfer, and said the board should stay put until that federal approval comes through.
But board member Katie Johnson, who works with the Brown administration as assistant secretary in the Office of Program And Fiscal Affairs in Health and Human Services, had a different point of view.
"It's pretty clear that the transfer takes place on Jan. 1," she said.
Figueroa answered that the logistics of the transition might preclude that. "I just don't know if that's possible," he said. "The feds do need to sign off on this."
Johnson insisted: "The [Brown] administration is still working with the Jan. 1 date," Johnson said.
She added that public comments on the transition are due today.
"We've been working collaboratively with everyone," she said.
Johnson's voice was the only one in favor of the full transition at yesterday's MRMIB monthly meeting.
"Families are scared out there," said Hellan Roth Dowden, head of HR Dowden and Associates. "When I hear Ms. Johnson say we're going to do this Jan. 1, I am very, very concerned."
Diane Van Maren, health consultant for the office of Senate President pro Tem Darrell Steinberg (D-Sacramento) said when the legislation was first passed some flexibility was built into the law.
"This legislation was drafted at the 11th hour, it was budget legislation. It was drafted as a process," Van Maren said. "We have a start date for this, but we intentionally did not have an end date for this. We realize we have a significant transition ahead of us, but we don't want to put children at risk."
Van Maren said network adequacy and appropriate planning are paramount to the transfer.
"Whenever we make any kind of change, and this is substantive change, we learn as we go," she said. "We want to make sure this is done well, and if we need more time, then we should take that time, and be able to make course corrections as we go."
Dowden put it a little more forcefully: "As I read the regulations, they say they just have to tell the Legislature if the networks are going to be adequate, and they're not adequate," Dowden said.
She said the Legislature doesn't convene until December at the earliest, and by then it would be too late, if the implementation went the way the state wants it to go.
"I don't know how the Legislature could act on this when the notices are already out," Dowden said. "Once the notices go out, that's when all hell will break loose."