The State of the State speech today by Gov. Jerry Brown (D) could kick off a flurry of health care activity in California.
The governor is expected to address the state's decision to join the Medicaid expansion (Medi-Cal in California) in today's speech. Two options proposed by Brown -- county- and state-based plans -- will be hashed out in the upcoming month or two, most likely during the Legislature's special session on health care. State health officials have said the special session will be called by Brown by the end of January.
All of that has to be worked out relatively soon, according to Lucien Wulsin, executive director of the Insure the Uninsured Project.
"There has to be a discussion between state and counties [about the two expansion options], but that has to be resolved quickly," Wulsin said. "There is a lot of preliminary work to be done before the start of 2014," when health care reform officially starts. "I really hope they can get the issue resolved in a timely way," he said.
As for today's speech, Wulsin said he's hoping for assurance that the state will soon implement the federally funded 10% primary care provider reimbursement rate hike for federally subsidized programs. Increased reimbursement was supposed to begin Jan. 1. State officials have said that when the increase is implemented it will be retroactive to Jan. 1.
Wulsin and other health care stakeholders say lower pay plays a big part in the state's shortage of primary care doctors.
"If you want to go out there and get more doctors," Wulsin said, "one of the weaknesses in primary care is reimbursement."
Steven Green, president of the California Academy of Family Physicians, said he hopes the governor will change his mind about the state's planned reimbursement rate reduction for all Medi-Cal providers -- an issue that's currently held up in federal court.
"We would like to see Governor Brown make health care programs for low-income people a priority," Green said. "This includes dropping his planned 10% payment reduction for physicians who provide care to patients in the Medi-Cal program. Thanks to health care reform, millions more Californians will gain coverage in an expanded Medi-Cal program in 2014. It's critical that we have enough physicians to care for them, and that means making it possible for physicians to afford to deliver that care."
Wulsin said one of the first steps is to figure out the preferred version of the two Medi-Cal expansion plans.
"There is a huge difference between them," Wulsin said. "One, the state-based program, is where you just incorporate the new enrollees into Medi-Cal, that's option one. Option two is to have 58 county systems all decide what to do by themselves. They would have more flexibility, but would have responsibility to cover the new eligibles with some flexibility in deciding what the provider network would be."
Wulsin, who sees more problems with the county-based system, said he's not sure federal officials would sign off on it. "If you were going to ask the federal government for a waiver for 58 counties, that might not fit within the rules," he said. "I'm not sure it would be administratively viable."
The governor might address some of that in his State of the State speech today, Wulsin said.