A legislative committee yesterday had a lot of questions about a proposal to expand the role of the Department of Finance in the state's Coordinated Care Initiative and to de-link some provisions in it. CCI is the plan to combine funding and coordinate services for 1.1 million Californians dually eligible for Medicare and Medi-Cal.
Yesterday's hearing came one working day after the budget language for the plan was officially released on Friday.
A floor vote on the proposal is expected today.
The rapid turnaround of the complicated measure left many legislators leafing through the proposal and puzzling over the language and ideas in it.
"The theory behind CCI is that it's a win-win in terms of folks getting unified, coordinated care and, from a finance perspective, [the state getting] savings that result from two systems coordinated as one," said Michael Cohen, chief deputy director of the Department of Finance.
Cohen said the state hopes to realize $120 million in savings the first year. "And those savings will grow over time," he said.
But in case savings aren't realized, he said, state officials want a sort of financial fail-safe built into the program. The new rules would "de-link" mandatory enrollment from the duals demonstration project -- Cal MediConnect, which is part of the Coordinated Care Initiative.
The new rules have a "poison pill" provision to allow the director of the Department of Finance to terminate the program if it is not saving money -- not just the first year, but for every year of the program.
Felix Su, a Medi-Cal policy analyst at the Legislative Analyst's Office, said the LAO had several concerns about the plan.
"In regards to de-linking, … we think there may be some concerns that there are no codified standards or requirements in place," Su said. "Secondly, in regard to … the proverbial poison pill, we do think it gives a lot of authority to the administration. We think the Legislature could consider maintaining more oversight, as to whether and when the project is shut down. And, thirdly, the Legislature might want to consider whether a total shutdown of all components CCI is warranted."
Gary Passmore, vice president of the California Congress of Seniors, had more pointed objections.
"When this was first presented 18 months ago, there were three clearly stated goals," Passmore said -- to coordinate care, shift people away from institutions and into home and community settings and save money along the way. "But your discussion today is showing that this all comes down to cost savings now."
Passmore said the oversight of such a huge public program belongs with legislators, rather than the finance director.
"I think it's essential the Legislature write in a role for itself here," Passmore said. "Candidly, I don't trust the Department of Finance to represent the people I do."