On Saturday, the California Department of Health Care Services (DHCS) and the Centers for Medicare and Medicaid Services (CMS) agreed in principle to a five-year, $6.2 billion waiver for California’s Medicaid program. The new waiver, or “Medi-Cal 2020,” is good news for California as it will provide the state with much needed funds to begin the next phase of Affordable Care Act (ACA) implementation – equitably improving health care quality and reforming delivery so that it is more targeted and efficient.
The waiver agreement, while a significant achievement, is lower than California’s original request for $17 billion in funding and is almost $1 billion lower than the state’s revised waiver request of $7.25 billion. CMS has granted the state a temporary two-month extension of the current waiver until December 31st while state and federal officials work out the remaining details of the new waiver.
The conceptual agreement includes the following core elements:
The latest issue of our Health Equity Forum newsletter came out today and it includes several great articles and dozens of resources. You'll be glad you have an extra hour because of the end of daylight savings this weekend because you want to make sure you have enough time to read it.
CPEHN’s Executive Director, Sarah de Guia, opens the newsletter by discussing some positive developments from the recently concluded 2015 legislative session, including all three of CPEHN’s bills being signed into law. She also talks about the fiscal challenges the state will have to address in 2016.
Our Ethnic Partner Spotlight features an article from the California Rural Indian Health Board (CRIHB) and it talks about all of the new initiatives they are working on to improve the health of the state’s rural Indians.
The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) has issued proposed regulations to implement Section 1557 of the Affordable Care Act (ACA). Section 1557 prohibits discrimination on the basis of race, color, national origin (including immigration status and language), sex (including sex stereotyping and gender identity), age, or disability in health programs. These protections apply to consumers in all federally funded state health programs, including Covered California and Medi-Cal.
The proposed regulations are a good first step, but the rule could be made stronger to better protect people at risk of discrimination in health coverage or care, including communities of color, Limited English Proficient, women, LGBTQ populations, and persons with disabilities.
Public comments are needed to strengthen these proposed regulations. While comments submitted by organizations are important, it also is very important for individual members of the public to submit personalized comments.
As Covered California’s third open enrollment period fast approaches, a new report sheds some light on the state’s remaining uninsured and finds that roughly half are eligible for either Medi-Cal or subsidized coverage through Covered California. Earlier this week, the Kaiser Family Foundation released New Estimates of Eligibility for ACA Coverage among the Uninsured, which looks at the over 32 million remaining uninsured across the country after the first two years of the Affordable Care Act (ACA) coverage expansions.
Nationally, the report shows the devastating impact of many states’ refusals to expand Medicaid. Roughly one-tenth of the remaining uninsured in the U.S. – over 3 million individuals – would fall into the coverage gap and could have been covered had their states decided to expand Medicaid as stipulated in the ACA.
But the report also looks at the remaining uninsured at a state-by-state level, and with this analysis we see that over half (53%) of California’s more than 3.8 million uninsured are eligible for either Medi-Cal (37%) or for subsidized coverage in Covered California (16%). These numbers show that while we have cut our state’s uninsured population nearly in half over the past three years, we still have an opportunity to continue this dramatic improvement. With another open enrollment period on the horizon, it is imperative that there are sufficient outreach and enrollment efforts, particularly in low-income areas, communities of color, and Limited English Proficient populations to maximize participation by the eligible population.
Today, Governor Jerry Brown made it easier for all children to enroll in affordable health coverage, regardless of immigration status, when he signed Senate Bill 4, authored by Senator Ricardo Lara. Under the measure, eligible children currently receiving limited health care services will be automatically enrolled in full-scope Medi-Cal coverage in 2016. This is a victory for all kids, and will serve as a good first step as we continue our work to expand coverage to undocumented immigrant adults.
However, health is about more than just coverage. Earlier this week, the Governor vetoed Assembly Bill 176, authored by Assemblymember Rob Bonta. This bill would have required several state agencies to use more detailed ethnic categories when collecting demographic data for Asian Americans, Native Hawaiians, and Pacific Islanders (AAs and NHPIs). This data is essential for identifying inequities within AA and NHPI communities, of which there are more than 50 in California. Existing data sources, including the California Health Interview Survey, show disparate rates of chronic health conditions such as diabetes, asthma, and obesity among diverse AA and NHPI communities. Combining all of these unique subgroups into one data category only serves to mask the underlying inequities.
CPEHN remains committed to Health for All and will continue to support policies that require more detailed data collection to help us fully understand the health needs of our communities.
Over the past two years, California’s implementation of the Affordable Care Act’s (ACA) coverage expansions has resulted in the biggest increase in access to affordable health care in a generation. Today, thanks to a new Field Poll sponsored by the California Wellness Foundation, we know that a large majority of voters in the state see the ACA as a success. Further, there is significant support for expanding access to coverage to undocumented immigrants, who are currently left out of the ACA.
Health care advocates credited the implementation of the Affordable Care Act as contributing to the shift in sensibilities.
“Californians acknowledge that the Affordable Care Act and the expansion of services is working,” said Sarah de Guia... “People understand what it’s like to be uninsured (and then get coverage). Now there’s this growing movement of ‘We need to finish the job.’”
Earlier today, the California Wellness Foundation hosted a hearing in Sacramento to discuss the results of the survey. The event featured a presentation by Field Poll director Mark DiCamillo followed by a panel including de Guia, Health and Human Services Agency Secretary Diana Dooley, Covered California Director Peter Lee, and Juan Esparza Loera, editor of Vida en el Valle.
DiCamillo gave a detailed overview of the results of the poll, with accompanying charts. The panel after his presentation went into more detail about the findings. Some highlights included:
The first week back after summer break has been a busy one in Sacramento, and today might’ve been the busiest day yet. Earlier this summer, Governor Jerry Brown signed a budget deal that stipulated two special legislative sessions, one on health care (particularly Medi-Cal) and developmental services, and the other focused on transportation funding. Today, we saw several hearings as part of both of these special sessions.
Senate Special Session on Transportation
This morning’s Senate special session on transportation focused on a number of strategies to raise revenues for transportation and infrastructure projects. The highlight of the hearing was Senator Jim Beall’s comprehensive transportation funding bill SBx1 1, which includes an increase in the state’s gas tax. Citing a lack of increase over the past two decades, Senator Beall noted that the increases included in his bill would adjust the tax to where it should be had it been increased as a result of inflation since the 1990s. There was testimony from a wide array of advocates in support of the proposal. However, some environmental and equitable transportation advocates expressed a desire for the bill to more explicitly gauge environmental impact and promote active transportation projects. The bill passed out of the committee on a partisan vote. Streetsblog California recently posted an excellent summary of the issues at stake with SBx1 1 and the special session on transportation.
Assembly Informational Hearing on Public Health and Developmental Services
In order to adequately address health disparities, it is important to have as much information as possible on where inequities exist and what populations are most impacted. One of the best ways to address disparities is through collection of disaggregated data on race, ethnicity, and language spoken. One of the key aspects of CPEHN’s policy agenda is enhancing the collection and use of this data to develop more detailed and targeted strategies for reducing disparities.
This week, the California Health Report looked at how data collection can be used to reduce disparities experienced by children in the Medi-Cal program. In particular, the story focused on how children’s health advocates are pushing for Medi-Cal to report on more quality measures besides the minimum required:
The federal Centers for Medicare & Medicaid Services, which regulates the Medi-Cal program, has a list of 24 child health indicators this year. States are required to report on the quality of their low-income health programs, but filing data on the 24 indicators is optional…
California reported on 13 of the indicators in April and expects to report on the same ones when it files next year’s report, which will use 2015 data, said DHCS spokeswoman Carol Sloan.
Advocates argue that California should take the lead in reporting more quality measures because it has the largest Medicaid population in the country.
CPEHN’s Cary Sanders is featured in the story and discusses how reporting on more quality measures in Medi-Cal would help inform efforts to reduce disparities.
This week, Georgetown University’s Center for Children and Families and The Children’s Partnership released a new paper outlining how to get ready for big coverage opportunities in California. It highlights opportunities that will provide coverage to more than a million people in California’s immigrant families when immigration relief takes effect.
But as spelled out in the paper, Immigration Relief for Parents and Youth = Whole Family Health Coverage in California, while we wait for some of the immigration relief-related coverage options in California to become available, there is a lot that advocates and community organizations can do right now to cover eligible children and youth in immigrant families. Here is the rundown of coverage opportunities “now playing” in California and also “coming soon” that could get many more children, youth, and parents in immigrant families covered.
Now Playing: More than 400,000 children in immigrant families are already eligible for full scope or state-funded Medi-Cal but are not yet enrolled. It is not too soon to roll up our sleeves and get to work on covering them. Here’s the breakdown:
Californians have a number of reasons to celebrate these days, particularly the victory of Health4All Kids. But even with this accomplishment, there is still work to be done to make sure that Health4All becomes a reality.
In the 1960’s, President Lyndon Johnson kicked off the original Health For All efforts with the War on Poverty. It gave us Medicare, Medicaid, and helped us establish a nation-wide network of community clinics and health centers, whose mission was to provide care to everyone, regardless of their ability to pay.
Despite the odds, obstacles and budget cuts, these determined non-profit health centers endured, and in fact, they grew. Passionately dedicated to their mission, they built a system of health care one patient and one community at a time.
Today, community clinics and health centers, referred to as CaliforniaHealth+, operate more than 1,100 health centers and serve more than 5.6 million patients each year - that’s 1 in 7 Californians! They live at the heart of our communities and provide care in a way that respects the culture, tradition, and values of those they serve.