Moving Medi-Cal Forward

California is a national leader in extending Medicaid to low-income people. But the program has not kept pace with dramatic changes in the Medi-Cal population, according to a report by the California Health Care Foundation (CHCF). Medi-Cal is now the largest single source of health insurance in the state. But Medi-Cal has also become a complex patchwork due to the its relationship with the counties, how care is delivered and financed, marketplace developments, and multiple initiatives that have been adopted throughout the years. This patchwork has had mixed results in quality of care, access to care, care coordination, and patient satisfaction. California is looking to reforms to drive timely access to high quality, coordinated, and cost effective care. The Affordable Care Act (ACA) has triggered a shift toward value-based purchasing in the commercial marketplace as well as in Medicare and Medicaid. These reforms are challenging in any environment, but the structural underpinnings of California’s Medicaid program make such changes all the more difficult to address.

Medi-Cal has accomplished a great deal in a short time, including a significant expansion of coverage, and important delivery system innovations in communities throughout the state. With Medi-Cal’s expanded role and the new Medi-Cal 2020 waiver recently launched, there is an extraordinary opportunity to reform the delivery system. To do so, California needs a plan to deliver better care and promote better health. The California Health Care Foundation (CHCF) retained Manatt Health to consider the current state of the Medi-Cal program and delivery reform, focusing particularly on Medi-Cal managed care.

Many states are developing ways to reform their Medicaid care delivery systems. For example, Oregon established locally driven regional coordinated care organizations, which bear full risk and are considered managed care organizations under federal rules. They have flexibility in designing their systems of care and, to some degree, choosing the services they will provide while meeting statewide quality and cost metrics. Massachusetts and New York are moving to require health plans to contract with accountable-care organizations or adopt alternative payment methods with a large portion of their providers. Colorado does not rely on managed care plans, but contracts directly with accountable care organizations. To get the report, “Moving Medi-Cal Forward on the Path to Delivery System,” visit chcf.org.

DMHC Approves Aetna’s acquisition of Humana

The California Department of Managed Health Care (DHMC) approved Aetna’s acquisition of Humana under these conditions:

  • Aetna will keep premium rate increases to a minimum for HMO small group.
  • The DMHC will have increased oversight on rates.
  • Aetna will keep key functions and operations in the state, such as medical decision making and
  • enrollee grievance and appeals systems.
  • Aetna will improve quality of care measured through rating and oversight programs under the National Committee for Quality Assurance and Office of the Patient Advocate.

Over the next three years, Aetna will make several community investments to educate at-risk populations on their health care rights, increase access to care for low-income and underserved communities, and improve California’s health care infrastructure:

  • $6 million to support consumer assistance programs to help seniors and people with disabilities understand their health care rights.
  • $3 million to provide dental services in low-income and/or underserved communities and scholarships for dentists to be trained to serve young children (ages 0-3).
  • $23 million to strengthen and support the health care industry in the economically distressed community of Fresno through the expansion of a service center.
  • $1 million to expand telehealth services to increase access to mental health care and reduce unnecessary emergency room visits.
  • $16.5 million in California’s health care infrastructure to support accountable care organizations and pay for performance programs.

Low Income Consumers Give Their Take on Reducing Health Care Costs

The California Healthcare foundation (CHFC) asked consumers what are the most acceptable ways to reduce harmful and wasteful medical care. They interviewed lower- to middle-income health plan members from Covered California and CalPERS and people with Medi-Cal. Participants got background information about the overuse of three common medical services — antibiotics for adult bronchitis, c-sections for first-time normal deliveries, and MRIs for common low back pain. These are their reactions:

  • 57% support oversight of physicians. This approach would change physician behavior through external approval, internal monitoring, or stricter rules about when the intervention will be covered.
  • 21% support patient cost sharing. A minority say that the patients should pay a higher copayment or pay the extra cost of care if they insist on an ineffective medical intervention.
  • 13% support physician payments to encourage appropriate and cost-effective care. A much smaller percentage support penalties or nonpayment to physicians.
  • 9% support taking no action. Fewer than one in 10 agree with leaving the decision entirely to individual doctors and patients.

CMS issues updated list of essential community providers

The CMS published the final list of more than 19,000 essential community providers, who care for predominantly low-income, medically underserved populations. Health insurance plans and standalone dental plans must contract with at least 30% of available ECPs in their service area. Health plans must offer contracts in good faith to at least one ECP in each of six categories: family planning, federally qualified health centers, hospitals, Indian health care providers, Ryan White providers and “other” ECPs, health care legal expert Timothy Jost explains. Health Affairs Blog (2/17)

One in Five Consumers Never Visit or Only Go to the Dentist for Urgent Situations

Twenty percent of consumers never visit the dentist or only go when they need urgent treatment, according to a survey by FAIR Health. This statistic increases to 30% for households with annual incomes of less than $35,000 and falls to less than 10% for households with incomes of $100,000 or more.

African-Americans, Latinos, and people living in lower-income households, as well as adults with a high school diploma or less visit the dentist less frequently than other racial, ethnic or socio-economic groups. African-Americans and Latinos are more likely to say that someone in their household visited a hospital emergency room for oral healthcare in the past five years.

Eleven percent of consumers have used daily deal sites for discounted dental services or would consider using them. Millennials (ages 18-34), African-Americans, Latinos, and men express the strongest interest in using these sites. Latinos are the most likely to say that a member of their household got dental care at a community clinic in the past five years. Consumers with a high school education or less are most likely to say they would be willing to receive treatment from a dental school or community health clinic to save money.

Report: Employer-sponsored health plans hold steady

Most people who enrolled in a health insurance plan through an Affordable Care Act exchange were previously uninsured and were not employees of companies dropping health plans, according to new Census Bureau data. Fewer middle-income Americans took advantage of the marketplace than did people with low incomes, and the uninsured rate dropped by a higher percentage in states that expanded Medicaid eligibility, the data show. The New York Times (free-article access for SmartBrief readers) (9/16), Bloomberg (9/16)

Older Californians: The Hidden Poor

More than three-quarters of a million older Californians are among the hidden poor with incomes above 100% of the Federal Poverty Level (FPL). The hidden poor are particularly vulnerable because they often have too much income to qualify for public assistance, but not enough to meet their basic needs as calculated by the Elder Index. In California, the hidden poor include 31% of single elder heads of households and 21% of older couple heads of households.The highest rates are among renters, Latinos, women, those who are raising grandchildren, and people in the oldest age groups. Many public assistance programs use the FPL to determine whether a person is eligible to get assistance for basic needs, such as health care and housing. The FPL is one uniform amount across the United States and does not account for the higher costs of housing and other expenses in California. The Elder Index is calculated at the county level. Second, the FPL was designed in the 1960s and was based on consumption patterns and standards of living among young families in the 1950s. It has been updated to account only for inflation, not for the increased standard of living.

The Elder Index is based on the basic living expenses of older adults. The geographical variation and actual costs of basic expenses in the Elder Index provide a more accurate picture. In 2011, the single nationwide FPL for an older adult living alone was $10,890. However, the average cost of basic living expenses as measured by the Elder Index was $23,364 for single older renters in California. Many single elders with incomes above the FPL, but below the Elder Index don’t qualify for assistance. For example, recipients of food assistance (SNAP, called CalFresh in California) cannot have net incomes above the FPL. The maximum income for Medicare Part D prescription assistance is 150% of the FPL. The authors suggest raising thresholds for income and asset eligibility for social support programs, such as Supplemental Security Income, housing, health care, and food assistance

Pregnant Women to Get Full Medi-Cal Coverage

The Centers for Medicare & Medicaid Services has approved California’s waiver to extend full Medi-Cal coverage to pregnant women. The amendment authorizes the state to provide full-scope Medi-Cal benefits to low-income pregnant women with incomes above 109% to 138% of the federal poverty level. The amendment also authorizes California to require pregnant women with incomes up to 138% of the federal poverty level to enroll in a Medi-Cal managed care health plan in counties in which such plans are available.

More Calif. patients say they receive very good or excellent care

Fifty-three percent of low-income California residents responding to a survey said they receive excellent or very good health care. The figure is 5 percentage points higher than in 2011 and might reflect a culture shift as health clinics have focused more on patient satisfaction under the Affordable Care Act. Kaiser Health News (2/11)

Tax Credit Helps Low- and Moderate-Income Workers Save for Retirement

TaxCredits2

By Leila Morris – Low- and moderate-income workers can take steps now to save for retirement and earn a special tax credit in 2014 and years ahead, according to the Internal Revenue Service.

The saver’s credit helps offset part of the first $2,000 workers voluntarily contribute to IRAs and 401(k) plans and similar workplace retirement programs. Also known as the “retirement savings contributions credit,” the saver’s credit is available in addition to any other tax savings that apply.

Eligible workers still have time to make qualifying retirement contributions and get the saver’s credit on their 2014 tax return. People have until April 15, 2015, to set up a new individual retirement arrangement or add money to an existing IRA for 2014. However, elective deferrals (contributions) must be made by the end of the year to a 401(k) plan or similar workplace program, such as a 403(b) plan for employees of public schools and certain tax-exempt organizations, a governmental 457 plan for state or local government employees, or the Thrift Savings Plan for federal employees. Employees who are unable to set aside money for this year may want to schedule their 2015 contributions soon so their employer can begin withholding them in January.
The following people can claim the saver’s credit:
• Married couples filing jointly with incomes up to $60,000 in 2014 or $61,000 in 2015.
• Heads of household with incomes up to $45,000 in 2014 or $45,750 in 2015.
• Married individuals filing separately and singles with incomes up to $30,000 in 2014 or $30,500 in 2015.

Like other tax credits, the saver’s credit can increase a taxpayer’s refund or reduce the tax owed. Though the maximum saver’s credit is $1,000, $2,000 for married couples, the IRS cautioned that it is often much less and, due in part to the impact of other deductions and credits, may, in fact, be zero for some taxpayers.
A taxpayer’s credit amount is based on filing status, adjusted gross income, tax liability and amount contributed to qualifying retirement programs. Form 8880 is used to claim the saver’s credit, and its instructions have details on figuring the credit correctly.

In tax year 2012, saver’s credits averaged $215 for joint filers, $165 for heads of household and $127 for single filers. The saver’s credit supplements other tax benefits available to people who set money aside for retirement. For example, most workers may deduct their contributions to a traditional IRA. Though Roth IRA contributions are not deductible, qualifying withdrawals, usually after retirement, are tax-free. Normally, contributions to 401(k) and similar workplace plans are not taxed until withdrawn. Other special rules that apply to the saver’s credit include the following:
• Eligible taxpayers must be at least 18.
• Anyone who is claimed as a dependent on someone else’s return cannot take the credit.
• A student cannot take the credit. A person enrolled as a full-time student during any part of 5 calendar months during the year is considered a student.

Certain retirement plan distributions reduce the contribution amount used to figure the credit. For 2014, this rule applies to distributions received after 2011 and before the due date, including extensions, of the 2014 return. Form 8880 and its instructions have details on making this computation. More information about the credit is on IRS.gov.

Last Updated 06/19/2019

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